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Principles I summer 2024 > clinical monitoring part 2 > Flashcards

clinical monitoring part 2 Flashcards

1
Q

what are the 3 sampling sites discussed in lecture

A

most common-end total CO2
Y pieve
some nasal cannulas

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2
Q

gas mixture analysis

A

gas must be brought to analyzer- side stream or diverting analyzers
the analyzer brought to the gas in the airway

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3
Q

transit time

A

time lag fro the gas sample to reach the analyzer

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4
Q

rise time

A

time taken by the analyzer to react to the change in gas concentration

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5
Q

side stream response

A

dependent on sampling tubing inner diameter, length, and gas sampling rate
going away from patient

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6
Q

sampling challenges mainstream

A

water vapor
secretions
blood
more interfaces for disconnections

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7
Q

sampling challenges side-stream

A

kinking of sampling tubing
water vapor
failure of sampling pump
leaks in the line
slow response time

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8
Q

what is daltons law

A

total pressure exerted by a mixture of gases is equal to the sum of the partial pressures exerted by each gas mixture

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9
Q

mass spectrometry

A

concentration determined according to mass charge ratio
abundance of ions at specific mass/charge ratios is determined and r/t fractional composition of the gas mixture
can calculate up to eight different gases

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10
Q

raman spectroscopy (raman scattering)

A

high powered argon laser produces photons that collide with gas molecules in a gas sample
scattered photons are measured in a spectrum that ID each gas and its concentration
not in use

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11
Q

what does infrared analysis measure

A

CO2, nitrous oxide, water, volatile anesthetic gas
DOES NOT MEASURE O2

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12
Q

what is fuel or galvanic cell

A

oxygen battery that measures the current produced with oxygen diffuses across a membrane
proportional to PP of oxygen

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13
Q

oxygen monitoring sampling inspiratory and expiratory limb

A

inspiratory limb -ensures oxygen delivery; analyzes hypoxic mixtures
expiratory limb- ensure complete pre oxygenation “denitrogenation”; ET O2 above 90% adequate

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14
Q

reasons for low O2 alarm

A

popline crossover
incorrectly filled tanks
failure of a proportioning system

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15
Q

high O2 alarm

A

premature infants
patient of chemotherapeutic drug

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16
Q

what does airway pressure monitoring detect

A

circuit disconnections
ETT occlusions
kinking in the inspiratory limb
fresh gas hose kink or disconnection
circuit leaks
sustained high circuit pressure
high and low scavenging system pressures

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17
Q

differences between mechanical pressure gauges and electronic pressure gauges

A

mechanical: requires no power always on, and have high reliability, non recording of data, no alarm system, must be continually scanned
electronic: built within ventilator or anesthesia machine, alarm system integrated, sensitive to small changes

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18
Q

what is the primary purpose of low pressure alarm

A

ID of circuit disconnection or leaks
does not detect some partial disconnecting
may not detect misconnections or obstructions

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19
Q

what should the low pressure limit be set to

A

just below the normal peak airway pressure

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20
Q

where do most disconnection occur at

A

Y piece

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21
Q

what does the sub atmospheric pressure alarm do

A

measure and alert negative circuit pressure ad potential for reverse flow of gas

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22
Q

what can negative pressure cause

A

pulmonary edema
atelectasis
hypoxia

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23
Q

what are causes of negative pressure

A

active (suction) scavenging system malfunctions
Pt inspiratory effort against a blocked circuit
inadequate fresh gas flow
suction to misplaced NGT/OGT
moisture in CO2 absorbent

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24
Q

causes of high pressure alarms

A

obstructions
reduced compliance
coughing/straining
kinked ETT
endobronchial intubation

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25
continuing pressure alarms
triggered with circuit pressure exceeds 10cmH2O for >15seconds fresh gas continues to enter the circuit but cannot leave
26
causes of continuing pressure alarm
malfunctioning adjustable pressure relief valve, scavenging system occlusion, activation of oxygen flush system, malfunctioning PEEP
27
the 3 types of peripheral nerve monitoring
electrical and magnetic electrical nerve stimulation (most common) magnetic- not used
28
2 sites of nerve stimulation
ulnar nerve- gold standard facial nerve
29
which nerve is the lowest risk of direct muscle stimulation
ulnar nerve-adductor pollicis muscle easily accessible
30
what nerve can be used when arms are unavailable
facial nerve orbicularis oculi and facial nerve corruptor supercilii muscle
31
what is the most resistant to depolarizing and non depolarizing NMBDs
diaphragm last to go to sleep first to wake up
32
what reflects extent of neuromuscular block of laryngeal adductor and abdominal muscle better
corrugated supercilii > adductor pollicis
33
single twitch has a single twitch applied from
1.0 Hx every second to 0.1Hz every 10seconds
34
train of 4 provided reliable information throughout
all phases of neuromuscular blockade w/o monitoring device
35
how often does train of 4 send supra maximal stimuli
every 0.5 seconds
36
what is the TOF ratio
4th response/ 1st response
37
partial non depolarizing block TOF
ration decrease fade and inversely proportional to degree of block
38
partial depolarizing block
no fade ratio is 1.0 if fade phase II block developed
39
double burst stimulation is
2 short bursts of 50Hz titanic stimulation separated by 750ms w/ 0.2ms duration of each square wave impulse in the burst
40
DBS 3,3 mode
3 impulses in each of the 2 burst
41
DBS 3,2 mode
1st burst has 3 impulses and 2nd has 2 impulses
42
tetanic stimulation is given at ______Hz for ________ seconds
50Hz for 5 seconds
43
post tetanic stimulation pattern
tetanic stimulation follows by 10-15 single twitches (1Hz after 3seconds post tetanic stimulation)
44
what is response dependent on for post tetanic stimulation
degree of blockade frequency and duration of tetanic stimulation length of time between the end of tetanic stimulation and first post tentanic stimulus frequency of the single twitch stimulation duration of single twitch stimulation before tetanic stimulation
45
how often do you preform post tetanic stimulation
every 6 minutes
46
non depolarizing blockade intense
period of no response 3-6 minuets after intubating dose of non-depolarizing NMBD
47
non depolarizing blockade deep
absence of TOF but presence of at least one response to post tetanic count stimulation
48
non depolarizing blockade moderate
gradual return of the 4 responses to TOF stimulation appears
49
when would neostigmine reversal be possible and impossible
moderate - after 4/4 TOF deep (usually impossible) intense-impossible
50
what is the dose of sugammadex for intense
16mg/kg
51
what is the dose of sugammadex for deep
4mg/kg
52
what is the dose of sugammadex for moderate
2mg/kg
53
depolarizing blockade phase 1
no fade or tetanic stimulation; no post tetanic facilitation occurs all 4 responses are reduced yet equal and then all disappear simultaneous in TOF (ratio 0.1) normal plasma cholinesterase activity
54
depolarizing blockade phase II
fade present in response to TOF and tetanic stimulation; occurrence of post tetanic facilitation response is similar to non depolarizing blockade abnormal plasma cholinesterase activity
55
what are reliable clinical signs
sustained head lift for 5 seconds sustained leg lift for 5 seconds sustained handgrip for 5 seconds sustained tongue depressor test maximum inspiratory pressure
56
what does the EEG ID
consciousness, seizure activity, stages of sleep, coma, inadequate oxygen delivery to the brain
57
Peri op uses for EEG concepts
ID inadequate blood flow to cerebral cortex guides an anesthetic induced reduction of cerebral metabolism used to predict neurologic outcome after a brain insult gauges the depth of the hypnotic state of patient under GA
58
EEG signals beta
>13Hz awake alert attentive brain
59
EEG signals alpha
8-13Hz eyes closed anesthetic effects
60
Theta and delta EEG signals
4-7Hz <4Hz depressed
61
what is the BIS
processes EEG signal to estimate anesthetic depth method to prevent intraop awareness
62
sensory evoked response latency
time measured from the application of the stimulus to the onset or peak of the response
63
sensory evoked response amplitude
size of voltage of recored signal
64
Somatosensory evoked potentials
monitor the responses to stimulation of peripheral mixed nerves
65
brainstem auditory evoked potentials
monitor the responses to click stimuli that are delivered via foam ear inserts along the auditory pathway from the eat to the auditory cortex
66
Visual evoked potentials
monitors the responses to flash stimulation of the retina using light emitting diodes embedded is soft plastic gogles through closed eyelids or contact lenses least commonly used monitoring technique intra op
67
transcranial motor evokes potentials
most common MEP monitors stimuli along the motor tract via transcranial electrical stimulation overlying the motor cortex
68
electromyography
monitors the responses generated by cranial and peripheral motor nerves to allow early detection of surgically induced nerve damage and assessment of the level of nerve function intra op assesses the integrity of cranial or peripheral nerves at risk during surgery
69
what is the primary thermoregulatory control center
hypothalamus
70
what fibers are heat and warmth receptors
unmylinated C fibers
71
what fibers are the cold receptors
alpha delta fibers
72
thermoregulatory response is characterized by
threshold -temp at which a response will occur gain -intensity of response response- sweating, vasodilation, vasoconstriction, shivering
73
hypothermia in GA initially
rapid decrease of approx 0.5-1.5 degrees C caused by anesthesia induced vasodilation increase heat loss d/t redistribution of body heat
74
hypothermia in GA slow linear reduction
approx 0.3C /hr GA decrease metabolic rate by 20-30% heat loss exceeds production 1-2 hours after anesthesia
75
hypothermia in GA plateau phase
thermal steady state heat loss equals heat production occurs 3-4 hours after anesthesia vasoconstriction prevents loss of heat from core but peripheral heat continues to be lost
76
mental thermoregulatory control is _________ by neuroaxial anesthesia
inhibited
77
methods of heat transfer radiation
heat loss to environment approx 40% of heat loss in patient BSA exposed to environment infants: high BSA/body mass ration makes them vulnerable
78
methods of heat transfer convection
loss of heat to air immediately surrounding the body approx 30% clothing or drapes decrease heat loss greater in rooms with laminar air flow
79
methods of heat transfer evaporation
latent heat of vaporization of water from open body cavities and respiratory tract, approx 8-10%; sweating is main pathway
80
methods of heat transfer conduction
heat loss due to direct contact of body tissues or fluids with a colder material negligible
81
hypothermia complications 7 discussed in lecture
coagulapathy (impairs plt aggregation) increase need for transfusion by 22%; blood loss by 16% decrease oxygen delivery to tissues 3x incidence of morbid cardiac outcomes shivering decreased drug metabolism post op thermal discomfort
82
benefits of hypothermia 5 discussed in lecture
protective against cerebral ischemia reduces metabolism 8% per degree celsius improved outcome during recovery from cardiac arrest neurosurgery when brain tissue ischemia is expected more difficult to trigger MH
83
who is airway heating and humidification used on mostly
infants and children
84
where should the hot water mattresses be placed
on top of patients
85
monitoring sites for temp
pulmonary artery-gold standard tympanic membrane-risk for perforation nasopharyngeal -more prone to error esophagus
86
what is the OR temperatures
70 F= 21C (children) 65F =18C

Principles I summer 2024 (7 decks)

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