Flashcards in Neuromuscular Deck (65)
General questions to ask during neuromuscular assessment
1) Have you ever had a stroke, seizure/fit/convulsion, or paralysis?
2) Every been diagnosed with a tremor or Parkinson's disease?
3) Have you ever had numbness/tingling/pins and needles in any of your extremities lasting more than 2 hours?
4) Have you ever had a nerve injury?
5) Ever have MS or other nervous system disease?
6) Ever have migraine headaches?
7) In the last year, have you taken any antidepressants, sedatives, tranquilizers, antiepileptics, or herbal meds?
8) Any pain in your joints? Limited ROM? Lower back pain?
9) Have you been able to perform all your activities at home and work in the last week/month/year?
10) Have you taken any pills or shots for pain in the last 6 months?
Effect of GA on normal protective pain reflexes
Takes them away
- Important to know ROM limitations and document their baseline
- Maintain their natural ROM during positioning
- May help to position to comfort BEFORE putting them to sleep (and document this!)
When would we assess the TMJ?
If the patient has trouble opening their mouth or if they have RA
What would we do if pt has limited ROM or pain in their TMJ?
Consider another mode of intubation (glidescope)
- Remember that on intubation, we scissor their mouth open very wide-we don't want to hurt their TMJ if they have problems with it
Is snapping and clicking normal on TMJ assessment?
How to assess TMJ
1) Finger in the joint-ask to open and close
2) Ask them protrude their jaw and to move it side to side
Assessment of the shoulder girdle
1) Abduct arms to shoulder level
2) Arms vertical and above head with palms facing eachother
3) Hands behind neck with elbows to the side
4) Both hands behind the small of the neck
What is thoracic outlet syndrome?
Compression of the neurovascular bundle between the two scalene muscles near the first rib
- will manifest as pain/extremity discoloration when the arms are above the head
When should we test/ask about thoracic outlet syndrome?
For prone positioning
1) Flexion- Hand under small of back for support, and bring their knee to their chest
2) Abduction- Stabilize the contralateral ASIS and abduct the leg closer to you. Stop once the iliac spine moves or the patient has pain!
When to perform hip assessment?
Function of the trigeminal nerve
Facial sensation and muscles of mastication
Corneal reflex (cotton ball method) tests what cranial nerve?
Test of the vagus nerve
Gag reflex, palate rises symmetrically when you say AHHH, any voice hoarseness?
Test for spinal accessory (CN XI)
Raising both shoulders and turning head against resistance
Elbow movement involves these nerves
Finger abduction involves these nerves
C8, T1, and ulnar
Thumb opposition involves these nerves
C8, T1, median nerve
Hip flexion and adduction involves these nerves
Hip abduction involves these nerves
Hip extension involves this nerve
Knee extension involves these nerves
Knee flexion involves these nerves`
Dorsiflexion involves these nerves
Plantar flexion involves this nerve
Anesthesia is usually called to intubate with a GCS of ____ or less
How to score GCS
Eye opening- never (1) -spontaneous (4)
Best verbal response- none (1) - oriented (5)
Best motor response- None (1) - obeys commands (6)
Why is steroid therapy a big deal for anesthesia?
Because exogenous steroids send the message to the hypothalamus that we are making enough steroid. Causes suppression of the pituitary/adrenal axis, and prevents the patient from being able to cope appropriately with the stress of surgery
Who do we give supplementary steroids to?
Any patient who has received corticosteroid therapy for at least a month in the last 6-12 months