2.2 MSK procedures

Who are @ risk for post-op complications

baseline pulmonary disease

smoking history

obesity

increased age

large IV fluid need intraoperatively

prolonged operative time

incisional pain

What are post-op neurological anesthesia considerations

decreased cortical and autonomic function

What are post-op CV anesthesia considerations

arrythmias

decreased BP

decreased heart contractility

decreased peripheral vascular resistance (PVR)

What are post-op pulmonary anesthesia considerations

O2 sat and respiratory pattern

What are post-op MSK anesthesia considerations

temporary inability to use

weakness and pain

What are post-op integument anesthesia considerations

incision inspection

position during surgery

Neurologic post-op complications

delayed arousal

agitation

altered consciousness

cerebral edema

seizure

stroke

peripheral muscle weakness

altered sensation

pressure complications

increased ICP

s/s of increased ICP

headache

nausea

vomiting

ocular palsy

altered mental status/consciousness

What would you see on imaging with ICP pressure complications

midline shift

hydrocephalus

herniation

restriction of blood flow

death

Post-op CV complications

high/low BP

dysrhythmia

MI

DVT

PE

Post-op pulmonary complications

airway obstruction

respiratory depression

hypoxia

aspiration

pulmonary edema

pneumothorax

Post-op renal complications

acute renal failure

decreased urine output

fluid/electrolyte imbalance

Other post-op complications

hypothermia

pain

infection

nausea/vomiting

hyperglycemia

What are TED hose

long compression stockings

What are SCDs

mechanical device that passively activates muscular pump

Typical joint replacement equipment

knee immobilizer

ON-Q

Hemovac

hip abductor

Types of procedures 

joint replacement

spine surgeries

trauma

non-healing fxs

What are the acute management protocol for total joint arthroplasties

• initial evaluation completed POD 0-1

• length of stay varies

• TKR goal→ 90 degree knee flexion

  • THR → dislocation precautions

Typical total joint evaluation

1. Chart review

2. subjective questioning

3. while supine, assess ROM/strength of the involved LE

4. transfer to EOB using lateral transfer technique with moving lines, drains, tubes

5. instruct in proper sit<>stand

6. gait training with AD

7. return to chair

8. discuss discharge recommendation

What is proper sit<>stand for total joint evaluation

more weight on non-op leg

keep operated leg more extended initially

What are we looking for when inspecting the incision

openings, excessive bruising, discoloration (inflammation)

What is a discectomy

minimally invasive spinal surgery where the damaged portion of the intervertebral disc is removed

What other operation is typically seen with a discectomy

laminectomy

What is typical procedure for post-op discectomy

no bracing

possible overnight stay

What is a laminectomy

slightly more complicated procedure, where the lamina (portion of the spinous process) of one or more vertebral levels is removed

What is typical procedure for post-op laminectomy

no bracing

What is a decompression spinal surgery

operation where the lamina and spinous processes of a vertebrae are removed

What is the goal of an decompression

to widen foramen and relieve pressure on neural structures

What is typical procedure for post-op decompression

possible overnight stay

What type of approach can a fusion be

anterior or posterior

What is a fusion

bones are connected with plates or screws

What is typical procedure for post-op fusions

bracing is common, but type varies

some fusions require bone grafts, where do these come from

bone bank or the pt’s iliac crest

What are the spinal precautions

avoid bending, lifting, and twisting (BLT)

avoid long periods in one position

need to have an upright posture in sittting

To abide by spinal precautions, what is the best way for pt’s to complete supine to seated tranfers

log rolling

What equipment is used for spinal surgery

lumbar corsett

hemovac

Jackson Pratt (JP) bulb

Typical spinal surgery eval

1. chart review

2. subjective questioning

3. transfer to EOB using log rolling

4. can asses ROM/MMT in sitting EOB

5. instruct in proper sit<>stand

6. gait training with/without AD

7. return to chair

   1. discuss discharge recommendation

What is a proper sit<>stand after spinal surgery

lean forward for legs to do the work (no arm lifting)

What are 4 types of traumatic spinal injuries

transverse/spinal processes

ligamentous

compression/burst fx

multi-level injuries

describe transverse/spinal processes injuries

non-op

stable

may need brace to decrease pain and increase functional mobility

describe spinal ligamentous injuries

typically requires bracing for 6-12 weeks

Where are spinal ligamentous injuries most common

C-spine

describe compression/burst fx

fx of the vertebral body

rigid or semi-rigid bracing and/or surgical intervention

What are compression/burst fxs typically from

fall from height or GSW

What are the surgical requirements for multilevel spinal injuries

will require surgical intervention if 2 columns are involved

Bracing post-op is determined by MD

need to stress mobility and post-op complications

Types of traumatic pelvic injuries

acetabular, pubic rami, pelvic ring, sacrum

describe pubic rami injuries

superior and/or inferior rami

very painful and will need aggressive pain management

Describe traumatic pelvic ring injuries

require external or internal fixation

limited ROM by pain and fixator placement

Types of traumatic Acetabulum injuries

non-displaced, displaced, dislocation

describe traumatic sacrum injuries

can be right ot left side

WB restrictions and may need ORIF

Describe non-displaced acetabular fx

typically not surgical, but will require WB restrictions

describe displaced acetabular fx

require ORIF, typically NWB restriction post-op

describe precautions for a dislocation of the acetabulum

posterior hip precautions

What should a PT watch for when working with a pt with a traumatic UE injury

may require a sling/cast

A/AA/PROM limitations/precautions

Watching for s/s of nerve injury

WB status?

What should a PT watch for when working with a pt with a traumatic LE injury

WB status

apply brace (if needed)

most appropriate AD/transfer

assess bandages before/after treatment

Why is it important to check a bandage before AND after the session

some drainage is expected with activity, but a lot of drainage is concerning and need to inform nurse