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Blocks and misc Flashcards

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1
Q

How often does an anastomotic leak happens after gastric bypass? What are the most common signs

A

2% of the time

  1. Unexplained tachycardia is the most sensitive sign
  2. Fever
  3. Abdominal pain
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2
Q

What may increase the incidence of an anastomotic leak and should be avoided?

A

Ketorolac

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3
Q

What is Ma Huang and its complications?

A

Natural source of ephedrine

  • adrenergic overstimulation
  • HTN
  • Seizures
  • CVA
  • Death
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4
Q

What is orlistat?

A

Lipase inhibitor that reversibly binds to lipase and inhibits absorption of fats

This may increase bleeding due to lack of vitamin K

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5
Q

Which coagulation factors does Vit K impair?

A

2,7,9,10

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6
Q

How does blood volume, MAP, and venous pressure change in trendelenberg? What must you be careful with?

A

Increased venous pressure - be careful in HF patients!

MAP stays the same or increases because of vasodilation

Venous pressure increases pressure of the face, eyes, and airway - also increases ICP

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7
Q

Respiratory changes in trendy vs reverse trendy

A
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8
Q

If you have concerns for airway swelling, what test can be done before extubation?

A

Leak test with a spontaneously breathing patient

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9
Q

Which positions can cause edema to the face

A

Prone
Trendelenburg
Sitting with neck flexion

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10
Q

What position is the brachial plexus at highest risk for being stretched?

A

Arms are abducted > 90 degrees, or the head is rotated to one side

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11
Q

What position is the brachial plexus at highest risk for being compression?

A

Compressed between the clavicle and the first rib by an external force (shoulder brace or bean bag)

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12
Q

Should shoulder braces be used? What is an alternative?

A

They should never be used and opt for a non-sliding mattress

IF used, then place over the acromion

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13
Q

How do you test for thoracic outlet syndrome? Which positions increase the likelihood of this?

A

Have the patient clasp their hands behind their head, if they have pain then at increased risk

This syndrome can occur in any position where the arms are placed over the head like being prone

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14
Q

Where is an axillary roll placed and why? What can happen?

A

Placed distal to the axilla

IF placed in the axilla then it can cause neurovascular compression. Poor SpO2 can signal in the dependent arm

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15
Q

Where does the ulnar nerve emerge?

A

From the cubital tunnel between the humeral and ulnar heads of the flexor carpi ulnaris

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16
Q

What is the common injured peripheral nerve?

A

ulnar

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17
Q

Other than positioning what else increases ulnar nerve injury?

A

Prolonged hospital stay
Obese or thin
Preexisting injury
Males over 50

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18
Q

Impaired sensation to the 4th and 5th digits signals what type of nerve injury?

A

Ulnar

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19
Q

Claw hand signals what type of nerve injury?

A

Chronic ulnar

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20
Q

Inability to abduct or oppose the pinky finger signals what type of nerve injury

A

Ulnar

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21
Q

Sensory vs motor nerve injury, which is more serious?

A

Motor is more serious

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22
Q

Sensory vs motor nerve injury, which is more common? When does it resolve?

A

Sensory is more common and less serious than motor injury

Usually subsides in 5 days

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23
Q

Which nerve can be injured when placing an IV in the antecube?

A

Median

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24
Q

Which nerve can be injured with carpel tunnel syndrome?

A

Median

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25
Which nerve can be injured with elbow hyperextension?
Median
26
Which nerve can be injured when forcing elbow extension during positioning after NMB?
Median
27
Unable to oppose the thumb is what nerve injury?
Median
28
Reduced sensation to the palmer surface of the thumb, index finger, middle finger, and lateral aspect of the ring finger is what nerve injury?
Median
29
What is the hand of benediction?
Median nerve injury
30
Where does the radial nerve pass through?
Spinal groove of the lateral aspect of the humerus
31
Which nerve can be injured with excessive BP cuff cycling?
Radial
32
Which nerve can be injured with external compression of IV pole?
Radial
33
Which nerve can be injured with an extremely tight tourniquet?
Radial
34
Which nerve can be injured if the sheet are too tight and the arms are tucked?
Radial
35
How does a radial nerve injury present?
Wrist drop, inability to extend the wrist
36
Inability to adduct the leg is caused by what nerve injury?
Obturator
37
Reduced sensation over the medial aspect of the thigh is what nerve injury?
Obturator
38
Forceps delivery may cause what nerve injury
Obturator
39
Excessive traction during lower abdominal surgery may cause what nerve injury? Multiple
Obturator and femoral
40
Excessive flexion of the thigh towards the groin may cause what nerve injury?
Obturator
41
What is the best way to prevent obturator nerve injury?
Minimize hip flexion
42
Impaired knee extension and hip flexion is what nerve injury?
Femoral
43
Reduced sensation over the anterior thigh and anteromedial aspect of the leg is what nerve injury?
Femoral
44
Reduced sensation over the anteromedial aspect of the leg is what nerve injury?
Saphenous
45
What is the best way to prevent a saphenous nerve injury?
Place padding between the leg and stirrup
46
Which nerve is likely injured during the lithotomy position?
1. Common peroneal 2. Saphenous
47
Foot drop is likely what never injury?
Common peroneal or sciatic
48
Inability to extend the toes dorsally is what nerve injury?
Common peroneal
49
Inability to evert the foot is likely what nerve injury?
Common peroneal
50
Which two positions may cause a sciatic nerve injury?
Lithotomy Sitting
51
Which position is most likely to cause compartment syndrome? How is it treated?
Lithotomy Fasciotomy
52
Which position may cause a venous air embolism?
Sitting but can happen in any position
53
Which air embolism causes a stroke?
Paradoxical
54
Which air embolism increases dead space and RV workload?
Venous
55
How many fingers should be able to be placed between the chin and chest while sitting? If unable to, what is the concern?
Midcervical tetraplegia due to hyperflexion of the neck 9C5)
56
What is the goal for the abdomen during the prone position?
To hang freely, if it is compressed - may cause increased intraabdominal pressure, and reduce pulmonary compliance
57
What is the best positioning device for the prone position?
Jackson table
58
Which position provides the optimal V/Q matching for an ARDS patient?
prone
59
Which 3 factors worsen tracheobronchial compression with an anterior mediastinal mass?
1. Supine 2. Induction of general anesthesia 3. PPV
60
What is the best induction method for a patient with a mediastinal mass?
Spontaneous ventilation, sitting
61
During an awake spontaneous intubation with a mediastinal mass, you lose the airway, what are the next steps?
1. Reposition laterally or prone 2. Rigid Bronch 3. Emergent bypass

Miscellaneous (10 decks)

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