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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