Term
| What must you do when you position/reposition someone? |
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Definition
| you MUST document the position, its effect, and how you protected the patient |
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Term
| What must you do if the head, neck, or whole body moves? |
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Definition
| recheck and document breath sounds |
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Term
| What is the biggest physiologic consequence of position changes? Why? |
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Definition
HYPOTENSION; anesthesia blunts the normal compensatory SNS response to hypotension from position changes
CHECK BP IMMEDIATELY AFTER REPOSITION! |
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Term
| Is FRC affected by being in the supine position? If so, how much? |
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Definition
| YES, it is decreased by ~20% because the abdominal contents limit the movement of the diaphragm. |
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Term
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Definition
| functional residual capacity: the volume of air remaining in the lungs after a normal expiration |
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Term
| How must the arms be positioned when someone is supine? |
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Definition
1. If at side, must be padded and tucked
2. If on arm boards they must be padded, palms UP (supinated), Shoulders MUST be at an angle no greater than 90 degrees |
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Term
| What is the #1 anesthesia related nerve injury? |
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Definition
| Ulnar nerve injury! happens from compression of nerve b/w table and median epicondyle |
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Term
| How are ulnar nerve injuries prevented? |
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Definition
| Supinate the hands (palms up), avoid hypotension, pad arms properly |
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Term
| what are the signs of ulnar nerve injury? |
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Definition
| inability to ABDUCT 5th finger (pinky), weakness/atrophy of hand muscles "claw hand" |
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Term
| What does trendelenburg position do to lung expansion? |
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Definition
| It decreases it worse than supine because it puts even more pressure on diaphragm. |
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Term
| What are the complications of trendelenburg position? |
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Definition
decreased lung expansion
increased ICP d/t dec. venous drainage
increased IOP (bad for someone with glaucoma)
Activation of baroreceptors
increased risk of aspiration |
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Term
| What is mendelson syndrome? |
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Definition
| aspiration of > 25 mL of gastric contents with a pH of < 2.5 during anesthesia (loss of layngeal reflex) |
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Term
| What is the most common nerve injury associated with lithotomy position**? |
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Definition
| common peroneal nerve injury d/t compression of lateral aspect of fibula head (improper padding against stirrups) |
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Term
| What sign will you see if there is common peroneal nerve injury**? |
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Definition
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Term
| What should you do to prevent common peroneal nerve injury from lithotomy position? |
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Definition
Elevate and flex simultaneously
Pad legs to decrease pressure against stirrups |
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Term
| What does prone positioning do to the cardiovascular system? |
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Definition
| Compresses abdominal viscera causing pooling of blood in extremities which decreases preload, CO, BO, and SV and increases SVR and PVR |
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Term
| What is the MAJOR complication that can occur with prone positioning**? |
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Definition
| Ischemic optic neuropathy which leads to irreversible blindness |
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Term
What does lateral decubitis position do to ventilation & perfusion in an AWAKE, spontaneously breathing patient?
What will V/Q matching look like? |
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Definition
Ventilation and Perfusion are significantly greater in the DEPENDENT lung (down) than in the non-dependent lung (up)
V/Q matching good which results in adequate oxygenation |
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Term
What does lateral decubitis position do to the ANESTHETIZED/PARALYZED ventilated patient?
What will V/Q matching look like? |
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Definition
Ventilation DECREASES in dependent lung (d/t decreased compliance) and perfusion INCREASES in dependent lung (gravity). Opposite happens to non-dependent lung.
V/Q mismatch develops which can lead to hypoxia |
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Term
| In an anesthetized patient in lat. decub. position. What will V/Q ratio look like in the dependent and non-dependent lung? |
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Definition
Dependent lung: low V/Q ratio
Non-dependent lung: High V/Q ratio |
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Term
| What is the normal V/Q ratio? |
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Definition
| ~0.8 because normal minute ventilation is 4 liters and normal cardiac output is 5 liter/min. |
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Term
| What is the MAIN complication of sitting position? |
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Definition
| Venous air embolism (VAE)caused by open venous system above level of heart in which atmospheric pressure exceeds venous pressure and vein sucks air in. |
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Term
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Definition
listen to heart sounds with doppler at Right 2nd intercostal space (millwheel murmur)
Will also see sudden decrease in ETCO2 (PaCO2 will be high), decrease in O2 sat., arrhythmias, and hypotension |
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Term
| What are the MAIN things you need to remember ANY time you position somebody? |
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Definition
MAINTAIN CONTROL OF THE PATIENT'S AIRWAY, IV ACCESS, AND MONITORING.
Have copious padding |
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Term
| Who is in charge of ANY positioning/moves? |
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Definition
| The person in charge of the airway and c-spine--> YOU!! |
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