Final Flashcards
High velocity flow across a valve signifies
Stenosis
6 Complications of PAC
Carotid/SC artery puncture/cannulation
Perf of RA, RV, or PA
Cardiac dysrhythmia
Heart block (RBBB)
Knotting of catheter
Improper tx based on data
Issues with propofol with EP
Shorten or no effect on QT
Monitor utility for ECG with imyocardial ischemia
QRST abnormality
Rhythm and conduction
Advantages of internal jugular central venous cannulation
Accessible
Good landmarks
Straight shot for PAC
Less chance of pneumo
On color Doppler blood flowing towards the transducer is what color
Red
PAC provide indirect measurement of LV filling and CO but are (2 disadvantages)
Invasive
Associated with adverse events
Clinical points of interest for radial cannulation
Preferred site
Ease of access
Low complication rate
Pacer mode for SSS in absence of AVB or AF
AAI
Strategies to minimize EMI during sg
Short burst of mono polar cautery
Ground pad should not be placed at vector with device
TENS and cells may interfere with unipolar devices
7 uses of TEE
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
6 potential complications of arterial cannulation
- Infection
-Hemorrhage - Thrombosis- distal
ischemia - skin necrosis
- embolization (central and
Peripheral) - inaccurate pressure measurement
4 complications associated with TEE
Esophageal perforation
GI hemorrhage
Oral damage
Misinterpretation
Conscious sedation for EP/device procedures
Responsive pt
NC only
Versed, fentanyl, low dose propofol
CVP is useful for trending _______ but not a reliable indicatior of _______
Trending intravascular volume
Not reliable indicator of LV filling
Basic TEE incorporates ___ windows to perform assessment of cardiopulmonary function
11
“X” and “Y” wave on CVP represent
Ventricular filling and diastolic collapse
3 effects of electromagnetic interference (EMI) with PPM/ICD
Pacer/ICD sensing issues
Inappropriate anti-tachy therapies
Generator damage
Floating PAC from RIJ
Do not float swan past
65cm
5 indications for TEE
CP instability
Suspicion of LV dysfx
MI
Hypovolemia
PE
Typically magnet may have what effect on PPM
Pace asynchronously
Arterial waveform analysis dichroic notch represents
Aortic valve closure
Arterial waveform analysis Ps represents
Pd represents
SBP
DBP
Floating PAC from RIJ
Distance to RA
20cm
Provides CVP trace
3 disadvantages of US guided arterial cannulation
Infection if poor sterile technique
Additional training required
Equipment costs
PPM codes by letters
1- paced
2- sensed
3- response to sensing
Advantages of femoral central venous cannulation
High success
Ease of placement
Compressible
No risk of pneumo
Trendelenberg not necessary
Single best monitor of heart function and perfusion of vital organs
Noninvasive blood pressure monitor
NIBP
6 indications for pacemaker
Symptomatic bradycardia
Heart block
Heart failure
Tachycardia-Brady syndrome with AF
Heart transplant with bradycardia
Temp. Pacer to support hemodynamics
Utility of advanced BP monitoring (TEE)
Continuous real time BP monitoring
continuous CO using pulse
Analysis of waveform
Femoral cannulation for a line clinical points of interest
Easy access
More accurate in low flow states
More central
Need longer catheter
Pacer mode for third degree heart block with afib in the OR
VOO
6 indications for use of pacing PAC
SA dysfx or symptomatic bradycardia
Second degree type 2 AVB
Complete heart block
Dig toxicity
Need for AV sequential pacing
Left BBB
2 issues with TEE
Manpower
TTEE training
Points of interest for brachial cannulation for a line
Median nerve damage potential
Clotting
6 factors affecting accuracy of TD CO
Inaccurate injectate temp or volume
Rapid volume infusion during injection
Respiratory cycle
Inaccurate computation constant
Thermal instability post CPB
6 indication for invasive BP monitoring
- continuous real time BP
- anticipated CV instability
- intentional pharm or
mech CV manipulation - failure of indirect measurement
(Obesity) - supplementary diagnostic clues
- ABG sampling
The % sensitivity for detecting myocardial ischemia using leads II and V5
80%