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Monitoring of CV Patient I > Final Exam > Flashcards

Final Exam Flashcards

1
Q

What does the left brain reflect?

A 
Logical
Sequential
Rational
Analytical
Objective
Look at parts
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2
Q

What does the right brain reflect?

A 
Random
Intuitive
Holistic
Synthesizing
Subjective
Looks at wholes
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3
Q

Frontal Lobe used in…

A 
Word Production
Problem Solving
Planning
Behavioral Control
Emotion
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4
Q

Temporal Lobe used in…

A

Memory
Emotion
Word Understanding

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5
Q

Occipital Lobe used in….

A

vision

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6
Q

Hypoxia

A

Inadequate oxygen in body tissue

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7
Q

Ischemia

A

inadequate blood supply in body tissue

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8
Q

Seizures

A

sudden attack of an illness or condition, synonyms: attack, fit, spasm, convulsion

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9
Q

Hypoglycemia

A

the medical condition of having an unusually low level of sugar in the blood (maybe more with kids)

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10
Q

Hyperglycemia

A

the medical condition of having an unusually high level of sugar in the blood (maybe more with adults)

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11
Q

Neurological Injury

A

Results from the combination of a patient chronically at risk with a variety of surgically related insults or stresses for which the vascular system is unable to compensate

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12
Q

What are the two types of morbid neurological outcomes?

A

Type I

Type II

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13
Q

Type I: Morbid Neurological Outcome

A

Cerebral Death
Non-fatal Strokes
New TIA’s

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14
Q

Type II: Morbid Neurological Outcome

A

New intellectual deterioration

New seizures upon discharge

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15
Q

Type I Predictors

A 
Advanced Age (predispose to stroke)
70: 4 to 9% risk

Aortic Atherosclerosis
Hx of prior neurologic events- 15%
Carotid Stenosis

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16
Q

Type II Predictors

A 
Low cardiac output states
Atrial arrhythmias
Systolic Hypertension
Diabetes
Pulmonary Disease
Excessive Alcoholism
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17
Q

What is the prevalence of neurological impairment?

A

6.1 %

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18
Q

What are some examples of neurological impairment?

A

Stroke, stupor, coma, deterioration in intellectual function, memory deficit or seizures

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19
Q

What is the prevalence of Post-Op Delirium?

A

10-60% (depends on age and type of surgery)

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20
Q

What is the LOS of patients with Post-Op Delirium?

A

These patients have LOS of 20-25 days vs. 10 days for patients with no adverse outcomes

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21
Q

Incidence of Transient Neurologic Dysfunction

A

7-44%

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22
Q

Incidence of Permanent Complications of neurologic dysfunction

A

1.6 to 23%

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23
Q

What type of vent placement reduces neurological risk?

A

RSPV (LA to MV to LV); direct

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24
Q

What part of cardiac surgery has the highest neurological risk?

A

Short filling of beating heart after XC

Filling again after taking out vent

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25
Q

Surgical Technique addressing Atheroembolism

A

Epiaortic ultrasound
Single Cross Clamp
No touch techniques
Paying attention

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26
Q

How to perfusionists contribute to neurological dysfunction?

A

Hypoperfusion
Inflammation
Focal (Embolism)
Global (Complete/Incomplete)

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27
Q

Types of Embolism

A 
Air
Plaque
Microemboli
LV thrombus
Fat
Debris
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28
Q

Global Examples (Complete and Incomplete)

A

Complete: cardiac arrest, DHCA
Incomplete: hypotension, inadequate CPB flow

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29
Q

3 Examples of Inflammation

A

Ischemia Reperfusion Injury
Vascular Integrity
Exposure to Blood

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30
Q

Ischemia Reperfusion Injury

A

Potent triggers for: activation of leukocyte, leukocyte-endothelial or leukocyte endothelial platelet binding

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31
Q

Vascular Integrity

A

Foreign Surface
Capillary Plugging
Liberation of free radicals

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32
Q

Exposure to Blood

A

Activates platelets, monocytes and neutrophils

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33
Q

Factors Affecting Blood Oxygenation

A

Tailoring Oxygen Delivery

Tailoring Oxygen Consumption

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34
Q

How do you tailor oxygen delivery?

A 
MAP
CO2
CI and Pump Flow
Hematocrit
Mechanical Issues
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35
Q

How do you tailor oxygen consumption?

A

Anesthetic Agent and Depth

Temperature

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36
Q

What could you do if you want to cool a kid quickly?

A

Increase CO2. CO2 is huge in changing co2 metabolic delivery

37
Q

Types of Brain Monitoring

A 
Neurological exam
Blood Pressure monitoring
EEG- electroencephalogram
BIS- Bispectral Index
TCD- Transcranial Doppler
ICP- Intra-cranial pressure monitoring
SjVO2- Saturation of Jugular Venous Oxygen
SvO2- Saturation of Venous O2 (global)
rSO2-Regional Saturation of oxygen
38
Q

rSO2

A

Regional Saturation of Oxygen

39
Q

What tools can we use to help prevent brain injury?

A 
EEG
BIS Monitoring (Bispectral Index)
INVOS Somanetics Cerebral Oximetry/Invivo Optical Spectroscopy
40
Q

What is an EEG?

A

Recording from scalp of electrical activity in underlying cerebral cortex

Signal by amplifying voltage differences between pairs of electrodes (each pair constitutes a lead attached to the scalp)

Reflects correlated synaptic activity caused by post-synaptic potentials of cortical neurons

Each lead covers a surface area of 2.5 cm

41
Q

Number of EEG Electrodes

A

21 International 10-20 electrodes are standard

OR: 2-4 lead monitoring (placed over the cerebral artery)

42
Q

What hemisphere are odd numbers? (EEG)

A

1,3,5,7

Left Hemisphere

43
Q

What hemisphere are even numbers? (EEG)

A

2,4,6,8

Right hemisphere

44
Q

What percent of the population show abnormalities due to old injuries?

A

15%

45
Q

How are EEG signals defined?

A

Frequencies

46
Q

What do alpha and beta activity indicate

A

patient awake

47
Q

What do theta and delta activity indicate

A

patinet asleep

48
Q

Alpha Wave

A

8-13 Hz
Medium amplitude
Predominant location: Occiput
Relaxed, awake

49
Q

Beta Wave

A

13-30 Hz
Low predominant amplitude
predominant location: frontal
Alert, awake

50
Q

Theta Wave

A

4-8 Hz
High predominant amplitude
predominant location: diffuse
Sleeping infant, child

51
Q

Delta Wave

A

0-4 Hz
High predominant amplitude
Predominant location: diffuse
Metabolic coma, cerebral ischemia, normal deep sleep, deep anesthesia

52
Q

Main Reason for using EEGs Clinically

A

Epilepsy
Brain TUmors
Stroke
Focal Brain disorders

53
Q

Secondary Reason for using EEGs Clinically

A

Diagnosis of coma
Encephalopathies
Brain death

54
Q

EEGs in monitoring depth of perfusion

A

indirect indicator of cerebral perfusion in carotid endarterectomy

55
Q

Disadvantages of the EEG in the OR

A 
Analysis is complex
distract anesthesia from patient care
Electrode impedances
Electrical devises in OR
Electrical activity in skeletal and cardiac myofibrils (pt moving or shivering)
Electromechanical devices (H/L machine)
56
Q

What voltages does EEG use?

A

50-100 micro volts (low voltages)

57
Q

Types of Electrode Impedances

A

Equal- interference eliminated

Different- appear as artifact

58
Q

Types of Electrical devices in the OR

A

Pacemakers
ECG
Electrocaudary units

59
Q

Increase Frequency associated with:

A 
Hyperoxia
Hypercarbia: mild
Hypoxia: initial
Seizure
Barbiturates: small dose
Diazepam: ambulatory dose
N2O: 30-70%
Inhalation Agents < MAC
Ketamine
60
Q

Decreased Frequency, increased amplitude associate with:

A 
Hypoxia: mild
Hypocarbia: moderate to extreme
Hypothermia
Barbiturates: moderate dose
Etomidate
Narcotics
Inhalation agents > 1 MAC
61
Q

Decreased frequency, decreased amplitude associated with:

A

Hypoxia: marked
Hypercarbia: severe
Barbiturates: large dose

62
Q

Electrical silence associated with:

A 
Brain death
Hypoxia: severe
Hypothermia: profound
Barbiturates: coma dose
Isoflurane:2 MAC
63
Q

Bispectral Index (BIS)

A
  • Processed EEG information as a measure of sedative effects of anesthesia meds
  • Monitor was approved for use in 1996
  • Information displayed every 10-15 seconds
  • Most validated measure of consciousness available
  • Graphical trend and numerical value
  • Non-invasive, continuous, direct and real time
  • Allows anesthesia the ability to access the complicated EEG information during the case
  • During the signal analysis, multiple characteristics from the EEG are determined and converted to an algorithm
  • Uses easy numbering system to identify depth of anesthesia
64
Q

What does BIS assess?

A

Relationships among signal components and captures synchronization within signals like the EEG. THen it converts it to a digital number for easy interpretation

65
Q

The BIS Index

A

The index is a number between 1 and 100
Correlates to important clinical endpoints and EEG states during anesthesia induction
100 is a fully awake patient

66
Q

What does a BIS value of 100 mean?

A

Awake

Responds to normal voice

67
Q

What does BIS value of 80 mean?

A

Light/Moderate Sedation

May respond to loud commands or mild prodding/shaking

68
Q

What does BIS value of 60 mean?

A

General Anesthesia
Low probability of explicit recall
Unresponsive to verbal stimulus

69
Q

What does BIS Value of 40 mean?

A

Deep Hypnotic State

70
Q

What does BIS value of 20 mean?

A

Burst Suppression

71
Q

What does BIS value of 10 mean?

A

Flat Line EEG

72
Q

Significant correlation seen between decreasing brain metabolic rate (BMR) and increasing __________.

A

Anesthesia Effect

73
Q

Target BIS Values

A

Tailored to each individual

74
Q

Target BIS Value using opoid anesthesia

A

40 to 60

75
Q

Target BIS Value using opoid anesthesia with supplementation with volatile gas on pump

A

Normally 25 to 35

Target to titrate to 45-55

76
Q

Benefits of BIS?

A

Reduction in primary anesthetic use
Decrease incidence of intraoperative awareness and recall
Reduction in emergence and recovery time
Improved patient satisfaction

77
Q

Disadvantages of BIS

A

It is a trending device
We can’t be responsible to treat the level of sedation
Often monitor only faces anesthesia

78
Q

Two types of Cerebral Oximetry

A

NIRS (near infra red spectroscopy)

INVOS (invivo optical spectroscopy)

79
Q

Transcranial Cerebral Oximetry

A

Non-invasive technique monitoring changes in cerebral oxygen metabolism, which presents additive information when the conventional key variables (as peripheral oxygenation and/or systemic hemodynamics) would not be predictive

80
Q

Benefits of INVOS

A

Non-invasive, continuous, direct, real time
Site specific (regional) measure vs systemic; often signals earlier warning of reversible ischemia
Detect and correct oxygenation issues that can lead to complications and poor outcomes
Immediately reflects pt reactions
Not pulse, pressure, or temp dependent
Monitor vascular beds
Identifies patient unique rSO2 baselines for customized care
Enhances clinical assessment and decision making
Objective data vs subjective assessment

81
Q

MOMM

A

Major Organ Morbidity or Mortality

82
Q

What is the MOMM value?

A

13.4%

83
Q

What is the MOMM with INVOS?

A

3%

84
Q

MOMM is a cumulative score of:

A 
Death within 30 days
Permanent stroke
>48 hours ventilation
Mediastinitis/deep sternal infection
Renal failure requiring dialysis
Re-operation
85
Q

Prevalence of Cognitive Decline

A

24-53%

86
Q

Prevalence of Prolonged Ventilation

A

5.96%

87
Q

What detects O2 supply issues associated with inflow obstructions?

A

Cerebral rSO2

88
Q

What are some causes of inflow issues?

A

Head Position
Heart Position
Arterial Obstruction (Carotid Disease, clamp, hand)
Sponge (cannula malposition)

Monitoring of CV Patient I (4 decks)

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