Term
| What are the 4 factors that affect amplitude and latency in SEPs? |
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Definition
- Temperature (hot and cold)
- Systolic BP (hypotension)
- PaCO2 (via changes in cerebral blood flow)
- PaO2 (O2 delivery to neurons)
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Term
T or F: General anesthesia (gas and IV) increases amplitude and prolongs latency?
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Definition
False:It DECREASES amplitude and prolongs latency.
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Term
| Because the change in SEP is directly proportional to MAC what kind of MAC is usually used for cases using SEPs? |
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Definition
| Usually a MAC of 1 or less. Let your SEP tech know your MAC level so that they have a general idea of how accurate the SEPs will be. |
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Term
| Each SEP has a different sensitivity. List the SEP subtypes in order from most sensitive to least sensitive. |
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Definition
1. VEP (most sensitive)
2. SSEP
3. BAEP (B in BAEP stands for "barely sensitive") |
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Term
| T or F: Motor evoked potentials monitor descending motor pathways in the posterior spinal cord. |
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Definition
| False: MEPs monitor DESCENDING motor pathways in the ANTERIOR spinal cord. |
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Term
| T or F: In MEPs stimulation begins at the motor cortex or cervicle spine and sensing occurs at a peripheral erve or individual muscle? |
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Definition
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Term
| The use of________should be discussed with the surgeon when there's a possible need for monitoring MEPs. |
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Definition
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Term
| T or F: MEP stimulation in the medial portion of the brain would send signals down the anterior spinal tract to the lower leg/foot region. |
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Definition
| True. The motor homonculus has feet in the medial portion of the brain and moves cephaled (generally speaking) as you move laterally across the brain. See slide 43 for a picture of the motor homonculus. |
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Term
| What types of patients generally present for spinal surgery? |
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Definition
| The population varies but they could have multiple comorbidities. |
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Term
| The EBL for spinal surgeries is high. What kinds of general considerations should be made based on this? |
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Definition
1. May need a-line, maybe even a PAC
2. Good IV access (positioning is crazy so make sure you can reach the ports of your lines).
3. Fluid management can be difficult.
4. Fluid warmer with blood setup (probably want a line going with 0.9 NS so you don't have to mess around changing bags.) You'll also want a warming blanket since your patient may be highly exposed. |
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Term
| The positioning for spinal surgery can be highly variable. Therefore, securing your______will be particularly important. |
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Definition
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Term
| What's a common emergence/post-op issue for pts presenting for spinal surgery? |
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Definition
| high narc requirement (chronic pain) |
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Term
| Post op anatomical changes secondary to spinal surgery can make regional more difficult. What might happen if you try an epidural on a spinal surgery patient? |
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Definition
| PATCHY BLOCK due to adhesions affecting the spread of the epidural. |
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Term
Arthroscopy is good b/c it provides reduced blood loss, less post op pain, reduced length of stay, and reduced rehab time.
It can be performed on all of the following joints except one: ankle, knee, hip, wrist, elbow, shoulder, or bonus medullaris. |
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Definition
| bonus medullaris: this is a highly sensitive and vascular area of the body. While there are some reports of successful bonus medullaris arthroscopy, the procedure frequently results in an inverted bonus medullaris, which may have dire psycho-social implications. |
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Term
What types of fluids (used to distent the joint cavity for visualization) may be used in arthroscopy?
What effect might each type of fluid have on the pt? |
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Definition
1. LR or saline solutions (hypotonic solutions may cause dilutional hyponatremia if enough is absorbed - confusion, lethargy, seizures, coma, death.)
2. Sometimes epi is used so you may see hemodynamic changes.
3. Antibiotics - make sure they're not allergic.
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Term
| T or F: local anesthetics and opiods may be injected into the joint during arthroscopy. |
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Definition
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Term
| What's the normal pressure of the arthroscopy fluid? |
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Definition
1. 90mmHg for hanging bags
2. 60-80 for mechanical pump |
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Term
| Shoulder arthroscopy has a special lung related implication: What is it and what is it and how often does it occur? |
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Definition
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Term
| What are the signs and symptoms of a tension pneumo? |
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Definition
| tachypnea, decreased SaO2, decreased breath sounds on ipsilateral side, tachycardia, hypotension, SQ emphysema. |
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Term
| How do you treat a tension pneumo? |
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Definition
- Increased FiO2
- needle decompression followed by chest tube
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