Midterm

Question 1

second leading cause of OR law suits?

Answer 1

Nerve injuries (22%)

Question 2

3 largest reasons of inadequate documentation

Answer 2

• Positioning
• Padding
• Preexisting nerve injuries

Question 3

most common nerve injuries (and %) (4)

Answer 3

• Ulnar (28%)
• Brachial Plexus (20%)
• Lumbosacral (?)
• Spinal cord (16%)

Question 4

Risk factors of nerve injuries (5)

Answer 4

• Positioning
• Preexisting conditions (DM, tobacco, hypotension, hypothermia, liver disease, anemia, alcoholism)
• General anesthesia
• Extremes of weight (obese/thin)
• OR >4hrs

Question 5

Pathophys of nerve injury (4)

Answer 5

• Transection
• compression
• stretch
• kink

(all equals ischemia)

Question 6

5 nerves of the Brachial Plexus

Answer 6

• Radial
• Ulnar
• Median
• axillary
• musculocutaneous

Question 7

Order of nerves in arms (medial to distal) and what saying to remember them?

Answer 7

• Roots
• Trunks
• Divisions
• cords
• branches

Randy Travis Drinks Cold Beer

Question 8

What spinal processes innervate the Brachial plexus

Answer 8

• C5-8

- T1

Question 9

which 3 nerves reach hand?

Answer 9

• Ulnar
• Radial
• Median

Question 10

which nerve is responsible for carpel tunnel?

Answer 10

• Median

Question 11

innervates bottom of hand and nailbeds

Answer 11

• Median

cant grasp if damaged

Question 12

innervates back of hand

Answer 12

• Radial

cant bend fingers back if damaged

Question 13

innervates shoulder joint and covers deltoid

Answer 13

• axillary

Question 14

innervates bicep and skin over bicep and forearm

Answer 14

• musculocutaneous

Question 15

spinal processes for lumbar plexus

Answer 15

L1-L5

Question 16

spinal processes for sacral plexus

Answer 16

• L4-L5
• S1-S5
• C0

Question 17

T4 located at the ?

Answer 17

Nipple line

Question 18

T6-T7 located at the ?

Answer 18

Xiphoid process

Question 19

T10 located at the ?

Answer 19

Belly Button

Question 20

Axillary Roll risk of ?

Answer 20

Brachial plexus compression

Question 21

tight table strap can damage?

Answer 21

spinal processes for lumbar plexus

Question 22

Stirrups can damage? (2)

Answer 22

Lateral - Common Peroneal Nerve

Medial - saphenous nerve

Question 23

Armboard or shoulder braces can damage?

Answer 23

Brachial Plexus

Question 24

Tourniquets, BP cuffs, firm surface can damage?

Answer 24

Radial Nerve

Question 25

longer length cases risk of damage what nerve?

Answer 25

Ocular Nerve

Question 26

Perioperative factors related to nerve damage?

Answer 26

- Longer cases - General anesthesia - Hypotensive technique - Neuromuscular blockade

Question 27

Respiratory considerations for supine position?

Answer 27

- Decreased FRC and total lung capacity

Question 28

pressure change in trend position

Answer 28

2 mmHg for every 2.5 cm above/below heart

Question 29

what receptors compensate for extra volume near heart?

Answer 29

Baroreceptors

Question 30

neuro considerations for trendelenburg position

Answer 30

- Increased ICP - Decreased CBF (from cerebral venous congestion) - Increased Intraocular pressure in glaucoma

Question 31

lithotomy considerations? (2)

Answer 31

- raise and lower both legs together | - lower legs slowly and together

Question 32

where to place pulse ox in Lateral position?

Answer 32

dependent side (side of positioning - left lateral = left side)

Question 33

high risk position for vision loss?

Answer 33

prone

Question 34

what to maintain for decreased eye nerve damage?

Answer 34

MAP within 20% baseline

Question 35

positions where air emboli greatest risk

Answer 35

-sitting -prone -lateral (when operative site above level of heart)

Question 36

positions with risk of compartment syndrome (2) and at what case length?

Answer 36

- Lateral - Lithotomy > 5 hours

Question 37

what does common peroneal nerve damage manifest as? Also, how common?

Answer 37

Foot drop most common lower extremity nerve damage

Question 38

radial nerve injury manifests as?

Answer 38

wrist drop

Question 39

ulnar nerve damage manifests as?

Answer 39

sensory loss fifth digit and claw hand

Question 40

what to do if air emboli suspected?

Answer 40

spill saline on field and turn pt left lateral