Term
| What happens physiologically when a patient goes from standing to a supine position. (Cardio/vascular) |
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Definition
| There is an increase in venous blood from the lower extremities which results in increase preload, stroke volum and cardiac output. As a result there is an increase in arterial blood pressure. Increase BP then is picked by baroreceptors (pressure receptors) located in the aorta via vagus nerve and the walls of the carotid sinuses via the glossopharyngeal nerve to the brain. Brain then says to decrease BP via parasympathetic impulses to SA node and myocardium. Results in decrease HR, SV, and CO. |
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Term
| How does neuraxial anethesia effect the body's own ability to self regulate hemodynamics during cases/postural changes |
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Definition
| spinal or epidural anesthesia can cause a significant sympathectomy across all dermatones effected on its own thereby reducing preload (Vasodilation) and blunting cardiac responses |
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Term
| THe immediate time after anesthesia is given is very delicate for hemodynamic compromises..why? |
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Definition
| This transition is very unbalance as various cardiac and regulatory systems are blunted by various anesthetic medications. Repositioning patients only comes after patient is stable. |
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Term
| muscle relaxant does what to the diagphram which results in what? |
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Definition
| Diaphragm is relaxed and assumes an abnormal position which this displacement results less areas for ventilation in bases |
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Term
| perfusion of each lung lobe favors what areas first |
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Definition
| perfusion in the lungs favors central-to-peripheral flow and is dependent on cardiac output. |
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Term
| How can you minimize a brachial plexus injury when positioning a patient? |
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Definition
| don't over abduct the arm. <90 degrees from body. Keep palm toward the body. |
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Term
| what are the benefits and risks with the trendelenburg position |
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Definition
Benefits:
1. increase central venous pressure
2. increase ICP
Risks:
1. increase intraocular pressure
2. swelling of all parts of neck and up
3. decrease FRC and compliance from ABD contents pushing up |
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Term
| what type of neuropathy is most common from bad positioning in the OR |
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Definition
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Term
| when is the lithotomy position used most |
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Definition
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Term
| If a patient is operated on in the lateral decubitis position what area are you most concerned with regarding pressure and nerve injury? |
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Definition
| pressure on the brachial plexus in the axillary area. To mitigate this place a role underneath patient dependent chest below (Caudal) to axillary. So axillary has no pressure on it. |
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Term
| Any pressre on arms or legs from various positions may alter blood flow.. how can you use interept SaO2 and BP to see this |
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Definition
| on an arm that is being rested on you may have decease SaO2 or lower BPs that indicate decrease perfusion from compressed arteries. TAke BPS in both arms to recognize this. |
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Term
| what nerve are you attempting to avoid hurting by placing patients legs slightly up while in a seated "beach chair" position in the OR |
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Definition
| Avoiding sciatic nerve damage. |
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Term
| how bad are the hemodynamic changes in a beach chair positioned patient? What is the physiology? |
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Definition
| DRAMATIC. Blood pools into the lower body under general anesthesia. |
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Term
| what is a major concern other than hemodynamics with patients in the sitting position |
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Definition
| air embolisms is a MAJOR risk if patient sitting for cranial or cervical neck surgeries |
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Term
| What conditions can cause a peripheral nerve injury |
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Definition
1. compression
2. stretch
3. ischemia
4. metabolic derangement
5. direct trauma/lcaeration |
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Term
| which position is most common for lower extremity nerve injuries |
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Definition
| lithotomy position effects teh sciatic and peroneal nerves being most common |
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Term
| most common type of eye injury |
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Definition
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Term
| ischemic optic neuropathy is most common from |
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Definition
1. prolonged prone position
2. hypotension
3. increase ocular pressure |
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