Hemodynamic Monitoring Flashcards
The five purposes of hemodynamic monitoring are:
assess homeostasis Observe for adverse reactions assess therapeutic interventions manage anesthetic depth evaluate equipment function
When is it okay for a qualified provider to not be in the room with an anesthetic?
OB laboring epidurals
Pain management
The 5 alarms that must be on graphic display are:
EKG BP HR Ventilation Status: inspired O2, Airway pressures O2 Saturation
6 AANA standards for monitors to be used are:
EKG (HR & Rhythm) BP Precordial Stethoscope Pulse Ox O2 Analyzer End tidal CO2
___________ allows for continual assessment of breath sounds and heart tones
Esophageal or precordial stethoscope
The esophageal stethoscope is placed __-__ cm into the esophagus
28-30cm
The esophageal/precordial stethoscope is a cry sensitive monitor for _____________ and is especially used in _______________ patients
bronchospasm
pediatrics
An EKG is a ______ monitor not a _________ monitor
heart rate
pulse rate
The 3 lead EKG has electrodes _____, ____, and _____. It shows ______ views of the heart with NO ____________ view
RA, LA, LL
3
anterior
The 3 lead EKG shows the _________, _______, and ___________ views
inferior
lateral
posterior
The 5 lead EKG shows ____ views of the heart
7
The 5 lead EKG is advantageous over the 3 lead bc it shows the _____ and ______ parts of the heart too
septum
anterior
In the OR we want to monitor the patient in lead______ (for ischemia detection) and lead _____ for rhythm detection
V5
II
Gain should be set at ______________. 1mV signal produces ______ calibration pause. A _______ mm ST segment change is accurately assessed.
Standardization
1mm
Filtering capacity should be set to __________ mode. It looks at the ___________ bandwidth coming in.
diagnostic
The Gain is the ____________ set. It is usually set at a ____________. We want this for ST monitoring.
Amplitude
fixed ratio
The 5 principle indicators of ACUTE ISCHEMIA on an EKG are:
ST elevation ST depression T wave inversion Peaked T waves Development of Q waves
Changes in leads II, III, and AVF will show _________________ ischemia which represents the ________________ artery
Posterior (inferior) wall
RCA
Changes in leads I, AVL, and V5-V6 will show ____________ ischemia which represents the ______________.
Lateral wall
Circumflex branch of the left CA
Changes in leads I, AVL, and V1-V4 will show _______________ wall ischemia which represents the ________________ artery
Anterior wall ischemia
Left coronary artery
Changes in Leads V1-V4 will show ____________ wall ischemia that represents the ______________ artery
anterioseptal
Left descending coronary artery
Changes in SBP correlate with changes in ____________
myocardial O2 requirements
The diastolic Bp reflects _________________
Coronary Perfusion Pressure
Pulse pressure is _________- ____________
SBP - DBP
MAP is the ______ weighted average of _________ during a _______ cylcle
time
arterial
pulse
What is the Equation for MAP
MAP = SBP + 2(DBP)/3
Something that could cause a widening PP is _______________
aortic insufficiency
Auscultation of the BP permits estimation of _____ & ______
SBP & DBP
_______________ senses fluctuations in cuff pressure produced by arterial pulsations while deflating a BP cuff. This is how automated cuffs work.
oscillometry
Cuff bladder width should be approximately ____% of the circumference of the extremity and length should encircle at least _____%.
40
80
A falsely high BP could be from what 4 things?
Cuff too small, cuff too loose, extremity below the heart, arterial stiffness
A falsely low BP could be from what 4 things?
cuff too large, extremity above the heart, poor tissue perfusion, too quick deflation
The 6 sites possible for an Aline are?
radial, ulnar, axially, brachial, femoral, DP
To test collateral flow for a radial a-line you would use ___________
allen’s test
You should level the transducer for the aline at _______________ in supine pts (at the level of the ____________) and at the level of the _________________ in sitting patients
mid axillary line (right atrium)
ear (circle of willis)
On an arterial waveform, the rate of upstroke represents ___________________
contractility
On an arterial waveform, the rate of downstroke represents ______________
SVR
Exaggerated variations in size with respirations on the Aline could mean ___________________
hypovolemia
The area under the curve on an aline is the ___________
MAP
The closure of the aortic valve on the aline waveform is the _____________
dicrotic notch
The 6 parts on the arterial BP waveform are:
- systolic upstroke
- systolic peak pressure
- systolic decline
- dicrotic notch (aortic valve closure)
- diastolic runoff
- end- diastolic pressure
*As arterial BP waveforms travel through the arterial tree to periphery have ______________________
distal pulse amplification
