principles-ortho anesth.

Question 1

ortho procedures for extremities usually involve tourniquet

1. what is put on the patient for the tourniquet
2. what should the nurse/crna be aware of?

Answer 1

1. eschmarch bandage (like coban), cuff inflated-bloodless surgical field (because leg is exsanguinated by tourniquet)
2. must be aware of tourniquet times-limit 2 hours (inform surgeon at 1 hour then q30 min)

Question 2

tourniquet:

1. what pressure for upper ext?
2. lower ext?
3. what must be documented?

Answer 2

1. 200 mmHg
2. 300 mmHg
3. tourniquet inflation and deflation times

Question 3

tourniquet pain:

1. what is the theory?
2. how is it described? when does it kick in?
3. how do you treat it?

Answer 3

1. pain transmission via A delta and C fibers, the fibers recover fast as the block dissipates.
2. excrutiating pain,; starts 45-60 minutes after inflation begins
3. treatment is deflate the cuff

Question 4

tourniquet:

what will you see when tourniquet is released?

Answer 4

1. you will see an increase in ETCO2 because co2 is washed out of leg
2. you will see a drop in blood pressure (now that the blood has to perfuse another organ again)
3. an increase in HR by 10-15%
4. (vasodilating)anerobic metabolites are released into circulation

Question 5

1. what is arthroscopy?
2. how much irrigation is used?
3. most common scopes done?

Answer 5

1. to visualize the interior of a joint with an endoscope
2. 3-5 liters of irrigation (pressurized)-may be absorbed if shoulder or hip
3. knee (#1), shoulder

Question 6

knee scope:

1. what are the pros?
2. positioning?
3. what type of anesthesia?
4. what is patient population?

Answer 6

1. less post op discomfort than open knee, reduced hospitalization (outpatient)
2. supine with foot of table lowered
3. general anesthesia (tube or LMA), regional or local (intraarticular injection of local at end)
4. old persons to healthy young athletes

Question 7

shoulder scope:

1. patient population?
2. anesthesia?
3. positioning?
4. issues?

Answer 7

1. usually older patients, rotator cuff
2. outpatient, GA (tube or LMA), interscalene block
3. lawnchair position or lateral decubitus
4. hypotension common, post op blindness risk

Question 8

interscalene block:

1. What is it?
2. for what procedures?
3. how is it done?

Answer 8

1. blocks the proximal brachial plexus
2. shoulder and proximal humerus surgeries
3. done with ultrasound and nerve stimulator

Question 9

name 7 potential problems with interscalene block:

Answer 9

assess for:

1. local anesthetic toxicity,
2. pneumothorax
3. phrenic nerve paralysis (diaphragm paralysis)
4. sub q emphysema
5. vessel injury
6. vocal cord paralysis
7. Horner syndrome

Question 10

what are signs of tension pneumo?

Answer 10

1. hypotension
2. hypoxemia
3. tracheal shift
4. sq emphysema

Question 11

1. what is Horner syndrome

2. s/s of horner syndrome

Answer 11

1. nerve damage to sympathetic nervous system during interscalene block (and other things)
2. miosis, partial ptosis, loss of hemifacial sweating

Question 12

what is a pulmonary condition that may occur during shouldre arthroscopy or subacromial decompression?

Answer 12

pneumomediastinum

Question 13

open fracture repair:

1. should be repaired within how long after?
2. anesthesia?
3. what other meds?
4. other or needs?

Answer 13

1. within hours
2. general or regional
3. antibiotics must go in prior!!!
4. table (fracture table), bean bags and other positioning devices

Question 14

potential problems with traumatic fractures;

Answer 14

1. hemorrhage

2. fat embolism

Question 15

fat embolism:

1. cause?
2. risk factors?

Answer 15

1. traumatic injuries to long bones, long bone surgery
2. 20-30y/o male, hypovolemia (affravates condition), intermedullary insturmentation, rheumatiod arthritis, bilateral total knee, long bone fractures

Question 16

Fat Embolus syndrome (FES)

1. minor s/s
2. major s/s

Answer 16

1. minor s/s= tachycardia, hyperthermia, retinal fat emboli. urinary fat globules, fat in sputum
2. major s/s=hypoxia (#1 symptom), axillary or conjunctival petechiae, CNS depression, pulmonary edema, coma

Question 17

FES (fat embolus syndrome)

1. incidence
2. mortality
3. onset?
4. treatment?

Answer 17

1. 3-4% occurence
2. 10-20% mortality
3. can occur 12-40 hours after injury
4. aggressive respiratory support

Question 18

joint replacement: Knee.

1. anesthesia?
2. incidence of DVT?
3. EBL?

Answer 18

1. usually regional (SAB or epidural)
2. 80%
3. up to 2 units of blood

Question 19

A. what is this potential problem with Methyl Methacrylate?

B. how is it prevented/treated?

Answer 19

It is an acrylic bone cement used during arthroplastic procedures, 1. can cause hypotension due to absorption of monamer (which is volatile)

2. can cauae air and marrow emboli during femoral reaming
3. lysis of blood and marrow (d/t exothermic reaction)
4. may convert to methacrylate acid

B. maintain adequate hydration and oxygenation