Clinical Monitoring in Anesthesia

Question 1

Standards for minimum requirements set by the

Answer 1

AANA

Question 2

Standards for monitoring

Answer 2

Set a legal precedence

Morbidity and mortality decrease

Question 3

When was standards for monitoring established

Answer 3

1974

Question 4

Expected standard of care established by

Answer 4

JCAHO

Question 5

Harvard established also in

Answer 5

1986

Question 6

Which standard number

Answer 6

Standard V professional practice manual

Question 7

What are the standards for monitoring

Answer 7

Ventilation
Oxygen
Circulation
Body Temperature
Neuromuscular function
Positioning

Question 8

AANA standard for Ventilation

Answer 8

Continuous ETCO2 monitoring

Question 9

Verify intubation by (3)

Answer 9

Auscultation
Positive chest excursion ( Bilaterally)
Presence of Exhaled CO2

Question 10

AANA Standards for Oxygenation

Answer 10

Continous clinical observation
Continuous Pulse Oximetry
ABG (if indicated)

Question 11

AANA Standards for Circulation

Answer 11

Continous ECG and heart sounds
KEEP volume level where you NEED to hear it
BP and HR at least q5minutes

Question 12

AANA Standards for Body Temperature

Answer 12

Continuous monitoring on all PEDIATRIC patients receiving GA

Question 13

Goal for body temperature

Answer 13

GREATER than 97F

LESS Than 97, WRITTEN UP

Question 14

The colder the patient

Answer 14

the longer the anesthetics stay on board

Question 15

Neuromuscular blockade need

Answer 15

Train of Four q15 minutes

Question 16

Need to show proof of

Answer 16

Reversal of agent need to be documented

Question 17

Reverse with

Answer 17

Neogstigmine and Glycopyrrolate

Question 18

INVASIVE monitors

Answer 18

Foley
Arterial line
CVP
PA catheter

Question 19

Urine output

Answer 19

1 ml/kg/hr

Question 20

Case over 3 hours, what may be indicated?

Answer 20

Foley may be indicated

Question 21

Brown port

Answer 21

CVP , position of the bed

Question 22

Ditstal port

Answer 22

Brown

Question 23

Your senses is

Answer 23

the ART of anesthesia

Question 24

Vigilance include

Answer 24

Vigilance, sight, hearing, Touch, smell

Question 25

Stethocoscope

Answer 25

Precordial vs Esophageal

Question 26

Required for every PEDIATRIC patient

Answer 26

Precordial

Question 27

Precordial does what

Answer 27

``` Metal chest piece connected Easily detect changes in breath and heart sound EndoBRONCHIAL INTUBATION ( ```

Question 28

Mainstay of intubation

Answer 28

Capnography

Question 29

Sampling port by

Answer 29

Elbow of the circuit

Question 30

To analyze the particle size and the concentration of the gas both inspired and exhaled

Answer 30

MASS SPECTOMETER

Question 31

Which part of the most important to monitor

Answer 31

EXHALATION of the gas

Question 32

Most soluble

Answer 32

Isoflurane

Question 33

Least soluble

Answer 33

Desflurane

Question 34

ETCO2 scavenging

Answer 34

None

Question 35

Clinical Application of Capnometry best indicator of MH

Answer 35

Increased CO2

Question 36

If CO2 start dropping

Answer 36

Monitor BP (estimate Co)

Question 37

Respiration Mandatory

Answer 37

Apnea monitor

Question 38

Hyperventilating (CO2 low) for craniotomy

Answer 38

Decrease CBF (CO2 low to 20 mmHg)

Question 39

Mannitol in craniotomy

Answer 39

decrease brain volume and Diuresis

Question 40

Phase of CApnograpy

Answer 40

I- IV

Question 41

Phase I is

Answer 41

Dead space Ventilation

Question 42

Baseline elevattion indicates

Answer 42

CO2 absorbent exhausted Incompetent ex or inspiratory valve Bain circuit flow too low

Question 43

CO2 should be

Answer 43

Zero unless rebreathing occurs

Question 44

PHase II

Answer 44

Exhalation , should be steep

Question 45

Prolonged upstroke of Phase II

Answer 45

Mechanical obstruction | Slow emptying of the lungs (COPD/ Bronchospasm)

Question 46

Phase III is

Answer 46

Plateau

Question 47

Phase III represents

Answer 47

maximum CO2 at end of phase

Question 48

Right main stem would see

Answer 48

Change in Phase III

Question 49

Phase IV

Answer 49

Inspiratory phased

Question 50

Prolonged phase IV

Answer 50

Restrictive lung disease

Question 51

Smaller and smaller Waveerform

Answer 51

Endobronchial or ESOPHAGEAL intubation

Question 52

Decreases height of capnography

Answer 52

Decrease in CO

Question 53

Esophageal intubation

Answer 53

smaller waverform of CO2

Question 54

Waveform increasing , gradual

Answer 54

Hypoventilating

Question 55

Long inspiratory phase

Answer 55

sticky inspiratory valve

Question 56

Cardiogenic Oscillations

Answer 56

Artifarct

Question 57

O2 analyzer

Answer 57

Inspiratory limb

Question 58

Require pulsatile (issues with cold finger)

Answer 58

Nitro paste on finger, put pulse ox back on

Question 59

Oximetry involves the measurement of oxyhemoglobin (HbO2) concentration based on the

Answer 59

Lambert-Beer law

Question 60

IV dye will

Answer 60

Pulse ox will decrease

Question 61

O2 saturation is

Answer 61

directly proportional to the hemoglobin

Question 62

SaO2 30 is

Answer 62

60

Question 63

SaO2 40 is

Answer 63

75

Question 64

No waveform

Answer 64

Digital palpation

Question 65

No CO

Answer 65

NO pulse ox

Question 66

Most commonly used is

Answer 66

Lead II

Question 67

Too small

Answer 67

Falsely high readings

Question 68

Too large

Answer 68

falsely low readings

Question 69

Correct size is

Answer 69

20-50% > than diameter of patient extremity