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Cardiology - Constable Summer > Cardiac Monitoring > Flashcards

Cardiac Monitoring Flashcards

1
Q

Every monitor we use really mointors cellular metabolism at the cellular level so that we can respond quickly so the patient can have a ____ _______

A

full recovery

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2
Q

Continuous or repeated observation + vigilance in order to maintain homeostasis

A

definition of monitoring

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3
Q

What are the ASA standards for delivery of an anesthetic

A

qualified personnel (CRNA, AA, MDA), oxygenation (Sa02, Fi02), Ventilation (ETC02, stethescope, disconnect alarm), Circulation (BP, pulse, ECG)

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4
Q

Other monitors

A

temp, peak airway pressure (PAW), Vt, ABG

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5
Q

Arterial line indications

A

beat-to-beat monitoring, frequent blood sampling, circulatory therapies (IABP, bypass, vasoactive drugs, deliberate hypotension), failure of indirect BP (due to burns or morbid obesity)

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6
Q

Complications of radial artery cannulation are uncommon except in

A

vasospasmotic disease, prolonged shock, high dose vasopressors, prolonged cannulation

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7
Q

The radial artery is ______ in true anatomical position

A

lateral

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8
Q

The more proximal you go with an arterial catheter placement, the higher chance of _______

A

thrombosis

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9
Q

When placing a brachial arterial line you have to use a _________ catheter to traverse the elbow joint, postoperative the arm needs to be kept ________, and ________ circulation is not as good as in hand

A

longer / extended / collateral

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10
Q

When placing a femoral arterial line you should puncture the femoral artery below the ______ ______ because it’s easier to ________ if required

A

inguinal ligament / compress

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11
Q

The difference in maximal and minimal values of systolic BP during postive pressure ventilation

A

systolic pressure variation

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12
Q

SPV > ____ mmHg or change down > ____mmHg is highly predictive of HYPOVOLEMIA. Is this an early or late sign?

A

15 / 15 / Early

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13
Q

Central venous line indications

A

CVP monitoring, advanced CV disease + major operation, secure vascular access for drugs (TLC), secure access for fluids (inroducer sheath), aspiration of entrained air for sitting craniotomies, inadequate peripheral IV access, pacer, Swan-Ganz

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14
Q

The IJ vein lies in groove between the _______ and ______ _______ of the sternocledomastoid muscle

A

sternal / clavicular heads

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15
Q

The IJ vein is _______ and slightly ______ to the carotid

A

lateral / anterior

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16
Q

Best position for IJ line placement

A

trendelenburg because it helps dilate the IJ

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17
Q

Of note when inserting a IJ central line, if the patient has a LBBB can cause a ________. If any ectopy or change in ECG noted what should you do?

A

RBBB / pull the wire back

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18
Q

In the OR, we place the line, use it and then get a _____

A

CXR

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19
Q

Advantages of RIJ

A

consistent and predictable anatomic location, readily identifiable landmarks, short straight course to the SVC, easy intraop access for anesthetist at patient’s head, high success rate (90-99%)

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20
Q

Subclavian central line notes

A

easier to insert vs. IJ if c-spine precautions, better patient comfort than IJ, risk of pneumo is 2%

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21
Q

External jugular notes

A

easy to cannulate if visible and no risk of pneumo, does not put them in adults but does put them in kids if needed

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22
Q

Serious complications of double-cannulation of same vein (RIJ)

A

vein avulsion (shearing), obstruction to head, you wouldn’t put one on each side, catheter entanglement, catheter fracture,

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23
Q

CVP monitoring reflects the pressure at junction of ____ _____ OR _____

A

vena cava / RA

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24
Q

CVP is driving force for filling the ____ and ____

A

RA and RV

25
Q

CVP provides estimate of _____ _____ _____ and ____ preload

A

intravascular blood volume / RV

26
Q

When considering using a CVP, _____ in CVP monitoring are useful. Must consider the patient and conditions

A

trends

27
Q

When do you measure CVP

A

end expiration

28
Q

Where do you zero CVP (I know we all know)

A

zero and mid-axillary line

29
Q

The PAC allows accurate bedside measurement of important clinical variables including CO, PAP, PCWP, CVP to estimate ____ filling volume and to help guide _____ and _____ drug therapy

A

LV / fluid / vasoactive

30
Q

PAC discloses pertinent CV data that cannot be accurately predicted from standard ____ and ____

A

signs and symptoms

31
Q

Basically, a PAC allows surgeons to treat _______ since they’re not at the bedside.

A

remotely

32
Q

Look at the PAC waveforms on slide

A

26

33
Q

When inserting a PAC and going from RA to RV, you have a slight bump in your ______ pressure

A

diastolic

34
Q

The ASA task force indications for PAC

A

High risk patient with severe cariopulmonary dz, intended surgery palces patient at risk because of magnitude or extent of operation, practice setting suitable for PAC monitoring which would require MD familiarity, ICU, nursing competence

35
Q

PAC education project webiste for learning how to use PAC

A

www.pacep.org

36
Q

Early use of PAC to optimize ______ status

A

volume

37
Q

FYI

A

PAC is only a MONITOR. It cannot improve outcome if disease has progressed too far, or if intervention based on PAC is unsuccessful or detrimental

38
Q

PAC complications

A

most common is arrhythmias, Tranisent RBBB, external pacer if pre-existing LBBB, misinformation, serious complications (knotting, pulmonary infarction, PA rupture, endocarditis, structural heart damage

39
Q

Important feature of PAC is it allows calculation of _____ output and calculation of ____

A

cardiac / D02

40
Q

CO is _______ proportional to area under curve

A

inversely. This means when you look at two curves the larger curve would indicate LESS cardiac output

41
Q

If a patient has tricuspid regurgitation, what problems may you see when attempting to obtain CO?

A

recirculation of thermal signal so the CO would be invalid

42
Q

CO from PAC technical problems and facts

A

use the average of 3 measurements due to variations in respiration (always do and end expiration), blood clot on thermistor tip can cause innaccurate temp, shunts can be problematic, you must enter the computation constant on the machine which varies with each PAC (check the package insert)

43
Q

Normal mixed venous oximetry

A

normal Sv02 is 60-75%

44
Q

If 02 sat, V02 and Hg remain constant _____ is indirect indicator of CO

A

Sv02

45
Q

Sv02 can be measured using oximetric Swan or CVP, or send blood gas from ___

A

PA

46
Q

He said there will be a question on

A

Mixed venous oximetry

47
Q

A significant decrease in Sv02 may have several causes including (3)

A

decrease in perfusion (CO) with a higher 02 extraction ratio, increase in metabolic rate (increased 02 extraction), and decrease in arterial oxygen saturation from a decreased 02 supply

48
Q

Increaed Sv02 (>75%) simply means _________ output or low _______

A

overabudnant / extraction

49
Q

Increased Sv02 >75% could be from inability to extract 02 from _____ ______ or high cardiac output situations like _____, _______, and L–>R shunts or AV fistulas

A

carbon monoxide / sepsis, burns

50
Q

V02 =

A

oxygen extraction

51
Q

Decreased Sv02 <60% can be due to HIGH EXTRACTION states.

A

Decreased CO: MI, CHF, hypovolemia | Decreased Hg: bleeding and shock | Decreased Sa02: hypoxia, resp distress | Increased V02: fever, agitation, thyrotoxic, shivering

52
Q

_____ _____ ______ of the left ventricular cavity can be used as an index of global systolic function on the TEE + TG SAX view

A

fractional area change

53
Q

FAC measurement is made at the ___-_______ level by calcuating the cross-sectional area of the ____ during systole and diastole

A

mid-papillary / LV

54
Q

FAC =

A

(LVAd-LVAs / LVAd)

55
Q

Normal range for FAC is

A

35-65%

56
Q

Normal FAC

A

> 50%

57
Q

Hypovolemia for estimated diastolic area (EDA)

A

< 8 cm^2

58
Q

Normal EDA

A

8 to 14

59
Q

Dilated EDA

A

> 14

Cardiology - Constable Summer (6 decks)

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