Ortho

Question 1

What is the max time a tourniquet can be on and why?

Answer 1

2 hrs – leads to tissue hypoxia, acidosis. Capillary leak.

Question 2

What is the UE max for tourniquet pressure?

Answer 2

250 mmHg (70-90 over SBP)

Question 3

What is the LE max for tourniquet pressure?

Answer 3

300 mmHg (2x SBP)

Question 4

What happens when you deflate tourniquet?

Answer 4

acidosis, hyperK, myoglobinemia, myoglobinuria, renal failure, hemodynamic changes, pulse ox changes, increased ETCO2, lower temp, lower pressures

Question 5

When does tourniquet pain occur?

Answer 5

about 1 hr after applied. hard to tx, convert to general

Question 6

What kind of pain does C fiber unmyelinated result in?

Answer 6

burning, ache

Question 7

What kind of pain does A, C fiber myelinated result in?

Answer 7

prickle pain

Question 8

When do you take down the tourniquet?

Answer 8

after dressing applied

Question 9

What is tourniquet paresthesia due to?

Answer 9

stretching of the myelin

Question 10

What kind of anesthesia do you use for arthroscopy usually?

Answer 10

LMA with general – it is usually outpt, so RA would last too long

Question 11

What are some issues with UE arthroscopy?

Answer 11

PTX, SQ emphysema, pneumomediastinum. Beach chair positioning issues. Fluid irrigation – can add up, if using water it can lead to hyponatremia. PE d/t released thrombin in sinus.

Question 12

What are some signs of PTX?

Answer 12

decreased O2, increased CVP, tachy, sweaty, tracheal deviation, JVD, increased airway pressures

Question 13

Who are likely to get hemi/arthroplasty redo?

Answer 13

young males

Question 14

Who are likely to get hemi/arthroplasty?

Answer 14

> 65 women

Question 15

Who is at risk of increased morbidity with arthroplasty?

Answer 15

older males

Question 16

Who is at risk of worse fx from arthroplasty?

Answer 16

older women

Question 17

What is a good anesthetic plan for arthroplasty if HD stable?

Answer 17

spinal

Question 18

Can you use N20 for arthroplasty?

Answer 18

NO d/t open bone

Question 19

Is LMA good for arthroplasty?

Answer 19

NO because of positioning, usually need a lot of narcotic

Question 20

What is a risk with joint disarticulation?

Answer 20

infection

Question 21

What is the EBL of arthroplasty?

Answer 21

500-1000 mL

Question 22

How do you prep for bone cement placement?

Answer 22

fluid load, FiO2 100%

Question 23

Bone cement syndrome risk factors

Answer 23

CV dz, pHTN, ASA III+, NYHA III+, pathologic fx, intertrochanter fx, long bone (occurs in 2-17% of pt)

Question 24

What is the 1st sign of bone cement syndrome, and then subsequent signs?

Answer 24

decreased ETCO2. then, decreased O2, decreased BP, arrhythmia, increased PVR, LOC if RA used, arrest even

Question 25

What is bone cement syndrome d/t?

Answer 25

maybe emboli, complement activation?

Question 26

How is bone cement syndrome treated?

Answer 26

as if R heart failure. Fluids, alpha agonists

Question 27

What is normal VQ?

Answer 27

0.8 (4/5L)

Question 28

What do you do if venous air embolism occurs and is known?

Answer 28

CV support, leave PEEP alone, NS/bone wax on field, aspirate via CVP line (doppler R 2nd ICS)

Question 29

What are signs of VAE?

Answer 29

millwheel murmur, low CO2/O2/BP

Question 30

What is the max level of spinal levels that can have kyphoplasty at one time?

Answer 30

2 bc of the cement

Question 31

What do you need to have available if your pt is in prone?

Answer 31

bed in the hallway incase pt arrests, need to flip them

Question 32

What do you do if they do anterior approach to spinal surgery?

Answer 32

it involves thoracotomy so have to use double lumen ETT

Question 33

What is POVL due to?

Answer 33

retinal occlusion/ischemia, optic neuropathy

Question 34

Who is at greatest POVL risk?

Answer 34

<18, >65, obese, male, Wilson bed, colloid use, EBL > 1 L, surgery > 5 hours, intraop hypotension, IOP > 40

Question 35

When does POVL set in?

Answer 35

1-2 days postop. painless.