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Equipment II > Final > Flashcards

Final Flashcards

1
Q

High velocity flow across a valve signifies

A

Stenosis

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2
Q

6 Complications of PAC

A

Carotid/SC artery puncture/cannulation

Perf of RA, RV, or PA

Cardiac dysrhythmia

Heart block (RBBB)

Knotting of catheter

Improper tx based on data

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3
Q

Issues with propofol with EP

A

Shorten or no effect on QT

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4
Q

Monitor utility for ECG with imyocardial ischemia

A

QRST abnormality

Rhythm and conduction

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5
Q

Advantages of internal jugular central venous cannulation

A

Accessible

Good landmarks

Straight shot for PAC

Less chance of pneumo

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6
Q

On color Doppler blood flowing towards the transducer is what color

A

Red

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7
Q

PAC provide indirect measurement of LV filling and CO but are (2 disadvantages)

A

Invasive

Associated with adverse events

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8
Q

Clinical points of interest for radial cannulation

A

Preferred site
Ease of access
Low complication rate

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9
Q

Pacer mode for SSS in absence of AVB or AF

A

AAI

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10
Q

Strategies to minimize EMI during sg

A

Short burst of mono polar cautery

Ground pad should not be placed at vector with device

TENS and cells may interfere with unipolar devices

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11
Q

7 uses of TEE

A

Ass. Heart fx and volume

Eval MI

Assess valve anatomy and fx

Eval aorta

Detect intracranial defects

Eval pericardial effusions

Detect intracardiac air, clots, masses

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12
Q

6 potential complications of arterial cannulation

A
  • Infection
    -Hemorrhage
  • Thrombosis- distal
    ischemia
  • skin necrosis
  • embolization (central and
    Peripheral)
  • inaccurate pressure measurement
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13
Q

4 complications associated with TEE

A

Esophageal perforation

GI hemorrhage

Oral damage

Misinterpretation

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14
Q

Conscious sedation for EP/device procedures

A

Responsive pt

NC only

Versed, fentanyl, low dose propofol

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15
Q

CVP is useful for trending _______ but not a reliable indicatior of _______

A

Trending intravascular volume

Not reliable indicator of LV filling

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16
Q

Basic TEE incorporates ___ windows to perform assessment of cardiopulmonary function

A

11

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17
Q

“X” and “Y” wave on CVP represent

A

Ventricular filling and diastolic collapse

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18
Q

3 effects of electromagnetic interference (EMI) with PPM/ICD

A

Pacer/ICD sensing issues

Inappropriate anti-tachy therapies

Generator damage

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19
Q

Floating PAC from RIJ

Do not float swan past

A

65cm

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20
Q

5 indications for TEE

A

CP instability

Suspicion of LV dysfx

MI

Hypovolemia

PE

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21
Q

Typically magnet may have what effect on PPM

A

Pace asynchronously

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22
Q

Arterial waveform analysis dichroic notch represents

A

Aortic valve closure

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23
Q

Arterial waveform analysis Ps represents

Pd represents

A

SBP

DBP

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24
Q

Floating PAC from RIJ

Distance to RA

A

20cm

Provides CVP trace

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25
Q

3 disadvantages of US guided arterial cannulation

A

Infection if poor sterile technique

Additional training required

Equipment costs

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26
Q

PPM codes by letters

A

1- paced
2- sensed
3- response to sensing

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27
Q

Advantages of femoral central venous cannulation

A

High success

Ease of placement

Compressible

No risk of pneumo

Trendelenberg not necessary

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28
Q

Single best monitor of heart function and perfusion of vital organs

A

Noninvasive blood pressure monitor

NIBP

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29
Q

6 indications for pacemaker

A

Symptomatic bradycardia

Heart block

Heart failure

Tachycardia-Brady syndrome with AF

Heart transplant with bradycardia

Temp. Pacer to support hemodynamics

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30
Q

Utility of advanced BP monitoring (TEE)

A

Continuous real time BP monitoring

continuous CO using pulse

Analysis of waveform

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31
Q

Femoral cannulation for a line clinical points of interest

A

Easy access

More accurate in low flow states

More central

Need longer catheter

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32
Q

Pacer mode for third degree heart block with afib in the OR

A

VOO

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33
Q

6 indications for use of pacing PAC

A

SA dysfx or symptomatic bradycardia

Second degree type 2 AVB

Complete heart block

Dig toxicity

Need for AV sequential pacing

Left BBB

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34
Q

2 issues with TEE

A

Manpower

TTEE training

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35
Q

Points of interest for brachial cannulation for a line

A

Median nerve damage potential

Clotting

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36
Q

6 factors affecting accuracy of TD CO

A

Inaccurate injectate temp or volume

Rapid volume infusion during injection

Respiratory cycle

Inaccurate computation constant

Thermal instability post CPB

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37
Q

6 indication for invasive BP monitoring

A
  • continuous real time BP
  • anticipated CV instability
  • intentional pharm or
    mech CV manipulation
  • failure of indirect measurement
    (Obesity)
  • supplementary diagnostic clues
  • ABG sampling
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38
Q

The % sensitivity for detecting myocardial ischemia using leads II and V5

A

80%

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39
Q

Disadvantage of femoral central venous cannulation

A

Sepsis

Increased risk of thrombosis and infection

Difficult to float PAC

Potential for retroperitoneal hemorrhage

Pt must be immobile

40
Q

Disadvantages of internal jugular central venous cannulation

A

Carotid puncture

Difficult if fat/obese neck

Increased infection rate

41
Q

Most common side for IJ central venous cannulation

42
Q

TEE provides (3 advantages)

A

Direct assessment of LV filling

Valve/cardiopulmonary function

Minimally invasive

43
Q

6 indication for PA catheter

A
  • LV dysfunction ***
  • symptomatic valve disease ***
  • vascular sg with clamp of major artery ***
  • 2 vessel disease/angina w/i 48 hrs
  • severe HTN w/ hx of angina
  • large operation with intravascualr volume change
44
Q

Floating PAC from RIJ

Distance to pulmonary artery

45
Q

Advantages of subclavian cannulation for central venous cannulation

A

Accessible

Good landmarks

No restriction in C-collar, trach

Potential for lower infection rate

46
Q

Three clinical parameters that may be assessed with analysis of arterial waveform

A

Ejection velocity

SV

Systole/diastole

Pulse pressure variation

47
Q

3 relative contraindications of PAC

A

Severe arrhythmia

Coagulopathy

Newly inserted pacemaker wires

48
Q

Pacer mode for third degree heart block with intact atrial contraction in OR with SVT

49
Q

“C” wave of CVP represents

A

Isovolumic ventricular contraction

Prior to AV opening

50
Q

Issues with Ketamine in EP

A

Prolongs QT and AV conduction

Sympathetic activation

51
Q

5 measurements obtained by doppler

A

CO

PAP

EF

Gradient across valves

Valve area

52
Q

In unipolar leads (older) where is anode and cathode

A

Pacer is anode

Cath tip is cathode

53
Q

Floating PAC from RIJ

Distance to RV

54
Q

ICD tachytherapies.

Rate ________ receives overdrive pacing

Rate _________ recieves defibrillation

A

150-180

> 180

55
Q

_________ enables quantitative assessment of heart and valve function by providing _____ and _____ of blood flow

TEE

A

Doppler ultrasound

Direction and velocity

56
Q

Limitations of using CVP as index of ventricular filling

A

Decreased RV compliance or fx

Tricuspid valve disease

Positive pressure ventilation

Rapid volume infusion

57
Q

_________ Doppler measures flow in a specific sample

A

Pulse wave

58
Q

Disadvantages fo external jugular central venous cannulation

A

Low success

Kinks at SC

High incidence of thrombosis

Difficult to maintain sterile dressing

59
Q

Advanced blood pressure monitoring provides indirect measurement of (3)

A

Stroke volume

Pulse pressure variation

Cardiac output

60
Q

7 causes other than ischemia that may affect ST segment

A 
LVH or RVH (strain)
Conduction defects
Drugs (dig, quinidine)
Electrolyte abnormalities (K,Ca, Mg)
Pericarditis, pericardial effusion
Intracranial hemorrhage
Hypothermia
61
Q

7 factors affecting cardiac filling pressures

A
  • decreased/increased ventricular compliance
  • MI
  • valve dysfx
  • increased filling (volume overload)
  • decreased volume (blood loss)
  • increased afterload
  • lung compliance
62
Q

General anesthesia for EP/device procedures

A

LMA, ETT

Inhalation vs TIVA

63
Q

Pacer mode for AVB and SSS

Also pt with LV dysfx and LVH that need coordination of atria and ventricles for adequate CO

64
Q

“A” wave on CVP represents

A

Atrial contraction

65
Q

Issues with Dexmedetomidine EP

A

Sympatholytic effect in large doses

66
Q

Temporary pacer mode used sometimes during surgery

67
Q

Dp/Dt *change in pressure / change in time

Represents

A

Contractility

68
Q

5 benefits of US guided arterial cannulation

A

Greater success on first attempt

Fewer overall attempts

Improved pt comfort

Useful in low or non pulsating flow

Useful in non-palpable pulse

69
Q

Disadvantages of subclavian central venous cannulation

A

Pneumothorax

Effusion

More difficult that IJ

Noncompressible

70
Q

Deep sedation for EP/Device procedures

A

Unresponsive

Versed, fentanyl, propofol (>60mcg/kg/min)

71
Q

Segments of LV are identified by TEE and ______ analyzed using ________

A

Segmental wall motion analyzed

Midesophageal and transgastric windows

72
Q

Typical effect of magnet on ICD

A

Turn off anti-tachycardia and defibrillation therapy

Will not turn back on without reprogramming

73
Q

Arterial waveform analysis

As represents

A

Area under systolic portion of curve

Proportional to stroke volume

74
Q

Intraop monitoring for CEIDs

A

External defibrillator available

External pads if sg makes access difficult

Plethysmography mandatory

ECG with pacing mode

Magnet must be available

75
Q

Calculating EF with TEE

A

EF= (EDA-ESA) / EDA

76
Q

5 indicators for ICD

A

Previous or inductively VF/VT

EF <30% with prior MI (>40days post MI)

Long QT syndromes w/ inductively VT

Hypertrophic cardiomyopathy

Pt awaiting heart transplant

77
Q

Degree of stenosis calculated value for mild and moderate to severe stenosis

A

< 36mmHg is mild

> 36 mmHg is moderate to severe

78
Q

Monitor utility for PAC with myocardial ischemia

A

Compliance

CO

Volume

SVR

79
Q

Complication of central venous line

A
  • accidental arterial puncture
  • cath induced dysrhythmia
  • infection
  • misinterpretation of data
  • pneumo/hemothorax
  • airway compromise
  • air embolus
  • tracheal puncture
  • cath wire shearing/foreign body
  • thromnophlebitis
  • tamponade
  • nerve injury
80
Q

Awake anesthesia for EP/device procedures

A

No sedation

Propofol infusion for femoral access only

81
Q

Color Doppler blood flowing away from the transducer is what color

82
Q

Pacer mode for AVB and atrial arrhythmias

83
Q

Floating PAC from RIJ

Distance for PAC to wedge (PCWP)

84
Q

6 potential complications with ICD insertion

A

Cardiac perforation

Esophageal perforation

Cardiac tamponade

Dysrhythmia

Mapping/ablation errors

Respiratory variation

85
Q

Limitation to use of advanced blood pressure monitoring involve the effects of (4))

A

Tidal volume

Vasopressin

right heart fx

Dysrhythmia

86
Q

Discrepancies causing PCWP < LVEDP

A

Non compliant LV

Aortic regurg (premature closure of mitral valve)

LVEPD > 25 mmHg

87
Q

“V” wave on CVP represents

A

Ventricular contraction and systolic filling of atrium

88
Q

3 absolute contraindications for PAC

A

Tricuspid or pulmonary stenosis

RA or RV mass

Tetralogy of Fallot

89
Q

Advantages of external jugular central venous cannulation

A

Superficial location

Safety

Compressible

Ease of insertion

90
Q

5 clinical uses of PAC data

A

Measure CO & optimize perfusion

Detect, tx, and trend MI

Measure and optimize ventricular preload and volume in sg w/ lg volume shifts

Measure and optimize ventricular preload and volume in sg during aortic cross clamp

Detect, tx, and trend valvular dysfx

91
Q

8 clinical/pt indications for invasive BP monitoring

A
  • Trauma/shock/MOF
  • IC, cardiac, thoracic,
    vascular sg
  • massive fluid shift/blood loss
  • deliberate hypotension
  • pulmonary disease, freq ABG
  • recent MI, USA, sig 2 vessel disease
  • decreased LV fx
  • need more frequent BP
92
Q

3 functions of ICD

A

Pacemaker (routine or CRT)

Defibrillator

  • anti-tachycardia pacing
  • defibrillation
93
Q

__________ Doppler measures all flow along a line

A

Continuous wave

94
Q

Pacer mode for third degree heart block with intact atrial contraction in OR

95
Q

5 clinical applications of TEE

A

Wall motion and compliance (ischemia)

Volume, contractility

96
Q

Discrepancies causing PCWP>LVEDP

A
  • PPV
  • PEEP
  • COPD
  • increased intrathoracic pressure
  • increased PVR
  • LA myxoma
  • MV disease
97
Q

TEE utilizes _________ to sound and requires manipulation to acquire ______ to US beam

A

Acoustic impedance

Perpindicularity

Equipment II (2 decks)

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