Hemodynamic Monitoring Flashcards
Standards for Basic Anesthetic Monitoring
1- During an anesthetic their should be a QUALIFIED PROVIDER
When there is a change in providers than it should be changed to another qualified provider
Need a qualified provider during the entire surgical procedure and the anesthetic.
exception: pain management (chronic and post op) and epidurals OB
Purpose of Hemodynamic Monitoring
- Assess homeostasis, trends
- Observe for adverse reactions
- assess therapeutic interventions
- manage anesthetic depth
- evaluate equipment function
We can prevent injury and other effects from occuring.
Standards say we need to monitor:
oxygenation, ventilation, circulation, temperature continually evaluated
temp is only mandated in pediatrics
How to monitor oxygenation:
spo2, skin color, ABGs, o2 analyzer, mental status
How to monitor ventilation:
pressures, end tidal co2, breath sounds with auscultation, chest rise
How do we monitor circulation:
pulse, BP, auscultate heart tones
Information to be contained on the anesthesia record:
Monitors to be used- minimal standard
- Electrocardiogram (HR and rhythm)
- Blood pressure
- Precordial Stethoscope
- Pulse oximetry
- Oxygen analyzer
- End tidal carbon dioxide
Information to be contained on the anesthesia record:
Monitoring Information- Minimal Standard- On graphic display
- Electrocardiogram
- Blood pressure
- Heart rate
- Ventilation status (End tidal Co2)
- Oxygen Sat
Information to be contained on the anesthesia record:
Minimal of 5 alarms must be audible:
- Pulse Ox
- EKG/HR
- BP
- Airway pressures
- O2 analyzer
Basic Monitoring Techniques
Inspection
Auscultation
Palpation
Alert and vigilant providers
Considerations
- indications/contraindications
- risk/benefit
- techniques/alternatives
- complications
- cost
- are you proficient to use it?
Hemodynamic monitoring
stethoscope ecg bp cvp pap and pcwp tee
esophageal or precordial stethoscope
fitted with an ear piece - tubing attaches to a bell and the bell stays on the patient during the entire anesthetic ; if it cant be placed on the chest than it could be placed on the neck
- CONTINUAL assessment of breath sounds and heart tones
- esophageal used in intubated patients only placed 28 to 30 cm into esophagus
- very sensitive monitor for bronchospasm and changes in pediatric patients
Electrocardiogram
- Recording of electrical activity of the heart
- Standard- every patient, continuous monitoring, from beginning of anesthesia until leaving anesthetizing location
Purpose: detect arrhythmias monitor HR-- NOT PULSE RATE detect ischemia detect electrolyte changes monitor pacemaker function
3 Lead ECG
Electrodes RA, LA, LL
Leads I , II, III
3 views of the heart
*no anterior view which is fed by the LAD (L anterior descending artery) and a commonly diseased artery that wont be viewed
5 Lead ECG
More common in the OR
Electrodes RA, LA, LL, RL, chest lead
Leads 1, II, III, aVR, aVL, aVF, V lead
7 views of the heart
Best Leads for What?
Lead II- best for rhythm detection- best display of your p waves
Lead IV or V- best for ischemia detection
ECG Complex
P wave: Arterial depolarization
QRS: ventricular depolarization
T wave: ventricular repolarization
artifact is caused by movement, electrocaudy (electrical equipment), shivering, muscle fisculations
Gain Setting and Frequency Bandwidth
Gain should be set at standardization
- 1 mV signal produces 10 mm calibration pulse
- 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
ECG Indicators of Acute Ischemia
5 principle indicators:
- ST segment elevation, > or = 1mm
- T wave inversion
- Development of Q waves
- ST segment depression, flat, or downslope of > or =1mm
- Peaked T waves
Changes in Lead II, III, aVF
Posterior/Inferior wall ischemia (RCA)
Changes in Lead I, AVL, V5 -V6
Lateral wall ischemia (circumflex branch of LCA)
Changes in Lead I, aVL, V1-V4
Anterior wall ischemia (LCA)
Changes in lead V1-V4
Anteriospetal ischemia (left descending coronary artery)
