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Flashcards in Positioning Deck (77)
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0

What is the purpose of operative positioning?

comfort
patient safety
surgical access

1

Who is responsible for operative positioning?

the anesthesia provider

2

What should the CRNA document in regards to positioning for a case?

baseline ROM and function
intraoperative positioning
pads/cushions used
body position
frequency of checks

3

What are the height and weight limits for a standard OR table?

136 kg (~300lbs)
80.7 inches

4

What are the 5 most common operative positions?

supine
prone
sitting
lithotomy
lateral decubitus

5

What are the advantages of the supine position?

access to airway
access to arms for IVs
less physiologic changes than the other positions

6

What is the benefit of placing a pillow under the head in the supine position?

avoids extension or flexion of the head
places the head/neck in sniffing position
doughnut pillow reduces alopecia (especially in neonates or the elderly)
no pressure on the eyes

7

How should arms be positioned in the supine position?

tucked - palm in, elbow padded, tuck draw sheet under patient torso

arm boards - secured to OR table, abducted <90 degrees, padded, safety strap on, hands supinated

8

How should the feet be positioned in supine position?

heels shouldn't hang over the bed
heels padded

9

How should the spine be positioned in the supine position?

slight flexion behind the hips and knees
pillows under the knees
legs should not be crossed
SCDs on

10

What are the 5 mechanisms of nerve injury?

compression
kinking
ischemia
transection
stretching

11

What are some modifiable factors that put you at risk for nerve injury?

obesity
smoking
diabetes

12

What is the most common upper peripheral nerve injury?

ulnar nerve

13

How can injuries occur to the brachial plexus?

mostly stretch injuries

1. neck extension or head turned too much to the side
2. excessive abduction of the arms >90 degrees
3. arm/arm board falling off the table

14

What symptoms would show in a brachial plexus nerve injury?

electric shocks or a burning sensation down the arm
numbness
weak arm function

15

How does injury to the radial nerve occur?

compression of the radial nerve on the lateral aspect of the humerus against surgical retractors, ether screen, "step off", repeated BP inflation

16

Injury to the radial nerve will result in..

inability to flex the elbow
wrist drop
weakness in abduction of the thumb

17

How does an injury to the ulnar nerve occur?

compression between the olecranon of the ulna and medial epicondyle of the humerus

stretching with severe elbow flexion

18

What are the consequences of ulnar nerve injury?

claw hand -- inability to abduct or oppose 4th and 5th finger, weak grip on the ulnar side of hand

19

How can you reduce the risk of ulnar nerve injury?

pad arm boards
avoid overcompression by arm straps
place BP cuff proximal to the cubital fossa
avoid prolonged flexion of the elbow

20

What are the cardiovascular effects in the supine position?

initially increased venous return to the heart but there is a compensatory activation of baroreceptors that decreases HR and PVR

21

Under what circumstances might venous return be impeded in the supine position?

abdominal/thoracic masses, obesity, pregnancy, ascites

22

What ventilatory changes occur in the supine position?

FRC changes +/- 800 mL

may be compounded by muscle relaxants

can be overcome with PPV

23

What cerebral changes occur in the supine position?

minimal changes r/t autoregulation

24

What are the benefits of trendelenburg

may transiently treat hypotension
may improve surgical exposure
helps prevent air embolism
facilitates placement of central line insertion

25

Describe the placement of shoulder pads

should be padded and placed laterally... away from the neck and near the acromioclavicular joint

26

What are the cardiovascular changes associated with trendelenburg position?

reduces blood flow to the lower extremities
can cause compression of the heart
increases venous return to the heart

27

What ventilatory changes are associated with trendelenburg position?

displacement of abdominal contents will cause decreased lung compliance, PIP increases, decreased lung volumes, V:Q mismatch, ETT displaced to the R main bronchus, risk of aspiration, airway edema

28

What are the cerebral changes associated with trendelenburg position?

increased ICP and increased IOP r/t vascular congestion

29

What must be considered when using a foot board with reverse trendelenburg position?

prolonged plantar flexion can cause anterior tibial nerve injury resulting in foot drop