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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
Q

continuing pressure alarms

A

triggered with circuit pressure exceeds 10cmH2O for >15seconds
fresh gas continues to enter the circuit but cannot leave

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26
Q

causes of continuing pressure alarm

A

malfunctioning adjustable pressure relief valve, scavenging system occlusion, activation of oxygen flush system, malfunctioning PEEP

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27
Q

the 3 types of peripheral nerve monitoring

A

electrical and magnetic
electrical nerve stimulation (most common)
magnetic- not used

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28
Q

2 sites of nerve stimulation

A

ulnar nerve- gold standard
facial nerve

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29
Q

which nerve is the lowest risk of direct muscle stimulation

A

ulnar nerve-adductor pollicis muscle easily accessible

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30
Q

what nerve can be used when arms are unavailable

A

facial nerve orbicularis oculi and facial nerve corruptor supercilii muscle

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31
Q

what is the most resistant to depolarizing and non depolarizing NMBDs

A

diaphragm
last to go to sleep first to wake up

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32
Q

what reflects extent of neuromuscular block of laryngeal adductor and abdominal muscle better

A

corrugated supercilii > adductor pollicis

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33
Q

single twitch has a single twitch applied from

A

1.0 Hx every second to 0.1Hz every 10seconds

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34
Q

train of 4 provided reliable information throughout

A

all phases of neuromuscular blockade w/o monitoring device

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35
Q

how often does train of 4 send supra maximal stimuli

A

every 0.5 seconds

36
Q

what is the TOF ratio

A

4th response/ 1st response

37
Q

partial non depolarizing block TOF

A

ration decrease fade and inversely proportional to degree of block

38
Q

partial depolarizing block

A

no fade ratio is 1.0
if fade phase II block developed

39
Q

double burst stimulation is

A

2 short bursts of 50Hz titanic stimulation separated by 750ms w/ 0.2ms duration of each square wave impulse in the burst

40
Q

DBS 3,3 mode

A

3 impulses in each of the 2 burst

41
Q

DBS 3,2 mode

A

1st burst has 3 impulses and 2nd has 2 impulses

42
Q

tetanic stimulation is given at ______Hz for ________ seconds

A

50Hz for 5 seconds

43
Q

post tetanic stimulation pattern

A

tetanic stimulation follows by 10-15 single twitches (1Hz after 3seconds post tetanic stimulation)

44
Q

what is response dependent on for post tetanic stimulation

A

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
Q

how often do you preform post tetanic stimulation

A

every 6 minutes

46
Q

non depolarizing blockade intense

A

period of no response
3-6 minuets after intubating dose of non-depolarizing NMBD

47
Q

non depolarizing blockade deep

A

absence of TOF but presence of at least one response to post tetanic count stimulation

48
Q

non depolarizing blockade moderate

A

gradual return of the 4 responses to TOF stimulation appears

49
Q

when would neostigmine reversal be possible and impossible

A

moderate - after 4/4 TOF
deep (usually impossible)
intense-impossible

50
Q

what is the dose of sugammadex for intense

A

16mg/kg

51
Q

what is the dose of sugammadex for deep

A

4mg/kg

52
Q

what is the dose of sugammadex for moderate

A

2mg/kg

53
Q

depolarizing blockade phase 1

A

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
Q

depolarizing blockade phase II

A

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
Q

what are reliable clinical signs

A

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
Q

what does the EEG ID

A

consciousness, seizure activity, stages of sleep, coma, inadequate oxygen delivery to the brain

57
Q

Peri op uses for EEG concepts

A

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
Q

EEG signals beta

A

> 13Hz
awake
alert attentive brain

59
Q

EEG signals alpha

A

8-13Hz
eyes closed
anesthetic effects

60
Q

Theta and delta EEG signals

A

4-7Hz
<4Hz
depressed

61
Q

what is the BIS

A

processes EEG signal to estimate anesthetic depth
method to prevent intraop awareness

62
Q

sensory evoked response latency

A

time measured from the application of the stimulus to the onset or peak of the response

63
Q

sensory evoked response amplitude

A

size of voltage of recored signal

64
Q

Somatosensory evoked potentials

A

monitor the responses to stimulation of peripheral mixed nerves

65
Q

brainstem auditory evoked potentials

A

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
Q

Visual evoked potentials

A

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
Q

transcranial motor evokes potentials

A

most common MEP
monitors stimuli along the motor tract via transcranial electrical stimulation overlying the motor cortex

68
Q

electromyography

A

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
Q

what is the primary thermoregulatory control center

A

hypothalamus

70
Q

what fibers are heat and warmth receptors

A

unmylinated C fibers

71
Q

what fibers are the cold receptors

A

alpha delta fibers

72
Q

thermoregulatory response is characterized by

A

threshold -temp at which a response will occur
gain -intensity of response
response- sweating, vasodilation, vasoconstriction, shivering

73
Q

hypothermia in GA initially

A

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
Q

hypothermia in GA slow linear reduction

A

approx 0.3C /hr
GA decrease metabolic rate by 20-30%
heat loss exceeds production
1-2 hours after anesthesia

75
Q

hypothermia in GA plateau phase

A

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
Q

mental thermoregulatory control is _________ by neuroaxial anesthesia

A

inhibited

77
Q

methods of heat transfer radiation

A

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
Q

methods of heat transfer convection

A

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
Q

methods of heat transfer evaporation

A

latent heat of vaporization of water from open body cavities and respiratory tract, approx 8-10%; sweating is main pathway

80
Q

methods of heat transfer conduction

A

heat loss due to direct contact of body tissues or fluids with a colder material negligible

81
Q

hypothermia complications 7 discussed in lecture

A

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
Q

benefits of hypothermia 5 discussed in lecture

A

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
Q

who is airway heating and humidification used on mostly

A

infants and children

84
Q

where should the hot water mattresses be placed

A

on top of patients

85
Q

monitoring sites for temp

A

pulmonary artery-gold standard
tympanic membrane-risk for perforation
nasopharyngeal -more prone to error
esophagus

86
Q

what is the OR temperatures

A

70 F= 21C (children)
65F =18C

Principles I summer 2024 (7 decks)

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