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

Clinical Monitoring (Exam I) Flashcards

1
Q

What physics law deals with pulse oximetry and the laws governing absorption of light?

A

Beer Lambert

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2
Q

A low concentration of hemoglobin results in a ____ light absorption rate.

A

lower

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3
Q

What should be utilized if oximetry is determined to be inaccurate?

A

Co-oximetry

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4
Q

What is co-oximetry?

A

Co-oximetry is the measurement of:
- O₂Hb
- DeO₂Hb
- MetHb
- CarboxyHb
all through differing wavelengths of light

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5
Q

Red wavelengths of light measure at ______ nanometers.

A

660

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6
Q

Infrared wavelengths of light measure at ______ nanometers.

A

940

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7
Q

Deoxyhemoglobin preferentially absorbs more ________ than oxyhemoglobin.

A

red

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8
Q

Oxyhemoglobin preferentially absorbs more ________ than deoxyhemoglobin.

A

Infrared

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9
Q

What makes up the AC portion of the graph below?

A

Light absorption from pulsatile arterial blood.

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10
Q

What makes up the DC portion of the graph below?

A

Light absorption from:

  • Non-pulsatile arterial blood
  • Venous and capillary blood
  • Tissue
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11
Q

What formula is used to determine the ratio of AC to DC light absorption? (and thus give our pulse oximetry)

A
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12
Q

What will falsely elevate SpO₂ ?

A

Elevated carboxyhemoglobin

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13
Q

Each __% of COHb (carboxyhemoglobin) will increase SpO₂ by __%.

A

1 : 1

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14
Q

_______ will absorb as much 660nm light at oxyHb does.

A

COHb

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15
Q

What percent carboxyhemoglobin will smokers have?

A

> 6% usually

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16
Q

What are possible reasons for SpO₂ signal artifact and thus incorrect readings?

A
  • Ambient light
  • Low perfusion
  • Venous blood pulsations
  • Dyes (ex. Methylene blue)
  • Nail polish
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17
Q

Where can a pulse ox be placed if the fingers won’t work?

A
  • Forehead
  • Tongue (!)
  • Cheek
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18
Q

What are Korotkoff sounds related to?

A

Blood pressure (Through partial occlusion with the BP cuff)

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19
Q

How is MAP calculated?

A

DP + ⅓(SP - DP)

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20
Q

What Korotkoff phase is the loudest?
Quietest?

A
  • Phase 1: loudest (SBP) due to turbulence
  • Phase 6: Sounds disappear (DBP)
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21
Q

How should a cuff fit on a person’s arm?

A
  • 40% of arm circumference
  • 80% of length of upper arm
  • Centered over artery
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22
Q

A BP cuff that is too large will read a blood pressure that is _______.

A

too low

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23
Q

A BP cuff that is too small will read a blood pressure that is _______.

A

too high

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24
Q

Where can a blood pressure be obtained from an obese patient if the upper arm won’t work?

A

forearm

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25
Q

What is the best site for invasive blood pressure monitoring?

A

Radial artery

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26
Q

How does the Transfixion technique for arterial catheter placement differ from the seldinger technique?

A

Transfixion involves puncturing through the back of the artery and withdrawing until the needle can be removed.

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27
Q

Label the various parts of the arterial waveform.

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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28
Q

What occurs to an arterial waveform as it moves centrally (aorta) to the periphery (ex. femoral artery) ?

A
  • Arterial upstroke steepens
  • ↑ systolic peak
  • Dicrotic notch occurs later
  • Lower EDP
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29
Q

How are summation waves formed?

A

Through the combination of Fundamental and Harmonic waves.

30
Q

How many oscillations should follow a square wave test?

A

No more than two

31
Q

What would the systolic pressure read in an underdamped system?

32
Q

What would the characteristics of an overdampened arterial waveform be?

A
  • ↓SBP
  • Absent dicrotic notch
  • Loss of detail
  • Narrowed pulse pressure w/ accurate MAP
33
Q

What occurs with RV and LV afterload during the inspiratory phase?

A

RV afterload increases
LV afterload decreases

34
Q

What occurs with RV and LV preload during the inspiratory phase?

A

RV preload decreases
LV preload increases

35
Q

RV stroke volume ____ during early phase of inspiration.

36
Q

How much systolic pressure variation is typical in mechanically ventilated patients?

A

7 - 10 mmHg

37
Q

What would increases systolic pressure variation be indicative of?

A

Volume responsiveness (i.e. patient needs fluids)

38
Q

What is the normal change in pulse pressure variation over an entire respiratory cycle?

A

13 - 17%

If greater than 13 - 17% you need to give volume.

39
Q

What is normal Stroke Volume Variation (SVV) ?

A

10 - 13%

If greater, patient will likely respond to fluids.

40
Q

What are the two types of gas sampling systems?

A
  • Side-stream monitoring
  • Mainstream monitoring
41
Q

What are challenges associated with mainstream CO₂ gas sampling?

A
  • H₂O vapor
  • Secretions
  • Blood
  • Disconnections
42
Q

What are challenges associated with sidestream CO₂ gas sampling?

A
  • Tubing kinking
  • H₂O vapor
  • leaks in line
  • slower response time
43
Q

What is the partial pressure of O₂ at sea level?

44
Q

What is the Patm ?

45
Q

What is the percentage O₂ at sea level?

exclude water vapor

A

160 mmHg ÷ 760 mmHg = 21%

46
Q

How are quantities of CO₂, N₂O, H₂O, and VAA’s measured?

A

Infrared Analysis

O₂ cannot be measured via IR analysis.

47
Q

Which gas cannot be measured via infrared analysis?

A

O₂ cannot be measured via IR analysis.

48
Q

The less IR light that reaches the sensor means that the gas has a ________ concentration.

49
Q

What is the partial pressure of water vapor?

50
Q

O₂ is at 30%, what is the partial pressure?

Be sure to take water vapor into account.

A

(760 - 47) x 0.30 = 214 mmHg

51
Q

Which type of oxygen analyzer is more rapid and utilized with side-stream sampling analyzers?

A

Paramagnetic

52
Q

Which type of oxygen analyzer has a slower response time and is best to monitor O₂ concentration in the inspiratory limb?

A

Fuel or Galvanic cell

53
Q

What two conditions would set off a high O₂ alarm?

A
  • Premature infants
  • Bleomycin (chemotherapy)
54
Q

What is normal peak airway pressure?

A

18 - 20 mmhg

55
Q

What nerve is the gold standard for peripheral nerve stimulation monitoring?

A

ulnar nerve

56
Q

What is the most resistant place to neuromuscular blocking drugs?

57
Q

What muscle(s) are better indicators (vs the adductor pollicis) of neuromuscular blockade at the laryngeal muscles and abdominal muscles?

A
  • Orbicularis Oculi
  • Corrugator supercilli
58
Q

Single twitch stimulations occurs every…

A

1hz every second

59
Q

TOF fade is noted with what drug class?

A

non-depolarizing NMBD’s

60
Q

What is the case if fade has occurred with succinylcholine administration?

A

Phase II Blockade

61
Q

What are the reversal drugs (and doses) use for intense/extreme blockade?

A
  • Neostigmine N/A
  • Suggamadex 16 mg/kg
62
Q

What are the reversal drugs (and doses) use for deep blockade?

A
  • Neostigmine usually doesn’t work
  • Succinylcholine 4 mg/kg
63
Q

What are the reversal drugs (and doses) used for moderate blockade?

A
  • Neostigmine after TOF 4/4
  • Succinylcholine 2 mg/kg
64
Q

What EEG signals are noted for an awake patient?

A
  • Βeta (>13Hz) waves
65
Q

What EEG signals are noted for patients who are mildly anesthetized?

A

Αlpha (8 - 13Hz) waves

66
Q

What EEG signals are noted for patients who are fully anesthetized?

A

Theta and Delta waves

67
Q

What causes the initial decrease of 0.5 - 1.5°C in anesthesia?

A

Anesthesia induced vasodilation

68
Q

How much will body temp decrease for every hour of surgery?

69
Q

What is the cause of heat loss during anesthesia?

A
  • Anesthesia-induced vasodilation
  • GA-induced decrease in metabolism
70
Q

21°C = ____°F

71
Q

18°C = ____°F

Principles of Anesthesia (24 decks)

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