Ex2 Invasive Monitoring

Question 1

SBP in radial artery is _______ than pressure in aorta

Answer 1

20-30 mmHg higher

Decreased diastolic

Question 2

Dicrotic notch

Answer 2

Aortic valve closes

Question 3

Underdamped ABP

Answer 3

High flush = 3-4 cycles

Question 4

Overdamped ABP

Answer 4

High flush = 0 oscillations

Question 5

NAVEL

Answer 5

Nerve artery vein as you move towards belly button (femoral line)

Question 6

As arterial cannulation moves peripherally, what occurs?

Answer 6

Distortion, Increased SBP, PP; Decreased DBP

Question 7

ABP slope of upstroke

Answer 7

Myocardial contractility

Question 8

Large variations in ABP

Answer 8

Respiratory variations - large variations may mean hypovolemia

Question 9

Slope of downstroke

Answer 9

SVR

Question 10

Slurred downstroke

Answer 10

Increased afterload

Question 11

Decreased waveform — variations (PPV)

Answer 11

Volume status

Mimic changes in intrathoracic/pulm pressures

Question 12

CVP is measured at the level of

Answer 12

Tricuspid valve

Question 13

Seldinger Technique

Answer 13

Guidewire threaded thru vein, needle removed/catheter advanced over guidewire then guidewire removed

Question 14

IJ CVP

Answer 14

Most common site
Sternal/clavicular heads of SCM muscle
30* towards ipsilateral needle

Question 15

Subclavian Central Line - pros/cons

Answer 15

Decreased rate of infection
*no finder needle
Most common risk of Pneumothorax, hemothorax

Question 16

Subclavian to RA distance

Answer 16

10 cm

Question 17

RIJ/LIJ to RA distance

Answer 17

15/20

Question 18

Femoral to RA distance

Answer 18

40 cm

Question 19

R/L median basilic to RA distance

Answer 19

40/50

Question 20

Distal tip of CVP catheter (x-ray)

Answer 20

Positioned at level above azygos vein
OR
Carina of trachea

Question 21

LIJ complications

Answer 21

Thoracic duct puncture (lymph)

Carotid artery puncture

Question 22

Air embolism risk is reduced from

Answer 22

T-berg position

Question 23

What complication is most common with a subclavian line?

Answer 23

Pneumothorax

Question 24

What complication is most common with LIJ insertion?

Answer 24

Thoracic duct puncture

Question 25

CVP waveform: a wave

Answer 25

Atrial contraction

Question 26

CVP a wave absent

Answer 26

A fib

Question 27

CVP a wave exaggerated

Answer 27

Junctional rhythms

Question 28

CVP c wave

Answer 28

Tricuspid elevation (ventricular contraction)

Question 29

CVP X wave

Answer 29

Right ventricular ejection

Question 30

CVP v wave

Answer 30

Venous return against closed tricuspid valve

Question 31

CVP y wave

Answer 31

Tricuspid valve opening, blood flow into ventricle, decrease in RA pressure

Question 32

CVP waveform - what’s in diastole?

Answer 32

CVP y, a

Question 33

CVP waveform - what’s in systolic phase?

Answer 33

CVP c, x, v

Question 34

CVP waveform represents changes in

Answer 34

Pressure (NOT volume)

Question 35

Giant V wave that replaces c, x, v waves

Answer 35

Tricuspid regurgitation

Question 36

CVP a and c waves fuse

Answer 36

Tachycardia d/t PR interval shortened

Question 37

CVP h wave

Answer 37

Seen in bradycardia

Question 38

Short y descent

Answer 38

Tachycardia

Question 39

CVP v and a waves merge

Answer 39

Tachycardia

Question 40

Junctional rhythm difference on CVP waveform

Answer 40

Cannon a wave

Question 41

Pronounced c and v wave on CVP

Answer 41

Tricuspid regurgitation

Question 42

Elevated CVP (a wave peaked, y descent muted)

Answer 42

Tricuspid stenosis

Question 43

Waves mixed together - monophasic CVP

Answer 43

Cardiac tamponade

Question 44

PAP contraindications (relative)

Answer 44

``` LBBB —> complete block WPW syndrome Coagulopathies/significant thrombocytopenia Prosthetic heart valve Infxn ```

Question 45

What is the leading complication of PAP monitoring?

Answer 45

Infection (CRBSI)

Question 46

What is the most life threatening complication of a PA catheter?

Answer 46

Intrapulmonary hemorrhage (PA rupture)

Question 47

Normal CVP pressure

Answer 47

1-15

Question 48

Normal RV pressure

Answer 48

15-30/0-8

Question 49

Normal PA pressure

Answer 49

15-30/5-15

Question 50

Normal pulm. Capillary wedge pressure

Answer 50

5-15

Question 51

Normal LA pressure

Answer 51

4-12

Question 52

Normal LV EDP

Answer 52

4-12

Question 53

Normal distance from RIJ insertion to RV

Answer 53

25-35

Question 54

Normal distance from RIJ to PA

Answer 54

35-45

Question 55

Normal distance from RIJ to PCWP

Answer 55

40-50

Question 56

Significant changes in SSEPs

Answer 56

Reduction in amplitude by 50% + Increase in latency by 10%

Question 57

SSEP tests only

Answer 57

Dorsal column function not motor

Question 58

What should be avoided in SSEPs?

Answer 58

Bolus injections, Nitric (additive) | *continuous infusions preferred

Question 59

Blood supply from anterior spinal artery

Answer 59

Motor pathways

Question 60

Blood supply from posterior spinal artery

Answer 60

Sensory pathways

Question 61

Are MEPs effected by VAA?

Answer 61

Yes - may choose TIVA