Nerve Injuries and Positioning

Question 1

somethign you should assess if gonna be prone

Answer 1

check for thoracic outlet syndrome, clasp hands behind head, if they have pain may be best to tuck the arms

Question 2

what to avoid with bean bags

Answer 2

pressure on bony prominences

Question 3

how to position in lateral decubitus

Answer 3

down leg: kne and thigh flexed

up side: thing and leg extended and separted from lower leg with pillows

dont let pt roll forward, risk circumduction for down sisde shoulder which could injury suprascapular nerve.

Question 4

what nerve is most commonly injured

Answer 4

ulnar nerve

Question 5

what nerve was injured if impaired sensation of 4th adn 5th digits and inability to adduct pinky finger

Answer 5

ulanr nerve

Question 6

chronic injury of ulnar nerve can lead to

Answer 6

claw hand

Question 7

risk factors for ulnar nerve injury

Answer 7

male (especially older than 50)
pre-existing ulnar neuropathy
extremees of body habitus
prolonged hospital stay
cardiac surgery
History of cancer

Question 8

ulnar nerve injury often presents when?

Answer 8

> 24hrs after injury

Question 9

what to consider after 5 days of nerve injury not resolving

Answer 9

neuro consult with EMG and nerve conduction studies

Question 10

how to position hands with arms are abducted

Answer 10

palms up or thumbs up

Question 11

how to position hands if tucked

Answer 11

thumbs up is only acceptble way

Question 12

how common is median nerve injury

Answer 12

rare

Question 13

s/s of median nerve injury

Answer 13

decreasead sensation on palamer surgace of thumb and index finger and middle finger

might not be able to oppose the thumbs

Question 14

what can develop with chronic median nerve injury

Answer 14

ape hand deformity

Question 15

what nerve passes through the carpal tunnel

Answer 15

median nerve is the only one

Question 16

causes of median nerve injury

Answer 16

IV in AC space
elbow hyperextension
carpal tunnel syndrome

Question 17

where does the radial nerve run?

Answer 17

lateral aspect of humerus 3 finger breadths above lateral epicondyle

also runs in the spiral groove

Question 18

presentation of radial nerve injury

Answer 18

wrist drop

Question 19

causes of radial nerve injuyr

Answer 19

external compression by IV pole
excessive cycling of NIBP cuff
UE tourniquete
sheets too tight if arms are tucked

Question 20

where does long thoraci nerve originate? what does it innervate?

Answer 20

C5-c7
Ant. serratus M.

Question 21

etiology of long thoracic nerve injury

Answer 21

lateral position
trauma
pre-existing neuropathy

Question 22

presentation of long thoracic n injury

Answer 22

winged scapula

Question 23

suprascapular n innervates what?

Answer 23

supraspinatus and infraspinatus muscles

Question 24

etiology is suprascapular nerve injury

Answer 24

pt rolls on to dependent arm is lateral decubitus position

Question 25

presentation of supra scapular nerve injury

Answer 25

dull shoulder pain

Question 26

flexion of thing toward groin, excessive traction during abdoominal surgery, and forceps delivery could injury what nerve

Answer 26

obturator nerve

Question 27

inability to adduct the leg occurs when what nerve has been injured

Answer 27

obturator nerve

Question 28

excessive traction during abdomindal surgery can injure what nerve

Answer 28

femoral nerve

Question 29

impaired knee extension, hip flexion, and decreased sensation over anteromedial aspect of the leg would indicated what nerve injury

Answer 29

femoral nerve injury

Question 30

external pressure applied over medial spect of the leg could injury what nerve

Answer 30

saphenous nerve

Question 31

decreased sensation in anteromedial leg would be an injuyr of what nerve

Answer 31

if only that symptom, saphenous n. injury.

Question 32

external pressure at level of the fibular head can injury what nerve

Answer 32

common peroneal nerve

Question 33

foot drop and inability to evert the foot would be an injury to what nerve

Answer 33

common peroneal nerve

Question 34

excessive hip flexion and external rotation of leg in lithotomy can injure what nerve

Answer 34

sciatic nerve

Question 35

only foot drop indicates what nerve injuy

Answer 35

sciatic nerve injuyr

Question 36

n compressed against perineal post on orthopedic fx table would injur what nerve

Answer 36

pudendal nerve

Question 37

loss of penile sensation would be from what injury

Answer 37

pudendal nerve injury

Question 38

when the legs are cross waht nerves can be injyred

Answer 38

top leg: sural nerve injury bottom leg: superficial peroneal nerve injury

Question 39

when is compartment syndrome commonly seen

Answer 39

lithotomy position

Question 40

compartment syndrome can progess to what

Answer 40

rhabdomyolysis or reperfusion injury

Question 41

what is the treatment for compartment syndrome

Answer 41

fasciotomy

Question 42

air embolims can occur when

Answer 42

in any position but most likely in the sitting position

Question 43

how can anesthesia cause back ache?

Answer 43

GA and regional relax lumbar ligaments which can lead to ack pain from the supine position, placing pading under lumbar spine may help prevent this

Question 44

when can positioning lead to paraplegia

Answer 44

extreme lumbar lordosis in the supine position

Question 45

what can cause midcervical tetraplegia

Answer 45

hyperflexion of the neck

Question 46

how does midcervical tetraplegia develop

Answer 46

ischemia can occur from stretching and compressing mid cervical spinal cord.

Question 47

mid cervical tetraplegia most common in what position

Answer 47

sitting position

Question 48

should be able to place how many fingers between chin and chest

Answer 48

at least two fingers

Question 49

another instance cervical tetraplegia can occur

Answer 49

post op after tracheal resection

Question 50

is jackson table or wilson frame better for maintaing pulmonary mechanics?

Answer 50

jackson table is better

Question 51

why is prone position good in ARDS

Answer 51

creates optimal V/Q matching

Question 52

4 ts that can become anterior mediastinal masses?

Answer 52

thymoma teratoma thyroid terrible lymphoma

Question 53

anterior mediastinal masses can compress what structures?

Answer 53

tracheobronchial tree, pulm artery, SVC

Question 54

SVC syndrome

Answer 54

edema in face, neck, and upper torso

Question 55

be warry of anyone who becomes what or waht when assuming the supine position?

Answer 55

dyspnic or develops a cough when getting supine

Question 56

what three things make tracheobronchial compression worse?

Answer 56

supine position GA PPV

Question 57

even if you use reinforced ETT, how can mass still create issues?

Answer 57

can compress airway distal to ETT, or airway an collapse before you get the tube in.

Question 58

what can you try to re open airway if it collapse under ant. mediastinal mass?

Answer 58

try the lateral or prone position

Question 59

what should be available when dealing with ant mediastinal mass?

Answer 59

rigid bronchoscope

Question 60

what is last resort if unable to ventilate

Answer 60

VV ECMO