APEX Hemodynamic Monitoring

Question 1

A BP cuff that is too large ____

Answer 1

Decreases pressure requirement to occlude the artery
Underestimates SBP

Question 2

A BP cuff that is too small ___

Answer 2

Overestimates BP

Question 3

Ideal bladder size

Answer 3

Length - 80% extremity circumference
Width - 40%

Question 4

Cuff location

Answer 4

SBP increases as cuff moves away from Aortic root, while DBP decreases, MAP stays the same
Close to the aortic root- SBP is lowest, and DBP is highest

Question 5

Etiologies of an over dampened A line tracing

Answer 5

Air bubbles/ clot/ kinks
Low pressure in pressure bag

Question 6

Ideal oscillations in A line after square test

Answer 6

1
Underdamped has many
Overdamped has 0

Question 7

Etiologies of underdampened A line tracing

Answer 7

Stiff tubing
catheter whip (artifact

Question 8

How far should the CVC be inserted into a RIJ? LIJ?

Answer 8

15cm
20cm

Question 9

How far should the PA catheter be inserted into RIJ?

Answer 9

25-35cm

Question 10

Which IJ to use and why?

Answer 10

RIJ
LIJ higher risk of damaging thoracic duct

Question 11

Most common complication while placing heart access

Answer 11

Dysrhythmias

Question 12

Classic presentation of pulmonary artery rupture

Answer 12

Hemoptysis

Question 13

Catheter related infection increases after how long?

Answer 13

3 days

Question 14

Distance from insertion site to subclavian

Answer 14

10cm

Question 15

A, C, V waves in CVP tracing

Answer 15

A- atrial contraction
C- closing of the tricuspid valve
V- Passive refilling of RA

Question 16

A,C,V waves in CVP, what is happening in the EKG?

Answer 16

A- Just after P wave
C- Just after QRS complex
V- Just after T wave

Question 17

How does PEEP effect CVP?

Answer 17

Increases it!

Question 18

Phlebostatic axis- definition and when is it used

Answer 18

4th IC space, mid axillary
A line / CVP

Question 19

Normal CVP

Answer 19

1-10mmHg

Question 20

What increases CVP?

Answer 20

PEEP
Cardiac tamponade
Hypervolemia
RVF

Question 21

When should CVP be measured?

Answer 21

End expiration

Question 22

When will A wave from CVP be increased?

Answer 22

Tricuspid stenosis
Diastolic dysfunction
RV hypertophy
Atria has to pump harder

Question 23

What causes tall v wave?

Answer 23

Tricuspid regurgitation- too much fluid in atria
RV papillary muscle ischemia

Question 24

When will you lose an a wave?

Answer 24

A fib
V pacing

Question 25

Which zone should PAC be placed in?

Answer 25

3

Question 26

How to tell if PA catheter is NOT in zone 3?

Answer 26

PAOP>PAD Inability to aspirate blood when wedged

Question 27

Zone 1,2,3 formulas

Answer 27

PA Pa Pv Pa PA Pv Pa PV PA

Question 28

When does PCWP overestimate LVEDV

Answer 28

PEEP Diastolic dysfunction Pulmonary HTN MV disease

Question 29

When does PCWP underestimate LVEDV

Answer 29

Aortic valve insufficiency- thats literally it

Question 30

When is thermodilution going to underestimate CO?

Answer 30

High injectate volume- pushing it makes injectate go to other side fast, then measurement of CO is low, think of timing

Question 31

When is thermodilution going to overestimate CO?

Answer 31

Wedged- creates high pressure like vasoconstrictor and adds to CO falsely Warmed- gonna open blood vessels more than normal and increase CO

Question 32

Thermodilution graph

Answer 32

Inverse correlation between height and CO

Question 32

When to use thermodilution over continuous cardiac output monitoring?

Answer 32

When the patient is critically ill- CCO has a delay that is unacceptable

Question 33

Factors that increase mixed venous saturation SvO2

Answer 33

Decreased O2 consumption or increased O2 delivery Sepsis O2 therapy Increased HGB Increased CO SNP toxicity

Question 34

Factors that decrease mixed venous saturation SvO2

Answer 34

Increased O2 consumption or decreased O2 delivery Anemia Thyroid storm Stress Decreased CO, dec HGB, dec O2 therapy

Question 35

SvO2 formula

Answer 35

SaO2-[VO2/ (1.34 x HGB x CO x 10) Normal range 65-75%

Question 36

How will you measure the effectiveness of a bolus with regards to fluid responsiveness

Answer 36

10% increase in SV from a 250 bolus

Question 37

Signs of dehydration on the monitor

Answer 37

Pleth variation PP variation SBP variation SV variation

Question 38

Pulse countour analysis (for preload and thus SV) wont show reliable analysis of variation when:

Answer 38

PEEP- unfairly occludes pressure in the heart small Vt- no change in return to the heart Spontaneous Vt- big breathes occlude heart Dysrhtyhmias RV dysfunction Open chest

Question 38

What limits the reliability of the esophageal monitor

Answer 38

Aortic cross clamp Aortic stenosis/ insufficiency

Question 39

Esophageal doppler

Answer 39

Used for fluid management Preload/ afterload/ inotropy

Question 39

Esophageal doppler CX

Answer 39

Esophageal disease d/t risk of traumatic injury

Question 40

PA Pressure

Answer 40

25/10

Question 41

Most accurate and inaccurate measurement by oscillometric method BP measurement?

Answer 41

Map DBP

Question 42

Esophageal doppler graph changes

Answer 42

thin to Wider- increased preload short to Taller- decreased afterload Short rounded to tall pointed- increased inotropy

Question 43

When not to use esophageal doppler for vest results (not cx)

Answer 43

Aortic stenosis, insufficiency, disease, cross clamping, pregnancy (dopper hit the baby on the head)

Question 44

Most common cause of acute MI

Answer 44

sinus tach Increases o2 demand decreases supply

Question 45

Amio for a fib vs a flutter

Answer 45

Amio will convert a fib and slow rate Amio will only slow rate of a flutter, wont convert a flutter

Question 46

What is the cause of a PVC

Answer 46

kypokalemia hypomagnesium Dig toxicity SNS MI/ infarct

Question 47

Best med for symptomatic PVC

Answer 47

Lidocaine 1mg/kg infusion of 1-4mg/min

Question 48

What med for long qt?

Answer 48

beta blockers

Question 49

Genetic disorder associated with MH

Answer 49

King Denborough

Question 50

syndromes that are associated with prolonged qt

Answer 50

romano ward timothy

Question 51

Potential causes of 1st degree hb

Answer 51

athlete age (old) amio POSTERIOR MI dig