Prodigy- Positioning Flashcards
The normal response to a increase venous return in the trendelenberg position is what 2 things
vasodilation and a decrease in HR
On average, the MAP in an extermity is about __ mmHg higher or lower for each inch it is position below or above the level of the heart
2 mmHg/inch
During two-lung ventilation in healthy, mechanically ventilated patients, about ____% of the pulmonary blood flow goes to the dependent lung
60%
Excessively tight table safety straps have been implicated to damage in what nerve?
lateral femoral cutaneous
What is the ultimate causitive factor in both compression and stretch-related nerve damage?
ischemia
When can compartment syndrome occur?
in any situation where perfuison to an extremity is signficantly decreased
>ischema > edema > increased pressure in the tissue
In pregnant patients, supine hypotensive syndrome is typically most prevalent at around __ - ___ weeks gestation.
Does the risk increase or decrease after this time frame and why?
36-38 weeks
risk decreases after 38 weeks as the head of the fetus descends into the pelvis
Another name for “Contoured spine position”
-an alternative way to create this position
lawn chair position
- hip tilt 15 degree upward
- knee tilt 15 degree downward
*placing a pillow under the knees is an alternative way of recreating this position
LUD roll should be placed when
2nd and 3rd trimester
-displaces uterus off of vena cava
In lithotomy, medially placed straps can impinge the ____ nerve, leading to altered sensation in the _____.
What about laterally placed straps?
medially placed- saphenous nerve
>altered sensation to medial calf
laterally placed - common peroneal nerve
>loss of dorsiflexion of the foot
T/F: Rhabdo is associated with the lateral decub position
True
In lateral jack-knife position, what part of the patient is placed over the hinge in the OR table?
the dependent iliac crest
What is another name for the ventral decubitus position
prone
if shoulder braces are used in steep T; they should be placed laterally or medially
laterally
label
Top = median
Middle = radial
Bottom = Ulnar
The radial nerve orginates from fibers of nerve roots ___ - ____
C5-T1
Gold standard for identifying air embolus
TEE
most sensitive non-invasive device for monitoring for VAE
doppler
-position at the right sternal borader between the 3rd and 6th intercostal spaces
what would you be concerned for with a suddeon drop in ETCO2 during a sitting crani case
air emboli - flood the filed!
Midcervical tetralgia results in paralysis below the level of ____
C5
why is VAE more likely if the operative site is above the level of the heart?
bc if they are operating lower, it has more time to diffuse before getting into the heart
Why is it important to ask patients preoperatively if they ever experience tingling in the hands or fingers?
A. They may have severe, undiagnosed diabetes mellitus
B. It can indicate undiagnosed hyperkalemia
C. 15 percent of the population has undiagnosed Raynaud’s syndrome
D. Many patients have pre-existing ulnar neuropathies
D
Which pulmonary parameter will increase in the exaggerated lithotomy position?
A. tidal volumes
B. peak airway pressure
C. functional residual capacity
D. lung compliance
B
What surgical position carries the highest risk for compartment syndrome?
A. prone
B. lithotomy
C. lateral
D. supine
B
A patient is being placed in lithotomy position in steep Trendelenburg. The surgeon requests that shoulder braces be placed on the patient to prevent the patient from sliding cephalad on the table. You place the braces _____ to reduce the risk of _____ injury.
A. medially, long thoracic nerve
B. laterally, long thoracic nerve
C. laterally, brachial plexus
D. medially, brachial plexus
C
With what surgical position is rhabdomyolysis associated?
A. Lateral decubitus
B. Prone
C. Supine
D. Lithotomy
A
Your patient is emerging from a craniotomy in the sitting position. Which postoperative symptom would most likely be attributed to hyperflexing the patient’s neck towards the chest?
A. trigeminal neuralgia
B. postural hypotension
C. severe swelling of the tongue
D. postoperative blindness
C
Excessively tight table straps across the thighs would be most likely to cause damage to which nerve?
A. lateral femoral cutaneous
B. common peroneal
C. genitofemoral
D. radial
A
Steep reverse Trendelenburg position for surgery on the head is associated with
A. an increase in cardiac output
B. an increase in mean thoracic pressure
C. a risk for air embolus
D. an increase in preload
Not D….I actually think it’s C…. but maybe B
When placed in the Trendelenburg position, the normal response to the associated increase in venous return is _____ and a(n) _____ in the heart rate.
A. vasoconstriction, increase
B. vasoconstriction, decrease
C. vasodilation, increase
D. vasodilation, decrease
D
You place a pillow under the knees of a patient in the supine position so that they are flexed. Doing this most closely resembles the
A. lithotomy position
B. contoured supine position
C. lateral decubitus position
D. lateral displacement position
B
Which nerve innervates the muscles that produce pronation and flexion of the wrist and flexion of the thumb, middle, and index fingers?
A. median
B. ulnar
C. spinal accessory
D. radial
A
Following a prolonged case with the hips in severe flexion, a patient exhibits noticeable bilateral foot drop in PACU. What nerves do you suspect are injured?
A. Sciatic
B. Lateral femoral cutaneous
C. Genitofemoral
D. Femoral
A
A patient with severe lumbar disc disease would be least able to tolerate the
A. lateral position
B. prone position
C. exaggerated lithotomy position
D. low lithotomy position
C
What is the most common injury after anesthesia?
A. Corneal abrasion
B. Brachial plexus injury
C. Cerebrovascular accident
D. Ulnar nerve injury
A
The underlying cause of compartment syndrome is
A. flexion of the hips
B. decreased hematocrit
C. prolonged surgery
D. decreased perfusion
D
Which statement indicates an incorrect understanding of the precordial doppler?
A. Injection of mannitol can result in a false-positive result for venous air embolism
B. The doppler should be placed over the right sternal border between the 3rd and 6th intercostal spaces
C. The precordial dopper is noninvasive
D. The precordial doppler is the single most sensitive device for detecting venous air embolism
C
When placing a patient in stirrups for a vaginal hysterectomy, the stirrups should be well padded to help prevent injury to the
A. obturator nerve
B. pudendal nerve
C. common peroneal nerve
D. femoral nerve
C
A patient undergoing a lumbar spinal fusion has known thoracic outlet syndrome. You know that when positioning this patient prone you should
A. use a Jackson table
B. turn the head to the side
C. position the head using skull pins
D. position the arms alongside the torso
D
A patient undergoing hysteroscopy is placed in lithotomy position with medially-placed strap supports. In the recovery area, the patient complains of numbness and tingling along the medial aspect of the calves. You suspect there could be damage to the
A. sciatic nerve
B. obturator nerve
C. common peroneal nerve
D. saphenous nerve
D
What nerve passes between the medial epicondyle of the humerus and the olecranon?
A. radial
B. musculocutaneous
C. median
D. ulnar
D
Which of the following factors is common in all peripheral nerve injuries due to positioning?
A. Compression
B. Transection
C. Stretch
D. Ischemia
D
After emergence from a prolonged procedure in the prone position, the patient exhibits conjunctival edema. You know that conjunctival edema
A. can lead to postoperative blindness
B. is likely a permanent condition
C. should be treated by applying pressure to the globe of the eyes
D. is typically inconsequential and resolves spontaneously in the head-up position
D
