Test 2 Ortho Flashcards
what is the leading cause of lower extremity disability among older adults in the US
osteoarthritis
what is the most common form of arthritis
osteoarthritis
_________________ is a degeneration of articular cartilage characterized by inflammation and pain with joint motion
osteoarthritis
what is the most common way that OA is defined
radiographically via the kellgren lawrence grading severity >/= 2
risk factors of OA
- age
- female
- obesity
- repetitive joint use
primary features of OA
pain, stiffness, and potentially decreased ROM in the absence of systemic features (fever)
anesthesia considerations with OA, RA, and ankylosing spondylitis
- difficult airway - video laryngoscope, C-spine neutral, awake fiberoptic intubation
- positioning concerns
- regional anesthesia: evaluate preoperative neuropathy
management of OA
- weight loss
- exercise
- physiotherapy
- bracing in certain cases
- tylenol and NSAIDs
- opioids
- local injections: LA +/- steroids
- viscosupplemntation
- arthroplasty surgery
why are pneumatic tourniquets used in orthopedic surgery?
- controls blood loss during extremity surgery
- maintain relatively bloodless field
- minimize intraoperative blood loss 4. aid identification of vital structures 5. expedites procedure
if a pneumatic tourniquet is going to be used for ortho extremity surgery, when should it be applied?
after induction of anesthesia
pneumatic tourniquets maximum time of ___________ hours is considered safe.
2
if a surgery needs a pneumatic tourniquet for > 2 hours, what should you do?
deflate for 15-20 minutes, then reinflate
why is the pneumatic tourniquet only allowed to be used for a max of 2 hours without interruption?
after two hours the interruption of blood supply –> tissue hypoxia and acidosis
when a pneumatic tourniquet is applied to the patient, you should document ____________, _________, and ________________
time of inflation; time of deflation; 60 min interval communication with the surgeon
pressure of the pneumatic tourniquet is dependent on ____________, __________/____________
Blood pressure; shape/size of extremity
when you deflate a pneumatic tourniquet it releases _________________ into systemic circulation
metabolic wastes
s/e of deflation of pneumatic tourniquet
- transient cardiopulmonary changes: HoTN, hypoxemia
- metabolic acidosis
- hyperkalemia
- myoglobinemia
- renal failure
____________ minutes after pressurization of pneumatic tourniquet, pts will start complaining of dull aching pain which progress to burning and excruciating pain that may require ________________
~45-60; general anesthesia
if a patient complains of dull, aching pain with pneumatic tourniquet, this is through _______________ fibers
unmyelinated C
if a pt complains of burning, tingling pain with pneumatic tourniquet, this is through _________ fibers
myelinated A-delta
T/F: tourniquet pain is often resistant to analgesic and anesthetic agents
true; need multimodal including regional anesthesia
what population of orthopedic surgery patients receive thromboprophylaxis ?
- total hip arthroplasty
- total knee arthroplasty
why would an orthopedic surgery need thromboprophylaxis
due to total hip and total knee arthroplasty having increased risk for VTE including DVT and PE
what is the most common agent used for VTE prophylaxis in certain orthopedic surgeries
low molecular weight heparin (lovenox)