3. Monitors in Anesthesia Flashcards
Monitoring
Patient must be ____ at all times
A ____ record must be kept
All patients must have a ____ and physical and baseline vitals
watched
comprehensive
history
Monitoring: Parameters
____ Ventilation ____ Temperature
oxygenation
circulation
Monitors: Desirable Properties
should be easy to ____
should be ____ (nasal cannula is NOT comfortable)
should be ____
should provide information ____
use
comfortable
reliable
rapidly
Monitors:
____ or automated
____ and/or visual alarms
____ devices
____ or noninvasive
most we use is ____
____ more important because we can’t constantly look
manual
audible
recording
invasive
noninvasive
audible
Standards for Basic Anesthetic Monitoring
Established in October 1986 by the American Society of Anesthesiologists
Require adherence to ____ levels of monitoring
Revised ____
minimal
revised
Standards for Basic Anesthetic Monitoring
Standard I:
Qualified anesthesia personnel shall be ____ in the room throughout the conduct
of all general anesthetics, regional anesthetics, and monitored anesthesia care.
Standard II:
During all anesthetics, the patient’s ____, ventilation, ____, and temperature shall be continually evaluated.
present
oxygenation
circulation
Mortality rates
Range from 7.9 per 10,000 to 1 per 400,000 anesthetic cases
65 to 87% of them is due to ____ error
The most common problem is failure to ____ a patient
human
ventilate
Goals of Monitoring
Aids in the ____ of anesthesia administration
Improves patient outcome by allowing ____
recognition of potentially life complications
efficiency
early
Monitors
Pulse Oximeter
Introduced into 1983
Based on the relative difference in which ____ and ____ blood transmit and absorb ____
Oxygenated blood - ____ nm
Dexoygenated blood - ____ nm
-
The percentage of oxygenated hemoglobin can be ____
oxygenated deoxygenated light 660 940 obtained
Oxygen-hb dissociation curve
We get percentage of oxygenation saturation of our hemoglobin from this oximeter. This is a ____ monitor and will give information quickly. Most importantly, it gives ____ in ____ blood. Without oximeter we would need to draw blood from patient’s arterial line to find out partial pressure of oxygen or carbon dioxide and blood pH level. This would take a while to do after sending to lab so the pulse oximeter does this right away.
A normal O2 saturation would be ____%. Once you start dipping to 90%, it is really telling you that the partial pressure of oxygen is only ____. Normal is ____. 80 in old, ____ in younger people. Curve starts to drop at ____% saturation.
non-invasive partial pressure of oxygen arterial 98-100 60 80-100 100 90
Pulse oximeters:
errors
Accuracy varies from unit to unit \_\_\_\_% failure rate \_\_\_\_ light reaching sensor Peripheral \_\_\_\_ - if blood isn't getting there readily you won't get a good read. \_\_\_\_ artifact \_\_\_\_ polish
because infrared needs to be read through nail bed. can use toe nail if this is the case haha
2.5 to 7.2 ambient vasoconstriction motion nail
Monitors: ventilation \_\_\_\_assessment \_\_\_\_ stethoscope \_\_\_\_
____ is the most important of the 4 parameters to monitor
visual and auditory
precordial
capnograph
ventilation
Precordial stethoscope
A weighted stethoscope head is secured with ____ to chest or neck
tape
Capnograph
Measures ____ (ETCo2)
Analyzes the concentration of carbon dioxide during ____
end-tidal carbon dioxide
exhalation
ETCO2 vs PaCO2
PaCO2 is the concentration of carbon dioxide in the ____ blood.
ETCO2 is the concentration of carbon dioxide in the ____ gases.
The gradient between these is less than ____ mm Hg
arterial
exhaled
5
Capnography Elevated CO2 indicates \_\_\_\_ Decreased CO2 indicates \_\_\_\_
hypoventilation
hyperventilation
Capnography
Used to verify ____ intubation
Monitors for ____ or altered ventilation
Early warning of ____
endotracheal
apnea
malignant hyperthermia
Malignant Hyperthermia
____ disorder
Causes muscle ____, a ____ state, heat production, oxygen consumption, ____, hypercarbia
Can cause cardiac ____ and cardiac arrest
Discontinue ____ agent, hyperventilate with ____, give ____, treat arrhythmias
autosomal dominant contracture hypermetabolic acidosis arrhythmias triggering 100% oxygen dantrolene
Monitors: circulation
____ cuff
____
blood pressure
electrocardiogram (EKG)
Blood pressure
Measured at ____ minute intervals
Measured with a ____ cuff or ____ line
5
blood pressure
arterial
Electrocardiogram
Evaluates the ____ activity of the heart
Can determine ____, heart rhythm, ____, infarction, and dysrhythmia
electrical
heart rate
myocardial ischemia
The EKG is going to give us a ____ monitor (not sure what that means but thats all she said and moves on). ____ used to monitor any ischemia or infarctio
lead 2
lead 2
Electrocardiogram
This is a normal sinus rhythm.
• • •
____ is atrial depolarization or atrial contraction ◦ first small spike
◦ where atria are contracting
____ waves are ventricular depolarization
◦ big spike
◦ don’t see repolarization of atrium because it is buried under QRS wave
____ is repolarization of ventricles
•
Pulse starts at ____ node then goes to ____ node then into ventricle into ____ in between atrium and ventricle and then into ____ branches on left and right heart then finally on ____ fibers in endocardium.
P wave
QRS wave
T wave
SA AV bundle of His bundle purkinje
Atrial fibrillation
____ rhythm
- no real ____ but multiple ectopic atrial spikes
- caused by multiple ectopic ____
• not ____ threatening
• A fib is rate controlled normally - meaning on a beta or calcium channel blocker to bring down heart rate
◦ if too high they won’t get enough blood flow to coronary vessels and ultimately heart
• A fib patients have issue with ____
• instead of pulse being generated from SA node to AV node etc. there is multiple ectopic pulses
◦ some of these ectopic pulses give random QRS spikes at different intervals ◦ won’t see p wave
◦ patient’s pulse will feel sporadic
irregular
P’s
foci
life
clotting
Premature ventricular contraction
PVC is similar phenomenon in ventricles
• will see irregular spike in QRS
• looks like widened ____ wave interspersed between normal spikes
• unlike A fib, is considered normal phenomenon in some healthy young individuals
◦ generated by caffeine and nicotine
◦ not concerning at all during anesthesia
‣ only concerning when you see ____ in a row, which is ____ (next slide)
QRS
multiple
ventricular tachycardia
Ventricular Tachycardia
A run of ____ or more ____ in rapid succession
• You see normal ____ waves then succession of ____ QRS waves • Called the ____ effect, because it likely leads to cardiac arrest • A ____ wave form - you need to deliver shock to patient
three PVC's QRS widened tombstone shockable
Ventricular fibrillation
Many ventricular ectopic ____ resulting in an erratic rapid twitching of the ____
Produce a ventricular rate of ____min
Mentioned 3 times that the 2 shockable wave forms are ____ and ____, which she describes next.
A simple PVC will not deliver a ____!
foci
ventricles
350 to 450
ventricular tachycardia
ventricular fibrillation by AED
shock
Automated External Defibrillator (AED)
Administers an electric shock to a patient with a ____
Allows ____ defibrillation
The ____, not the operator, analyzes the rhythm and determines the presence of VF/VT
life-threatening arrhythmia
hands-free
device
Defibrillators
Placed in a position that will maximize ____ through the myocardium
current flow
Temperature
Should be taken prior to and after a ____ procedure where conscious sedation is used
____, rectal, ____ or tympanic membranes
surgical
oral
axillary
Anesthesia Record
No specific ____
Record must be neat, concise and coherent
Should document the patients ____, the preanesthetic evaluation of the patient, the ____ events, postanesthetic condition of the patient
format
demographics
intraoperative
