Positioning and nerve injury 2

Question 1

Which nerve is MOST likely to be injured by an IV pole that presses against the dorsolateral aspect of the humerus?
a. median
b. radial
c. ulnar
d. axillary

Answer 1

b. radial

Question 2

The radial nerve passes along the

Answer 2

spiral grove at the lateral aspect of the humerus (about three fingerbreadths above the lateral epicondyle)

Question 3

Etiologies of radial nerve injury include

Answer 3

excessive cycling of the NIBG cuff
upper extremity tourniquet
external compression by an IV pole
sheets that are too tight (if the arms are tucked)

Question 4

Radial nerve injury presents with

Answer 4

wrist drop

Question 5

Long thoracic nerve injury presents with

Answer 5

a winged scapula

Question 6

Suprascapular nerve injury presents with

Answer 6

dull shoulder pain

Question 7

The long thoracic nerve arises from

Answer 7

C5-C7

Question 8

The long thoracic nerve innervates the

Answer 8

serratus anterior muscle

Question 9

Long thoracic nerve injury can occur from

Answer 9

lateral position
trauma
preexisting neuropathy (possibly d/t a virus)

Question 10

The suprascapular nerve innervatest he

Answer 10

supraspinatus and infraspinatus muscles

Question 11

The suprascapular nerve is anchored between

Answer 11

the cervical spine and the suprascapular notch

Question 12

Etiology of suprascapular nerve injury is

Answer 12

the patient in the lateral decubitus position rolls onto their dependent arm

Question 13

Properly stabilizing the patient and placing a roll distal to the axilla may reduce the risk of

Answer 13

suprascapular nerve injury

Question 14

A patient developed foot drop following a vaginal hysterectomy. She was positioned in candy cane stirrups. which nerve was injured?
a. common peroneal
b. obturator
c. saphenous
d. femoral

Answer 14

a. common peroneal

Question 15

The etiology of obturator injury is

Answer 15

flexion of the thigh towards the groin
excessive traction during abdominal surgery
forceps delivery

Question 16

Obturator injury presents with

Answer 16

an inability to ADDuct the leg

Question 17

Etiology of femoral injury is

Answer 17

excessive traction during lower abdominal surgery

Question 18

Femoral injury presents with

Answer 18

impaired knee extension and hip flexion as well as reduced sensation over the anterior thigh and anteromedial aspect of the leg

Question 19

Saphenous injury etiology is

Answer 19

external pressure applied to the medial aspect of the leg

Question 20

Saphenous injury presents with

Answer 20

reduced sensation over the anteromedial aspect of the leg (just like femoral n. injury)

Question 21

Etiology of common peroneal injury

Answer 21

external pressure at the level of the fibular head (common in the lithotomy position)

Question 22

Common peroneal nerve injury presents as

Answer 22

foot drop and the inability to ever the foot

Question 23

Etiology of sciatic injury is

Answer 23

excessive hip flexion and external rotation of the legs in the lithotomy position
sitting with straight legs

Question 24

Patients with sciatic injury present with

Answer 24

foot drop

Question 25

Etiology of pudendal injury is

Answer 25

the nerve is compressed against a perineal post on an orthopedic fracture table

Question 26

Patients with pudendal injury present with

Answer 26

loss of perineal sensation

Question 27

Leaving the patient’s legs crossed during surgery increases the risk of

Answer 27

sural nerve injury in the top leg and superficial peroneal injury in the bottom leg

Question 28

Prevention of obturator nerve injury includes

Answer 28

minimizing hip flexion

Question 29

Prevention of femoral injury includes

Answer 29

the surgical team should avoid excessive traction during lower abdominal surgery

Question 30

Prevention of saphenous nerve injury includes

Answer 30

placing padding between leg and stirrup

Question 31

Prevention of common peroneal injury includes

Answer 31

placing padding between the leg and stirrup
pad under the fibular head
knees should be flexed with minimal rotation

Question 32

Prevention of sciatic injury includes

Answer 32

ample padding under buttocks
avoid excessive external rotation of the hips
flex table at the knees

Question 33

Prevention of pudendal injury includes

Answer 33

adequate padding between the perineal post and the patient

Question 34

Which complications are MOST commonly associated with the sitting position? (select 2)
a. tracheobronchial compression
b. midcervical tetraplegia
c. lower extremity compartment syndrome
d. paradoxical air embolism

Answer 34

b. midcervical tetraplegia
d. paradoxical air embolism

Question 35

Compartment syndrome is most commonly seen in the

Answer 35

lithotomy position

Question 36

Compartment syndrome can progress to

Answer 36

rhabdomyolysis or reperfusion injury

Question 37

___________ is the treatment for compartment syndrome

Answer 37

Fasciotomy

Question 38

This position is most commonly associated with VAE

Answer 38

the sitting position

Question 39

VAE can occur in any position that produces

Answer 39

a pressure gradient between the atmosphere and the veins at the surgical site

Question 40

Midcervical tetraplegia is associated with

Answer 40

hyperflexion of the neck (chin to chest)

Question 41

Midcervical tetraplegia occurs in the __________ position and can also occur postoperatively in patients who have undergone ___________

Answer 41

sitting; tracheal resection

Question 42

When compared to the Wilson frame and chest rolls, the ______________ is the best option to preserve normal pulmonary mechanics in prone patients (compliance is better and PIP is lower).

Answer 42

Jackson table

Question 43

The _________ position provides optimal V/Q matching which explains its use for ARDS patients

Answer 43

prone

Question 44

In the patient with a mediastinal mass, there are three things that worse tracheobronchial compression (i.e. airway collapse):

Answer 44

supine position
induction of general anesthesia
loss of spontaneous ventilation

Question 45

When anesthetizing the patient with an anterior mediastinal mass, you should

Answer 45

preserve spontaneous ventilation and use a reinforced endotracheal tube

Question 46

If the airway collapses in the patient with a mediastinal mass,

Answer 46

repositioning the patient laterally or prone may restore airway patency

Question 47

Risk factors for lower extremity compartment syndrome include

Answer 47

surgical time >2-3 hours
Increased BMI
decreased tissue oxygenation (hypotension)

Question 48

What is a venous air embolism?

Answer 48

VAE–> right heart–> pulmonary vasculature–> increased dead space and increased RV workload

Question 49

What is a paradoxical air embolism?

Answer 49

right heart–> patent foramen ovale–> left heart–> systemic circulation–> stroke

Question 50

In the supine position, ______________ of the lumbar spine can cause paraplegia

Answer 50

extreme hyperextension

Question 51

Risk factors for paraplegia include

Answer 51

maximal retroflexion of the OR table
raising the kidney rest to its highest position
placing large rolls under the patient’s lumbar spine

Question 52

When positioning the patient for surgery, you should be able to place __________________ in-between the chin and the chest

Answer 52

at least 2 fingers to prevent midcervical tetraplegia

Question 53

The tumors likely to occur in the anterior mediastinum include

Answer 53

the four T’s
1. thymoma
2. teratoma
3. thyroid
4. terrible lympoma

Question 54

A tumor of the anterior mediastinum can compress three vital structures:

Answer 54

tracheobronchial tree
pulmonary artery
superior vena cava

Question 55

What action can help improve comfort in a supine patient with a history of back pain?

Answer 55

placing a small pad under the lumbar spine to preserve lordosis