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A1 > APEX Hemodynamic Monitoring > Flashcards

APEX Hemodynamic Monitoring Flashcards

1
Q

A BP cuff that is too large ____

A

Decreases pressure requirement to occlude the artery
Underestimates SBP

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2
Q

A BP cuff that is too small ___

A

Overestimates BP

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3
Q

Ideal bladder size

A

Length - 80% extremity circumference
Width - 40%

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4
Q

Cuff location

A

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

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5
Q

Etiologies of an over dampened A line tracing

A

Air bubbles/ clot/ kinks
Low pressure in pressure bag

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6
Q

Ideal oscillations in A line after square test

A

1
Underdamped has many
Overdamped has 0

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7
Q

Etiologies of underdampened A line tracing

A

Stiff tubing
Catheter whip (artifact)

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8
Q

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

A

15cm
20cm

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9
Q

How far should the PA catheter be inserted into RIJ?

A

25-35cm

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10
Q

Which IJ to use and why?

A

RIJ
LIJ higher risk of damaging thoracic duct

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11
Q

Most common complication while placing heart access

A

Dysrhythmias

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12
Q

Classic presentation of pulmonary artery rupture

A

Hemoptysis

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13
Q

Catheter related infection increases after how long?

A

3 days

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14
Q

Distance from insertion site to subclavian

A

10cm

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15
Q

A, C, V waves in CVP tracing

A

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

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16
Q

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

A

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

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17
Q

How does PEEP effect CVP?

A

Increases it!

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18
Q

Phlebostatic axis- definition and when is it used

A

4th IC space, mid axillary
A line / CVP

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19
Q

Normal CVP

A

1-10mmHg

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20
Q

What increases CVP?

A

PEEP
Cardiac tamponade
Hypervolemia
RVF

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21
Q

When should CVP be measured?

A

End expiration

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22
Q

When will A wave from CVP be increased?

A

Tricuspid stenosis
Diastolic dysfunction
RV hypertophy
Atria has to pump harder

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23
Q

What causes tall v wave?

A

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

24
Q

When will you lose an a wave?

A

A fib
V pacing

25
Q

Which zone should PAC be placed in?

A

3

26
Q

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

A

PAOP>PAD
Inability to aspirate blood when wedged

27
Q

Zone 1,2,3 formulas

A

PA Pa Pv
Pa PA Pv
Pa PV PA

28
Q

When does PCWP overestimate LVEDV

A

PEEP
Diastolic dysfunction
Pulmonary HTN
MV disease

29
Q

When does PCWP underestimate LVEDV

A

Aortic valve insufficiency- thats literally it

30
Q

When is thermodilution going to underestimate CO?

A

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

31
Q

When is thermodilution going to overestimate CO?

A

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

32
Q

When to use thermodilution over continuous cardiac output monitoring?

A

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

33
Q

Factors that increase mixed venous saturation SvO2

A

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

34
Q

Factors that decrease mixed venous saturation SvO2

A

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

35
Q

SvO2 formula

A

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

36
Q

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

A

10% increase in SV from a 250 bolus

37
Q

Signs of dehydration on the monitor

A

Pleth variation
PP variation
SBP variation
SV variation

38
Q

What limits the reliability of the esophageal monitor

A

Aortic cross clamp
Aortic stenosis/ insufficiency

39
Q

Esophageal doppler CX

A

Esophageal disease d/t risk of traumatic injury

40
Q

PA Pressure

A

25/10

41
Q

Most accurate and inaccurate measurement by oscillometric method BP measurement?

A

Map
DBP

42
Q

Esophageal doppler graph changes

A

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

43
Q

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

A

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

44
Q

Most common cause of acute MI

A

sinus tach
Increases o2 demand
decreases supply

45
Q

Amio for a fib vs a flutter

A

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

46
Q

What is the cause of a PVC

A

kypokalemia hypomagnesium
Dig toxicity
SNS
MI/ infarct

47
Q

Best med for symptomatic PVC

A

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

48
Q

What med for long qt?

A

beta blockers

49
Q

Genetic disorder associated with MH

A

King Denborough

50
Q

syndromes that are associated with prolonged qt

A

romano ward
timothy

51
Q

Potential causes of 1st degree hb

A

athlete
age (old)
amio
POSTERIOR MI
dig

52
Q
A
53
Q

Esophageal doppleris used for ___

A

Used for fluid management
Preload/ afterload/ inotropy

54
Q

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

A

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

55
Q

Thermodilution graph

A

Inverse correlation between height and CO

A1 (124 decks)

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