Ortho anesthesia 2/14/23

Local

100

what system will be first to present in LAST following a pre op nerve block

neuro 

200

Exparel concentration per cc

13mg/mL

300

Surgeon asks you how much 0.25% Marcaine they can inject in 82kg patient 

41

400

Following VATS where surgeon during injected local at end of case claiming he was doing a paravertebral end though he was no where near spine and was not intrapleural. In PACU they develop last. Where did he likely inject .

Intercostal 

Biceps

500

Maximum dose of exparel in 16 y/o 50 kg pt undergoing rotator cuff repair 

200mg 

4mg/kg in pt 17 and under

266mg max in adult

Blood on aspiration

100

Saphenous nerve block 

superficial femoral a.

200

supraclavicular 

Subclavian a.

300

Infraclavicular

Axillary a.

400

PECS

thoracoacromial a

500

Interscalene block

Vertebral a.

Fractures

100

Pt is on Eliquis for A. Fib. How long should you get a popliteal block for ankle orif

72 hours

200

Benefit to regional over general in total  joint repair

Dec delirium and pain post op

Dec in one month mortality 

300

Intracapsular or extracapsular hip fracture are associate with more blood loss

Extracapsular 

400

Ortho asks you how long therapeutic lovenox needs to be held prior to hip pinning

24 hours

12 hours for prophylactic 

500

Patient undergoing tibial shaft ORIF develops sudden drop in EtCO2 following deflation of tourniquet and a petichial rash is noted on upper chest. what likely happend and how could it have been prevented

Fat emboli 

tourniquet increase risk given suspected increase in intramedullary pressure

Tourniquet

100

which color cord goes on patients right leg 

Red right

Blue left 

200

What should tourniquet minimium pressure in pt with BP off 110/80

approx 210

around 100 greater than SBP

300

Tourniquet is accidently left inflated for 150 minutes. How long should it be down before reinflating?

25 minutes

5 minutes for every half hour 

400

One hour into elbow ORIF, Patients BP shoots up to 200/100. Pt had received a pre op block and has received no narcotics. What could have been done to prevent this pre operatively 

Intercostal brachial nerve block 

500

How can you prevent tourniquet pain in case where Bier block is being utilized

Inflate proximal cuff first followed by distal cuff once tourniquet pain sets in 

Random

100

cerebral mean pressure in pt in beach chair with cuff 40 cm lower than head; BP 110/70 (85)

55-60

200

TXA mechanism of action 

inhibit plasminogin conversion to plasmin

plasmin binds with tpa to fibrin to breakdown clot 

300

Nerve block for complete clavicular coverage 

Cervical plexus + interscalenes

400

 patient with RVSP of 77 about to undergo TKA suddenly becomes persistently hypoxic despite efforts and codes. what was likely the inciting incident 

Cement use

can lead to pulmonary htn. Recomend euvolemia; inc O2 and possible distal femur vent hole and lavage 

500

Best test to evaluate OA instability in pt with rheumatoid arthritis; be specific pls

flex and extended lateral cervical XR