Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles of Anesthesia I > E1 > Flashcards

E1 Flashcards

1
Q

What is pulse oximetry dependent on to obtain a measurement?

A

Pulsatile expansion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Automatic BP standards and important considerations

A

Average difference +/- 5 mmHg
In reality
• Large variances
• Underestimate MAP during HTN
• Overestimate MAP during HoTN
• Ankle, thigh, calf cuffs  never validated
Averaging/trending for measurements reliability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What information is provided by EtCO2

A

PRIMARY= ventilation

  • Pulmonary blood flow
  • Aerobic metabolism
  • Placement of endotracheal tube/LMA
  • Integrity of breathing circuit
  • Adequacy of cardiac output
  • Dead space (VD) to tidal volume (VT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes, solutions, and description of overdampened system

A 
•↓ SBP=underestimated
•↑DBP=over estimated
•	No dicrotic notch
•↓ pulse pressure
•Loss of detail d/t
•	System too rigid
•	System too short
	Fix= extension
•	Problem w/ Fluids/pressure bag
	Not enough pressure on bag
	Bag is empty
	Fix=change bag; ↑ pressure
•	Air bubbles
	Fix=remove bubbles from system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the law of absorption

A

Beer-Lambert equation
• If a known intensity of light illuminates a chamber of known dimensions
• then the concentration of a dissolved substance can be determined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mechanism of metabolic alkalosis

A

increase PCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are causes of respiratory alkalosis

A 
Increased minute ventilation
Over ventilation
Abnormal CNS ventilation
pulmonary insult (PE)
Liver failure
sepsis
pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Abnormal renal [hco3] reabsorption and [h] elimination is…

A

Metabolic acidosis or alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Characteristics of Oxyhgb dissociation curve in lungs vs tissues/capillaries

A

O2 uptake in lungs
• Bloody nearly saturated
• Across large range of tensions (LEFT shift)
During passage through systemic capillaries
• Large amount of O2 released (RIGHT shift)
• Relatively small drop in tension
 As long as blood is saturated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the diagnostic accuracy of invasive BP monitoring?

A

About 80% accurate
• For color change at 5 second
Pulse oximetry, Doppler doesn’t improve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe waveforms of art-line

A 
1: systolic upstroke
•	Pulsatile flow down artery
2: systolic peak pressure
•	As ventricle repolarizes
3: systolic decline
•	Begin diastole
4: dicrotic notch
•	Produced by blood pushing back on aortic valve
•	Diastole
5: diastolic runoff
•	Atrial contraction
6: end-diastolic pressure
•	DBP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of increased PetCO2 d/t decreased alveolar ventilation

A 
Hypoventilation
Resp center depression
NM disease
High spinal anesthesia
COPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Drawback to sidestream EtCO2 measurement

A

analyzers have a delay time and rise time

the concept being similar to other expired gas analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What determines pH in ECF?

A

A-B balance between [HCO3] and [CO2]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What physiologic action alters CO2?

Why is this important?

A
  • lung ventilation

- Can help correct respiratory disorders quickly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

AANA monitoring standards
Oxygenation
Ventilation
CV

A 
Oxygenation
	Clinical observation
	Pulse oximetry
	ABG’s as indicated
Ventilation
	Auscultation
	Chest excursion
	ETCO2
	Pressure monitors as indicated
Cardiovascular
	ECG
	Auscultation as needed
	BP and HR q 5minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Disadvantages of automatic BP. Rationales

A 
Unsuitable in rapidly changing situations
Patient discomfort
Clinical limitations
•	Extremes of heart rate, pressure
Can cause trauma d/t frequent recycling
•	Coagulopathies
•	Peripheral neuropathies
•	Arterial/venous insufficiency
•	Compartment syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the degree of weak acid dissociation determined by?

What are examples of weak acids?

A

pH
Temperature

Examples:
albumin, phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are symptoms of respiratory acidosis

A

vasodilation
narcosis
cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Arterial line complications

A 
Distal ischemia or pseudoaneurysm
Hemorrhage, hematoma
Arterial embolization
Local infection
Peripheral neuropathy
•	Nerves and vessels in close proximity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the Stewart approach to A-B balance interpretation?

A

Understanding how strong ion difference (SID), weak acid concentration [Atot] and PaCO2 affect AND explain A-B balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is SaO2

A

A ratio of reduced (deoxygenated) Hb to all Hb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are limitations and their causes to auscultating BP

A 
	↓ peripheral flow
•	Shock
•	Intense vasoconstriction
	Changes in vessel compliance
•	Severe edema
•	Calcific arteriosclerosis
	Shivering
	incorrect cuff size
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is systolic pressure variation represent and why does it occur

A

SV changes btwn LH and RH

D/T increased intrathoracic pressure and lung volumes

INC LH and DEC RH SBP d/t end-exp pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What happens when lung volume increases from increased intrathoracic pressure to left ventricular preload, afterload, SV

A

INC LV preload
DEC LV afterload
INC LV SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Invasive BP monitoring sites

A 
Radial
Brachial
Posterior tibial 
Axillary
Dorsalis pedis
Femoral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the stepwise approach of the traditional A-B analysis. 7 steps

A
  1. Is patient hypoxic?
  2. Is the pH normal?
  3. Is it respiratory or metabolic? and What are PaCO2 and HCO3 levels?
  4. Simple or mixed?
  5. Compensated, partially or uncompensated?
  6. Suspected or actual cause?
  7. Treatment?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How is systolic pressure variation measured? Effects of mechanical ventilation

A

 Min pressure, compared to Max pressure
 In mechanically ventilated patients
• Normal = 7-10mmHg total

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Treatment of respiratory acidosis

A

Increase Vm
Ventilator setting changes = increase RR or Vt
Treat cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How are arterial waveforms made?

A

Summation of sine waves

Fundamental wave + harmonic wave = typical pressure wave
•Fundamental wave = Expansion & contraction of vessel in response to pressure wave
• Systolic
•Harmonic wave = “echo” or “ripple” effect of wave
• Diastolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What happens when lung volume increases from increased intrathoracic pressure to right ventricular preload, afterload, SV

A

DEC RH preload/VR
INC RH afterload
DEC RH SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Distal pulse difference in waveforms in periphery

A 
As pressure wave moves TO periphery:
•	Arterial upstroke steeper
•	Systolic peak higher
•	Dicrotic notch later
•	Seen later in waveform
	Longer distance for sine wave to travel
•	End-diastolic pressure lower
•	Wider pulse pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the 3 major causes of decreased PetCO2

A

Equipment malfunction

Decreased CO2 production and delivery to lungs

Increased alveolar ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Acidic or alkalotic?
[H+] > [OH-]
[OH-]>[H+]

A

[H+] > [OH-] = acidic

[OH-]>[H+] = alkalotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the bohr equation

A

(Vd/Vt) = [(PACO2 - PeCO2)/PACO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What happens to dissociation curve if blood poorly saturated

A

• Small amounts of O2 released
• LARGER drop in tension
 Steep slope of dissociation curve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the treatment for respiratory alkalosis?

A

Decrease minute ventilation
Make ventilator changes (dec RR or Vt)
Treat cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are 3 rules of A-B balance

A
  • Electrical neutrality
  • Dissociation equilibriums
  • Mass conservation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

4 types of adult hb

A
  • Oxyhemoglobin (HbO2)
  • Reduced Hb (deoxy)
  • Methemoglobin (metHb)
  • Carboxyhemoglobin (COHb)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Pulse pressure variation equation

A

PPV=[(PPmax-PPmin)/(PPmax + PPmin)/2] x100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

EtCO2 monitor requirements

A

CO2 reading within +/- 12% of actual value

Manufacturers must disclose interference caused by ethanol, acetone, halogenated volatiles

Must have a high CO2 alarm for inhaled and exhaled CO2

Must have an alarm for low exhaled CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are Korotkoff phases?

A 
Phase 1
•	the most turbulent/audible (SBP)
Phase II-III
•	sound character changes
Phase IV-V
•	muffled/absent (DBP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How does HbCO compare to HbO2 at 660 and 940? How does HbCO affect SpO2, especially in smokers?

A

 Absorbs as much light in the 660 nm range as oxyhemoglobin does
 Falsely elevates SpO2
 Each 1% ↑ COHb will ↑ SpO2 1%
 Many smokers have >6% COHb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is SVV

A

Computer analysis of arterial pulse pressure waveform

Area under the waveform

Correlates resistance and compliance
 based on age, gender
 computes SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Describe the Allen’s test

A 
Compresses radial and ulnar arteries
Patient makes a tight fist
•	Exsanguinating the palm
Patient opens hand
Release ulnar artery
•	Color of palm should return in < 10 seconds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

SV pressure curve and contractility

A

slope directly r/t contractility
High slope = high contractility

INC stretch = INC contractility = INC CO/SV

Low slope = low contractility
Less stretch = low contractility = dec CO/SV
d/t dec preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What occurs to substances with polar bonds in water

A

They dissolve or dissociate into component parts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Degree of H2O dissociation and [H+] is affected by what 3 things

A

Strong ions
Weak Acids
CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How is light absorption affected by solute concentration?

A

Light absorption must be measured at wavelengths equal to the number of solutes
• More solutes = more light absorbed
• Less solutes absorbs less light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are symptoms of respiratory alkalosis?

A

Vasoconstriction, lightheadedness, visual disturbances, dizziness, possible hypocalcemia

51
Q

Physiologic cause of metabolic alkalosis

A

Net loss of H+

addition of HCO3-

52
Q

Causes, solutions and description of underdampened system

A 
•↑ SBP = exaggerated
•Square wave  Too much oscillation
•System TOO responsive (↑ resonance) d/t:
•	Longer tubing
	Transmits extra waveforms
	Fix=Decrease tubing length
•	Tubing too distensible
	Fix=Use stiffer tubing
53
Q

What is the traditional and stewart interpretation of respiratory

A

Traditional = increased PaCO2 and decreased pH

Stewart = increased PaCO2

54
Q

What factors are considered in the Stewart approach?

A
  • PaCO2
  • Strong ion difference (SID)
  • Total weak acid concentration [Atot]
55
Q

Principles of distal pulse amplification

A

Arterial pressures measured at different sites
will have different morphologies
• Due to impedence changes along vascular tree

56
Q

Causes of hypocarbia

A

Respiratory alkalosis

Decreases CBF

Potassium shifts to the intracellular space

Blunts normal urge to breath

57
Q

Equation for SVV

A

 SVV= SV max – SV min / SV mean

58
Q

Inflation and bladder standards for BP

A 
Maximum cuff pressure 
•	300mm Hg for adults
•	150mm Hg for neonates
To prevent extended inflation
	Cuff bladder
•	40% of arm circumference
•	80% of length of upper arm
59
Q

Expected PCO2 compensation in metabolic alkalosis

A

PaCO@ = (0.7 x HCO3-) +20

60
Q 
What is normal range of 
PaO2
pH
PaCO2
HCO3
Anion Gap
A 
PaO2= 80-100 mmHg (90)
pH= 7.35-7.45 (7.4)
PaCO2= 35-45 mmHg (40)
HCO3= 22-26 mEq/L (24)
Anion Gap= 14-18 mEq/L (16)
61
Q

What does and increased SPV indicated? How should it be addressed?

A

indicates= early hypovolemia

Give fluid

62
Q

SpO2 limitations (10)

A 
	Failure to determine sat
	Poor function with poor perfusion
	Difficulty in detecting high partial pressures
	Delayed hypoxic event detection
	Erratic performance with dysrhythmias
	Inaccuracy with different hgb	Inaccuracy with dyes
	Optical interference
	Nail polish and coverings
	Motion artifact
63
Q

Causes of hypercarbia

A

Respiratory acidosis

Increases cerebral blood flow

Increases ICP in susceptible patients

Increased pulmonary vascular resistance

Potassium shifts from intracellular to intravascular

64
Q

How are SID and Atot related?

A

Inversely
Acidosis = DEC SID/INC Atot

Alkalosis = INC SID/DEC Atot

65
Q

How is light transmitted when measuring SpO2

A 
Via
	Skin
	Soft tissue
	Venous blood
	Arterial blood
	Capillary  blood
66
Q

How do changes in SID affect A-B balance?

What is normal ECF SID?

A
  • Changes in SID cause changes in [H] and [OH]
  • INCREASED SID = alkalosis
  • DECREASED SID = Acidosis

-Normal = 40-44 mEq/L

67
Q

Advantages of automatic BP

A 
Automaticity
Simplicity
Noninvasive
Reliable
Monitor integration
•	Pulse ox doesn’t alarm if BP monitor inflates
68
Q

First knowledge of pulse?
First recorded BP ?
First sphygmomanometer?

A

 Ancient China and India had some knowledge of pulse
 1st recorded blood pressure: 1733 by Reverend Hales on a horse
 1st sphygmomanometer: 1881 invented by Samuel von Basch

69
Q

What are the signs of acute and chronic respiratory alkalosis compensation

A

Acute = HCO3 will decrease
2 mEq/L for q 10 mmHg decreased CO2 (down to 20)

Chronic = HCO2 will decrease
5 mEq/L for q 10 mmHg decreased CO2 (down to 20)

70
Q

Traditional and stewart interpretation of respiratory alkalosis

A 
Traditional = decreased PCO2 and increased pH
Stewart = Decreased PCO2
71
Q

Accuracy of SpO2 compared to ABG

A

 Accurate (+/- 2%)
• when measured against ABG’s (sat > 70%)
• Not as accurate w/ sat<70%

72
Q

How does peripheral vasoconstriction affect SpO2 and what can lead to it.

A
  • Cold or exogenous catecholamines

* Decrease in pulsatile strength

73
Q

Causes of metabolic alkalosis

A 
Common = GI loss (excess GI suction and Cl- loss)
Diuretics 
Diarrhea
Third spacing
bleeding hypokalemia
74
Q

What is dampening in the art-line system

A
  • Decreases system resonance

* Prevents exaggerated waveforms

75
Q

Treatment of metabolic alkalosis

A

Hypoventilation
Fluid replacement
treat cause

76
Q

What is the ratio of ratios

A

R= (AC 660/DC 660) / (AC 940/DC 940)

77
Q

Abnormal CO2 levels primarily causes…

A

Respiratory acidosis or alkalosis

78
Q

Describe the function of automatic flush, zeroing and leveling the invasive BP monitor

A

Automatic flush
• 1-3ml/hr
• prevents thrombus formation

Zeroing
• References pressures against atmospheric air

Leveling
• Typically  aortic root
• midchest/midaxillary line
• Level where you want to monitor

79
Q

Traditional and stewart interpretation of metabolic alkalosis

A

Traditional= Increased HCO3 and increased pH

Stewart= Increased SID, Cations > anions

80
Q

How is [Atot] related to A-B balance?

A

Increased [Atot] = acidosis

Decreased [Atot]= alkalosis

81
Q

Causes increased PetCO2 due to increased CO2 production/delivery

A 
INC metabolic rate
Fever/sepsis
Sz
MH
Thyrotoxicosis
Inc CO
HCO3 admin
82
Q

How does equipment malfunction cause decreased Petco@

A

Vent disconnection
Esophageal intubation
Complete airway obstruction
leak around ETT

83
Q

Describe the square wave test & purpose

A 
Fast flush
•	Waveform becomes square
•	Flush pressure high matching pressure on bag
Release of fast flush
•	Produces oscillations
•	No more than 2 oscillations
•	Subsequent oscillations = 1/3rd height of previous
This indicates presence of dampening
84
Q

What does degree of dissociation of a substance in water determine?

A

If the substance is a strong acid or base

85
Q

Causes of increased PetCO2 d/t equipment failure

A

Rebreathing
Exhausted SODA lime
Faulty ins/exp valves

86
Q

What does the pulse oximeter actually measure and how

A

Pulsatile expansion of the artery
• ↑ length of light path
• ↑ absorbency

87
Q

How is EtCO2 clinically measured

A

Most commonly relies on IR absorption techniques

The greater the CO2 in the sample, the less IR that reaches the detector

Samples are extracted by one of two methods…

  • Mainstream (non-diverting)
  • Sidestream (diverting)
88
Q

EtCO2 chemical indicator

A

Semi-quantitative
Color change of pH sensitive paper (Litmus)
A type of capnoMETER

89
Q

What is the automatic non-invasive BP technique

A 
Based on oscillometry
•	The maximal amplitude is MAP
•	SBP and DBP calculated from algorithm
•	SBP usually 25-50% of MAP amplitude
•	DBP is least accurate 
Roughly  to directly measured arterial pressure
•	When MAP = 75 mmHg
90
Q

When would monitoring SpO2 on toes be appropriate?

A
  • may be more reliable with epidural blocks

* Vasodilation from block improves pulsatile flow

91
Q

difference in capnometry and capnography

A

Capnometry
-The measurement and quantification of inhaled/exhaled CO2

Capnography
-The method of measurement but also a graphic display or time

92
Q

What does increased and decreased SID indicate

A

Increased = presence of unmeasured ANIONS

Decreased = presence of unmeasured CATIONS

93
Q

What are the major causes of increased PetCO2

A

Increased CO2 production/delivery to lungs

Decreased alveolar vent

Equipment malfunction

94
Q

Tips for monitoring SpO2 on fingers

A

• Dark polish or synthetic nails inhibit transmission
Absorbs or redirects light
• Detection of desaturation and resaturation is slower peripherally
• Don’t put on index finger
High use = ↑ artifact
• sensitive to vasoconstriction

95
Q

How does decrease alv vent cause decreased PetCO2

A

Hyperventilation

96
Q

Indications for invasive BP monitoring

A 
	Continuous needed, real-time
	Planned pharmacologic manipulation
	Repeated blood sampling
	Determination of volume responsiveness
	Timing of IABP counterpulsation
97
Q

What is pulse oximetry

A

Absorbance of light Light through matter

• Transmitted, absorbed or reflected

98
Q

What are the signs of acute and chronic respiratory acidosis compensation?

A

Acute = increase 1 mmHg for q 10 mmHg (>40)

Chronic= increase 4 mEq/L for q 10 mmHg (>40)

99
Q

What information does EtCO2 give and how does it correlate w/ PaCO2

A

informs us about PACO2

Approximates PaCO2 about 4 mmHg

100
Q

If EtCO2 is 36 mmHg what is PaCO2 estimate

A

PaCO2 = ~40 mmHg

101
Q

Disadvantages of invasive BP monitor at brachial, DP, and femoral sites

A 
Brachial 
•	Not used much d/t poor collateral flow
Dorsalis Pedis
•	Much smaller
	Femoral 
•	Easy to access
•	Better in emergency situations
•	Problems
•	Much more positional
•	Infection complications
•	Ligament injury
102
Q

How does dec CO2 production/delivery to lund cause dec PetCO2

A 
Hypothermia
Arrest
PE
Hemorrhage
HoTN
103
Q

What are normal up and down variations for SPV

A

 Normal UP= 2-4mmHg

 Normal DOWN= 5-6mmHg

104
Q

What is strong ion difference (SID)

A

SID = strong cations - strong anions

SD=(Na + K + Ca2 + Mg2) - (Cl- + lactate)

105
Q

What are causes of SpO2 signal artifact and how are they corrected?

A 
-Ambient light
solved by alternating red/infrared
-Low perfusion
if signal amplified, artifact is too
-venous blood pulsation
Longer signal, slower change
-Additional lights
IV dyes, New pulse ox w/ 8 wavelengths filters dye
-Additional forms of Hb
106
Q

What are symptoms of metabolic alkalosis

A

Widespread vasoconstriction
lightheadedness
tetany
paresthesia

107
Q

What does SVV calculation rely on?

What is normal SVV

A

Assumes SR, Vt 8 ml/kg, stable respiration

normal = 13%

108
Q

Difference between uncompensated, partially compensated and fully compensated A-B disorders?

A

uncompensated= abnormal pH and CO2/HCO3

Partially compensated = pH abnormal and both CO2 and HCO3 are adjusting in same direction.

Fully compensated = pH normal, CO2 and HCO3 abnormal and adjusted in same direction

109
Q

Causes of respiratory acidosis

A

Primary = lungs fail to eliminate CO2-hypoventilation

Drug related resp depression/OD
Neuro injury
Lung injury/disease (COPD, ARDS etc)
NMBD

110
Q

What is the best method to confirm endotracheal intubation

A

Detection of carbon dioxide breath-by-breath the

111
Q

Which SpO2 monitoring sights are most sensitive and why

A

Tongue, Cheek, Forehead
• less affected by vasoconstriction
• reflects desat quicker

112
Q

How is hydrogen ion concentration measured?

A

pH (negative log of H concentration)

113
Q

Invasive BP placement techniques

A

1st: Seldinger’s Technique
• Use of guidewire passed through needle

2nd: Transfixion Technique
•	Same positioning and preparation
•	Front and back walls are punctured intentionally
•	Needle removed
•	Catheter withdrawn until pulsatile blood flow appears and then advanced
•	Difficult with
	Long caths
	Small &amp; stiff caths
	Low BP may not be as pulsatile
-not associated w/ more complications
114
Q

What pathology can alter art-line waveform (7)

A 
Age: lack of distensibility
Atherosclerosis
•	↑SBP; ↓DBP?
Embolism
•	Clot on cath
Arterial dissection
Shock
Hypothermia
Vasopressor infusions
115
Q

What is an abnormal pulse pressure variation and what does it indicate?
How should it be addressed?

A

abnormal = >17%

Decrease preload and increased intravascular volume

Fix= volume resus

116
Q

How can invasive BP monitoring waveform be maximized

A 
•Limit stopcocks
•limit tubing length
•	↑s waveform falsely ↑ BP
•non-distensible tubing
•	Prevents pulsatile expansion 
	So that waveform isn’t amplified by tubing
117
Q

Advantages of SpO2 (10)

A 
Accurate
Not affected by gas
Noninvasive
continuous
Can indicate decreased CO
Convenient
Tone modulation
Probe variety
Battery operated
Economical
118
Q

What are Korotkoff sounds?

A

 Series of audible frequencies

 Produced by turbulent flow beyond partially occluding cuff

119
Q

Describe weak acid dissociation in H2O?

A

Partially dissociates in H2O

Degree of dissociation determined by: pH and temp

120
Q

How is pulse pressure measured and what does it indicate?

What is normal

A

utilizes max and min pulse pressures over entire respiratory cycle

Normal <13% ∆

 Maximal difference in arterial pulse pressure
 Divided by average of max & min pulse pressures
 Normal 13-17%

121
Q 
AANA monitoring standards 
Thermoregulation
Neuromuscular
Positioning and protection
Additional
Omission
A

-Thermoregulation
 When significant ∆ in body temp are anticipated or suspected
-Neuromuscular
 When NM blocking agents are administered
-Positioning and protective measures
 Except aspects performed exclusively by other providers
 Note no involvement, or check yourself
-Additional means
 depending on needs of patient, surgical technique or procedure
-Omission with reason must be charted
 Reason why monitoring wasn’t done

122
Q

What is the Boston approach to A-B analysis?

A

A-B maps and relationship between CO2 and HCO23

123
Q

What is AC and DC

A 
AC = pulsatile 
DC = non-pulsatile
124
Q

Why analyze waveform

A

 Hemodynamic resuscitation = begins w/ adequate preload

 Who would benefit from ↑ preload ”reserve”

Principles of Anesthesia I (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions