Exam 3 Flashcards
fire location %:
head, face, neck, upper chest, airway
65%
Surgeries that require “open oxygen delivery”: use less than ____% O2
less than 30% O2
standard V
positioning
standard VIII
safety
_______ position carries some degree of risk
Every position carries some degree of risk
Erect to supine leads to ___________ venous return
INCREASED venous return
Increased MAP leads to:
stimulation of _____________
baroreceptors
Stimulation of baroreceptors leads to:
_____________ HR, SV, CO (decreased SNS, increased PNS)
DECREASED HR, SV, CO
(decreased SNS, increased PNS)
Stimulation of ______ and __________ mechanoreceptors leads to:
____________ SNS to muscle and vascular beds
stimulation of atrial and ventricular mechanoreceptors leads to DECREASED SNS to muscle and vascular beds
Atrial reflexes leads to:
changes in ____ activity
RAA activity
MAP is maintained within a narrow range during postural changes in a ___________________ setting
MAP maintained in non-anesthetized setting
volatiles cause
vasodilation and dependent pooling
NMBs cause
abolished muscle tone (decreased venous return and pooling)
MAP decreases __ mmHg per _____ change between the heart and a body region
MAP decreases 2 mmHg per inch
Decreased compliance and increased resistance from shifting organs & positioning devices?
decreased FRC and lung capacity
______ position change may cause ETT migration
ANY change
what is common to all nerve injuries
ischemia (due to perfusion issues)
Length of procedure that commonly can cause nerve injury
> 4 hours
NMB leads to _____________ mobility and stretching
NMB leads to increased mobility and stretching
ulnar nerve comes from what cord
medial
ABDUCT arms _____ degrees
< less than 90 degrees
(try to keep arms closer to the body)
make sure head is turned _________ the arm that is extended
toward
venous air emboli is common with which position
sitting
AVOID hyperflexion of the neck
if necessary, use ___ fingerbreadths between chest and chin
2 fingerbreadths
Common nerve injuries
ether screen, retractor pole
radial or circumflex
Common nerve injuries
lateral position, dependent arm with shoulder circumducted
suprascapular
Common nerve injuries
inadequate padding supine or sitting
sciatic
Common nerve injuries
lithotomy stirrups, bar, knee support
Common Peroneal
Posterior tibial
Saphenous
Common nerve injuries
lithotomy with excessive hip flexion
Obturator
Common nerve injuries
traction against perineal post of fracture table
pudendal
most common postop vision loss (accounts for 89% prone, spinal cases)
Ischemic Optic Neuropathy (ION)
risk factors for Ischemic Optic Neuropathy (ION)
big back cases
prone
spinal
long cases
HTN, male, CV dx, DM, obesity
Patients should be aware of risks!
how does ION occur
watersheds are highly vulnerable
ION:
_____________ perfusion with ___________ intraocular pressure
DECREASED perfusion with INCREASED intraocular pressure
OPP ocular perfusion pressure =
MAP – intraocular pressure IOP
What does NOT cause ION
globe pressure!
what is second most common postop vision loss
Central Retinal ARTERY Occlusion (CRAO)
postop vision loss:
HYPERtension, CV disease, obesity, glaucoma, Sickle Cell anemia
Central Retinal VEIN Occlusion
postop vision loss:
CP bypass, HYPOtension, increased extraocular pressure
Central Retinal ARTERY Occlusion (CRAO)
postop vision loss:
Results from ischemia or trauma from emboli, CP bypass, decreased perfusion
Corticol blindness
postop vision loss:
L-arginine deficiency leads to accumulated ammonia leads to vision loss (very rare syndrome)
glycine toxicity
1 positional cause of compartment syndrome
lithotomy
what gas is associated with VAE
nitrogen gas
when can VAE occur (2 things)
sitting position
surgical site above right atrium (air vacuum)
patent foramen ovale in ____ of patients
1/3
paradoxical air embolism occurs through the _____ when ____>____ pressure
PFO
RA>LA
what is gold standard monitoring for VAE
TEE
what is most common monitoring for VAE
precordial doppler
3rd – 6th intercostal space, RIGHT of sternum
airway complications are usually due to what problem
lymphatic flow obstruction
airway complications are usually caused by:
ETT displacement
mainstem intubation
kinking
disconnects
esophageal stethoscopes
oral airway
pregnancy: use ______ _____________ uterine displacement
LEFT LATERAL
T-burg helps to __________ venous return during hypotension
increase venous return
when MAP is NORMAL, it leads baroreceptors to _____________ CO, PVR, HR, BP
MAP normal= decreased CO, PVR, HR, BP
shoulder braces: center above the acromioclavicular joint
should you use IMPROPER placement?
YES, use improper placement (otherwise brachial plexus risk)
reverse t-burg is often used for
laparoscopic procedures
when MAP, CO, preload is DECREASED, it leads to ___________ HR, SNS, PVR
MAP decreased= increased HR, SNS, PVR
Lithotomy
increased risk of _________ so do NOT use LMA
aspiration
often the position used for renal surgery, thoracic, ortho
lateral decubitus
use ______________ arm for pulse ox
dependent arm
issues with lateral decubitus
ears hurting
rhabdo
V/Q mismatch
what is the worst position
sitting
eye issues are common with what position
prone
position for LONG spinal procedures (scoliosis)
Jackson Table
hypothalamus uses both ________ and _________ feedback
positive AND negative feedback
requires nearly constant internal body temp
homeothermic
organism takes on the temperature of the surrounding environment
poikilothermic
what 3 body parts are part of the core temp
abdomen, thorax, head
dispersion of heat
thermolysis
(Conduction, Evaporation, Radiation, Convection)
production of heat
thermogenesis
(shivering, nonshivering, diet, BMR)
what can change body temp
o Circadian rhythm (peaks at 6pm)
o Exercise
o Food intake
o Infection
o Thyroid function
o Age
o Anesthesia, sedatives, alcohol
o Obesity (increased BMR)
