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ARCHIVED: Assessment > Exam 1: Hemodynamic Monitoring > Flashcards

Exam 1: Hemodynamic Monitoring Flashcards

1
Q

Four parameters that are continually evaluated during anesthesia:

A

Oxygenation
Ventilation
Circulation
Temperature

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2
Q

Two exceptions to constant-presence requirement:

A

Laboring moms

Pain mgmt

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3
Q

Minimal standard monitors (6):

A 
BEPPOE:
BP
EKG
Precordial stethoscope 
Pulse ox
Oxygen analyzer
ETCO2
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4
Q

Minimal information on monitor display:

A 
BEVOH:
BP
EKG
Ventilation status (ETCO2)
O2 Saturation
HR
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5
Q

Means of hemodynamic monitoring (6):

A 
Stethoscope
EKG
BP (invasive and non)
CVP
PAP/PCWP
TEE
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6
Q

Esophageal stethoscope distance of insertion:

A

28-30cm

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7
Q

Advantage of esophageal/precordial stethoscope:

A

Very sensitive monitor for bronchospasm/changes in pediatric patients

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8
Q

Purposes of EKG monitoring (5):

A 
Detect arrythmias
Monitor HR
Detect ischemia
Detect electrolyte changes
Monitor pacemaker
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9
Q

Best EKG lead for rhythm detection:

A

II

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10
Q

Best EKG lead for ischemia detection:

A

V

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11
Q

3-lead leads:

A

I, II, III

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12
Q

5-lead leads:

A

I, II, III, aVR, aVL, aVF, V

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13
Q

Significant coronary artery not viewed in a 3-lead:

A

LAD

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14
Q

Reasons for EKG artifact:

A 
Cautery/electrical equip
Movement
Hair
Sweat
Shivering
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15
Q

Gain standard: ____ signal produces _____ calibration pulse so that a _____ ST segment change can be accurately assessed

A

1mV; 10mm; 1mm

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16
Q

Two EKG filtering modes:

A

Monitor

Diagnostic

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17
Q

Filtering should be set to this mode:

A

Diagnostic

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18
Q

Five principle indicators of acute ischemia:

A

ST segment elevation or depression
T wave inversion or peaking
Q wave development

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19
Q

Leads to detect posterior/inferior wall ischemia (RCA):

A

II
III
AVF

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20
Q

Leads to detect lateral wall ischemia (circumflex):

A

I
AVL
V5-V6

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21
Q

Leads to detect anterior wall ischemia (LCA):

A

I
AVL
V1-V4

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22
Q

Leads to detect anterioseptal ischemia (LAD):

A

V1-V4

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23
Q

Changes in SBP correlate with:

A

Changes in myocardial O2 requirements

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24
Q

Changes in DBP correlate with:

A

Coronary perfusion pressure

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25
Q

MAP calculation:

A

SBP+2(DBP)/3

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26
Q

As pulse moves distally, it’s distorted this way:

A

Exaggerated SBP/wider pulse pressure

27
Q

Rate of a-line upstroke correlates with:

A

Contractility

28
Q

Rate of a-line downstroke correlates with:

A

SVR

29
Q

Exaggerated change in a-line waveform with respiration indicates:

A

Hypovolemia

30
Q

Area under the a-line curve equals:

A

MAP

31
Q

Biggest a-line risk:

A

Hemorrhage/hematoma

32
Q

Best site for CVC and why:

A

RIJ - straight shot to heart, best success rate

33
Q

Better side for subclavian:

A

R

34
Q

Lowest infection rate CVC site:

A

Subclavian

35
Q

Highest infection rate CVC site:

A

Femoral

36
Q

CVC placement confirmation in OR setting:

A

Aspiration of blood from all 3 ports

37
Q

Contraindications to CVC:

A

R atrial tumor
Infection at site
Contralateral pneumothorax

38
Q

The one non-technique based CVC risk:

A

Dysrhythmias

39
Q

Normal mean RA/CVP pressure during spontaneous respiration:

A

1-7mmHg

40
Q

Normal mean RA/CVP pressure during mechanical ventilation:

A

4-12mmHg

41
Q

CVP “a” wave caused by:

A

Atrial contraction

42
Q

CVP “c” wave caused by:

A

R ventricular contraction and bulging of tricuspid back into R atrium

43
Q

CVP “x” descent caused by:

A

Ventricular contraction and relaxation of atrium

44
Q

CVP “v” wave caused by:

A

Filling of atrium with blood from vena cava

45
Q

CVP “y” descent caused by:

A

Tricuspid valve opening and ventricular filling

46
Q

Dimensions of PAP catheter:

A

7-9 Fr

110 cm

47
Q

Dimensions of CVC catheter:

A

7 Fr

20 cm

48
Q

Only patients with demonstrated benefits to PAP monitoring:

A

Shock/sepsis pts

49
Q

Biggest complications of PAP monitoring:

A

Arrythmias

PA rupture

50
Q

Pressures in RA:

A

1-7 mmHg

51
Q

Pressures in RV:

A

0-25mmHg

52
Q

Pressures in PA:

A

10-25mmHg

53
Q

Pressures in PAW:

A

8-12mmHg

54
Q

Distance from RIJ to RA:

A

15-25cm

55
Q

Distance from RIJ to RV:

A

25-35cm

56
Q

Distance from RIJ to PA:

A

35-45cm

57
Q

Distance from RIJ to PAW:

A

40-50cm

58
Q

PAWP “a” wave represents:

A

Contraction of LA

Tallest wave

59
Q

PAWP “c” wave represents:

A

Rapid rise in LV pressure during early systole that causes mitral valve to bulge backwards

(Shortest wave)

60
Q

PAWP “v” wave represents:

A

Blood entering LA during late systole

61
Q

Prominent PAWP “v” wave reflects:

A

Mitral valve insufficiency

62
Q

Cardiac parameters observed via TEE (7):

A 
Ventricular wall motion
Valve structure/function
EF estimation
CO
Flow characteristics
Intracardiac air
Intracardiac masses
63
Q

Indications for TEE:

A

Unusual and unknown causes of acute hypotension

64
Q

Major complication of TEE:

A

Esophageal trauma

ARCHIVED: Assessment (11 decks)

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