hemodynamic monitoring Flashcards
what are the standards headings for basic anesthetic monitoring
oxygen, ventilation, circulation, temperature
why do we do hemodynamic monitoring
assess homeostasis, trends observe for adverse reactions assess therapeutic interventions manage anestheic depth eval equipment fx
look at to assess o2
pulse ox, oxygen analyzer on machine, LOOK AT YOUR PT
ass ventilation
LOOK AT PT- chest rise/bs/bag mvt, etco2
what are the minimal standard monitors
EKG bp precordial stethoscope pulse ox ox analyzer etco2
minimal standard for graph display
ekg bp hr vent status - etco2 o2sat
how often must we document
at least every 5 min
basic monitoring techniques
inspection
auscultation
palpation
ALERT AND VIGILANT PROVIDERS
CONSIDERATIONS
INDICATIONS/CONTRA risk/benifit technques/alternatives complications cost my skill level
hemodynamic monitoring
stethoscope ekg bp cvp pap/pcwp tee
precordial steth
continual assess of breath sounds and heart tones
INTUBATED PTS ONLY
28030 cm into esophagus
very sensitive for bronchospasm and changes in peds
ekg purpose
detect arrhythmias monitor hr detect ischemia detect electrolyte changes monitor pacemaker fxn
ekg tells me ___________________
ZERO ABOUT THE PULSE
3 lead EKG— what leads and where don’t you see?
i, ii, iii
no anterior view
5 lead ekg ___ views and leads
7
i, ii, iii, aVR, aVL, aVF, V
see changes in 2, 3, and aVF- where and artery
posterior wall ischemia
right coronary artery
changes in lead 1, AVL, V5-V6- where and artery
lateral wall ischemia
circumflex branch of left coronary artery
changes in lead 1 AVL, V1-V4—- where and artery
anterior wall ischemia
LCA
changes in lead V1-V4
anterioseptal ischemia
Left descending coronary artery
what don’t you see with a 3 lead ekg
anterior LAD!!!
5 lead shows you
septum and lad
what should my gain and frequency be set at
1mV= 10mm calibration pulse; 1mm st segment is accurately assessed
diagnostic mode—— if you select filter could distort st segment
5 principle indicators for acute ischemia
st segment elevation, >=1mm T wave inversion Development of Qwaves St segment depression, flat or downslope of >= 1mm Peaked Twaves
what do changes in SBP correlate to?
changes in myocardial o2 requirements
