Principles I - Positioning In The Or

Front 1

closed claims on positioning issues is secondary only to

Back 1

airway mishaps and death

Front 2

what nerves are frequently injured

Back 2

ulnar (28%)
brachial plexus (20%)
lumbosacral nerve root (16%)
spinal cord (13%)

Front 3

what patterns of nerve damage lately

Back 3

ulnar nerve injuries have decreased by spinal cord injuries have increased

Front 4

spinal cord injuries are due to

Back 4

hypoperfusion

Front 5

what are 85% of ulnar nerve injuries associated with

Back 5

general anesthesia

Front 6

what are the goals of positioning

Back 6

maximum exposure to surgical site
prevent injury
adequate physiological functioning
anesthesia access
return to preop health

Front 7

nutshell positioning goals

Back 7

good surgeon exposure
good anesthesia access
patient safety

Front 8

responsibility for positioning falls to

Back 8

the anesthetist and surgeon although supposedly the entire surgical team

Front 9

problem with general anesthesia and positioning

Back 9

pt can't tell you is something is uncomfortable

Front 10

MAC stands for

Back 10

modified anesthesia care

Front 11

advantage/disadvantage of MAC positioning

Back 11

pt will move if uncomfortable

Front 12

anesthetist responsibility for positioning is

Back 12

to continuously monitor positioning until the patient is out of the OR

Front 13

most positioning injuries are presumed to be

Back 13

preventable regardless of other factors

Front 14

time out is not done until

Back 14

pt is positioned and draped. CRNA reads name band, circulator reads consent

Front 15

potential injuries for head, ENT area

Back 15

blindness, corneal abrasion, facial edema, vocal cord damage and edema

Front 16

cardiovascular injuries from positioning

Back 16

DVT, ischemic injuries, vascular occlusions

Front 17

respiratory injuries from positioning

Back 17

atelectasis, endobronchial intubation

Front 18

neurologic injuries from positioning

Back 18

peripheral neuropathy, quad or paraplegia, decreased cerebral blood flow, increased ICP

Front 19

GU problems from positioning

Back 19

myoglobinuria, acute renal failure

Front 20

musculoskeletal injuries from positioning

Back 20

amputation, backache, compartment syndrome, rhabdomyolysis

Front 21

skin issues with positioning

Back 21

abrasions, bruising, decubitus, burns, alopecia

Front 22

alopecia results from

Back 22

hypoperfusion of scalp

Front 23

position related surgical complications can lead to

Back 23

prolonged hospital stays, infection, psychological trauma, life long debilitation

Front 24

causes of positioning injuries

Back 24

pressure points cause decreased arterial to venous gradient reduces tissue perfusion which leads to edema, ischemia, and cellular breakdown

Front 25

the underlying cause of all tissue damage is

Back 25

lack of perfusion

Front 26

describe the ischemic cell cycle

Back 26

despite lack of perfusion, cell functions continue anaerobically, lactic acid builds up, ion pumps fail due to lack of ATP and sodium accumulates in the cell, the cell swells and cuts off more circulation

Front 27

injury to soft tissue occurs when

Back 27

pressure is applied over a period of time - limiting fluid movement into and out of the capillary bed

Front 28

contributing factors to the development of compartment syndrome

Back 28

prolonged OR time, positioning, elevated extremity, OR hypotension (prolonged), increased age, extreme body habitus

Front 29

what has been implicated in developing compartment syndrom

Back 29

elevating one leg with hypotension, tourniquets

Front 30

treatment for compartment syndrome

Back 30

fasciotomy

Front 31

compartment syndrome pathophysiology is

Back 31

a swelling of tissues within a muscular compartment - within the muscle bundles are nerves and arteries - the bundles are covered with fascia that does not expand well, so when swelling begins to occur, the nerves and arteries are cut off

Front 32

what about compartment syndrome and tourniquets

Back 32

won't see symptoms until after the tourniquet is removed

Front 33

compartment syndrome is most common

Back 33

in extremeties

Front 34

compartment syndrome can occur

Back 34

anywhere with fascia and bone in a tight space around a muscle

Front 35

compartment syndrome is associated with

Back 35

reperfusion injuries

Front 36

surgically related causes of compartment syndrome are

Back 36

tight wound closures, expanding hematomas, external pressure by a positioning device or a leaning OR member, compression stockings, body weight

Front 37

general things that reduce flow and may contribute to compartment syndrome

Back 37

bad positioning, trauma, embolic events, tumors, vascular insufficiency

Front 38

a higher incidence of compartment syndrome occurs with what positions

Back 38

lithotomy position and lateral decubitus positions

Front 39

mechanisms of causing nerve damage

Back 39

compression, cutting, stretching, kinking or angulation

Front 40

the most commonly injured nerves are

Back 40

superficial nerves - the ulnar, brachial plexus, and the common peroneal

Front 41

crossing legs puts pressure on what nerves

Back 41

peroneal and sural nerves- the peroneal in the dependent leg and the sural in the superior leg

Front 42

the lithotomy position stretches what nerve

Back 42

sciatic

Front 43

honorable mention causes of nerve damage per Nagelhout

Back 43

brachial plexus injuries r/t arm boards falling off beds
blood pressure cuffs and tourniquets
axillary role positioning
surgeries > 4-5 hours
hypo or hypertension
chest cases manipulating the brachial plexus

Front 44

long surgeries can cause

Back 44

rhabdomyolysis and acute renal failure

Front 45

regardless of positioning, liability

Back 45

for an injury may fall to the anesthetist even inspite of the best positioning possible

Front 46

proper positioning is a

Back 46

standard of care

Front 47

anesthesia blunts

Back 47

the compensatory mechanisms of the sympathetic nervous system - leading to peripheral vasodilation

Front 48

changing position from standing to supine does what to venous return

Back 48

increases b/c pooled blood in the LE redistributes towards the heart

Front 49

increased preload from laying down causes what events to occur (in an awake patient)

Back 49

increased CO, increased BP, baroreceptor triggeres increases parasympathetic impulses to the SA node, slowing heart rate, reducing CO, atria and ventricular pressure sensors cause reduced renin release, ANP, and vasopressin

Front 50

respiratory effects of muscle relaxants

Back 50

paralyze respiratory muscles including the diaphragm, reduced TV, FRC, and closing capacity

Front 51

when you have good blood flow to the alveoli, but the alveoli are closed, it is called

Back 51

perfusion-ventilation mismatching

Front 52

perioperative factors that contribute to injury

Back 52

positioning devices
length of procedure
anesthetic technique

Front 53

pt related factors contributing to nerve injury

Back 53

body habitus
pre-existing conditions

Front 54

why is ulnar nerve injury common in cardiac surgery patients and what %

Back 54

38% because of median sternotomy and sternal retraction

Front 55

the ulnar nerve is derived from

Back 55

the brachial plexus

Front 56

the anatomy of the ulnar nerve is

Back 56

from the brachial plexus it runs the length of the upper arm, then into a groove between the medial epicondyle of the humerus and the olecranon of the ulna

Front 57

with flexion of the elbow, the ulnar nerve

Back 57

stretches and the tunnel becomes smaller pinching the nerve

Front 58

ulnar nerve injuries are more common in men or women?

Back 58

men

Front 59

the tunnel the ulnar nerve travels through is called

Back 59

the cubital tunnel

Front 60

when the ulnar nerve is affected, what areas is it felt

Back 60

the pinking finger and the lateral half of the ring finger

Front 61

muscles supplied by the ulnar nerve (almost all motor)

Back 61

(forearm) flexor carpi ulnaris, medial division of flexor digitoum profundus, (wrist) hypothenar eminence, (deep palmar branch) palmar interossei, dorsal interossei, 3rd and 4th lumbricals, adductor pollicis, deep head of flexor pollicis brevis

Front 62

symptomatic changes with ulnar nerve injury

Back 62

claw hand, pain, can't open doors or jars, progressive weakness

Front 63

anacronym for brachial plexus

Back 63

Robert Taylor Drinks Cold Beer -
Roots, Trunks, Divisions, Cords, Branches

Front 64

nerve roots for the brachial plexus arise from

Back 64

C5 - T1 - including C8

Front 65

what nerve is vulnerable to injury in almost every position

Back 65

the brachial plexus

Front 66

anatomy of the brachial plexus

Back 66

as the nerve roots merge they form the superioir, middle, and inferior trunks which the split into divisions as they pass over the first rib posterior to the clavicle. The divisions the separate into cords in the axilla and then subdivide further into branches

Front 67

the brachial plexus movement is limites by

Back 67

fixed at the vertebrae and the terminal branches - limited by the first rib and clavicle

Front 68

causes of brachial plexus injury from positioning

Back 68

depressed shoulder
head turned away
abducted arms >90
no shoulder support in prone position
arms above the head

Front 69

brachial plexus injury occurs most frequently in what position

Back 69

lateral

Front 70

alternate causes of brachial plexus injuries

Back 70

positioning devices (shoulder braces in deep trendelenberg) or sternal retractors during OH (especially internal mammary dissection)

Front 71

spinal cord injuries commonly associated with what surgeries

Back 71

thoracic and vascular procedures that interrupt blood flow

Front 72

positions common for spinal cord injury

Back 72

sitting, prone

Front 73

sitting position worsens spinal cord positioning when

Back 73

head is flexed forward which moves the cord anteriorly and stretches teh cord causing compression against the vertebrae, also compresses blood vessels, increases venous pressure, reduced perfusion in already hypotensive case

Front 74

sitting position is notorious for

Back 74

hypotension

Front 75

POVL stands for

Back 75

post op visual loss

Front 76

POVL is associated with what position

Back 76

prone

Front 77

risk factors for POVL are

Back 77

smoker, male, obesity, diabetes, vascular disease, hypertension

Front 78

anesthesia factor contributing to POVL

Back 78

head down or tilt position or prone
prolonged procedure
large blood loss
low hct
SBP < 100 for a sustained time

Front 79

the optic nerve is

Back 79

an extension of the brain with the retina containing cell bodies that supply axons to the optic nerve and the brain

Front 80

what reduces outflow from the eye and thereby increases IOP

Back 80

head down
increased abdominal pressure
increased right atrial pressure
obstruction of jugular veins

Front 81

what can obstruct the jugular veins

Back 81

extreme neck torquing, tight ETT ties

Front 82

optic perfusion pressure =

Back 82

MAP - IOP

Front 83

remember about the eye that

Back 83

it is an enclosed globe, IOP is affected by aqueous humor production and removal, increased venous pressure prevents outflow

Front 84

other causes of POVL

Back 84

air or particulate emboli, glycine toxicity

Front 85

glycine toxicity is associated with

Back 85

TURPS

Front 86

visual loss is also associated with

Back 86

bypass machines

Front 87

what other disease increases risk of POVL

Back 87

sickle cell disease

Front 88

if vision is loss due to an embolic event,

Back 88

the vision often improves gradually with time

Front 89

the supine position is aka

Back 89

dorsal decubitus position

Front 90

the most common position in the or is

Back 90

the dorsal decubitus or supine position

Front 91

what do we like about the supine position

Back 91

least hemodynamic and ventilatory changes

Front 92

the only gradient that really exists in the supine cavity is

Back 92

that in the venous system in the chest due to respiration - the rest of the gradients are about the same from head to toe

Front 93

what is one change between standing to supine position

Back 93

the FRC decreases by about 800 ml in the adult male because the diaphragm is shifted upward

Front 94

what position should the head be in in the supine position

Back 94

neutral - remember to pad according to what is neutral for that patient

Front 95

how do you treat the head in the supine position

Back 95

massage and reposition at intervals, doughnut headrest maybe, never turn head far laterally due to possible brachial plexus injury

Front 96

what contributes to post op back pain

Back 96

loss of natural lordosis

Front 97

how can you help post op back pain

Back 97

small towel, blanket, fluid bag under the back, lounge chair position, small pillow under the knees

Front 98

to prevent peroneal and sural nerve damage remember to

Back 98

uncross the patients legs once they are asleep

Front 99

also remember in the supine position to

Back 99

pad or elevate the heels, but do not hyperextend the knees

Front 100

minimize ulnar nerve injury in the supine position by

Back 100

abducting < 90 when on arm board, supinated or neutral arm position

Front 101

reduce pressure on what to prevent ulnar injuries

Back 101

the cubital tunnel

Front 102

when arms are tucked at the side, they should be positioned so

Back 102

the hands are parallel to the body and not tucked under the buttocks

Front 103

when arms are tucked at the side, remember to check

Back 103

that the elbows won't fall out (ulnar damage), and fingers aren't in the bed joints (amputation)

Front 104

what positions help prevent sciatic nerve damage

Back 104

the beach or lawn chair position, and pillow under the knee

Front 105

trendelenburg position is useful for

Back 105

increasing venous return during hypotension
improving exposure for lower abdominal surgeries
preventing venous air emboli during central venous line placement

Front 106

why don't we use shoulder braces anymore

Back 106

compression to brachial plexus

Front 107

cardiovascular changes associated with a head down position

Back 107

CVP increases, pulmonary pressures increase, ICP increase, IOP increase,

Front 108

other changes with long time head down position

Back 108

swelling of face, conjunctiva, tounge, larynx

Front 109

trendelenberg increases risk of

Back 109

upper airway obstruction due to swelling

Front 110

complications of the trendelenberg position

Back 110

belly contents push diaphragm up, reducing the functional residual capacity and pulmonary compliance (steep trendelenberg does this more than any other position)

Front 111

what is the worst position for functional residual capacity and lung compliance?

Back 111

steep trendelenberg

Front 112

what airway is preferred for patients in the trendelenberg position

Back 112

ETT

Front 113

complications associated with the supine position

Back 113

alopecia, backache, pressure sores

Front 114

why alopecia?

Back 114

pressure on scalp from same position,
hypotension
hypothermia
(remember to rotate head side to side a little bit)

Front 115

bony prominances should be

Back 115

padded

Front 116

pt with unusual spinal curvatures should

Back 116

be placed in a position of comfort for them

Front 117

why do patients get backache after surgery

Back 117

general or regional anesthesia relaxes the paraspinal musculature which causes a loss in the normal lordosis of the back

Front 118

help back pain by

Back 118

elevating knees or flexing the hips

Front 119

the prone procedure is good for what surgeries

Back 119

spinal, posterior fossa procedures

Front 120

in the prone position the patients body is supported by

Back 120

a frame or with parallel blanket rolls

Front 121

in the prone position the patients lower legs are supported by

Back 121

pillows

Front 122

types of frames associated with the prone position

Back 122

wilson frame, jackson table, rleton frame, mayfield tongs, prone view

Front 123

upper extremities in the prone position are put where

Back 123

either pronated and tucked near the torso or flexed < 90 on either side of the head

Front 124

what to remember when placing arms in the prone position

Back 124

< 90, slightly lower than the shoulders, forearms should be padded

if tucked, pad elbows, pronate hands

Front 125

what else to remember in the prone position

Back 125

intubate before positioning, check and document all pressure points, check the nose, eyes, ears, genitalia, breasts need to be tucked in or out, knees, ankles, toes, elbows, put 4x4 in mouth

Front 126

what do you not use in a prone patient

Back 126

oral airway

Front 127

what can you use to dry up secretions

Back 127

glycopyrrolate

Front 128

should a BIS be placed on prone patients

Back 128

maybe - but make sure no pressure is on the bis or may cause skin breakdown

Front 129

cardiovascular considerations of the prone position

Back 129

decrease CO, decreased venous return due to abdominal pressure, venous engorgement of spinal canal vessels due to compressed mesenteric and paravertebral vessels

Front 130

turning the head in the prone position will

Back 130

impede venous return from the head and arterial flow to the head

Front 131

common occurrences with prone position

Back 131

facial edema, conjunctival edema,

Front 132

risk with neurosurgery

Back 132

if head is higher than heart, risk a venous air embolism if the sinus is open

Front 133

in a patient with a less than ideal cardiovascular system, it may be useful to

Back 133

have an art line

Front 134

increased bleeding from the spinal cord during spinal surgeries is a problem because

Back 134

the surgeon can not hold pressure on the spine

Front 135

respiratory issues with the prone position

Back 135

decreased rib cage compliance, cephalad displacement of diaphragm, improved ventilation to perfusion ratios

Front 136

most common eye injury in the prone position

Back 136

corneal abrasions

Front 137

most dangerous eye injury in the prone patient is

Back 137

blindness

Front 138

how do you reduce eye risk in the prone patient

Back 138

lube and tape eyes before placing in prone position, maybe eye goggles

Front 139

blindness from the prone position is associated with

Back 139

global pressure and hypotension by decreased perfusion through the retinal artery and damage to the optic nerve

Front 140

an enlarged tongue is aka

Back 140

macroglossia

Front 141

protect the tongue in the prone position by

Back 141

placing a rolled 4x4 between teeth to prevent tongue from resting on teeth

Front 142

problems associated with the prone position

Back 142

eye injuries, blindness, VAE, macroglossia, brachial plexus injuries

Front 143

what is thoracic outlet syndrome

Back 143

a parasthesia in the arms of people when they put their arms above their heads for a while

Front 144

thoracic outlet syndrome is caused by

Back 144

a compression of the brachial plexus and subclabian vessels near the 1st rib

Front 145

how would you test your patient before deciding how to prone them?

Back 145

have them clasp their hands behind their head for a while when you talk to them to make sure they do not have thoracic outlet syndrom

Front 146

if a patient with thoracic outlet syndrome is placed prone with the hands up by the head

Back 146

they will have agonizing and debilitating pain post operatively

Front 147

three types of lithotomy positions

Back 147

low, standard, high or exaggerated

Front 148

lithotomy position used for what procedures

Back 148

ones needing perineal access

Front 149

a hemilithotomy position is when

Back 149

one leg is somewhat higher than the other leg

Front 150

arms in the lithotomy position are placed

Back 150

either extended or tucked

Front 151

once a patient is in the lithotomy position,

Back 151

then the foot of the table is dropped

Front 152

cardiovascular considerations in the lithotomy position

Back 152

increased venous return, increased pulmonary circulation, hypotension can be masked because of elevated legs

Front 153

how much blood is sequestered in the legs

Back 153

estimated that 100 - 250 ml per leg (some say as much as 600 total)

Front 154

what patients don't tolerate the lithotomy position well

Back 154

CHF, and restrictive lung diseases

Front 155

what to remember with the lithotomy position

Back 155

make sure patient is hemodynamically stable before bringing down the legs

Front 156

respiratory considerations in the lithotomy position

Back 156

same as the supine patient, diaphragm shifts up and the FRC is reduced - but neither is more significant than in the supine patient

Front 157

what position reduces the functional reserve capacity the most

Back 157

the trendelenberg position

Front 158

complications of the lithotomy position

Back 158

hip dislocation, neurovascular injury at hip and knee, peroneal nerve injury, compartment syndrome, lower back pain, hypotension with lowered legs

Front 159

two things to remember when positioning the patient in the lithotomy position

Back 159

raise and lower the legs at the same time, and watch the fingers when the foot of the table drops

Front 160

if you raise or lower just one leg in the lithotomy position, you risk

Back 160

hip dislocation

Front 161

acute abduction and external rotation of the hips can cause

Back 161

femoral nerve or lumbosacral plexus stretch injuries

Front 162

flexion of the hips > 90 can cause

Back 162

kinking or compression of femoral neurovascular structures under the tight inguinal ligament with possible arterial or venous occlusion and nerve palsy

Front 163

extreme knee flexion can cause

Back 163

obstructed popliteal veins

Front 164

the most frequently injured nerve in the lithotomy position is the

Back 164

peroneal

Front 165

the peroneal nerve is located

Back 165

along the lateral aspect of the knee (along the fibular head)

Front 166

the peroneal nerve can be damaged in the lithotomy position by

Back 166

resting against the candy canes or an unpadded edge

Front 167

a damaged peroneal nerve will cause

Back 167

foot drop

Front 168

compartment syndrome risk increases with

Back 168

length of surgery

Front 169

what is commonly associated with the lithotomy position too

Back 169

back pain

Front 170

incidence of litho related complications increases after

Back 170

2 hours

Front 171

lowering the patients legs after surgery in the lithotomy position can worsen

Back 171

hypotension

Front 172

tools used in the lithotomy position

Back 172

the candy canes and the yellow fins

Front 173

the lateral decubitus position is often used for what surgeries

Back 173

thorax or kidney surgeries - any surgery where the supine position doesn't provide enough lateral or posterior exposure

Front 174

what to remember about positioning patient in the lateral decubitus position

Back 174

do it after induction and intubation, log roll (shoulders, hips, head and legs in the same plane)

Front 175

head flexion or extension in the lateral decubitus position can cause

Back 175

venous and artial occlusion, elevated ICP, brachial plexus injuries

Front 176

the dependent leg in the lateral decubitus position needs to be

Back 176

flexed and padding placed between legs and the lower legs peroneal nerve needs to be padded from table pressure

Front 177

in the lateral decubitus position the dependent arm

Back 177

is positioned on a padded arm board perpendicular to the torso and flexed no more than 90 degrees

Front 178

the non dependent arm in the lateral decubitus position is placed

Back 178

on a mayo stand, or arm rest with padding and remember to support the shoulder

Front 179

the dependent arm in the lateral decubitus is susceptible to injury at

Back 179

the axilla compressing vessels and the brachial plexus

Front 180

how do we try to prevent brachial plexus injuries in the lateral decubitus position

Back 180

axilla roll

Front 181

proper placement of the axilla roll in the lateral decubitus position is

Back 181

a few fingers below the axilla - the axilla should be free but chest excursion should be maximized - place perpendicular to body line

Front 182

in the lateral decubitus position do not allow the shoulder to

Back 182

push outward or fall inward

Front 183

straps to hold patient in place should be

Back 183

placed carefully - never over joints or in the axilla

Front 184

in the lateral decub position remember to check

Back 184

the eyes and ear - may need doughnut

Front 185

pressure points in the lateral decubitus position

Back 185

ear, shoulder, elbow, hip, knee, heel, ankle, inner knee

Front 186

cardiovascular changes in the lateral position

Back 186

no changes unless combined with the trendelenberg position, or other position

Front 187

respiratory considerations in the lateral position in the awake patient

Back 187

ventilation and perfusion is best in the dependent lung

Front 188

in the pt with general anesthetic in the lateral position, ventilation

Back 188

is best in the nondependent lung

Front 189

respiratory considerations in the lateral position

Back 189

ventilation:perfusion mismatching

Front 190

explain ventilation perfusion mismatching in the lateral position

Back 190

typically ventilation is best in the dependent lung if the patient is awake, but when knocked out the diaphragm on that side is paralyzed and moves upward, decreasing lung compliance and worsening ventlation. Ventilation in the upper lung actually improves relatively, but due to gravitational pull, the dependent lung gets better perfusion. PPV abolishes affect of gravity in gas movement

Front 191

most common injuries in the lateral position are

Back 191

corneal abrasions, blindness, brachial plexus injuries and ulnar injuries (ulnar is most common - even with adequate padding there is still a risk of injury)

Front 192

the sitting position can be

Back 192

any position where the torso is higher than the legs

Front 193

the sitting position aka

Back 193

lounging position, beach chair, lawn chair

Front 194

the sitting position is still used for

Back 194

shoulder surgeries, breast reductions and implants

Front 195

when positioning the head in the sitting position remember to

Back 195

never flex it so there is less than 2 finger breadths between the mandible and the sternum - protect eyes with goggles in some surgeries

Front 196

over flexing the neck in the sitting position can cause

Back 196

decreased venous return from the head or decreased arterial flow to the head - can cut off blood supply to the circle of willis in the brain

Front 197

arms in the sitting position should be placed

Back 197

slightly flexed with shoulders supported

Front 198

knees in the sitting position should be

Back 198

slightly flexed, remembering to pad the heels and knees

Front 199

in long sitting cases the feet should

Back 199

be placed at a 90 degree angle with a foot board

Front 200

cardiovascular considerations of the sitting position

Back 200

hypotension, reduced venous return, increases SVR, extreme hip flexion reduces venous return creating stasis, intracranial perfusion decreases

Front 201

other contributors to hypotension in the sitting position (not just position)

Back 201

long NPO status, dehydration, induction drugs

Front 202

how does MAP relate to elevation in the sitting position

Back 202

MAP decreases .75 mmHg per cm of elevation

Front 203

if cerebral perfusion is a concern, then

Back 203

use an art line

Front 204

respiratory consequences of the sitting position

Back 204

improved FRC and VC, although may be limited if legs are extremely flexed and patient is sitting at 90

Front 205

the most common complication associated with the sitting position is

Back 205

hypotension

Front 206

the most dangerous complication of the sitting position is

Back 206

a venous air embolism

Front 207

why do Venous Air Embolisms occur?

Back 207

an open sinus or open vein above the level of the heart and because of the pressure gradient, the air gets sucked in

Front 208

symptoms of VAE depend on

Back 208

how much air and how fast the air is entrained

Front 209

symptoms of VAE are

Back 209

nothing, hypotension, arrhythmias, cardiac arrest

Front 210

explain a paradoxical air embolism

Back 210

an air embolism enters the right side of the heart, increased pressures in the pulmonary circulation forces a PFO to open and the deoxygenated blood and the foamy air is shunted into the left side of the heart and out to circulation

Front 211

open foramen ovale are how common

Back 211

35% in post mortem cadavers

Front 212

what about Nitric Oxide

Back 212

Nitric Oxide can expand air bubbles - so don't use it if at risk for a VAE

Front 213

air in the cranium when it is closed after surgery is called

Back 213

pneumocephalus

Front 214

if pt has pneumocephalus and nitrous is given,

Back 214

it can increase size of air bubble in head, increasing pressure on the brain structure and ICP

Front 215

air and the heart

Back 215

don't like each other - air by nature is irritating to the heart conduction system - air and blood make foam in the ventricles

Front 216

instances of VAE are associated with what surgeries

Back 216

cranies, C-sections

Front 217

problem with foamy blood is

Back 217

ventricular contracting creates less pressure because can compress air in foam much more

Front 218

the foramen Ovale connects

Back 218

the right and left ventricles - a hole in the septum

Front 219

right ventricle pressures are higher than the left ventricle in

Back 219

utero

Front 220

risks with sitting position

Back 220

hypotension, VAE, quadraplegia, pneumocephalus, stroke

Front 221

damage to the ulnar nerve results in

Back 221

numbness and flexion of the pinky finger and the lateral half of the ring finger - looks like a claw hand

Front 222

most common nerve injury in the OR

Back 222

ulnar nerve damage

Front 223

radial nerve damage results in

Back 223

wrist drop - or Saturday night palsy

Front 224

the radial nerve is located

Back 224

come around the humerous and around to the front surface of the hand

Front 225

median nerve injury can occur in what positions

Back 225

any position

Front 226

most common cause of median nerve injury

Back 226

tight wrist holders, deep IV sticks, infiltrated IVs

Front 227

median nerve parasthesia looks like

Back 227

ape hand or the opposite of claw hand

Front 228

the median nerve innervates

Back 228

what the ulnar nerve doesn't - the palm side of the thumb, forefinger, middle finger, and medial ring finger

Front 229

the peroneal nerve is a branch of

Back 229

the sciatic nerve

Front 230

damage to the peroneal nerve can cause

Back 230

foot drop and loss of sensation over the dorsum of the foot

Front 231

peroneal nerve damage is caused by pressure on

Back 231

the lateral aspect of the knee

Front 232

what nerve is damaged by pressure on the inside of the knee

Back 232

the saphenous nerve

Front 233

if the saphenous nerve is damaged,

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there is a loss of sensation to the medial thigh and leg (saddle block)

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a saddle block numbs what nerve

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saphenous nerve

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pneumonic for remembering facial nerves

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two zebras bit my cookies

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the five facial nerves are

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temporal, zygomatic, buccal, mandibular, and cervicle

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facial nerve damage can be caused by

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placement of items on forehead (ETT), mask straps placed incorrectly, holding the mask