Outpatient Surgery Magazine

Manager's Guide to Orthopedic Surgery - August 2014

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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5 9 A U G U S T 2 0 1 4 | S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E made of metal, which you obviously can't X-ray through. Making attachments out of more radiolucent materials, such as carbon fiber, would improve proce- dures by allowing for easier imaging. Some manufacturers have started doing that, but the radiolucent attachments haven't gained widespread use yet, I imagine because of the cost. Figuring out a way to put improved radiolucency within everyone's reach may be the next step forward for precision and added safety. OSM Dr. Raab ( d ra a b 29@g ma il.com ) is an orthopedic surgeon at Premier Orthopedics-PA in Malvern, Pa. T A B L E S & A T T A C H M E N T S supported with a positioning device or rested on a padded Mayo stand. The other arm should be secured to a padded arm board or placed in a sling. • Lateral decubitus: Complications include brachial plexus palsy, traction-related soft-tissue injury, digital nerve compression, ischemic injury and neurovascular injury. To minimize risks, roll the patient onto a vacuum beanbag or adjacent to lateral positioning posts. If you use a beanbag, the anterior portion should be flush with the downside leg. The edge of the beanbag closest to the head must be level with the upper thorax and not protrude into the underarm. Place an axillary roll below the underarm adjacent to the chest wall, but not into the underarm. Secure the head in a neutral position. Place the upside arm outstretched on an armrest or pillow and secure the down arm to an armboard. Shoulder flexion shouldn't exceed 90°. Finally, secure the trunk and down leg to the table. • Prone : Complications include loss of airway or vascular access, pressure necrosis of skin and peripheral nerve injury. Make sure you have an adequate number of assistants to safely roll the patient onto the table. Rotate the patient slowly, with arms at the sides. Arms should rest slightly lower than table level. Maintain the head and neck in a neutral alignment. Place arms either onto padded boards at less than 90° angles or secure them against the sides of the body. Place a well-padded roll under the thorax and pelvis and provide good padding. Tilting the patient into slight reverse Trendelenburg (10° to 15°) decreases intraocular pressure and facial edema. — Jim Burger

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