Apex- Orthopedic Surgery

Question 1

What does methyl methacrylate do

Answer 1

it helps bind the implant to the patient’s bone

it increases intramedullary pressure in the bone which can produce microemboli (fat, bone marrow, cement) that travel to the lungs, resulting in V/Q mismatch (dead space)

Question 2

What is bone cement emplantation syndrome and what caues it

which procedure carries the highest risk for BCIS

what are 3 other high risk procedures

Answer 2

it’s when residual methyl methacrylate enters sytemic cirulation causing:

bradycardia, dysthmias, systemic hypotension, pulm htn, hypoxia, and cardiac arrest

Hip Arthorplasty

knee arthroplasty, vertebroplasty, kyphoplasty

Question 3

Fat embolism syndrome is a complication of long bone trauma. In what time frame is the risk for this the greatest?

Answer 3

within the first 72 hrs of injury - which is why prompt stablization of the injury is important

Question 4

triad of fat embolism syndrome

Answer 4

resp insufficency, neurologic changes, petechial rash

Question 5

maximum time for tourniquet inflation

Answer 5

2 hours

risk of limb ischemia

Question 6

when a tourniquet is used for a bier block, it must be inflated for atleast how long after the local anesthetic is injected

what happens if its released prior to that

Answer 6

at least 20 mins

szs, cardiac arrest as the load of LA is introduced into systemic circ all at onces

Question 7

Under GA, what does tourniquet pain manifest as?

what can you do?

Answer 7

hypertension and tachycardia

if old and dont want to stress their heart, give esmolol

opioids are genereally not effective

Question 8

In the awake patient under regional, what are the first 2 signs on BCIS

1st sign under GA

first line tx (3)

Answer 8

dyspnea and altered mental status

decreased EtCO2

100% FIO2, IVF, Phenylephrine

Question 9

Max inflation pressure for upper extremity tourniquet

lower?

Answer 9

70-90mmHg above SBP

2x over SBP

Question 10

Beir block max pressure for upper extremity

for lower

Answer 10

250mmHg or 100mmHg over SBP (whichever is higher)
350-400mmHg

Question 11

5 effects from releasing the tourniquet

Answer 11

1. increase etco2
2. decreased core temp
3. decreased BP
4. decreaed SvO2 (SaO2 usually normal)
5. Metabolic acidosis

Question 12

when does tourniquet pain usually begin

most likely cause of hte pain

Answer 12

45-60 mins after inflation

tissue ischemia

Question 13

tourniquet pain is transmitted by what type of fibers

Answer 13

C fibers (slow pain)

Question 14

T/F: tourniquet pain begins as dull, aching, and burning and can progress to agonizing pain despite successful regional anesthesia

Answer 14

true

k so tourniquet pain suprases regional and is unresponsive to analgesics
-prob have to convert to general

Question 15

T/F: tourniquet pain is unresponsive to analgesics

Answer 15

True

so if your giving fent, and pt still unhappy - think how long the touniquet has been up and do we need to go to sleep

Question 16

What is the best way to treat intractable pain when using an othopedic tourniquet in a patient with a neuraxial block?

Answer 16

convert to GA

this type of pain is unresponsive to analgesics