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Principles of Anesthesia > Clinical Monitoring (Exam 1) > Flashcards

Clinical Monitoring (Exam 1) Flashcards

1
Q

Which AANA Standard involves clinical monitoring?

A

standard 9

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2
Q

What are the 3 standards of monitoring oxygenation and which are required?

A
  1. clinical observation (chest rise and fall) required
  2. pulse oximetry required
  3. ABG’s as indicated

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3
Q

What are the 5 standards of monitoring ventilation and which are required?

A
  1. ausculation required
  2. chest excursion (aka depth and pattern) required
  3. EtCO2 required, must chart by exception if not using
  4. Pressure monitors as indicated
  5. Monitor RR every 3-5 minutes required

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4
Q

What are the 3 standards of cardiovascular monitoring?

A
  1. EKG
  2. Auscultation as needed
  3. BP and HR every 3-5 minutes

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5
Q

What is the standard of monitoring thermoregulation?

A

When clinically significant changed in body temperature are anticipated or suspected.

just doc for all cases

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6
Q

What patient population loses body heat the fastest?

A

children and some elderly

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7
Q

What is the standard for monitoring neuromuscular function?

A

Any time neuromuscular blocking drugs are administered.

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8
Q

Additional needs for monitoring outside of the AANA standards depend on what?

A

the needs of the patient, surgical technique, or procedure.

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9
Q

Does a left shift of the oxyhemoglobin curve cause an increase or decrease affinity for O2?

A

Increased affinity

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10
Q

Name 6 things that would cause a left shift of the oxyhemoglobin curve.

A
  1. alkalosis
  2. hypocarbia
  3. hypothermia
  4. decreased 2,3 DPG
  5. COHb
  6. Fetal Hb

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11
Q

Name 4 things that would cause a right shift of the oxyhemoglobin curve.

A
  1. Acidosis
  2. Hypercarbia
  3. Hyperthermia
  4. Increased 2,3 DPG

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12
Q

At a PO2 of 60 mmHg, what is likely the SpO2?

A

90%

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13
Q

At a PO2 of 40 mmHg, what is likely the SpO2?

A

75%

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14
Q

At a PO2 of 27 mmHg, what is likely the SpO2?

A

50%

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15
Q

What is the Beer-Lambert Law?

A

Law of light absorption:
Related the transmission of light throught a solution to the concentration of the solute in the solution.

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16
Q

Beer Lambert Law:

Light absorption must be measured at ——– that are proportional to the nuber of ———.

A

wavelengths; solutes

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17
Q

A low concentration of solutes will cause _ _ _ _ _ abosorption of light.

A

low

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18
Q

A hgh concentration of solutes will cause _ _ _ _ _ absorption of light.

A

high

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19
Q

Less light path length will cause _ _ _ _ _ absorption of light.

A

less

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20
Q

More light path length will cause _ _ _ _ _ absorption of light.

A

more

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21
Q

What are the 4 types of hempglobin in adult blood?

A
  1. Oxyhemoglobin (O2Hb)
  2. Reduced Hemoglobin (deoxyhemoglobin, deO2Hb, Hb)
  3. Methemoglobin (metHb)
  4. Carboxyhemoglobin (COHb)

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22
Q

What is the difference between O2Hb and metHb?

A

The iron in O2Hb is ferrous iron (Fe2) while methemoglobin has ferric iron (Fe3)

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23
Q

What is the gold standard for measuring SpO2 if oximetry is inaccuate?

A

Co-Oximetry which measures all 4 wavelengths

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24
Q

Red light is measured at what nm?

A

660 nm

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25
Q

Infrared light is measured at what nm

A

940 nm

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26
Q

Which wavelength of light does oxyhemoglobin absorb more of than deoxyhemoglobin?

A

Infrared.

Deoxyhemoglobin absorbs more red light than oxyhemoglobin.

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27
Q

How is SaO2 estimated?

A

through pulsatility of arterial blood flow which is alternating current (AC)

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28
Q

DC (direct current) is made of absorption of light through what tissues?

A

absorption from nonpulsatile arterial blood, venous and capilalry blood, and tissue.

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29
Q

SaO2 is the ratio of what?

A

AC and DC light absorption.

The pulsatile component for each wavelength divided by the nonpulsatile component for each wavelength.
The pulsatile expansion of the artery increases length of light path which increases absorbancy.

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30
Q

Each 1% increase of COHb will increase SpO2 by ___?

A

1%

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31
Q

Which wavelength (nm) is absorbed equally for carboxy and oxyhemoglobin?

A

660 nm (red light)

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32
Q

What might cause signal artifact for SpO2 monitors?

A
  • ambient light
  • low perfusion
  • venous blood pulsations
  • additional light absorbers
  • additional forms of Hb
  • nail polish

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33
Q

What solves signal artifact caused by ambient light?

A

usually solved by alternating red/infrared

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34
Q

What would be considered an additional light absorber and cause SpO2 artifact?

A

IV dyes such as methylene blue

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35
Q

How accurate is pulse oximetry when measured againse ABGs?

A

+/- 2% when ABG sat > 70%

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36
Q

Is pulse oximetry affected by anesthesia vapos?

A

no

13

37
Q

What are some disadvantages to using pulse oximetry

A
  • poor function is decreased perfusion
  • delayed hypoxic event detection
  • erratic performance with dysrhythmias
  • inaccuracy with different hemoglobin and dyes
  • motion artifact

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38
Q

What pose oximetyr site may be more reliable with epidurals?

A

toes

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39
Q

Which pulse oximetry sites are less affected by vasoconstriction and may reflect desaturation quicker?

A

tongue, cheek, forehead

40
Q

KNOW THIS

What is the formula (according to this class) for Mean BP?

A

DBP + 1/3 (SBP - DBP)

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41
Q

What are the 5 phases of Korotkoff sounds?

A

Phase 1: the most turbulent/audible (SBP)
Phase 2: softer and longer
Phase 3: crisper and louder
Phase 4: softer and muffled
Phase 5: sounds disappear (DBP)

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42
Q

What size should the BP cuff be?

(Percentages of pts arm)

A

40% of arm circumference
80% of length of upper arm

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43
Q

What is the maximal amplitude of oscillations?

Based on Oscillometry

A

MAP

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44
Q

With oscillometry, which BP measurement has the least agreement with invasive BP measurements?

A

SBP

Usually only with critically ill or elderly pts.

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45
Q

What change in automatic NIBP is expected in patients with atherosclerosis, edema, obesity, and chronic HTN?

A

narrow pulse pressure:
Low SBP
High DBP

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46
Q

What is the AANA standard for average differences across automatic NIBP machines?

A

< +/- 5 mmHg but “deviations up to 20 mmHg are ‘acceptable’”

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47
Q

Automatic NIBP machines make estimates based on oscillations. How do these estimates create inaccuracies during hyper/hypotension?

A

MAP is underestimated in hypertension and overestimated in hypotension.

typically SBP is always underestimated and DBP is always overestimated (found with the algorithm)

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48
Q

What are the advantages of automatic NIBP machines?

A
  • eliminate clinician subjectivity
  • improved quality and accuracy
  • automaticity
  • noninvasive

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49
Q

What are the disadvantages to automatic NIBP machines?

A
  • unsuitable for monitoring rapid changes
  • patient disconfors
  • Complications such as pain, petichiae/ecchymosis, edema, neuropathy, compartment syndrome, limb edema, venous stasis, and thrombophlebitis.

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50
Q

What disease processes shoud we use caution with automatic NIBP machines?

A
  • sever coagulopathies
  • peripheral neuropathies
  • arterial/venous insufficiency
  • recent thrombolytic therapy

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51
Q

What are the indications for invasive blood pressure monitoring?

A
  • gives real-time continuous measurement
  • planned pharmacologic manipulation
  • repeated blood sampling
  • determination of volume responsiveness
  • timing of IABP counter pulsation

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52
Q

What is the most common site for arterial lines?

A

radial

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53
Q

What are possible sites for arterial lines besides radial?

A
  • ulnar
  • brachial
  • axillary
  • femoral
  • posterior tibial
  • dorsalis pedis

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54
Q

What is a complication of using a brachial art line?

A

If you don’t have good collateral blood flow, you could lose perfusion to the hand.

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55
Q

What is a common complication of femoral art lines?

A
  • infection
  • hidden hematomas form under tissue

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56
Q

When doing the allen’s test, what is considered severely reduced collateral flow?

A

color of palm not returning for more than 10 seconds?

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57
Q

Which artery do you release to perform allen’s test?

A

ulnar

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58
Q

What is different about the transfixion technique for inserting art lines?

A

the front and back walls of the artery are punctured intentionally during needle insertion.

not associated with more complications

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59
Q

What do these waveforms correlate to? (1-6)

A
  1. Systolic upstroke
  2. systolic peak pressure
  3. systolic decline
  4. dicrotic notch
  5. diastolic runoff
  6. end-diastolic pressure

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60
Q

Where do we level art line transducer when zeroing?

A

at the aortic root

“phlebostatic axis”

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61
Q

What does Distal Pulse Amplification mean?

A

As the art line site moves further away from the aortic arch, the waveform will change due to ompedence and harmonic resonance.

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62
Q

As pressure wave moves towards the periphery, what changes happen to the waveform?

A
  • arterial upstroke steeper
  • systolic peak higher
  • dicrotic notch later
  • end-diastolic pressure lower

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63
Q

What are the 3 different types of waves associated with wave formation?

A

fundamental waves
harmonic waves
summation waves

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64
Q

How many harmonics are required for most arterial pressure waveforms?

A

6-10

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65
Q

What is fourier analysis?

A

analysis of the summation of multiple sine waves

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66
Q

What square wave test produces an underdamped waveform?

A

too many bounces after the square wave test

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67
Q

What inaccuracy is produced with an underdamped arterial waveform?

A

Elevated systolic bp

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68
Q

What inaccuracy is produced by an overdamped arterial waveform?

A
  • lower SBP
  • falsely narrowed pulse pressure

MAP will be accurate

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69
Q

What pressure gradient changes will we see in patients that are older, atherosclerotic, in shock, or hypothermic?

A

Lack of distensibility of vessels. So they will have increased pressure readings.

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70
Q

What are some complications of arterial lines?

A
  • distal ischemia or pseudoaneurysm
  • hemorrhage, hematoma (most common)
  • arterial embolization
  • local infection
  • peripheral neuropathy

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71
Q
A

Principles of Anesthesia (2 decks)

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