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apa 1 /sim S. Horvath > positioning > Flashcards

positioning Flashcards

1
Q

primary mechanisms of nerve injury

A

transection (cut nerve), compression, stretch, kinking = ischemia

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2
Q

common component for all peripheral nerve injuries

A

ischemia

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3
Q

pre existing conditions that increase risk of position related injuries

A

anemia, DM, PVD, peripheral neuropathies, alcoholism , limited joint mobility, liver disease, smoking

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4
Q

risk for length of procedure is longer than __ hours

A

4

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5
Q

body habitus associated with positioning injuries

A

obesity, malnutrition, milky musculature

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6
Q

anesthetic techniques associated with position related injuries

A

general anesthesia, hypotensive techniques, neuromuscular blockade

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7
Q

randy travis drinks cold beer

A

5 routes, 3 trucks, 6 divisons (3 ant+3 post) 5 branches

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8
Q

what are the 5 branches

A

musculocutaneous, axillary, radial, median, ulnar

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9
Q

which 3 make it down to your hand

A

radial medial ulnar

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10
Q

radial nerve covers

A

thumb, first finger,secondfinger,half of ring finger

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11
Q

ulnar nerve

A

pinky and other half of ring finger

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12
Q

arm abduction greater than ___ degrees causes brachial plexus injury

A

90

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13
Q

brachial plexus is from

A

c5-T1

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14
Q

lumbar plexus is from

A

L1-L5

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15
Q

obturator controls movement of

A

hip

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16
Q

lumbar plexus covers

A

abdomen and front part of the leg

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17
Q

sacral plexus

A

back part of the leg

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18
Q

sacral plexus runs from

A

L4 to S5

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19
Q

sciatic nerve is in the

A

sacral plexus

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20
Q

which two nerves are called the siatic nerve when they are together

A

tibial, common fibular

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21
Q

which roots go down to the foot

A

L4 L5 S1

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22
Q

axillary roll

A

to avoid compression of dependent neurovascular bundle in axilla, roll placed under depended thorax just caudad to axilla

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23
Q

zone 2

A

a A V

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24
Q

zone 3

A

a V A

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25
Q

in zone 1, ventilation ___ perfusion

A

without

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26
Q

causes of zone 1

A

pulm htn, excessive peep, over-distention of alveolar units during pos pressure ventilation (excessive TV)

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27
Q

zone 2 capillary flow is determined by

A

a-A gradient

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28
Q

zone 2 is found in

A

non-dependent portions of the lung

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29
Q

in zone 2, ventilation ___ perfusion

A

equals

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30
Q

which part of lung has the best perfusion/ventilation in the awake patient d/t gravity

A

dependent

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31
Q

zone 3 in the upright lung is the

A

best perfused zone

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32
Q

in the anesthetized patient, ___ lung has the best perfusion and ____ lung has the best ventilation

A

dependent, non-dependent . creating a v/q mismatch

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33
Q

___ lung has the best ventilation due to

A

pressure

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34
Q

___ lung has the best ventilation due to

A

pressure

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35
Q

we relax all their musculature so weight pushes down which lowers the compliance of the lower lung, also decreasing

A

FRC

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36
Q

postural hypotension is exaggerated bc

A

general anesthesia bunts the sympathetic nervous system response that would normally minimize BP changes associated with abrupt position changes

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37
Q

how to treat postural hypotension

A

delay pos change, reduce concentration of inhaled anesthetics. give IVF. use vasopressors

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38
Q

head should not be turned ___ when arms abducted or

A

laterally, brachial plexus stretch

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39
Q

in the supine position,FRC and total lung capacity are____

A

reduced

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40
Q

in supine gravity increases perfusion of __ lung

A

posterior

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41
Q

in supine, spont ventilation favors ______)lung segments while controlled ventilation favors _____ lung segments

A

spont: dependent (posterior)
controlled: independent (anterior)

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42
Q

potential airway problems of supine

A

one lung ventilation, kinking of ETT

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43
Q

pressures may change by __ for each __ that a given point varies in vertical height or above the reference point of the heart

A

2mmhg for each 2.5cm

44
Q

trendelenburg activation of baroreceptors causes

A

decrease in CO, decrease in PVR, decrease in HR and BP

45
Q

trend ___ FRC

A

decreases

46
Q

trend moves carina…

A

closer to ETT so can causeR mainstrem

47
Q

trend causes an ___ likelihood of regurgitation

A

increased

48
Q

trend __ v/q mismatch and atelectasis

A

increases

49
Q

trend __ ICP

A

increases

50
Q

tred __ CBF due to

A

decreases due to cerebral venous congestion

51
Q

trend ___ IOP

A

increases in pt’s with glaucoma

52
Q

reverse trend cardiac

A

decrease in preload, CO, and arterial pressure

53
Q

reverse trend baroreceptor..

A

increase in sympathetic tone,Hr,BP

54
Q

reverse trend __ FRC

A

increases

55
Q

reverse trend __ CPP and CBF

A

decrease

56
Q

lithotomy position also causes ___of blood

A

autotransfusion (same w trend)

57
Q

standard lith

A

90

58
Q

low lith

A

30-45

59
Q

high lith

A

flexed 90 or more

60
Q

high lith produces

A

significant uphill gradient for arterial pressure

61
Q

high lith stretches which nerve

A

sciatic

62
Q

with lith when you return the legs to supine what happens to circuating blood volume and preload

A

decrease

63
Q

lith ___ FRC

A

decreases

64
Q

left side down = ___ lateral

A

left

65
Q

lateral can cause ___ compression due to improper placement of kidney rest at flank instead of iliac crest

A

vena caval

66
Q

in lateral, put the pulse ox in the ___ hand

A

lateral

67
Q

in the lateral position you have ___ ventilation to dependent lung

A

decreased

68
Q

in the lateral position you have ___ perfusion to dependent lung

A

increased

69
Q

lateral position v/q mismatch may manifest as

A

unexpected arterial hypoxemia

70
Q

sitting position CV

A

pooling in lower extremity.. decreases central blood volume

71
Q

sitting position big concern for

A

venous air embolism

72
Q

sitting respiratory

A

favorable

73
Q

sitting neuro

A

decrease CBF decrease CPP

74
Q

prone position is also called

A

ventral decubitus

75
Q

prone rolls are placed

A

parallel to chest

76
Q

prone cv

A

pooling of blood in extremities and compression of abd muscles may decrease preload, CO and BP

77
Q

prone resp

A

increased work of breathing

78
Q

prone neuro

A

extreme rotation decreases cerebral venous drainage and CBF

79
Q

if intra-abdominal pressure approaches or exceeds venous pressure, return of blood from pelvis and lower extremities is

A

reduced or obstructed. prevent with pads and frames

80
Q

alopecia occurs

A

hair loss 3 to 28 days post op

81
Q

air embolism is a risk when

A

operative site is above level of heart

82
Q

air embolism causes

A

death- CV collapse and arterial hypoxemia

83
Q

with air embolism.. blood cant get to

A

PA and blocks it

84
Q

*most sensitive and most specific indicator for air embolism is *

A

TEE

85
Q

symptoms of air embolism

A

dysrhythmias, decreased ETCO2 or loss of ETCO2, decreased arterialO2 sat

86
Q

patient with air embolism you should put them in what position

A

left lateral trendelenberg

87
Q

blindness big concern for what position

A

prone

88
Q

lateral rotation of head and neck in prone position can stretch relaxed skeletal muscles
and ligaments and injure articulations of cervical
spine

A

stretch relaxed skeletal muscles
and ligaments and injure articulations of cervical
spine/ ** stretch brachial plexus

89
Q

thoracic outlet syndrome

A

compression of brachial plexus or subclavian vessels or both due to inadequate passageway thru the thoracic outlet, between base of neck and armpit.

90
Q

screen for thoracic outlet symdrome by

A

questioned in preanesthetic interview about their
ability to work or sleep with arms elevated
overhead

91
Q

second most common post op nerve injury

A

brachial plexus

92
Q

most frequently damaged nerve of the lower extrem

A

common peroneal nerve compression, foot drop

93
Q

arm slips off surgical table will injure

A

radial nerve

94
Q

radial nerve injury results in

A

wrist drop

95
Q

what nerve is damaged in lithotomy

A

saphenous , compressed by stirrups

96
Q

saphenous is a branch of the ___

A

femoral nerve

97
Q

inside of leg is ____ nerve, outside it __-

A

peroneal , saphenous

98
Q

sciatic nerve injury results in

A

foot drop

99
Q

most common post op peripheral neuropathy

A

ulnar nerve

100
Q

ulnar nerve injury results in

A

sensory loss fifth digit and claw hand

101
Q

3 ways blindness happens

A

ischemic optic neuropathy, retinal artery occlusion, cortical blindness

102
Q

visual loss after nv or cpb procedures my be due to

A

embolic events

103
Q

visual loss after non cardiac, non-neurovascular procedures may be initially noticed by

A

loss of acuity, loss of visual field, or both

104
Q

causes of blindess

A

direct pressure increasing IOP, hypotension, massive blood loss, venous congestion with prone position, *long, prone, procedures, massive fluid replacement

105
Q

compartment syndrome is most common in which two positions

A

lithotomy and lateral

106
Q

compartment syndrome results in

A

ischemia, hypoxic edema, rhabdomyolysis

apa 1 /sim S. Horvath (17 decks)

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