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BOA#4
| Question | Answer |
|---|---|
| What is a common component of nerve injury? | tissue ischemia |
| What is a potentially life threatening complication that causes neural and vascular structure damage due to swelling into the muscles compartment? | Compartment syndrome |
| What are 4 causes of compartment syndrome? | prolonged operative procedures, hypotension, elevation of extremities, body habitus |
| Compartment syndrome can be precipitated by ____________ with leg elevation. | hypotension |
| What is considered the definitive treatment of compartment syndrome? | Fasciotomy |
| What does untreated compartment syndrome lead to? | tissue necrosis with myoglobinuria, acute renal failure, amputation, death |
| The common denominator for all injuries is a procedure time greater than _____ | 4 hrs |
| This technique to decrease bleeding is a perioperative contributing factor to pt injury? | hypotensive techniques |
| These preexisting conditions are related to positioning injuries? | Peripheral neuropathy, PVD, smoking, subclinical ulnar nerve entrapment, thoracic outlet syndrome |
| What are the most common injured nerves in the upper extremities? | ulnar and brachial plexus |
| What is the most common injury of the lower extremities? | Common peroneal |
| Where does the brachial plexus run from? | C5----->T1 |
| What is the selmonosky triad of thoracic outlet syndrome? | Elevation of hands, supraclavicular tenderness, weakness of the 4th and 5th fingers |
| What is the longest nerve in the body? | Sciatic |
| What kind of fracture causes damage to the peroneal nerve? | Broken fibula |
| Tight table straps or leg holding devices for arthroscopy can injure which nerve? | lateral femoral cutaneous nerve in the thigh |
| Crutch stirrups can injure which nerve? | common peroneal nerve |
| Laying supine can cause what to the occiput? | alopecia |
| Excessive neck turning strains what? | brachial plexus |
| Pts develop back aches in the supine position due to the abolishment of what? | lumbarsacral curve |
| Crossed legs may cause pressure injury to what nerve? | superficial peroneal nerve |
| Arms may be tucked to the side or abducted no greater than how many degrees? | 90 |
| What position produces minimal effects on circulation and perfusion of the lungs? | supine |
| What decreases when changed from sitting to supine position? | Functional residual capacity |
| Expansion of the rib cage is not limited in supine position and these effects are offset by mechanical ventilation? T or F | True |
| Hips and knees should be slightly flexed in the supine position, which increases venous return. This position is called what? | lawn chair position |
| What position doesn't predictably improve CO in hypotensive, hypovolemic patients? | Trendelenburg |
| In trendelenburg, the abdominal viscera pushes the diaphragm against the heart, resulting in a decreased ______ _______. | stroke volume |
| Trendeleburg may increase _____ by elevating venous pressure. | ICP |
| Prone positioning compresses the ____________ and ____________ due to cephlad displacement of the diaphragm. | inferior vena cava and aorta |
| What is the name of the table that allows the abdomen to hang free and allows for better diaphragmatic excursion? | Jackson |
| What may offset the effects of prone position? | mechanical ventilation |
| In the prone position, turning of the head may obstruct what? | jugular venous drainage |
| In the prone position, chest rolls are placed under the patients sides from where to where? | clavicle to iliac crest |
| What is another name for the knee-chest position? | jack knife position |
| What is position is associated with significant circulatory and ventilation effects during mechanical ventilation? | lateral decubitus |
| The dependent lung tends to be underventilated because it is compressed by the abdominal contents and the weight of the mediastinum. T/F | True |
| When gravity favors the dependent lung, there will be an increase in pulmonary blood flow. This is called what? | VQ mismatch |
| The accentuated mismatching of ventilation to perfusion may manifest itself as unexpected what? | arterial hypoxemia |
| In the lateral position, periodically check the _____ ________ of the dependent arm. | radial artery |
| Legs should be flexed in the lateral position. T/F | True |
| True sitting position is at what angle? | 90 degrees |
| What position decreases CO, CVP, and PAWP. MAP decreases 0.75mmhg per cm elevation. | sitting |
| What is the most serious complication in the sitting position? | Venous air embolism |
| What is the worst position for functional residual capacity? | Trendelenberg with lithotomy |
| What nerve injuries are the principle hazards of the lithotomy position? | sciatic, common peroneal, femoral, saphenous, and obturator |
| Both legs should be elevated and lowered at the same time in lithotomy to avoid stretching of the peripheral nerves and minimize effects on decreased venous return. T/F | True |
| Lithotomy greater than 4 hours may result in what? | compartment syndrome |
| Nerve injuries are more likely to occur under what kind of anesthesia? | general |
| Acute nerve injury will appear how many days after the onset of symptoms? | 18-21 days |
| How long is recovery usually from nerve injury? | 3-12 months |
| What is the prevalence of ulnar nerve injury after cardiac surgery? | 38% |
| Bending the elbow can narrow the cubital tunnel and compress which nerve? | ulnar |
| Forearms should be supinated (palms up). T/F | T |
| Claw hand occurs with which nerve injury? | ulnar |
| The brachial plexus is susceptible to which types of injuries? | stretch and compression |
| Which type of injury may occur when the neck is extended, head is turned to the opposite side, or the arms are abducted >90 degrees | stretch injury |
| Which type of injury may occur between the clavicle and first rib when shoulder braces are not placed over the acromioclavicular joint? | Compression injury |
| What are the causes of brachial plexus injury? | shoulder straps, first rib fracture, lateral decub positioning, sternal retractors |
| brachial plexus injury is most common in what position? | lateral decub |
| What is characterized by a burning sensation that radiates along the arm and may last several weeks? | stinger or burners syndrome (associated with brachial plexus injury) |
| How should a prone patient's arms be placed? | overhead, bent at elbow, abducted less than 90 degrees |
| This nerve may be injured if the arm slips off the OR table, and pressure is applied to the nerve as it transverses the spiral groove of the humerous | radial |
| Which nerve injury is manifested by wrist drop, weakness of abduction of the thumb, and decreased sensation over the dorsal surface of the lateral three and a half fingers? | radial nerve |
| Which nerve is located along the anticubital fossa? | median nerve |
| How do median nerve injuries usually occur? | IV placement or by extravasation by drugs (thiopental) |
| Median nerve injury is typically called what? | ape hand deformity |
| Compression injury of the sciatic nerve may occur as the nerve passes under which muscle? | piriformis |
| Sciatic Stretch injury occurs by external rotation of the leg or extension of the knee. T/F | True |
| What are the branches of the sciatic nerve? | tibial, and common peroneal |
| IM injections in the OR should be performed where? | lateral aspect of the thigh |
| The most frequently damaged nerve of the lower extremity is what? | the common peroneal nerve |
| Damage to the common peroneal nerve reflects compression of the nerve between the head of the _____ and the metal brace used in the lithotomy position. | fibula |
| Common peroneal nerve injury manifests itself as: | foot drop, loss of dorsal extension of the toes, and inability to evert the foot |
| What may manifest post op if the feet are plantar flexed for extended periods during anesthesia? | foot drop |
| What nerve may be compressed at the pelvic brim by the blade of a self-retaining retractor as used during laparotomy? | femoral nerve |
| Which other position may affect the femoral nerve because of excessive angulation of the thigh in this position? | lithotomy |
| In femoral nerve injury where is sensation decreased or absent? | superior aspect of the thigh, medial and anterior medial side of the leg |
| What nerve is a branch of the femoral nerve? | saphenous nerve |
| Damage to the saphenous nerve can occur by compression against the _________ ________ _______ if the foot is suspended lateral to a verical brace | medial tibial condyle |
| Saphenous nerve injury is manifested by medial knee and leg pain with prolonged walking and standing. T/F | T |
| Inability to adduct the legs and decreased sensation over the medial side of the thigh that can occur during difficult forceps delivery or excessive flexion of the thigh to the groin, injures what nerve? | obturator |
| Non neural injury includes what? | skin, eyes, appendages |
| Excessive pressure to the skin causes what? | ischemia and localization ulcers |
| What is a rare but devastating complication of non-opthalmic surgery? | visual loss |
| Higher risk of vision loss are seen in what kinds of surgeries? | cardiac and prone spine surgery |
| What contains cell bodies that supply axons to the optic nerve and brain? | retina |
| What extends from the globe to the optic chiasm and is divided into 4 sections: intraocular, intraorbital, intracannicular, and intracranial? | optic nerve |
| Where does the optic nerves blood supply come from? | central retinal artery and long & short posterior ciliary arteries that arise from the internal carotid |
| What are preexisting conditions that affect autoregulation? | diabetes and hypertension |
| What position can cause thrombosis of the central retinal artery with permanent blindness? | head rest in the prone position |
| What can also increase the chance of blindness? | deliberate or accidental hypotension |
| What damage does the face mask straps do? | hair loss to the outer third of the eyebrow |
| What happens due to pressure on the buccal branch of the facial nerve? | parasthesia of the orbicularis oris muscle |
| Necrosis of the bridge of the nose can be avoided by periodically removing the mask and massaging. T/F | T |
| How does compression of the suborbital nerve from the ETT manifest? | As decreased sensation over the forehead and pain in the eye |
| What nerve can be damaged because of compression of the fingers with the ascending ramus of the patients mandible? | facial nerve |
Created by:
Jmw015
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