Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesia II > Hemodynamic Monitoring > Flashcards

Hemodynamic Monitoring Flashcards

(75 cards)

Start Studying
1
Q

How far is an esophageal stethoscope inserted into the esophagus?

A

28-30cm. This allows us to hear heart sounds and BS internally.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are precordial and esophageal stethoscopes useful for?

A

Continuous assessment of heart and breath sounds. Very sensitive monitor for bronchospasm and changes in pediatric patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How often should we have a regular stethoscope available?

A

At all times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What 4 general things are continually evaluated?

A

Oxygenation, ventilation, circulation, and temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Considerations in deciding what type of monitoring to use

A

1) Indication
2) Risk/benefit
3) Complications
4) Alternatives
5) Cost
6) Skill level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Types of hemodynamic monitoring used

A

EKG, BP (NIBP and IABP), CVP, PAP, PCWP, TEE, stethoscope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can the EKG tell you?

A

Heart rate, arrhythmias, Ischemia, electrolyte imbalances, pacemaker function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aspects of the 3 Lead EKG

A

Electrodes used: RA, LA, LL
Leads: I, II, III
Number of views of the heart: 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Aspects of the 5 lead EKG

A

Electrodes used: RA, LA, RL, LL, chest
Leads: I, II III, AVL, AVR, AVF, V lead
Number of views of the heart: 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Value of the length and width of each EKG box

A

.1mV and .04s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to calculate HR based on EKG lead

A

1500/# boxes between R waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should the gain be set in order to accurately assess the ST segment?

A

At standardization (1mV signal gives a rise of 10mm). This setting also fixes the ratio of the QRS complex to the ST segment size so that a 1mm change in the ST segment can be accurately assessed. If the wrong gain setting is used, ST changes may be under or over-diagnosed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What filtering mode should the EKG be on for accurate ST assessment?

A

Diagnostic mode. Filtering out the low end of frequency bandwith (which can happen on monitor mode) can lead to ST distortion (either elevation OR depression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5 main indicators of acute ischemia

A

ST elevation ( >1mm), ST depression ( >1mm), flipped Ts, peaked Ts, development of Q waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Posterior / inferior wall ischemia is seen in these leads and is due to a blockage in this artery

A

II, III, AVF

Right coronary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lateral wall ischemia is seen in these leadsand is due to a blockage in this artery

A

I, AVL, V5-6

Left circumflex coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Anterior wall ischemia is seen in these leadsand is due to a blockage in this artery

A

I, AVL, V1-4

Left coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Anterioseptal wall ischemia is seen in these leads and is due to a blockage in this artery

A

V1-4

Left anterior descending coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

This part of BP correlates to the point of the most demand on the heart

A

SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The pulse pressure changes as you move from where to where

A

From the central arterial system to the periphery. The pulse pressure widens due to wave reflections in the vasculature.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

These factors can cause a falsely high NIBP reading

A

Cuff too small, cuff below the level of the heart, loose cuff, arterial stiffness (HTN, PVD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

These factors can cause a falsely low NIBP reading

A

Cuff too large, cuff above the level of the heart, poor tissue perfusion, deflation is too rapid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Fals NIBP reading can also occur with

A

Cardiac dysrhythmia, tremors/shivering/ and improper cuff placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

This type of NIBP reading only gives you SBP

A

Palpation. It measures the return of arterial pulse during deflation. This is simple, inexpensive, and underestimates the SBP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
This NIBP reading only gives you SBP but measures it fairly reliably
Doppler. Measures it by a shift in frequency of sound waves that is reflected by RBCs moving through an artery.
26
This NIBP method estimates both SBP and DBP
Auscultation with a sphygmomanometer. Measures BP by auscultation Karotkoff sounds created by turbulent blood flow though the artery created by the mechanical deformation from the BP cuff. This method is unreliable in patients with HTN.
27
Changes in SBP correlate with changes in ____
Myocardial O2 demand.
28
Automated cuffs work by this mechanism
Oscillometry
29
Complications of NIBP measurement
Ulnar nerve damage, compartment syndrome, edema of the extremity, bruising / petechiae, pain, interference of IV flow, altered timing of IV drug administration
30
Indications for IABP monitoring
1) Deliberate hypotension 2) Risk of rapid BP changes 3) Wide swings in BP intra-op 4) Rapid fluid shifts 5) Titration of vasoactive drugs 6) End organ disease 7) Repeated blood sampling 8) NIBP measurement failure
31
What test has to be done before radial a-line placement?
Allen's test
32
Rate that NS moves through the a-line system to prevent clot formation
1-3mL/hr
33
How can a-line dynamics and accuracy be improved?
Remove bubbles, calibrate at the level of the heart, limit tube length and number of stop-cocks, use non-compliant stiff tubing, and make sure the mass of the fluid used is small
34
Where should the a-line be calibrated?
Supine patients- midaxillary line (right atrium) | Sitting patients- level of the ear / circle of willis because we are concerned about CBF
35
Rate of a-line upstroke tells you about
Contractility
36
Rate of a-line downstroke tells you about
SVR
37
Exaggerated variations in a-line tracing size with respirations indicates
Hypovolemia
38
The area under the a-line curve tells you
MAP
39
The dicrotic notch indicates the closure of this valve
Aortic valve
40
What happens to IABP readings as they move further into the periphery?
Distal pulse amplification! This causes increased SBP, decreased DBP, and increased pulse pressure. MAP remains unchanged. The dicrotic notch becomes less and less apparent and appears later in the tracing (takes longer for the pressure wave to reach the transducer).
41
Complications of IABP measurement
Nerve damage, hemorrhage/hematoma, retained guidewire, infection, thrombosis, air embolus, arterial aneurysm, vasospasm (usually self-limiting), skin necrosis, loss of digits
42
Are fluids able to be given faster through a PIV or central line?
PIV
43
Indications for getting central access
Need more vascular access (unable to get enough PIVs) and need to rapidly give fluids, give vasoactive meds, monitor CVP, assess fluid status/blood volume, sample venous blood, remove air emboli, pulmonary artery access, insertion of transvenous pacing leads
44
Why is the right IJ preferred to the left
It provides a more direct route to the heart and the dome of the lung is higher on the left
45
Typical central venous catheter size
7 french | 20cm
46
If anesthesia places a central line, is placement confirmed with an x-ray?
No, it is confirmed with blood aspiration from all 3 ports. X-ray is taken after surgery.
47
Where should the tip of the central line be located?
Just above the RA at the SVC/RA junction and parallel to the vessel walls. Should be at the level of the 3rd rib or the T4/5 interspace or the level of the carina or R mainstem bronchus.
48
When is a central line contraindicated?
R atrial tumor | Injection at site of desired placement
49
Central line risks
Thrombo-embolism, air embolism, guidewire embolism, carotid puncture, hematoma, dysrhythmia, pneumo/hemothorax, vascular damage, cardiac tamponade, infection
50
What does CVP measure?
CVP measures the RAP (because it's right at the RA junction), which is a measure of preload
51
Normal RA pressure in a spontaneously breathing patient is ______ and it rises by _______ during mechanical ventilation
1-7mmHg | 3-5mmHg
52
How is RVEDP measure with CVP tracing?
The a wave at end-expiration, which correlates with maximal filling of the right ventricle.
53
What is the a wave?
Contraction of the right atrium, which results in increased RAP.
54
The a wave follows this on the EKG
The p wave.
55
This CVP wave is the atrial kick
The a wave
56
What is the c wave a reflection of?
Isovolumetric contraction of the right ventricle, resulting in the bulging back of the tricuspid valve into the RA
57
The c waves follows this waveform on the EKG
The QRS complex. The c wave occurs in early systole
58
The x descent occurs during
Mid-systole. The x descent follows the c wave.
59
The v wave reflects what?
Venous return into the RA against a closed tricuspid valve
60
When does the V wave occur during the cardiac cycle and EKG?
At the end of systole with the tricuspid valve still closed, and it occurs just after the T wave.
61
What does the y descent reflect?
Passive ventricular filling after ventricular relaxation. The y descent reflects a fall in RAP due to this. This is referred to the "diastolic collapse in atrial pressure"
62
Size of pulmonary artery catheters and number of lumels
7-9 french 110cm 4 lumens (distal is for PAP, second is 30cm proximal for CVP, third is for balloon, and fourth is for the thermistor wires)
63
Indications for PAP monitoring
1) Unstable cardiac patients 2) LV dysfunction 3) Pulmonary HTN 4) ARDS/resp failure 5) Shock/sepsis 6) ARF 7) CAD 8) Valvular disease 9) Surgical procedures, such as cardiac, aortic, or OB
64
Complications of pulmonary artery catheters
``` Arrhythmias (v-fib, RBBB, complete heart block)*** PA rupture**** Balloon rupture Pulmonary infarction Thromboembolism/air embolism Pneumothorax Catheter knotting Damage to cardiac structures (valves) Infection (endocarditis) ```
65
Relative contraindications to a PA catheter
WPW syndrome | Complete LBBB
66
Distance from right IJ to various structures
``` SVC/RA junction- 15cm RA- 15-25cm RV- 25-35cm PA- 35-45 PA Wedge 45-50 ``` If you go beyond these measurements and don't see the proper waveform, you may be coiling the catheter
67
When might the a wave be larger than normal
Mitral/tricuspid stenosis
68
When might the v wave be larger than normal?
Mitral/tricuspid insufficiency, causing blood to reflux into the atrium during systole. Remember that the v wave reflects atrial filling during late systole
69
Ways that we can measure CO
Thermodilution, continuous thermodilution, ultrasound, TEE, pulse contour, and mixed venous oximetry
70
"a" waves may be lost with
a-fib or ventricular pacing
71
Giant a waves ("Cannon" a waves) may be caused by
Junctional rhythms, complete HB, mitral stenosis, diastolic dysfunction, myocardial ischemia, ventricular hypertrophy
72
Large V waves may be caused by
Mitral/tricuspid regurgitation | Acute increase in intravascular volume
73
7 things you can observe with TEE
1) CO 2) Ventricular wall characteristics and motion 3) Valve structure and function 4) Measurement of EDV and ESV 5) Blood blow characteristics 6) Intracardiac masses 7) Intracardiac air
74
When is the use of TEE indicated?
1) Pericardial tamponade (for trauma) 2) Unusual causes of acute hypotension 3) PE 4) Aortic dissection 5) Myocardial ischemia 6) Valvular dysfunction Overall, if someone is still very unstable and unresponsive to our treatments, we can use TEE to get a better overall picture of our patients- checking to see what the actual structural problem might be
75
Complications of TEE
Esophageal trauma Dysphagia Hoarseness Dysrhythmias Most complications are reported in awake patients

Anesthesia II (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions