Asa Standards Flashcards
Standard monitors
Pulse ox, capnography, o2 analyzer, disconnect alarm, ecg sbp hr temp
Lead 1/2/3
Lead 1 - on R + on l arms
Lead 2 - on Ra +on LL
Lead 3 - on la + on LL
Dinamap -device for noninvasive automatic mean art press compared to art line
Systolic and mean usually same, diastolic is 10 mmhg higher with automated
Map equation
Map = co x svr Map = pressure dias + 1/3(p sys - p dias)
Kroktof sounds
Phase 1 = systolic bp
Phase 5 = diastolic
Ischemia with art line
Less then .1%
Arterial blood flow hand
Majority is ulnar
Brachial artery cannulization
Can injure median nerve
Subclavian vein cannulization
Cannulated between middle third and latereal third clavicle
At the scalenea the subclavian vein goes anterior to ant scalene while artery goes between ant and mid
Both go over first rib
Advantages include shorter distance and more comfort and less infection
Chylothorax
Most common with left subclavian
Median nerve to brachial artery in ac
Median nerve is medial
Facet joint intervention for block
Medial branch of posterior division of spinal nerve
Stellate ganglion
Found c6/c7
Sympathetic innervation for hand neck arm head
Blocking causes unopposed parasympathetic and horners syndrome
Includes vasodilation of arm head neck, stuffiness, miosis, ptosos and anhydrosis. No sweat
Celiac plexus
Located l1
Lateral to aorta near celiac artery takeoff
Mediates innervation to small intestine, ascending and transverse colon, liver kidney spleen gallbladder
Blocking it blocks visceral pain, leads to inc parasympathetic including diarrhea
Changes in blood pressure as you move farther away from heart
Increase in systolic, decrease in diastolic, same map
Change in bp every 1 cm
.74 mmhg
A wave
after atrial contraction
C wave
Represents bulging of tricuspid valve into atrium during systole (after qrs)
X decent
Atrial relaxation as ventricle is contracted
V wave
Filling of the atria with tricuspid closed
Y decent
Tricuspid opens and blood passively flows into ventricle
Afib on cvp
No a wave and increaeed c wave for increased filling pressures
Av disassociation for cvp
Cannon a wave, atrial contraction against closed tricuspid valve
Cardiac tamponade cvp
Elevated filling pressures with no y decent
Normal mvO2
40 mmhg correspondes to 75% sat
Pulm art cathter enters pulm artery at
35-45 cm
Normal svr pulm art cathter
900-1500 dynes
Normal pulm vasc resistance
50-150 dynes
Normal cardiac index
2.2 to 4.2
Wave lengths of pulse ox
660 oxygenated 940 deoxy
Meth hgb / methelyne blue sat
85 for methhemoglobenemia, 65% for methelene blue
Heat loss in first hour
Redistribution from core to periphery
Best core temps
Typanic > bladder > axillary /skin
Men 1
Pancreas pituitary parathyroid
Primary hypothyroidism tsh t3 t4
Increae in tsh, low t3/t4. Primary means at the sight of organ. Secondary means the signaling from head
Phenoxybenzamone
Irreversible nonselective alpha adrenergic antagonist
Treatment of thyroid storm
Hydration bblocker (esp propanolol blocks conversion of t4-t3) and ptu
Refeeding syndrome hallmark
Hypophosphatemia can also have hypokalemia
Carcinoid tumor
Releases seretonin and kalkiormkn
Causes diarrhea and fushing and palpitation
Causes rhf from tricuspid and pulm vslve sclerosis
Normal cortisol in a day
20-30 mg normal
300 at times of stress
Maximal blood loss formula
MBL= hgb - allowed hgb / (avg of two hgb) x ebv
(Initial - final (allowed) / avg ) * ebv
Sirs criteria
Need 2: Temp 38 Hr > 90 Rr > 20 Paco2 12k
Sepsis is with confirmed or suspected infxn
Septic shock is hypotension
Cvc normal Cvp Possitive pressure airway Pcwp Co
Cvp normal 2-6, decreased is hypovolemia Pa pressure 25/10 Pawp normal 8-12 reflects lvedp Ci normal 2.4-4.2 Co normal 4-8L/min
Dopamine receptor
Alpha 1 beta 1 da1
Definition of acute renal failure
Urine output
Autonomy
Right of the individual to self determination
Benificence
The principle of taking the action that best serves the patient
Peak vs pleatue pressure
Peak large airways. Pleatu is small airways and alveoli
Large increase in pip with no chance in pleatue means bronchospasm or biting of tubes
Ards cc/ pip
6cc/kg
Pleatue
Mcc lawsuit
Respiratory intubation amywhere
Npo
Clear liquids 2
Breast milk 4
All others six
