Ap Exam 3 Lecture 3: Patient Positioning

Front 1

AP EXAM 3 LECTURE 1: PATIENT POSITIONING

Back 1

AP EXAM 3 LECTURE 1: PATIENT POSITIONING

Front 2

Why the need for proper patient positioning?

Back 2

1. nerve damage
2. neuropathies, crush injuries, pressure necrosis, hyperextension of joints, blindness, etc..
3. physiologic changes: CV, respiratory, venous stasis
4. anatomical: pressure points, motionless

Front 3

Which nerve has the most reported injury?

Back 3

Ulnar

Front 4

ASA states what concerning patient positioning?

Back 4

Elbows need to be padded.

Front 5

Brachial plexus injury

Back 5

Caused by excessive abduction.

Prevented by extending LESS THAN 90 degrees.

Avoid arm falling off the table.

Front 6

Lithotomy position

Back 6

Birthing position, i.e. knees up above pelvis with feet put thru stirrups.

Front 7

Common peroneal nerve injury:

Back 7

Caused by direct pressure on nerve with legs in lithotomy position.

Nerve compressed against the neck of the fibula.

Prevent by padding the lithotomy poles.

Front 8

Causes of radial nerve injury:

Back 8

1. tourniquet
2. misplaced injection in deltoid muscle.
3. lateral compression of arm

Prevent by padding of tourniquets.

Occurs when there is loss of sensation in part of hand.

Front 9

Position lung volume

Back 9

1. 20% reduction after induction due to reduced thoracic dimensions.
2. greater decline w/ obesity.

Nerve inhibition due to anesthetics lead to less muscle functions which can lead to paradoxical inward thorax motion.

Front 10

Some possible hazards on a dorsal decubitus (supine position).

Back 10

1. skin breakdown
2. lumbar strain
3. nerve injury
4. alopecia

Front 11

Physiological effects on a supine position:

Back 11

Cardiac: minimal influence of gravity on vascular.
1. BP equalization throughout body--> no gradient b/w heart and arteries.
2. PVR increases
3. HR decreases
4. CO increases (increase right heart filling).
5. hypotension in pregnancy

Respiratory
1. decreases FRC

Front 12

How to position a patient in a supine position:

Back 12

1. arm not needed for surgery is tucked at the side.
2. elbows padded
3. draw sheet is tucked under patient's hip, NOT under mattress.
4. extended arm is not extended more than 90 degrees, on padded arm board.

Front 13

To avoid ulnar nerve injury, arm is:

Back 13

supinated and padded.

Front 14

Draw sheet

Back 14

ABOVE elbow and tucked under hip, NOT mattress.

Front 15

When is the beach (lawn) chair position indicated?

Back 15

For long awake cases.

Front 16

What is the indication for putting a patient in the beach lawn chair position?

Back 16

Long awake cases

Front 17

How to avoid or decrease the risk of ulnar nerve injury?

Back 17

Supinate and pad

Front 18

The nerve most commonly injured in a lithotomy position is?

Back 18

Common peroneal nerve

Front 19

What are the physiologic effects of a lithotomy position?

Back 19

Cardiac
1. increased circulation
2. increased BP/ CO
3. hypotension upon termination

Respiratory
1. decreased FRC/VC
2. V/Q mismatches
3. increased risk of aspiration

Front 20

What access does the low lithotomy provide?

Back 20

Allows simultaneous access to perineum and abdomen.

NOTE: limited access to head and face.

Front 21

Pressure on eye orbit can lead to?

Back 21

Corneal abrasion

Monocular blindness due to ophthalmic venous obstruction.

Front 22

What to keep in mind when a patient is in a prone (ventral decubitus) position?

Back 22

1. eyes
2. ET tube
3. upper extremity
4. breast
5. hips from excessive pressure.
6. pt's sides (avoid abduction or more than 90 degrees).

Front 23

Risks of prone position?

Back 23

Respiratory
1. decreases compliance
2. V/Q mismatches
3. ET tube problems
4. increased intra-abdominal pressure.

Head
1. eyes
2. three point (Mayfield) head holder.

Breasts and genitals

Front 24

What is the Wilson Frame?

Back 24

Longitudinal support device

It can be adjusted to increase lumbar flexion.

Front 25

What is the Kraske(Jack knife) position?

Back 25

Supine on table

Then table gets flexed (bent inward) to approx 90 degrees.

Front 26

What is the use for a Kraske position?

Back 26

Rectal surgery

Front 27

Lateral decubitus

Back 27

1. Both arms extended
2. One arm (bottom) suppinated on arm board(the one on directly on table) while the other pronated and bent.
3. Bottom leg flexed
4. Top leg straight
5. head aligned with body
6. straped around hips.
7. "axillary" roll placed caudal to and outside of lower axilla to avoid brachial plexus injury.

Front 28

Park bench aka semi-prone

Back 28

Aka semiprone

Used most often in pediatric PACU.

For posterolateral thoracic area.

Front 29

Sitting position

Back 29

Helps with visualizing the sources of bleeding.

Risk of air embolism is increased.

Front 30

Early uses of trendelenburg position were for:

Back 30

1. improving surgical exposure of the pelvic organs.
2. managing patients with shock.
3. preventing air embolism during central venous cannulation
4. enhancing the effects of spinal anesthesia.

Front 31

Trendelenburg

Back 31

No beneficial hemodynamic effects.