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Gen Exam 3 + Final > Positioning > Flashcards

Positioning Flashcards

1
Q

“Res ispa loquitur”

A

“the thing speaks for itself”

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2
Q
A

identify major safety concerns

patterns of injury and strategies for prevention

improve patient safety by anesthesiologists working in pain management, operating rooms, labor floor, remote locations and critical care.

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3
Q

After induction, the patient can no longer respond to

A

painful stimuli with poor positioning

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4
Q

“most commonly associated” with positioning-related problems in anesthetized or sedated patients

A

Tissue stretch and compression

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5
Q

Stretch

A

> 5% of normal resting length

Kinks or decreases lumens feeding arterioles and draining venules

-Direct Ischemia: reduced arteriole blood flow
-Indirect ischemia: venous congestion

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6
Q

Compression

A

(neuropraxia or axonotmesis)

Direct pressure reduces local blood flow & cellular integrity

tissue edema, ischemia and possibly necrosis

Padding

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7
Q

T/F
We don’t really know “exactly” why nerve injuries happen

A

True

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8
Q

Mechanisms of Positioning Injury

A

Periop Inflammatory Response
-Inflammatory neuropathy
-Microvascular neuropathies
-Autoimmune disease/Viruses/immunosuppression

Radiation-induced

Systemic inflammation from drugs, transfusions of blood products

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9
Q

Perioperative Inflammatory Responses

A

-Inflammatory neuropathy
-Microvascular neuropathies
-Autoimmune Dz/Viruses/immunosuppression

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10
Q

Goals of Proper Positioning

A

Clear view & best access to surg site

Anesthesia can give drugs

reduce bleeding & resp issues

less risk pressure/nerve injury & circulation

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11
Q

Team Member Responsibilities
Surgeon

A

Optimal procedural exposure

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12
Q

Team Member Responsibilities
Anesthesia

A

-Physiologic requirements (ABC’s)
-Ongoing assessment
-Ensure patient safety

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13
Q

Team Member Responsibilities
Nursing

A

-Safe transfer
-padding and positioning aids
-Ongoing assessment

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14
Q

T/F
Positioning is everyone’s responsibility.

A

True

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15
Q

biggest physiologic consequence of position changes

A

HypoTN

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16
Q

you must recheck and document breath sounds when…

A

head, neck or whole body moves

(ETT migration possible)

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17
Q

You MUST document every position change, along with…

A

how you protected the patient

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18
Q

Common Perioperative Neuropathies

A

Ulnar Neuropathies
Brachial Plexopathies
Median Neuropathies
Radial Neuropathies
Lower Extremity Neuropathies

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19
Q

Most COMMON perioperative neuropathy

A

Ulnar Neuropathy

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20
Q

Key factors associated with ulnar neuropathy:

A

-Direct extrinsic nerve compression (often medial aspect of elbow)
-Intrinsic nerve compression (associated with prolonged elbow flexion)
-Inflammation

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21
Q

Risk factors for Ulnar Neuropathy

A

Mainly:
Male, high BMI, older, prolonged postop bed rest

Others:
Abnormal ulnar nerves before surgery (Contralateral neuropathy)

Poorly formed fibrotendinous roof of the cubital tunnel

External compression in the absence of stretch

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22
Q

only major peripheral nerve in the body that always passes on the extensor side of a joint

A

ulnar nerve

All other major peripheral nerves primarily pass on the flexion side

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23
Q

Flexion vs extension

A

We prefer extension

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24
Q

What happens when peripheral nerves stretched >5% of their resting length

A

start to lose function and can develop ischemia

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25
Q

> __° degree of elbow flexion stretches the ulnar nerve

(≅___° high-risk for injury)

A

90

110

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26
Q

Anatomy and Elbow flexion

A

Ulnar nerve passes:
behind medial epicondyle
under the aponeurosis that holds the two muscle bodies of the flexor carpi ulnaris together

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27
Q

Anatomy and Elbow flexion
…. is thick, especially in men

A

Proximal edge of aponeurosis (cubital tunnel retinaculum)

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28
Q

Ulnar nerve injury
Compression at nerve between …

A

table and medial epicondyle

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29
Q

Ulnar nerve injury
prevention

A

supination
avoid hypotension and hypoperfusion
Pad arms properly

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30
Q

Ulnar nerve injury
Manifested by

A

inability to abduct the 5th finger

Weakness / atrophy of hand muscles “claw-hand”

Numbness/tingling/pain in lateral hand on affected side

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31
Q

Outcomes
Sensory Only Neuropathy

A

40% resolve within 5 days
80% resolve within 6 months

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32
Q

Outcomes
Sensory & Motor Ulnar Neuropathy

A

20% resolve within 6 months
Many have permanent pain and dysfuction

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33
Q

Follow Up
Sensory - only neuropathy

A

Observe patient as most resolve within 5 days

persists = neurologist consult

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34
Q

Follow Up
both motor and sensory neuropathy

A

Consult neurologist ASAP

may need decompression surgery

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35
Q

Brachial Plexus Injury
Most common in…

A

patients undergoing sternotomy (especially those with internal mammary artery mobilization)

Things to think about:
Brachial plexus entrapment
Prone positioning
Anatomy of shoulder abduction

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36
Q

Many patients don’t notice or complain until up to 48 hours later.. why?

A

We’ve medicated them heavily

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37
Q

Brachial Plexus Injury
Patients in ___ have a higher risk than supine

A

prone and lateral

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38
Q

Brachial Plexus Entrapment

A

Prone and lateral position patients:
entrapped between compressed clavicles and rib cage

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39
Q

Prone positioning

A

(surrender position)

somatosensory-evoked potential changes when their arms are abducted

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40
Q

T/F
Shoulder Braces can cause brachial plexus injury

A

True
braces tight against the base of the neck

should be more laterally over the acromioclavicular joint

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41
Q

Proper Shoulder Brace placement

A

more laterally over the acromioclavicular joint

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42
Q

Causes of Brachial Plexus Injury

A

These stretch the plexus

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43
Q

What injury should be concerned with after a procedure using a sternal retractor?

A

Brachial plexus

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44
Q

shoulder abduction goal

A

avoid abduction > 90°

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45
Q

shoulder abduction > 90°

A

places the distal plexus on the extensor side of the joint and possibility of stretching the plexus

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46
Q

Brachial plexus injury
How it happens

A

Excessive external rotation or abduction of arm

Avoid:
> 90 degree abduction
arm falling off of table

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47
Q

Brachial plexus injury
Positions affecting it

A

prone:
watch flexion & abduction of arms overhead

Lateral position:
-requires a chest roll (inaccurately called an axillary roll)
-avoids compression of humerus into axilla
-avoids compression of neurovascular bundle in axilla

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48
Q

When a pt is in lateral position, use which method to avoid brachial plexus injury?

A

Chest roll
(inaccurately called an axillary roll)

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49
Q

Brachial Plexus Nerve Injury
Manifestations

A

depend on which nerves are injured

Median – “Ape hand” deformity, inability to oppose thumb
Axillary – inability to abduct the arm
Ulnar – “Claw hand” deformity
Musculocutaneous – inability to flex forearm
Radial – wrist drop

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50
Q

Long Thoracic Nerve Dysfunction

A

Scapular winging

Serratus anterior muscle (long thoracic nerve branches from C5-C7, ~C8)

Long thoracic nerve palsy allows the dorsal protrusion of the scapula

Traumatic in nature

Viral/inflammatory?

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51
Q

allows the dorsal protrusion of the scapula

A

Long thoracic nerve palsy

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52
Q

Axillary Neurovascular Injury

A

Abduction of the arm on the arm board > 90 degrees

Head of the humerus into the axillary neurovascular bundle

Compression and stretch injury

Compression/occlusion = decreased perfusion

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53
Q

Mastectomy procedures can cause which nerve injury?

A

Axillary Neurovascular Injury

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54
Q

Abduction of the arm on the arm board > 90 degrees

A

Axillary Neurovascular Injury

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55
Q

Muscular men with large biceps are susceptible to

A

median nerve injury if the arm is fully extended during surgery

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56
Q

Median Nerve Neuropathies
most common in

A

men between: 20 - 40 yrs.

Men with large biceps and decreased flexibility

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57
Q

Prevention of complete extension at the elbow contributes to

A

Median Nerve Neuropathies

(Creates a shortening of the median nerve over time)

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58
Q

Usually, motor dysfunction doesn’t readily resolve with which nerve injury?

A

Median Nerve Neuropathies

~80% motor dysfunction still present 2 years post injury

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59
Q

IVs in the antecubital fossa area are a/w which nerve injury?

A

Median Nerve Neuropathies

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60
Q

nerves become ischemic if stretched ___ of their resting length which can …

A

> 5%

kink penetrating arterioles & exiting venules
↓
perfusion pressure

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61
Q

Full extension of the elbow stretches chronically contracted ___ and promotes ischemia (at the level of the __)

A

median nerves
elbow

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62
Q

Arm Support
support/pad the forearm and hand to prevent…

A

full extension

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63
Q

Radial Neuropathies are (Less/More) common than median neuropathies

A

more

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64
Q

Radial Neuropathies

A

usually compression of the nerve @ mid-humerus area (arising from roots C6-8 and T1)

Surgical retractors: compress radial nerve (bars holding abdominal retraction)

Lateral position (impinged by overhead arm boards)

Unsupported arms/ poles / repeated cycling of the BP cuff

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65
Q

Radial nerve injury: more often by

median nerve injury: mostly due to

A

radial: direct compression

median: stretch

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66
Q

T/F
NIBP is a/w injury of the median nerve.

A

False
more closely a/w radial never injury

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67
Q

Nerve Injury Presentation
Radial, Ulnar, Median

A

Radial got that limp wrist 👀

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68
Q

Arm board use

A
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69
Q

Lower Extremity Neuropathies

A

Common peroneal
Sciatic nerve
Obturator nerve
Lateral femoral cutaneous nerve
Femoral nerve

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70
Q

Hip
Excessive flexion or abduction

A

Flexion: injure lateral femoral cutaneous

abduction: obturator nerves

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71
Q

Obturator Neuropathy

A

Hip abduction >30 degrees can cause strain on obturator nerve

Excessive hip flexion of thigh can cause compression

Excessive traction in abdominal Sx

Motor dysfunction is common

Inability to adduct the leg with decreased sensation over the medial side of the thigh

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72
Q

Obturator passes through…

A

through the pelvis and out the obturator foremen

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73
Q

Hip flexion >90 ° causes

A

laterally displaces anterior superior iliac spine
&
stretches inguinal ligament

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74
Q

T/F
Lateral Femoral Cutaneous Nerve injury results in motor disability.

A

False
only sensory fibers

But can have:
disabling pain
dysesthesias of the lateral thigh

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75
Q

Prolonged hip flexion >90° can cause ischemia of

A

Lateral Femoral Cutaneous Nerve

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76
Q

Lateral Femoral Cutaneous Nerve
1/3 of the nerve’s fibers pass through…

A

the inguinal ligament as it passes through the thigh (originates at L2-3)

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77
Q

Sciatic & its branches
-common peroneal (fibular)
-tibial nerves

cross which joints?

A

the hip and knee joints

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78
Q

Sciatic & its branches
-common peroneal (fibular)
-tibial nerves

are stretched by:

A

hyperflexion of the hips and extension of the knees

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79
Q

Sciatic Nerve is
stretched when…

A

external rotation of the leg

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80
Q

Sciatic and its branches:

A

common peroneal (fibular)
tibial nerves

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81
Q

Usually associated with direct pressure of the lateral leg, just below the knee

A

Peroneal Neuropathy

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82
Q

The peroneal nerve wraps around the…

A

head of the FIBula

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83
Q

Peroneal Neuropathy
causes

A

leg holders (candy canes)
-hold the leg and foot
-Impinge nerve around the head of the fibula

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84
Q

can cause foot drop

A

Pressure on Peroneal Nerve

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85
Q

Saphenous Nerve Injury

A

when the medial tibial condyle is compressed by leg supports

difficult forceps delivery or by excessive flexion of the thigh to the groin
Muscle cramps & Tightness
difficult mobility

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86
Q

Physiological changes related to change in body position are mostly from…

A

gravitational effects on cardiovascular and respiratory systems

redistribute blood within the venous, arterial, and pulmonary vasculature

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87
Q

(In an awake pt)
Changing from erect to supine ___ venous return and stroke volume.

What happens after?

A

increases

Increased preload = PNS stimulation to adapt HR & contractility

88
Q

can reduce venous return (preload) when in the supine procedure

A

Obesity, pregnancy, and abdominal tumors

(big belly)

89
Q

Starling’s Law

A

heart matches cardiac ejection to the dynamic changes occurring in ventricular filling and thereby regulates ventricular contraction and ejection

90
Q

Jackknife position

A
91
Q

Pulmonary changes in Supine

A

functional residual capacity and total lung capacity are reduced due to changes to the diaphragm

92
Q

Pulm response in supine is exaggerated in

A

obese patients

93
Q

Anesthesia and muscle relaxants further reduce __ & __ due to diaphragm position with ___

A

FRC & TLC
relaxation

94
Q

Trendelenburg position also (increases/decreases) lung volumes.

A

decreases

95
Q

Any position that limits movement of the diaphragm, chest wall or abdomen may:

A

increase atelectasis
intrapulmonary shunt

96
Q

Variations of Supine

A
97
Q

Pre-op considerations

A
98
Q

Supine
Upper body

A

on back with pillow/donut under head

Arms: boards/tucked; (< 90° ); supinated (palm up)
If at side must be padded and tucked

additional padding under elbow

Check fingers

Check IV lines and SaO2 probe

99
Q

Supine
Resp changes

A

FRC decreased by 20%

Abdominal contents limit diaphragm movement

GA decreases muscle tone

Small airways close sooner → hypoxia
VQ changes cause shunting → hypoxia

Compression of the IVC

Obesity and pregnancy problems

100
Q

T/F
Supine position can contribute to alopecia

A

True
Pressure on occiput → alopecia
Pad back of head
Check often in long cases

101
Q

Supine
lower body

A

Keep hips and knees slightly flexed
Blanket/ pillow under knees

Cervical, thoracic and lumbar spines should be in straight alignment

102
Q

Supine
if using arm boards

A

Padded
palms up (supinated)
< 90-degree

103
Q

Complications of Supine

A

Peripheral neuropathies can occur in any position
Backache
Ischemic pressure injuries
Pressure Alopecia
Pressure-Point issues

104
Q

Alopecia in Supine

A

Prolonged compression of hair follicles
↓
hair loss

Pain and swelling where the occiput has been supporting weight

tight face mask straps
hypoTN
hypothermia

105
Q

Supine pressure point issues

A

Hypotherm & vasoconstrictive hypoTN

Heels
Sacrum
Elbows

106
Q

Check legs when patient in supine to make sure…

A

legs are UNCROSSED

107
Q

Arm restraint too tight leads to

A

compresses the anterior interosseous nerve (branch of the median nerve) in the upper forearm

carpal tunnel like sydrome

108
Q

Can resemble compartment syndrome in the lower extremity

A

anterior interosseous nerve compression (branch of the median nerve)

ex: Arm Restraint too tight

109
Q

Nerve Injury and Supine Position

A

Brachial plexus neuropathy
Sternal retraction
Long Thoracic Nerve Injury
Axillary trauma from humeral head
Radial nerve compression
Median Nerve Dysfunction
Ulnar Nerve Neuropathy
Back pain
Compartment syndrome

110
Q

chest roll is placed

A

caudad to the downside axilla

111
Q

the chest rolls lifts the thorax enough to

A

relieve pressure on the axillary neurovascular bundle

112
Q

Helps prevent decreases in blood flow to the hand and arm

A

chest roll

113
Q

Decreases shoulder pain after postop

A

chest roll

114
Q

flexed lateral decubitus

A
115
Q

flexed lateral decubitus flexion should be

A

under the iliac crest

116
Q

flexed lateral decubitus positioning

A

Chest roll
Neck neutral
Pillow between knees and flexed
Padding under ankles/feet

117
Q

the flank and thorax are horizontal in what positioning

A

flexed lateral position

118
Q

feet and legs in flexed lateral position

A

Feet/legs below the atria causing pooling of blood

119
Q

flexed lateral position can cause

A

lumbar stress

120
Q

flexed lateral position is used for

A

thoracotomy

121
Q

kidney surgery positioning

A

Lateral jackknife with elevated kidney rest

122
Q

lateral decubitus dependent lung VQ mismatch

A

underventilated

more perfusion

123
Q

lateral decubitus non dependent lung

A

over ventilated

less perfusion

124
Q

VQ mismatching can cause

A

hypoxia

125
Q

lithotomy position

A

Patient is supine with arms extended laterally <90 °

Each lower extremity is flexed at the hip (about 90°) and knees bent parallel to the floor

126
Q

in lithotomy position, extremities should be

A

elevated and lowered slowly and together

127
Q

when is lithotomy position used most often

A

GYN and Urology cases

128
Q

hip flexion > 90º in lithotomy position can increase

A

stretch of the inguinal ligaments

129
Q

how should legs be moved when positioning patient in and out of lithotomy

A

move legs at the same time

130
Q

low lithotomy

A

About 30-45 degrees

Reduces perfusion gradients

131
Q

high lithotomy

A

Suspend the patient’s feet high with stirrups

Patient’s legs almost fully extended on the thighs flexed 90° or more on the trunk

132
Q

significant uphill gradient for arterial perfusion to the feet

A

high lithotomy

133
Q

high lithotomy can cause

A

Stretch of sciatic nerve

Compression of femoral canal by inguinal ligament

134
Q

exaggerated lithotomy

A

Pelvis flexed ventrally on the spine, thighs forcibly flexed on trunk and lower legs aimed skyward

Associated with compartment syndrome

135
Q

lithotomy can impair

A

impair ventilation due to upward pressure

More prominent in obese patients

136
Q

most common problem with lithotomy

A

Nerve Injuries: Sciatic, common peroneal, femoral, saphenous and obturator

137
Q

hand injury risk

A

lithotomy

138
Q

Common peroneal nerve damage

A

Occurs from compression of lateral aspect of fibula head (improper padding against stirrups)

FOOT DROP

139
Q

elevating and flexing simultaneously avoids

A

stretching of one side of the nerve

140
Q

> 4 hours in lithotomy

A

increases risk of injury

Ischemia, edema to skin and muscles

141
Q

femoral nerve injury causes

A

Excessive angulation of the thigh on the abdomen

Excessive traction during abdominal surgery

142
Q

femoral nerve injury can cause

A

Decreased flexion of the hip
Decreased extension of the knee

143
Q

femoral nerve injury causes loss of sensation over the

A

superior aspect of the thigh

medial or anteromedial side of the leg

144
Q

Perfusion to an extremity is inadequate

A

compartment syndrome

145
Q

characteristics of compartment syndrome

A

Characterized by ischemia, hypoxic edema, elevated tissue pressure within fascial compartments and extensive rhabdomyolysis

146
Q

which positions can cause compartment syndrome

A

Lateral position(arm) and lithotomy (legs)

147
Q

compartment syndrome is associated with

A

Systemic hypotension and loss of driving pressure to the extremity (elevation)

Vascular obstruction from excessive flexion, knee or pelvic retractors

External compression from straps

148
Q

common factor of lithotomy for > 5 hours

A

compartment syndrome

149
Q

prone position is used for

A

posterior fossa of the skull, posterior spine, buttocks and perirectal and lower extremities (Achilles)

150
Q

how should arms be placed in prone position

A

Arms at side or “surrender position” < 90° to prevent stretching of brachial plexus

151
Q

supine to prone

A
152
Q

how is patient moved supine ➔ prone

A

Patient is log rolled gently so there are no abnormal movements or twisting of body parts

153
Q

Chest rolls from below clavicles to iliac crest

A

in prone position to provide adequate lung expansion and help alleviate pressure on abdomen

154
Q

prone positioning

A

Pillow under lower legs and ankles help flex knees and prevent pressure on toes

Head on special pillow with cut out area free of pressure on face/eyes

Head positioned to side may impair drainage on one side or neutral

Elastic stockings and active compression to minimize pooling of venous blood

155
Q

prone position cardiac

A

Compression of abdominal viscera can cause:
- Pooling of blood in extremities
- Decreased preload, CO, BP, SV

156
Q

cardiac changes in prone position

A

increased SVR and PVR

157
Q

pulmonary changes in prone position

A

Decreased total lung compliance
Increased work of breathing
ETT can be dislodged

158
Q

blindness from retinal ischemia

A

prone position

159
Q

prone position eye indications

A

blindness from retinal ischemia

ION- Ischemic optic neuropathy

Corneal abrasions

160
Q

Reverse Trendelenburg can be used for

A

Cholecystectomy, head and neck procedures

161
Q

Shifts the abdominal contents caudad

A

reverse trendelenburg

162
Q

May have hypotension may result in decreased venous return and perfusion to brain

A

reverse trendelenburg

163
Q

Facilitates exposure, aids in breathing (increased FRC)

A

reverse trendelenburg

164
Q

Causes further pressure upwards on diaphragm from abdominal contents and further decreases lung expansion

A

trendelenburg

165
Q

Increases ICP by decreasing venous drainage

Increased IOP (pt with glaucoma)

A

trendelenburg

166
Q

increased risk of aspiration

A

trendelenburg

167
Q

Mendelson syndrome

A

aspiration of > 25cc of gastric contents with a pH of < 2.5

168
Q

physiologic effects and risks associated with Trendelenburg position

A

Further increases translocation of blood to central compartment (along with lithotomy)

Intracranial and intraocular pressure increases

169
Q

pulmonary changes in trendelenburg

A

Decrease in pulmonary compliance, FRC and vital capacity

170
Q

What injuries can occur to the eye?

A

corneal abrasion is most common

Chemical injury, direct trauma (pressure and crush), blurred vision

171
Q

Flexion of the head may move the endotracheal tube

A

toward the carina

172
Q

extension of the head moves the ett

A

away from the carina

173
Q

Sudden increases in airway pressure or oxygen desaturation may be caused by

A

mainstem bronchial intubation.

174
Q

head down vs head up positions

A
175
Q

sitting position is used most often for

A

posterior fossa, cervical spine, shoulder or neck surgery

176
Q

sitting position causes pooling of blood

A

in the lower extremities (compression stockings)

177
Q

decreases venous return and decreased cardiac output (20-40%)

A

sitting position

178
Q

sitting position pulmonary changes

A

Increased lung volumes

Decreased work of breathing

179
Q

awake vs anesthetized in sitting position

A
180
Q

flexion of the head in beach chair position

A

Flexion of the head may obstruct the internal jugular and cause cerebral venous engorgement or hypoperfusion (swelling in the face, eyes

181
Q

extension of the head in beach chair position

A

can impair cerebral blood flow causing cerebral ischemia, obstruction of ETT and pressure on the tongue

182
Q

Cerebral vasculature dilates and constricts to maintain

A

constant blood flow to the brain

183
Q

CPP=

A

MAP - ICP (or CVP)

184
Q

Autoregulation occurs when MAP in between

A

50 and 150 m Hg

185
Q

Poorly controlled HTN the CPP curve is shifted

A

higher to the right

186
Q

BP in the arm is similar to ____________

A

CPP in the absence of ICP

187
Q

beach chair MAP and BP in the arm

A

is higher than Cerebral perfusion

188
Q

where is CPP monitored

A

at external auditory meatus (represents the base of the brain)

189
Q

CPP is about

A

which is about 20 cm above the heart (15 mm Hg difference)

190
Q

blindness and stroke due to

A

inaccurate BP

191
Q

1 mm Hg decrease/

A

1.35 cm height

192
Q

20 cm ~ ____________ mmHg change

A

15 mmHg change

193
Q

sitting position potential complications

A

Venous air emboli

Hypotension (fluids, vasopressors, decrease agent)

Brainstem manipulations resulting in hemodynamic changes

Risk of airway obstruction

Decrease venous return (stockings or compression devices)

Macroglossia (avoid chin against chest)

194
Q

midcervical tetraplegia

A

Hyperflexion of the neck, with or without rotation of the head

Stretching of the spinal cord resulting in compromise of the vasculature of the midcervical region

195
Q

mid cervical tetraplegia paralysis below

A

the level of the 5th cervical vertebra

196
Q

position for mid cervical tetraplegia

A

Sitting position

197
Q

Prolonged head flexion for intracranial surgery in the supine position can cause

A

mid cervical tetraplegia

198
Q

venous air embolism is caused by

A

open venous system above level of the heart

199
Q

detecting venous air embolism

A

by listening to heart sounds with Doppler at R 2nd intercostal space

200
Q

s/s of venous air embolism

A

sudden decrease in CO2, hypoxia, arrhythmias, hypotension and a “millwheel murmur” (usually a late sign)

201
Q

venous air embolism treatment

A
202
Q

durant’s position

A
203
Q

face masks can cause

A

pressure damage over nose

204
Q

facial nerve damage can occur from

A

fingers over mandible

205
Q

Face straps can cause injury or even necrosis to

A

face, ears and eyes and alopecia

206
Q

visual injuries

A
207
Q

patients at risk for visual injuries

A

DM
Smokers
Obese
ETOH abuse
Anemic
HTN

208
Q

Wilson Frame

A

head is lower than the heart

209
Q

Potential Etiology of POVL

A

acute venous congestion of the optic canal

210
Q

Obesity can increase

A

intraabdominal pressure in prone patients

211
Q

how to reduce post-op vision loss

A

Reduce venous congestion in the optic canal
Keep head above the heart or at the same level
Colloids vs Crystalloids
Reduce intra-abdominal pressure
Limiting duration of surgery

212
Q

The retinaculum stretches from ___ to the ___

A

the medial epicondyle

olecranon

213
Q

How does elbow flexion affect the retinaculum?

A

stretches the retinaculum and puts a lot of stress on the nerve as it passes underneath

214
Q

Radial Nerve Injury
Causes
S/S

A

compression against spiral groove of humerus and other object (i.e. ether screen or excessive cycling of NIBP)

wrist drop, weakness of abduction of thumb, and loss of sensation in web space between thumb and index finger

215
Q

This nerve carries only sensory fibers, so no motor disability occurs

A

Lateral Femoral Cutaneous Nerve

But can have:
disabling pain
dysesthesias of the lateral thigh

Gen Exam 3 + Final (13 decks)

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