Positioning
0.8 (4-5L) - ANS-What is a normal VQ ratio?
A sudden decrease in CO2
Decrease O2 Sats, Arrythmias,
Decrease BP Millwheel murmur - ANS-What are the symptoms of a venous air emboli?
Age
Body habitus
Baseline Limitations of Mobility
Preexisting neurological symptoms
DM
PVD
Arthritis
Smoking/alcohol
Preexisting lesions/ injuries - ANS-List pre-op considerations for positioning
An air leak test d/t increased potential for post-op upper air obstruction from swelling - ANS-A
patient that has been in the trendelenburg position for an extended period of time should have
what test performed before extubation?
An Ulnar nerve injury - ANS-After surgery your patient c/o an inability to abduct her 5th finger.
What do you suspect?
Anterior tibial nerve - ANS-What type of nerve injury could occur is the feet are plantar flexed for
extended periods of time
aspiration of > 25cc of gastric contents with a pH of < 2.5 - ANS-What is Mendelson syndrome?
At the Circle of Willis or auditory meatus - ANS-Where should the mean arterial pressure be
transduced in a sitting position?
Backache and Ischemic pressure injuries - ANS-List the major complications of the supine
position.
Blindness can occur from retinal ischemia,
ION=Ischemic optic neruopathy - ANS-What can happen to the eyes if there is too much
pressure?
Blood pooling in the lower extremities
Decreased venous return
, 20-40% decrease in CO - ANS-What are the hemodynamic effects of the sitting position?
Brachial plexus injury - ANS-This injury can occur d/t excessive external rotation or abduction of
the arm
Brachial plexus nerve injury - ANS-What is the 2nd most common type of nerve injury?
Brachial Plexus Nerve Injury - ANS-What type of injury often occurs when nerves are stretched
or compressed between the clavicle and 1st rib
Brachial Plexus Nerve Injury - ANS-What type of nerve injury can been seen when the arm is
extended posteriorly past the plane of the torso?
Brachial Plexus Nerve Injury - ANS-What type of nerve injury can occur d/t nerve compression
from shoulder braces placed too close to the neck
Caused by open venous system above level of the heart
Atmospheric pressure > venous pressure and vein sucks air in - ANS-What causes a venous air
embolism?
Changing from erect to supine increases venous return and stroke volume
Parasympathetic stimulation regulates heart rate and contractility to adjust to increased preload
Obesity, pregnancy, and abdominal tumors can reduce preload when in the supine procedure d/t
compression of the IVC - ANS-What cardiovascular changes occur with positioning?
Common peroneal (a branch of the sciatic nerve) - ANS-Injury to this nerve can result in foot
drop
Common peroneal nerve - ANS-What nerve could be injured when the lateral aspect of the knee
is compressed against stirrup?
Compression of the abdominal viscera, pooling of blood in extremities decreasing preload, CO,
BP and SV, Increased SVR and PVR - ANS-What are the cardiac complications of the prone
position?
Compression of the IVC; can cause hypotension in obese, pregnant and volume depleted
patients - ANS-What concerns should you have with obese or pregnant pateints when placed in
the supine position?
Corneal abrasions - ANS-What is the most prevalent eye injury?
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