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NU 758 Adv Principles > ortho > Flashcards

ortho Flashcards

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1
Q

SCIP aims to decrease peri-op risks assoc w/ what factors

A

SSI, post-op VTE, peri-op glucose mgmt, & maintenance of normothermia

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2
Q

when should ancef be given? vanc?

A

within 1 hr of incision
vanc: 2h

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3
Q

3 respiratory concerns for older patients undergoing ortho sx

A
  1. decreased PaO2
  2. increased closing volumes
  3. decreased FEV (10%)
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4
Q

STOP-BANG criteria

A

Snore?
Tired during the day?
Observed apnea?
Pressure (HTN)?
BMI > 35
Age >50
Neck circumference >40cm
Gender: male
(3+ is high risk for OSA)

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5
Q

cardiac concern with ortho sx (2)

A
  1. SIRS leading to tachycardia, HTN, high O2 demand, and MI
  2. blood loss/fluid shifts
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6
Q

what is a common neurologic complication post-op ortho sx

A

delirium

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7
Q

intra-op RF for delirium (7)

A

hypoxemia, hypoTN, hypervolemia, electrolyte imbalances, pain, benzos, anticholinergics

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8
Q

components of the pneumatic tourniquet

A

inflatable cuff, connective tubing, pressure device, timer

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9
Q

purpose of pneumatic tourniquet

A

creates a relatively bloodless field, minimized blood loss, and improves surgical view

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10
Q

max time you can have pneumatic cuff inflated

A

2h

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11
Q

what pressure do you put tourniquet to (upper and lower ext)

A

upper: 70-90mmHg above SBP
lower: 2x SBP

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12
Q

when are somatosensory EPs and nerve conduction abolished w pneumatic tourniquet

A

within 30 min

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13
Q

when does pain and HTN occur w tourniquet

A

> 60min

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14
Q

if tourniquet is inflated over 2h what happens

A

postop neuropraxia (loss of sens/motor function)

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15
Q

6 effects of pneumatic tourniquet

A

HTN, pain, leaky capillaries, nerve conduction issues, acidosis, tissue hypoxia

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16
Q

tourniquet deflation causes release of…

A

acid metabolites like thromboxane

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17
Q

5 effects seen with tourniquet deflation

A
  1. transiet fall in temp
  2. transient met acidosis
  3. transient fall in CvO2
  4. transient fall in pulm & systemic arterial pressures
  5. transient INCREASE in EtCO2
    (treat cautiously bc effects are transient)
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18
Q

describe tourniquet pain

A

-ischemic pain like DVT/PVD pain
-starts as dull/aching –> burning & excruciating pain
-resistant to analgesics

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19
Q

what fibers cause burning/excruciating oain

A

unmyelinated c fibers

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20
Q

what type of pain fibers control pinprink, tingling, and buzzing pain

A

myelinated a-delta

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21
Q

what can you add to LA solns to help w tourniquet pain

A

opioids, toradol, melatonin, clonidine, dex

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22
Q

purpose of TXA & MOA

A

antifibrinolytic: prevents the breakdown of existing clots to prevent bleeding intra-op

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23
Q

TXA dose

A

1g in 50ml over 5-10min, 5-20 min before incision

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24
Q

contraindications to TXA (5)

A

clotting disorders, acquired defective color vision, SAH, active clotting, hypersens to TXA

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25
relative contraindications to TXA (3)
hx of vascular occlusive events, taking a procoagulant, taking oral contraception
26
deliberate hypoTN...what parameters for BP
if no HTN: SBP 80-90 & MAP 50-65 if HTN: 30% reduction of baseline MAP
27
risks of deliberate hypoTN
-vision loss -complications in ppl with CV, renal, hepatic, severe PV diseases
28
contraindications for deliberate hypoTN
uncorrected hypovolemia and severe anemia (although this is not used in general today)
29
what surgeries have a high risk of VTE
pelvic fx, hip fx, TKA, THA (less common w/ upper ext fx/sx)
30
leading cause of M&M after orthopedic sx
thromboembolism
31
treatment/prevention choice for VTE
LMWH (up to 35 days post op)
32
RF for VTE (5)
age, cancer, bedrest, Factor V Leiden, hx of DVT/PE
33
3 major features of fat embolism syndrome (diagnosis needs at least 1)
respiratory insufficiency cerebral involvement petechial rash
34
5 minor features of fat embolism syndrome (diagnosis needs at least 4)
pyrexia, tachy, retinal changes, jaundice, renal changes
35
lab features of fat embolism syndrome
fat microglobulinemia anemia, thrombocytopenia, high ESR
36
what value is required for FES diagnosis
fat microglobulinemia
37
most common site of injury for acute compartment syndrome (ACS)
tibial diaphysis (midshaft)
38
what are the 4 muscle compartments in the lower leg
ant, lateral, deep posterior, superficial posterior
39
s/s of ACS
5P's: pain, pallor, paresthesias, pulselessness, paralysis -may also see swelling (if no cast) and pain on passive stretch
40
what is normal compartment pressure in the leg and when does injury occur
<10mmHg normal 30-50mmHg + injury
41
treatment for ACS
fasciotomy
42
risks with sitting position
hypoTN, bradycardia, air embolism, PTX, cerebral hypo-perfusion
43
where do you measure BP in the sitting position
level of brain
44
lateral position considerations
protect ear use ax roll avoid twisting of spine (beanbags/braces) non-dep arm on a padded arm holder dependent arm padded and <90 degrees at the elbow
45
concern with knee surgery positioning
table bends at the knee so legs dangle, risk for blood pooling, DVT. use compression devices
46
what positions is elbow sx done in and what has best limb stability
supine, lateral, prone prone
47
considerations with fracture table
-risk of pt sliding -arms are bent so no IV in the AC -temp control bc most of pt is exposed
48
3 benefits to arthroscopy
reduced blood loss, less postop pain, reduced rehab time
49
general complications with arthroscopy
-SubQ emphysema/pneumomediastinum -life-threatening tension PTX* -eye injury -joint irrigation fluid --> fluid overload -rare: trocar vessel puncture
50
if peak inspiratory pressures rise, O2 sat drops, and no breath sounds on operative side suspect...
tension PTX
51
treatment for tension PTX
-chest tube ideal -needle decompression wth 14-18g angiocath inserted 2 or 3rd ICS anteriorly OR 4 or 5th ICS laterally
52
is regional or GA better for hip fracture sx? what are advantages to regional?
no difference per REGAIN study regional: avoids ETT/med admin, lower VTE risk, vasodilation from spinal can help with CHF patients
53
what is cause of mortality with pelvic fractures
RP bleed
54
purpose of arthroplasty
return motion and function of the joint and restore the controlling function of the surrounding soft tissues -pain relief, stability of joint motion, and correction of the deformity
55
what are prosthesis made of for arthroplasty
titanium or cobalt (nonferrous metals)
56
anterior vs posterior approach for THA: positioning
ant = fracture table (supine) post = lateral
57
2 risk with THA
1. high EBL from highly vascular femur (500-1000ml) 2. VTE
58
whats 7 RF for BCIS (bone cement implantation syndrome)
1. hx CV disease 2. pHTN 3. ASA 3+ 4. surgical technique (must use cement, hips>knees) 5. pathological fracture 6. trochanteric fracture 7. long-stem arthroplasty
59
6 s/s of BCIS
1. hypoxia 2. hypoTN 3. arrhythmias 4. increased PRV 5. loss of consc 6. cardiac arrest
60
first sign of BCIS under GA? if awake/sedation?
GA: drop in EtCO2 awake/sed: dyspnea and change in LOC
61
BCIS treatment
FiO2 100% and treat like R sided HF with aggressive IVF and hypoTN with alpha-agonists
62
why do some surgeons avoid regional anesthesia with shoulders
concern for postop neurologic symptoms
63
shoulder surgery concerns
1. high EBL bc vascular area 2. PONV 3. pain 4. long recovery time
64
2 analgesia options wiht shoulder sx
interscalene block and post-op nerve catheters with LA infusion
65
2 position options for TSA
lateral decubitus or beach chair (modified Fowler)
66
major risk with TSA
inadvertent extubation from positioning and sx manipulation near the head (also protect eyes and avoid c-spine stretching)
67
Nerve: innervation:
68
Nerve: post tibial innervation:
plantar surface
69
Nerve: saphenous innervation:
medial malleolus
70
Nerve: deep peroneal innervation:
space btwn big and 2nd toe
71
Nerve: superficial peroneal innervation:
dorsum of foot and toes 2-5
72
Nerve: sural innervation:
lateral foot and 5th toe
73
temp consideration with MS patients (from jeopardy, idk if related to this content?)
don’t warm them too much. Keep normo bc 1C higher can cause issues
74
6 complications from sterile water irrigation fluid during TSA
fluid overload, hypoNA, pulm edema, CHF, hypothermia, and airway compromise

NU 758 Adv Principles (5 decks)

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