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Anesthesia > Anesthesia Monitoring & Record Keeping > Flashcards

Anesthesia Monitoring & Record Keeping Flashcards

1
Q

What are 4 ways to monitor circulation? What should be recorded?

A
  1. ECG - electrical activity of the heart
  2. blood pressure
  3. esophageal stethoscope
  4. pulse palpation, mm color/capillary refill (can be affected by drugs)
  • HR
  • BP
  • pulse quality
  • ECG rhythm abnormalities
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2
Q

What is the standard lead placement for a 3-lead ECG system? How are the 3 leads read?

A

white = RA; black = LA; red = LL

  1. RA to LA
  2. RA to LL
  3. LA to LL
    (cycle through all 3 until the best trace is achieved)
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3
Q

How can the ECG leads be troubleshooted if there is a poor-quality ECG trace or 60-cycle interference?

A
  • improper skin contact
  • no gel (more long-term than alcohol)
  • worn leads
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4
Q

How can the ECG leads be troubleshooted if there is a small trace size?

A
  • increase gain
  • improve lead contact
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5
Q

How can the ECG leads be troubleshooted if there is an isoelectric trace or double counting?

A

(PQRS looks the same)

  • use a different lead
  • move leads further apart
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6
Q

What should be done is there is a sudden loss of an ECG trace?

A

could be cardiac arrest, but…

  • confirm pulse and pulse oximeter
  • check is leads fell off
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7
Q

What does mean arterial pressure indicate?

A

organ inflow pressure

  • remember, a normal ECG can be present with cardiac arrest
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8
Q

What 3 things determine systolic blood pressure? What does this indicate?

A
  1. left ventricular stroke volume
  2. vascular compliance
  3. backward reflected waves

left ventricular wall tension (afterload)

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9
Q

What determines pulse pressure? What does this indicate?

A

difference between systolic and diastolic blood pressure

stroke volume

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10
Q

What determines mean arterial pressure? What does this indicate?

A

average pressure over the cardiac cycle

inflow pressure for most organ systems

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11
Q

What determines diastolic blood pressure? What does this indicate?

A

systemic vascular resistance

pressure the left ventricle must overcome to begin ejecting blood into the aorta

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12
Q

Why is it so important to monitor blood pressure?

A

no blood flow = no oxygen delivery to organs = ischemic injury

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13
Q

What 3 things is intraoperative hypotension associated with?

A
  1. increase in mortality
  2. increase in major adverse cardiac/cerebrovascular events
  3. increase in perioperative mortality
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14
Q

What 2 things does tissue perfusion and oxygen delivery depend on? How does this relate to blood pressure?

A
  1. cardiac output
  2. blood oxygen content

BP is a great indicatory of perfusion and is an indirect measure (changes often and is an estimation)

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15
Q

How does Doppler BP work? What does it measure?

A

ultrasound signal hits moving RBCs in the artery, returning echoes detected and converted into a sound (continuous)

systolic BP

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16
Q

What 2 qualities of the sound of Doppler BP machines are affected by RBCs?

A
  1. frequency is associated with RBC velocity
  2. intensity is associated with the number of RBCs detected
17
Q

How does oscillometric BP work? What is the most accurate measurement?

A

automated intermittent measurement of intracuff pressure oscillations (inflation vs. deflation) due to pulsations of the artery

MAP —> SAP and DAP are calculated based on manufacture algorithms

18
Q

What is the gold standard for measuring BP?

A

invasive/direct BP by arterial catheters (requires special transducer and flush; more difficult than IV catheters)

  • most accurate and definitive measurement of SAP, MAP, and DAP
19
Q

How large should a BP cuff be? What happens when it is too large or small?

A

width should be 40% of limb circumference (30-50%)

  • TOO LARGE = underestimate of BP
  • TOO SMALL = overestimate of BP
    (too loose or tight = inaccurate measurements)
20
Q

What commonly causes inaccurate measurements of BP during long procedures?

A

Doppler gel dries out

21
Q

What BP machines work best for small and large patients?

A

> 7 kg = oscillometric

< 7 kg = Doppler, but man underestimate SAP

22
Q

What are the 3 most common errors seen in BP measurement?

A
  1. hypertension tends to be underestimated
  2. hypotension tends to be overestimated
  3. arrhythmias and profound tachycardia or bradycardia reduce the accuracy of measurements, especially in oscillometric measurements
23
Q

What is a major pro and con to using esophageal stethoscopes?

A

easy to use on draped patients

more things down the esophagus makes regurgitation more common

24
Q

What is percent oxygen saturation (SaO2) a measurement of? What should the normal arterial SaO2 and venous SvO2 be?

A

total number of hemoglobin binding sites occupied by oxygen molecules

  • SaO2 > 97% (estimate of SpO2)
  • SvO2 ~ 75%
25
Q

How does pulse oximetry equipment work? What is required for it to work?

A
  • red and infrared light are emitted from a probe, which passes through or is reflected off tissue and detected by a sensor
  • SpO2 calculations are based off of the differences in light absorption between saturated and desaturated hemoglobin

pulsatile flow —> won’t work in a patent in cardiac arrest

26
Q

What additional reading is achieved on a pulse oximeter?

A

heart rate

27
Q

At which SpO2 levels does hypoxemia and dangerous hypoxemia occur?

A

< 95%

< 90% (PaO2 < 60 mmHg)

28
Q

What which SaO2, PaO2, and PCV levels is visual detection of hypoxemia possible?

A

SaO2 < 85%

PaO2 < 50 mmHg

PCV > 15

29
Q

What is ventilation defined by? How is it monitored?

A

PaCO2, which is indirectly measured by end-tidal CO2

capnometer —> measures CO2 concentration of inspired and expired air

30
Q

What are the 2 forms of capnography?

A
  1. MAINSTREAM - sensor is at the patient end and immediate real-time readings are achieved breath to breath
  2. SIDE-STREAM - sampling port is at the patient end, which creates a lag of approximately 2-3 seconds
31
Q

What does end-tidal CO2 reflect? How is it seen on a capnograph?

A

alveolar gas —> estimation of PaCO2

end plateau phase

32
Q

What does an increase in inspired CO2 on a capnograph indicate?

A

should be 0 —> can indicate equipment dead space

33
Q

What 3 things is end-tidal CO2 determined by?

A
  1. rate of CO2 production
  2. rate of CO2 transport to the lungs - hypotension, low cardiac output, and open chest surgeries can cause ETCO2 to be artificially low
  3. rate of CO2 elimination from the lungs - increased RR would cause an increased ETCO2
34
Q

Capnographs:

A
35
Q

How can ventilation be monitored without equipment?

A
  • chest excursion
  • rebreathing bag movement
  • frequency of breathing
  • quality and character or chest movements: abdominal effort, normal volume movement, panting, irregular/infrequent breathing

(all should be monitored, even if capnography and pulse oximeters are used)

36
Q

How is temperature monitored during surgery?

A

esophageal/rectal probes = core temps

  • hypothermia is most common in small patients and in long procedures
  • hyperthermia is more rare, but seen with porcine malignant hyperthemia, iatrogenic, or in winter breeds
37
Q

What are important aspects of a trained and attentive anesthetist?

A
  • knowledgable about how, what, and when to monitor
  • recognizes areas of concern in a timely manner
  • troubleshoots problems with the team
  • should not be multitasking —> no doing dentals while monitoring
  • uses hands-on evaluation AND monitors
38
Q

In what intervals should recorded physiological parameters be taken?

A

5 minutes —> any longer can cause a miss in trends

39
Q

What peri-operative recordings are important to be taken?

A
  • drugs (can help with future anesthetic events)
  • fluids
  • oxygen flow rates
  • equipment, like breathing systems, ventilators, ET tube size
  • anything regarding patient management

Anesthesia (40 decks)

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