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AP III > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

What is OA?

A

Osteoarthritios
inflammation of the joint capsule and surrounding tissues

Develops pain/swelling of the joint

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2
Q

What is the most common location for OA

A

Weight bearing joints
Can see in cervical spine

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3
Q

What is the treatment for OA?

A

Meds
Arthroplasty

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4
Q

What is the anesthetic management for a patient with OA?

A

Assess ROM
NSAIDS
Steroids
Consider regional

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5
Q

What is RA?

A

chronic inflammatory disease that affects joints BILATERALLY

Autoimmune of unknown etiology

Activated endothelial cells start an inflammatory cascade leading to synovial hypertrophy, destruction of cartilage and articular surfaces

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6
Q

Who gets RA more often: Men or Women

A

Women

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7
Q

Where is the most common location to have RA?

A

Cervical spine – 80%
May see systemic effectsW

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8
Q

What are some systemic effects you can see with RA?

A

myocarditis
pericardial effusions
Pleural effusions
anemia
infections
amyloidosis
Adrenal insufficiency d/t steroids

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9
Q

How do you treat RA?

A

DMARDS
TNF inhibitors
Methotrexate
Steroids
NSAIDS

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10
Q

What is the anesthetic management of pts with RA?

A

Risk of Difficult airway due to
- TMJ instability
- Cricoarytenoid Arthritis
- Easy dislocation of laryngeal cartilages

Consider fiberoptic or glide scope and awake intubations

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11
Q

What is the level of blocked for an axillary block

A

Branches

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12
Q

What are the peripheral nerves associated with an axillary block?

A

Radial
Ulnar
Median

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13
Q

What does the axillary block cover?

A

Forearm and HandW

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14
Q

What level of blockade does the infraclavicular block cover?

A

Cords

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15
Q

What peripheral nerve is covered by the infraclavicular?

A

Radial
Ulnar
Median
Musculocutaneous
Axillary

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16
Q

What areas does the infraclavicular block cover?

A

Elbow
Forearm
HandW

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17
Q

What is the risk with an infraclavicular block?

A

risk of pneumothorax
not for outpatient proceduresW

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18
Q

What level does the supraclavicular block cover?

A

Distal trunk and Proximal cord

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19
Q

What peripheral nerves are covered by the supraclavicular block?

A

Radial
ulnar
median
musculocutaneous
axillaryM

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20
Q

What areas of the arm does the supraclavicular block?

A

Mid humorous
Elbow
Forearm
Hand

21
Q

What is the risk with supraclavicular blocks?

A

Pneumothorax

22
Q

What level of blockade is seen with the inter scalene?

A

Upper and middle trunks

23
Q

What peripheral nerves are covered by the interscalene?

A

Entire BP
ULNAR IS NOT BLOCKED IN 15-20% OF PEOPLE

24
Q

What is the application of the interscalane block?

A

Shoulder
Proximal and middle humorous

25
Q

What is the risk associated with inter scalene block?

A

Phrenic nerve paresis decreases pulmonary function by 25%

26
Q

What roots make up the superior trunk?

A

C5 & 6

27
Q

What root makes up the middle trunK?

A

C7

28
Q

What root makes up the inferior trunk?

A

C8 and T1

29
Q

What cord does the superior trunk branch into?

A

Lateral and Posterior

30
Q

What cord does the middle trunk branch into?

A

The posterior division

31
Q

What Cord does the inferior trunk branch into?

A

Medial and Posterior divisions

32
Q

The medial Cords branches into what nerves?

A

Median and UlnarW

33
Q

The Posterior cord branches into what nerves?

A

Axillary and Radial

34
Q

The lateral cord branches into what nerves

A

Musculocutaneous
Median

35
Q

What are some concerns with the beach chair position?

A

Cerebral ischemia
Behold Jarish reflex

36
Q

What are the concerns of cerebral ischemia In the beach chair position?

A

head is up 20-30 cm higher than BP cuff so cuff will show a BP 16-24 points higher than what the head is seeing

BP decreases 2 torr for every 1inch
Also think about the circle of willis (another 10 cm above)

37
Q

Where should you zero your arterial line when you have a patient in the beach chair position?

A

External auditory meatus (circle of willis)C

38
Q

What is the equation for CPP?

A

CPP = MAP - ICP or CVP

39
Q

What is the Behold Jarish Reflex?

A

response to noxious ventricular stimuli sensed by chemoreceptors and mechanoreceptors in the LV by inducing a triad:
- HOTN
- Bradycardia
- Coronary artery dilation

40
Q

Why does the Bezhold Jarish reflex work?

A

the heart reacts to the decrease in Preload by withdrawing SNS tone and reflexively increasing PNS toneW

41
Q

When is the bezhold jarish reflex seen most often?

A

Awake patients with interscalene blocks

42
Q

What are some concerns with tourniquet use?

A

eliminates flow distal to the tourniquet

43
Q

What is the pain associated with the tourniquet?

A

Not fixed with narcotics –> DULL, ACHING, RESTLESSNESS

44
Q

When does pain start with the tourniquet

A

30 minutes for awake, 45-60 for GA patientsW

45
Q

What type of pain fibers are associated with tourniquet pain?

A

Type C fibers and A delta fibers

46
Q

What is the treatment for tourniquet pain?

A

Rlease of tourniquet
but may lead to transient metabolic acidosis

47
Q

What does the transient metabolic acidosis associated with tourniquet pain look like?

A

Increase ETCO2
HOTN
Tachycardia

48
Q

How do you use the tourniquet?

A

LE max 2H
UE max 1.5H

Inflate 50-75 mmHg above systolic UE
Inflate 100-150 above systolic for LE

Inflation: increase in central blood volume –> increased preload and after load

49
Q

When you are preparing to deflate a tourniquet, what do you need to expect?

A

Preload acutely drops
Post-Ischemic hyperemia
Decreased after load causes HoTN

AP III (25 decks)

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