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Sp: PMI > 9. Blood Pressure Monitoring > Flashcards

9. Blood Pressure Monitoring Flashcards

1
Q

hypotension problems

A

causes decreased tissue organ perfusion
- stroke, MI, renal failure
postoperative delerium

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2
Q

causes of hypotension (8)

A

vasodilation
- anesthetic induced
hypovolemia
pt positioning
- head up (reverse trend, beach chair)
vagal response
chronic steroid pts
decreased cardiac contractility/EF
- decr CO
too large BP cuff
lateral decubitus

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3
Q

hypovolemia causes

A

dehydration/NPO status
blood loss
bowel prep
(reqs 1000-1200mL to replace fluid loss)

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4
Q

hypotension treatments (6)

A

IV fluids and/or blood products
- volume replacement takes time
vasoconstrictors
- treats anesthetic induced vasodilation
lighten anesthetic
change pts position
- trendelenberg
ionotropes
- improve contractility
stress dose steroids

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5
Q

most common cause of hypotension during surgery

A

anesthetic induced hypotension

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6
Q

is there any reason to believe low BP isn’t just vasodilation from the anesthetic?

A

reverse trendelenburg?
high blood loss?
too large BP cuff?
lateral decibutus position?
poor EF?
vagal response after incision?

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7
Q

vasoconstrictors primarily act on

A

peripheral arterioles

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8
Q

vasoconstrictors mechanism

A

decr blood flow in peripherals
incr blood flood to vital organs

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9
Q

hypertension problems

A

LV pumps against greater resistance

incr strain on heart = more O2 consumption

incr strain on cerebral vasculature
–intracerebral hemorrhage and stroke

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10
Q

hypertension etiologies

A

chronic:
- aging
- poor lifestyle (diet, sedentaty, etc)
Acute:
- pain
- light anesthesia

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11
Q

hypertension treatments

A

increase depth of anesthesia
narcotics (works if pt is in pain)
vasodilators

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12
Q

blood flow/perfusion and blood pressure

A

blood flow is proportional to blood pressure

incr BP: incr perfusion
decr BP: decr perfusion

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13
Q

autoregulation of blood flow

A

ability for an organ to maintain constant blood flow over a wide range of blood pressures
brain
heart
kidneys

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14
Q

cerebral autoregulation range

A

MAP: 60-160mmHg

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15
Q

renal autoregulation range

A

MAP: 80-180mmHg

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16
Q

coronary autoregulation range

A

MAP: 50-120 mmHg

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17
Q

if pt is hypotensive, cerebral blood vessels will

A

vasodilate

increases cerebral perfusion

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18
Q

if pt is hypertensive, cerebral blood vessels will

A

vasoconstrict

prevents too much blood flow going to the brain
prevents increase in ICP

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19
Q

cerebral autoregulation curve: Right Shift

A

chronically hypertensive pts
takes higher than normal BP to keep blood flow to the brain constant
lower autoreg level is higher than normal

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20
Q

renal glomerular filtration rate ceases below what level

A

MAP 40-50mmHg

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21
Q

what threshold should we keep pt’s BP within during surgery?

A

20-30% of baseline (preop) MAP value

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22
Q

systolic BP during anesthesia

A

> 90mmHg

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23
Q

diastolic BP during anesthesia

A

> 50mmHg

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24
Q

MAP during anesthesia

A

> 65mmHg

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25
pulse pressure during anesthesia
>35mmHg
26
"controlled hypotension"
surgeon request decreases bleeding at surgical site
27
caution during "controlled hypotension" requests
sick/chronically hypertensive pts beach chair position communicate concerns w/surgeon
28
If BP falls below autoregulatory range
autoregulation organs receive blood flow, just not as much
29
If BP rises above autoreg range
autoreg organs receive more blood flow than they should BF is proportional to blood pressure
30
autoregulation ability impairement
ischemia hypercarbia acidosis stroke high end tidal concentration of volatile agent (>2 MAC)
31
auscultation is aka
sphygmomanometry
32
korotkoff sounds disappear (first time)
when artery is completely compressed no blood flow through compressed artery
33
korotkoff sounds appear
when artery is partially compressed blood flow is turbulent in partial compress state
34
korotkoff sounds disappear (2nd time)
when artery is completely open blood flow is laminar
35
systolic BP manual measurement
appearance of korotkoff sound
36
diastolic BP manual measurement
disappearance of korotkoff sound
37
NIBP cuff uses
oscillometry
38
oscillometry
arterial pulses cause oscillations of varying amplitudes in the cuff as it is inflated and deflated
39
BP cuff above systolic
pulse amplitude is low cannot be felt
40
BP cuff at systolic
pulse amplitude increases can be felt
41
BP cuff at mean arterial pressure
pulse amplitude at maximum pulse maximally felt
42
BP cuff at diastolic pressure (and below)
pulse amplitude decreases cannot be felt
43
NIBP cuff determines
systolic diastolic MAP separate readings
44
oscillometry is accurate w/
regular rhythms
45
oscillometry is inaccurate w/
irregular rhythms
46
NIBP cuff sizing: width
20-50% greater than extremity diameter
47
BP cuff too large
underestimates BP has to squeeze harder to flatten artery
48
BP cuff too small or loosely placed
overestimation of BP has to inflate to higher pressure to compress artery
49
systolic leg BP
10-20mmHg greater than arm BP
50
diastolic leg BP
equal (or lower) to BP in arm
51
MAP in leg
higher in leg than arm
52
NIBP cuff accuracy
only accurate with adequate distal perfusion
53
causes of innacurate BP readings
kinked blood pressure tubing leaning on cuff defective cuff/cable limited blood flow to extremity
54
diagnose false BP readings
move monitoring site
55
signs low BP is more likely
low EtCO2 lack of SpO2 waveform clinical causes of hypotension - induction - large blood loss
56
when to be suspicious of false High BP reading
really high diastolic very narrow pulse pressure
57
NIBP cuff should not be placed
on operative arm side of mastectomy or lymph node removal - lymphedema risk arm w/AV fistular or AV graft
58
dialysis
excess waster and fluid removed from blood in pts w/renal failure
59
2 types of dialysis
hemodyalysis (HD) peritoneal dialysis (PD)
60
hemodialysis (HD)
vein/artery access (fistula, graft, central line) machine draws blood machine purified blood machine returns blood to vein
61
AV fistula
artificial connection between artery and vein larger vain so pt can tolerate dialysis vein swells bc under higher (arterial) pressure MAC anesthesia for surgery
62
AV graft
artificial tube that connects artery to vein mature faster than fistulas higher infection rate/clot risk
63
central line dialysis
subclavian vein access short term solution 12 or 14F
64
peritoneal dialysis
solution infused into peritoneal cavity waster products diffuse across peritoneum into solution solution w/waste is drained
65
renal failure pt management
anemic restrict fluids - 500mL bag w/microdrip cautious of serum [K+] increase - sux contraindicated - LR not contraindicated
66
higher measuring site BP impact
lower BP reading
67
lower measuring site BP impact
higher BP reading
68
lateral decibitus BP
dependent arm (lower): BP overestimated independent arm (upper): BP underestimated
69
sitting/reverse trendelenberg BP reading
BP in arm will be higher than BP in brain BP in brain will be lower than the monitor BP reading
70
phlebostatic axis
4th intercostal space along mid axillary line external location of right atrium
71
only place in a standing pt where blood pressure readings are not affected by gravity
phlebostatic axis
72
what valve aligns with the phlebostatic axis?
tricuspid
73
where should blood pressure readings be taken
at the level of the heart
74
sitting position BP reading
BP in brain is lower than BP in cuff
75
brain BP estimation
distance from middle of cuff to the external auditory meatus (ear) every 1 cm above cuff, MAP decreases by 0.77mmHg

Sp: PMI (18 decks)

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