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P&P Fall 2019 > Ex2 Invasive Monitoring > Flashcards

Ex2 Invasive Monitoring Flashcards

1
Q

SBP in radial artery is _______ than pressure in aorta

A

20-30 mmHg higher

Decreased diastolic

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2
Q

Dicrotic notch

A

Aortic valve closes

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3
Q

Underdamped ABP

A

High flush = 3-4 cycles

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4
Q

Overdamped ABP

A

High flush = 0 oscillations

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5
Q

NAVEL

A

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

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6
Q

As arterial cannulation moves peripherally, what occurs?

A

Distortion, Increased SBP, PP; Decreased DBP

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7
Q

ABP slope of upstroke

A

Myocardial contractility

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8
Q

Large variations in ABP

A

Respiratory variations - large variations may mean hypovolemia

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9
Q

Slope of downstroke

A

SVR

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10
Q

Slurred downstroke

A

Increased afterload

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11
Q

Decreased waveform — variations (PPV)

A

Volume status

Mimic changes in intrathoracic/pulm pressures

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12
Q

CVP is measured at the level of

A

Tricuspid valve

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13
Q

Seldinger Technique

A

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

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14
Q

IJ CVP

A

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

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15
Q

Subclavian Central Line - pros/cons

A

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

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16
Q

Subclavian to RA distance

A

10 cm

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17
Q

RIJ/LIJ to RA distance

A

15/20

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18
Q

Femoral to RA distance

A

40 cm

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19
Q

R/L median basilic to RA distance

A

40/50

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20
Q

Distal tip of CVP catheter (x-ray)

A

Positioned at level above azygos vein
OR
Carina of trachea

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21
Q

LIJ complications

A

Thoracic duct puncture (lymph)

Carotid artery puncture

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22
Q

Air embolism risk is reduced from

A

T-berg position

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23
Q

What complication is most common with a subclavian line?

A

Pneumothorax

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24
Q

What complication is most common with LIJ insertion?

A

Thoracic duct puncture

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25
Q

CVP waveform: a wave

A

Atrial contraction

26
Q

CVP a wave absent

A

A fib

27
Q

CVP a wave exaggerated

A

Junctional rhythms

28
Q

CVP c wave

A

Tricuspid elevation (ventricular contraction)

29
Q

CVP X wave

A

Right ventricular ejection

30
Q

CVP v wave

A

Venous return against closed tricuspid valve

31
Q

CVP y wave

A

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

32
Q

CVP waveform - what’s in diastole?

A

CVP y, a

33
Q

CVP waveform - what’s in systolic phase?

A

CVP c, x, v

34
Q

CVP waveform represents changes in

A

Pressure (NOT volume)

35
Q

Giant V wave that replaces c, x, v waves

A

Tricuspid regurgitation

36
Q

CVP a and c waves fuse

A

Tachycardia d/t PR interval shortened

37
Q

CVP h wave

A

Seen in bradycardia

38
Q

Short y descent

A

Tachycardia

39
Q

CVP v and a waves merge

A

Tachycardia

40
Q

Junctional rhythm difference on CVP waveform

A

Cannon a wave

41
Q

Pronounced c and v wave on CVP

A

Tricuspid regurgitation

42
Q

Elevated CVP (a wave peaked, y descent muted)

A

Tricuspid stenosis

43
Q

Waves mixed together - monophasic CVP

A

Cardiac tamponade

44
Q

PAP contraindications (relative)

A 
LBBB —> complete block 
WPW syndrome
Coagulopathies/significant thrombocytopenia
Prosthetic heart valve
Infxn
45
Q

What is the leading complication of PAP monitoring?

A

Infection (CRBSI)

46
Q

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

A

Intrapulmonary hemorrhage (PA rupture)

47
Q

Normal CVP pressure

A

1-15

48
Q

Normal RV pressure

A

15-30/0-8

49
Q

Normal PA pressure

A

15-30/5-15

50
Q

Normal pulm. Capillary wedge pressure

A

5-15

51
Q

Normal LA pressure

A

4-12

52
Q

Normal LV EDP

A

4-12

53
Q

Normal distance from RIJ insertion to RV

A

25-35

54
Q

Normal distance from RIJ to PA

A

35-45

55
Q

Normal distance from RIJ to PCWP

A

40-50

56
Q

Significant changes in SSEPs

A

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

57
Q

SSEP tests only

A

Dorsal column function not motor

58
Q

What should be avoided in SSEPs?

A

Bolus injections, Nitric (additive)

*continuous infusions preferred

59
Q

Blood supply from anterior spinal artery

A

Motor pathways

60
Q

Blood supply from posterior spinal artery

A

Sensory pathways

61
Q

Are MEPs effected by VAA?

A

Yes - may choose TIVA

P&P Fall 2019 (17 decks)

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