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Apex > Positioning And Nerve Injury > Flashcards

Positioning And Nerve Injury Flashcards

1
Q

How does trendelenburg and lithotomy affect blood circ?

A

Blood shifts towards central > increase venous return >shifts Frank starling curve to the right

**MAP stays the same or increases
**venous pressure increases > increased hydrostatic pressure > edema of face, eye, and airway

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2
Q

What are some complications to Tberg and lithotomy?

A

Patients with poor cardiac fx may not tolerate shift

Mask hypovolemia

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3
Q

How does sitting, flexed lateral and prone affect blood circ?

A

Away from central > venous pooling > decreased venous return > shifts patient to the left on Frank starling

**higher incidence of Hemodynamic instability (decreased SV, CO, and BP)

**risk of cerebral hypoperfusion

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4
Q

Where should you zero the a-line in a patient in the sitting position?

A

Auditory meatus

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5
Q

How does t-berg affect the pulmonary system?

A

Diaphragm moves cephalad
FRC is reduced
Pulmonary compliance is decreased
Risk of endobronchial intubation is increased

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6
Q

How does the head up position (reverse t) affect the pulmonary system?

A

Diaphragm caudad
Increased pulmonary compliance
Decreased peak pressures
Increased total lung volume
Increased FRC

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7
Q

What should you do if you are concerned about airway patency before extubation?

A

Perform a leak test
Visually inspect the larynx

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8
Q

How should you position for a robotic assisted laparoscopic radical prostatectomy?

A

Arms ticked at side on a non-sliding mattress

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9
Q

When is the risk for brachial plexus injury the highest?

A

When the arms are abducted > 90 degrees and the head is rotated to the other side

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10
Q

Should you ever use shoulder braces?

A

No! They do more harm than good. A non-sliding mattress is the better option

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11
Q

How do you assess for thoracic outlet syndrome? Especially in prone

A

Ask patient to clasp hands behind their head ~ if pain, tuck arms in prone position

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12
Q

Where is a axillary roll placed?

A

Distal to the Axilla

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13
Q

How are the legs positioned in laterus decubitus?

A

Downside though and knee are flexed; upside thigh and leg are extended and separated by pillow

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14
Q

What is the most commonly injured peripheral nerve?

A

Ulnar nerve

Presentation:
> impaired sensation to 4th or 5th digit
> inability to ABDuct or oppose pinky finger
> chronic injury presents as CLAW hand

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15
Q

What is claw hand?

A

Chronic ulnar nerve injury

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16
Q

Wha rare some risk factors to ulnar nerve injury?

A

Male gender
Preexisting ulnar nerve injury
Extremes of body habitus
Prolonged hospital stay
Cardiac surgery

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17
Q

What is the Best way to position the arm in the supine patient?

A

Abducted < 90 with hand kind of in the middle (not supinated, not pronated)

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18
Q

Are sensory deficits or motor deficits more serious?

A

Motor

If sensory, ~ tend to resolve on their own. If > 5 days, consult neurology

If motor ~ more serious, can take up to 6 wks to heal ~ will need a neuro cosult

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19
Q

Which nerve can be injured as result of traumatic IV insertion?

A

Median nerve

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20
Q

What vascular objects is the median nerve next to?

A

Basilic vein and median cubical veins

21
Q

What is the only nerve that passes the carpal tunnel?

A

Median

22
Q

What other conditions can affect the median nerve?

A

Carpal tunnel syndrome
Elbow hyper extension
Forced elbow extension during positioning after NMB

23
Q

How does a median nerve injury present?

A

Reduced sensation over palmar surface of thumb, index finger, middle finger, and lateral aspect of ring finger

> unable to oppose thumb
hand of benediction (make a clenched fist)
ape hand deformity

24
Q

What nerve is injured in ape hand deformity?

A

Chronic median nerve injury

25
Q

What are the 4 most common ways the radial nerve can be injured?

A

External compression by an IV pole
Excessive cycling of the BP cuff
Upper extremity tourniquet
Sheets that are too tight

26
Q

what is the main presentation with radial nerve injury?

A

Wrist drop
**inability to extend the hand at the wrist

27
Q

Where does the long thoracic nerve arise from?

A

C5-C7

28
Q

What does the long thoracic nerve innervate?

A

Serratus anterior muscle

(SALT ~ serratus anterior long thoracic)

29
Q

What are some causes of long thoracic nerve injury?

A

Lateral position
Trauma
Preexisting neuropathy

30
Q

How does a long thoracic nerve injury present?

A

Scapular winging

31
Q

How does a suprascapular nerve injury present?

A

Dull shoulder pain

Causes: patient in lateral decubitus rolls onto dependent arm

32
Q

Which nerve is highly susceptible to injury when placed in stirrups?

A

Common peroneal

33
Q

What is the presentation of a common peroneal nerve injury?

A

Foot drop
Inability to every the foot
Inability to extend the toes dorsally

34
Q

How does a obturator injury present?

A

Inability to addict the leg; reduced sensation over medial aspect of thigh

**causes: excessive flexion of thigh, excessive traction during lower abd surgery, forceps delivery

35
Q

How does a femoral nerve present?

A

Impaired knee extension/hip flexion
Reduced sensation over anterior thigh

**causes: excessive traction during lower abd surgery

36
Q

How does a saphenous injury present?

A

Reduced sensation over anteriolateral aspect of leg

**causes medial aspect of leg leans against the supporting cradle in the lithotomy position

37
Q

How does a sciatic injury present?

A

Foot drop

**causes: extreme hip flexion or external rotation of the legs, sitting with straight legs

38
Q

What does a pudendal injury present?

A

Loss of peroneal sensation

**causes: compressed against peroneal post on an orthopedic fx table

39
Q

What two nerves can be injured if patients legs are crossed during case?

A

Sural injury (top leg)
Superficial peroneal injury (bottom leg)

40
Q

Which complications are MOST commonly associated with the sitting position?

A

Mid cervical tetraplegia
Paradoxical air embolism

41
Q

When is compartment syndrome most commonly seen?

A

Lithotomy

Risk factors:
> surgical time > 2-3 hours
> increased BMI
> decreased tissue oxygenation (hypotension)

42
Q

What is the treatment for compartment syndrome?

A

Fasciotomy

43
Q

What is associated with hyper flexion of the neck (chin to chest)?

A

Midxcervical tetraplegia
Ischemia can occur as result of stretching and compression of the mid cervical spinal cord (C5)

44
Q

Which table is better ~ Jackson or Wilson?

A

Jackson!!

45
Q

What are the 4 tumors likely to occur in the anterior mediastinum?

A

Thymoma
Teratoma
Thyroid
“Terrible” lymphoma

46
Q

What 3 vital structures can a tumor in the anterior mediastinum compress?

A

Tracheobronchial tree
Pulmonary tree
Superior vena cava

**these patients may present with super vena cava syndrome (edema of the neck, face, and upper torso)

47
Q

What 3 things worsen tracheobronchial compression?

A

General anesthesia
Supine position
PPV

48
Q

What can you do if the airway collapses prior to airway securement in an anterior mediastinum mass?

A

Position patient laterally or in prone position

***a rigid bronch should be available

Apex (47 decks)

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