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Health Assessment > Hemodynamic Monitoring > Flashcards

Hemodynamic Monitoring Flashcards

0
Q

Standards for Basic Anesthetic Monitoring

A

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

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1
Q

Purpose of Hemodynamic Monitoring

A
  1. Assess homeostasis, trends
  2. Observe for adverse reactions
  3. assess therapeutic interventions
  4. manage anesthetic depth
  5. evaluate equipment function

We can prevent injury and other effects from occuring.

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2
Q

Standards say we need to monitor:

A

oxygenation, ventilation, circulation, temperature continually evaluated

temp is only mandated in pediatrics

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3
Q

How to monitor oxygenation:

A

spo2, skin color, ABGs, o2 analyzer, mental status

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4
Q

How to monitor ventilation:

A

pressures, end tidal co2, breath sounds with auscultation, chest rise

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5
Q

How do we monitor circulation:

A

pulse, BP, auscultate heart tones

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6
Q

Information to be contained on the anesthesia record:

Monitors to be used- minimal standard

A
  1. Electrocardiogram (HR and rhythm)
  2. Blood pressure
  3. Precordial Stethoscope
  4. Pulse oximetry
  5. Oxygen analyzer
  6. End tidal carbon dioxide
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7
Q

Information to be contained on the anesthesia record:

Monitoring Information- Minimal Standard- On graphic display

A
  1. Electrocardiogram
  2. Blood pressure
  3. Heart rate
  4. Ventilation status (End tidal Co2)
  5. Oxygen Sat
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8
Q

Information to be contained on the anesthesia record:

Minimal of 5 alarms must be audible:

A
  1. Pulse Ox
  2. EKG/HR
  3. BP
  4. Airway pressures
  5. O2 analyzer
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9
Q

Basic Monitoring Techniques

A

Inspection
Auscultation
Palpation
Alert and vigilant providers

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10
Q

Considerations

A
  1. indications/contraindications
  2. risk/benefit
  3. techniques/alternatives
  4. complications
  5. cost
  6. are you proficient to use it?
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11
Q

Hemodynamic monitoring

A 
stethoscope
ecg
bp 
cvp
pap and pcwp
tee
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12
Q

esophageal or precordial stethoscope

A

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
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13
Q

Electrocardiogram

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 HR-- NOT PULSE RATE
detect ischemia
detect electrolyte changes
monitor pacemaker function
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14
Q

3 Lead ECG

A

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

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15
Q

5 Lead ECG

A

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

16
Q

Best Leads for What?

A

Lead II- best for rhythm detection- best display of your p waves
Lead IV or V- best for ischemia detection

17
Q

ECG Complex

A

P wave: Arterial depolarization
QRS: ventricular depolarization
T wave: ventricular repolarization
artifact is caused by movement, electrocaudy (electrical equipment), shivering, muscle fisculations

18
Q

Gain Setting and Frequency Bandwidth

A

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

19
Q

ECG Indicators of Acute Ischemia

A

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
20
Q

Changes in Lead II, III, aVF

A

Posterior/Inferior wall ischemia (RCA)

21
Q

Changes in Lead I, AVL, V5 -V6

A

Lateral wall ischemia (circumflex branch of LCA)

22
Q

Changes in Lead I, aVL, V1-V4

A

Anterior wall ischemia (LCA)

23
Q

Changes in lead V1-V4

A

Anteriospetal ischemia (left descending coronary artery)

24
Q

Systolic BP

A

peak pressure generated during systolic ventricular contraction
-changes in SBP correlate with changes in myocardial O2 requirements

25
Q

Diastolic BP

A

trough pressure during diastolic ventricular relaxation

-changes in DBP reflect coronary perfusion pressure

26
Q

Pulse pressure

A

SBP-DBP

27
Q

MAP

A

time weighted average of arterial pressure during a pulse cycle

MAP=SBP + 2(DBP)/3

28
Q

Blood pressure rule

A

as a pulse moves peripherally wave reflection distorts the pressure waveform- exaggerated SBP and wider pulse pressure

29
Q

Blood Pressure- NIBP

A

Palpation

Doppler

Auscultation

Oscillometry

Health Assessment (4 decks)

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