Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia Concepts 2 > Hemodynamic Monitoring > Flashcards

Hemodynamic Monitoring Flashcards

1
Q

What is the purpose of hemodynamic monitoring?

A 
Assess homeostasis, trends
Observe for adverse reactions
Assess therapeutic interventions
Manage anesthetic depth
Evaluate equipment function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Monitoring standards

A

Monitors to Be Used - Minimal Standard
1 .Electrocardiogram (HR and rhythm) 2. Blood pressure 3. Precordial stethoscope 4. Pulse oximetry 5. Oxygen analyze r6. End tidal carbon dioxide

Monitoring Information - Minimal Standard - On Graphic Display

  1. Electrocardiogram 2. Blood pressure 3. Heart rate 4. Ventilation status 5. Oxygen saturation
    * * All alarms must be audible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Basic monitoring techniques

A

Inspection
Auscultation
Palpation
*Vigilance

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

What are some considerations regarding monitoring techniques?

A 
A.  Indications/contraindications
B.  Risk/ benefit
C.  Techniques/alternatives
D.  Complications
E.  Cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the hemodynamic monitoring devices?

A 
Stethoscope
ECG
BP
Invasive
Non-invasive
CVP
PAP and PCWP
TEE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the precordial stethoscope

A

Continual assessment of breath sounds and heart tones
Esophageal used in intubated patients only placed 28-30 cm into esophagus
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
7
Q

Describe the electrocardiogram monitoring?

A 
Recording of electrical activity of the heart
Standard- every patient, continuous monitoring, from beginning of anesthesia until leaving anesthetizing location 
Purpose- 
detect arrhythmias
monitor heart rate
detect ischemia
detect electrolyte changes
monitor pacemaker function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the 3 lead vs. 5 lead monitoring?

A

3 lead:
Electrodes RA, LA, LL
Leads I, II, III
3 views of heart (no anterior view)

5 lead:
Electrodes RA, LA, LL, RL, chest lead
Leads I, II, III, aVR, aVL, aVF, V lead
7 views of heart

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

Gain Setting and frequency bandwidth

A

Gain should be set at standardization
1 mV signal produces 10-mm calibration pulse
A 1-mm ST segment change is accurately assessed
Filtering capacity should be set to diagnostic mode
Filtering out the low end of frequency bandwidth can distort ST segment

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

ECG indicators of acute ischemia:

A

5 Principle Indicators:

ST segment elevation , ≥1mm 
T wave inversion 
Development of Q waves 
ST segment depression, flat or downslope of  ≥1mm
Peaked T waves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Coronary Anatomy and ECG: Myocardial Ischemia

A

(Posterior)/ Inferior wall ischemia (right coronary artery) Changes in Lead II, III, AVF
Lateral wall ischemia (circumflex branch of left coronary artery) Changes in Lead I, AVL, V5-V6
Anterior wall ischemia (left coronary artery) Changes in Lead I, AVL, V1-V4
Anterioseptal ischemia (left descending coronary artery) Changes in Lead V1-V4

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

Blood Pressure generalities

A

Systolic BP-peak pressure generated during systolic ventricular contraction
Changes in SBP correlate with changes in myocardial O2 requirements
Diastolic BP-trough pressure during diastolic ventricular relaxation
Changes in DBP reflect coronary perfusion pressure
Pulse pressure=SBP-DBP
MAP-time weighted average of arterial pressure during a pulse cycle
MAP=SBP+2(DBP)/3
As a pulse moves peripherally wave reflection distorts the pressure waveform-exaggerated SBP and wider pulse pressure

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

Blood pressure 4 ways to measure NIBP

A
  1. Palpation- palpating the return of arterial pulse while on occluded cuff is deflated
    Underestimates systolic pressure, simple, inexpensive, measures only SBP.
  2. Doppler- based on shift in frequency of sound waves that is reflected by RBCs moving through an artery
    Measures only SBP reliably.
  3. Auscultation- using a sphygmomanometer, cuff, and stethoscope; Korotkoff sounds due to turbulent flow within an artery created by mechanical deformation from BP cuff (unreliable in HTN pts-usually lower)
    Permits estimation SBP and DBP
    Oscillometry- Senses oscillations/fluctuations in cuff pressure produced by arterial pulsations while deflating a BP cuff
    1st oscillation correlates with SBP
    Maximum/ peak oscillations occurs at MAP
  4. Oscillations cease at DBP
    Automated cuffs work by this mechanism-measure changes in oscillatory amplitude electronically, derives MAP, SBP, DBP by using algorithms.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

NIBP cuffs rules

A

Bladder width is approximately 40% of the circumference of the extremity
Bladder length should be sufficient to encircle at least 80% of the extremity
Applied snugly, with bladder centered over the artery and residual air removed

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

Erroneous BP Measurement with NIBP

A 
Falsely high BP
Cuff too small
Cuff too loose
Extremity below level of heart
Arterial stiffness- HTN, PVD
Falsely low BP
Cuff too large
Extremity above level of heart
Poor tissue perfusion
Too quick deflation
Also- improper cuff  placement,dysrhythmias,tremors/shivering
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Complications of NIBP

A 
Edema of extremity
Petechiae/ bruising
Ulnar neuropathy
Interference of IV flow
Altered timing of IV drug administration
Pain
Compartment syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Invasive IABP: what are its implications and what does it involve?

A 
Involves percutaneous insertion of catheter into an artery, which is then transduced to convert the generated pressure into an electrical signal to provide a waveform
Generates real-time beat to beat BP
Allows access for arterial blood samples
Measurement of CO/ CI/ SVR
Indications
Elective deliberate hypotension
Wide swings in intra-op BP
Risk of rapid changes in BP
Rapid fluid shifts
Titration of vasoactive drugs
End organ disease
Repeated blood sampling
Failure of indirect BP measurement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you increase the accuracy of invasive IABP?

A

System dynamics and accuracy improved by minimizing tube length, limit stop cocks, no air bubbles, the mass of fluid is small, using non compliant stiff tubing, and calibration at level of heart
Accuracy depends on correct calibration and zeroing
Leveling transducer
Mid axillary line in supine pts (right atrium)
Level of the ear (circle of Willis) in sitting pts.

Dampening and overshooting

19
Q

Describe the Normal Arterial Pressure Waveforms

A

Rate of upstroke-contractility
Rate of downstroke-SVR
Exaggerated variations in size w/ respirations-hypovolemia
Area under the curve-MAP
Dicrotic notch- closure of aortic valve
Normal arterial blood pressure waveform and its relationship to the electrocardiographic R wave.
1. Systolic upstroke; 2, systolic peak pressure; 3, systolic decline; 4, dicrotic notch aortic valve closure); 5, diastolic runoff; 6, end-diastolic pressure.

20
Q

Distal Pulse Amplification

A

Remember arterial BP waveforms as they travel through the arterial tree to periphery— distal pulse amplification
SBP peak increases
DBP wave decreases
MAP not altered
Dicrotic notch becomes less and appears later

21
Q

IABP

A 
Nerve Damage 
Hemorrhage/ Hematoma 
Infection 
Thrombosis 
Air embolus 
Skin necrosis 
Loss of digits 
Vasospasm 
Arterial aneursym 
Retained guidewire
22
Q

Indications of CVCs

A 
Indications:
Measuring right heart filling pressures
Assess fluid status/blood volume
Rapid administration of fluids
Administration of vasoactive drugs
Removal of air emboli
Insertion of transvenous pacing leads
Vascular access
Sample central venous blood
Pulmonary artery catheters
23
Q

Describe the length, diameter, and distal placement position of CVCs

A

7 french
20 cm length
Multiport catheters most common

Placement usually not confirmed by XRAY in OR
Aspirate blood from all ports
After surgery, XRAY
Ideally, tip within the SVC, just above junction of venae cavae and the RA, parallel to vessel walls, positioned below the inferior border of clavicle and above the level of 3rd rib, the T4/T5 interspace, the carina, or takeoff right main bronchus

24
Q

What are contraindications and risks for CVCs?

A 
Contraindications:
R atrial tumor	
Infection at site	
Risks:
Risks: Usually due to poor  technique
Air or thrombo-embolism
Dysrhythmia
Hematoma
Carotid puncture
Pneumo/hemothorax
Vascular damage
Cardiac tamponade
Infection
Guidewire embolism
25
Q

What is the normal CVP and normal pressure?

A

The waveforms result from ebbs and flows of blood in the right atrium.
CVP pressures = RAP = RV preload.
A mean RA pressure in a spontaneously breathing patient is approximately 1-7 mmHg
This rises about 3-5 mmHg during mechanical ventilation

26
Q

Measuring CVP

A

The peak of the “a” wave coincides with the point of maximal filling of the right ventricle
Therefore, this is the value which should be used for measurement of RVEDP
Machines just “average” the measurement
Should be measured at end-expiration

27
Q

CVP Waveform

A 
5 Phasic Events
Three Peaks (a, c, v)
Two Descents (x, y)
“a” wave
Due to contraction of the right atrium, which results in increased pressure in the atrium (since there is no pressure difference  between the vena cava and the atrium)
28
Q

“a” wave

A

“a” wave
Due to contraction of the right atrium, which results in increased pressure in the atrium (since there is no pressure difference between the vena cava and the atrium)
Caused by atrial contraction (follows the P-wave on EKG)
End diastole
Corresponds with “atrial kick” which causes filling of the right ventricle

29
Q

“c” wave

A

“c” wave
Due to closure of the tricuspid valve and isovolemic ventricular contraction; results in the tricuspid valve “bulging” back into the atrium.
Atrial pressure decreases after the “a” wave as a result of atrial relaxation
The “c” wave is due to right ventricular contraction; tricuspid valve closed bulges back into the right atrium
Occurs in early systole (after the QRS on EKG)

30
Q

“x” descent

A

Atrial pressure continues to decline during ventricular contraction due to atrial relaxation
“Systolic collapse in atrial pressure”
Mid-systolic event

31
Q

“v” waveform

A

“v” wave
Reflects venous return against a closed tricuspid valve (which encompasses a portion of RV systole)
The last atrial pressure increase is caused by filling of the atrium with blood from the vena cava
Occurs in late systole with the tricuspid still closed
Occurs just after the T-wave on EKG

32
Q

“y” descent

A

“y” descent
After ventricular relaxation, the tricuspid valve opens due to the venous pressure, and blood flows from the atrium into the ventricle.
The y descent is the fall in atrial pressure following opening of the tricuspid valve.
Decrease in atrial pressure as the tricuspid opens and blood flows from atrium to ventricle
“Diastolic collapse in atrial pressure”

33
Q

Pulmonary Artery Pressure Monitoring used for direct bedside assessment of?

A 
Right-sided heart catheter used for direct bedside assessment of :
Intracardiac pressures (CVP, PAP, PCWP)
Estimate LV filling pressures
Assess LV function
CO 
Mixed venous oxygen saturation
PVR and SVR
Pacing options
34
Q

Pulmonary Artery Pressure Catheters size and dimensions

A 
7 or 9 french
110 cm length marked at 10 cm intervals
4 lumens
distal port PAP
second port 30 cm more proximal CVP
third lumen balloon
forth wires for temp thermister
35
Q

Pulmonary Artery Pressure Monitoring indications:

A 
Indications:
LV dysfunction
Valvular disease
Pulmonary HTN
CAD
ARDS/ resp failure
Shock/sepsis
ARF
Surgical procedure: cardiac, aortic, OB
36
Q

PA catheter complications

A

Arrhythmias (including V-fib, RBBB, complete heart block)
Catheter knotting
Balloon rupture
Thromboembolism; air embolism
Pneumonthorax
Pulmonary infarction
PA rupture
Infection (endocarditis)
Damage to cardiac structures (valves, etc.)
Relative Contraindications– WPW syndrome, Complete LBBB

37
Q

PCWP a and c waveforms

A

The ‘a’ wave represents contraction of the left atrium. Normally it is a small deflection unless there is resistance in moving blood into the left ventricle as in mitral stenosis.
The ‘c’ wave is due to a rapid rise in the left ventricular pressure in early systole, causing the mitral valve to bulge backward into the left atrium, so that the atrial pressure increases momentarily.

38
Q

PCWP’ v’ waveforms

A

The ‘v’ wave is produced when blood enters the left atrium during late systole.
Prominent ‘v’ wave reflect mitral insufficiency causing large amounts of blood to reflux into the left atrium during systole.

39
Q

Cardiac output monitoring

A 
Thermodilution
Continuous thermodilution
Mixed venous oximetry
Ultrasound
Pulse Contour
40
Q

Factors That Can Distort CVP and PAOP Waveforms

A 
Loss of a waves
A fib
Ventricular pacing
Giant a waves “Cannon” a waves
Junctional rhythms
Complete HB
Mitral stenosis
Diastolic dysfunction
Myocardial ischemia
Ventricular hypertrophy
Large v waves
Mitral regurgitation
Acute increase in intravascular volume
41
Q

Transesophageal Echocardiography 7 cardiac parameters observed

A 
7 Cardiac Parameters Observed
Ventricular wall characteristics and motion
Valve structure and function
Estimation of end-diastolic and end-systolic pressures and volumes (EF)
CO
Blood flow characteristics
Intracardiac air
Intracardiac masses
42
Q

Transesophageal Echocardiography uses:

A 
Uses:
Unusual causes of acute hypotension
Pericardial tamponade
Pulmonary embolism
Aortic dissection 
Myocardial ischemia
Valvular dysfunction
43
Q

Transesophageal Echocardiography complications:

A 
Complications:
Esophageal trauma
Dysrhythmias
Hoarseness
Dysphagia

Most complications in awake patients

Anesthesia Concepts 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions