Hemodynamic Monitoring

Question 1

The five purposes of hemodynamic monitoring are:

Answer 1

assess homeostasis 
Observe for adverse reactions
assess therapeutic interventions
manage anesthetic depth
evaluate equipment function

Question 2

When is it okay for a qualified provider to not be in the room with an anesthetic?

Answer 2

OB laboring epidurals

Pain management

Question 3

The 5 alarms that must be on graphic display are:

Answer 3

EKG
BP
HR
Ventilation Status: inspired O2, Airway pressures
O2 Saturation

Question 4

6 AANA standards for monitors to be used are:

Answer 4

EKG (HR & Rhythm)
BP
Precordial Stethoscope
Pulse Ox
O2 Analyzer
End tidal CO2

Question 5

___________ allows for continual assessment of breath sounds and heart tones

Answer 5

Esophageal or precordial stethoscope

Question 6

The esophageal stethoscope is placed __-__ cm into the esophagus

Answer 6

28-30cm

Question 7

The esophageal/precordial stethoscope is a cry sensitive monitor for _____________ and is especially used in _______________ patients

Answer 7

bronchospasm

pediatrics

Question 8

An EKG is a ______ monitor not a _________ monitor

Answer 8

heart rate

pulse rate

Question 9

The 3 lead EKG has electrodes _____, ____, and _____. It shows ______ views of the heart with NO ____________ view

Answer 9

RA, LA, LL
3
anterior

Question 10

The 3 lead EKG shows the _________, _______, and ___________ views

Answer 10

inferior
lateral
posterior

Question 11

The 5 lead EKG shows ____ views of the heart

Answer 11

7

Question 12

The 5 lead EKG is advantageous over the 3 lead bc it shows the _____ and ______ parts of the heart too

Answer 12

septum

anterior

Question 13

In the OR we want to monitor the patient in lead______ (for ischemia detection) and lead _____ for rhythm detection

Answer 13

V5

II

Question 14

Gain should be set at ______________. 1mV signal produces ______ calibration pause. A _______ mm ST segment change is accurately assessed.

Answer 14

Standardization

1mm

Question 15

Filtering capacity should be set to __________ mode. It looks at the ___________ bandwidth coming in.

Answer 15

diagnostic

Question 16

The Gain is the ____________ set. It is usually set at a ____________. We want this for ST monitoring.

Answer 16

Amplitude

fixed ratio

Question 17

The 5 principle indicators of ACUTE ISCHEMIA on an EKG are:

Answer 17

ST elevation
ST depression
T wave inversion
Peaked T waves
Development of Q waves

Question 18

Changes in leads II, III, and AVF will show _________________ ischemia which represents the ________________ artery

Answer 18

Posterior (inferior) wall

RCA

Question 19

Changes in leads I, AVL, and V5-V6 will show ____________ ischemia which represents the ______________.

Answer 19

Lateral wall

Circumflex branch of the left CA

Question 20

Changes in leads I, AVL, and V1-V4 will show _______________ wall ischemia which represents the ________________ artery

Answer 20

Anterior wall ischemia

Left coronary artery

Question 21

Changes in Leads V1-V4 will show ____________ wall ischemia that represents the ______________ artery

Answer 21

anterioseptal

Left descending coronary artery

Question 22

Changes in SBP correlate with changes in ____________

Answer 22

myocardial O2 requirements

Question 23

The diastolic Bp reflects _________________

Answer 23

Coronary Perfusion Pressure

Question 24

Pulse pressure is _________- ____________

Answer 24

SBP - DBP

Question 25

MAP is the ______ weighted average of _________ during a _______ cylcle

Answer 25

time
arterial
pulse

Question 26

What is the Equation for MAP

Answer 26

MAP = SBP + 2(DBP)/3

Question 27

Something that could cause a widening PP is _______________

Answer 27

aortic insufficiency

Question 28

Auscultation of the BP permits estimation of _____ & ______

Answer 28

SBP & DBP

Question 29

_______________ senses fluctuations in cuff pressure produced by arterial pulsations while deflating a BP cuff. This is how automated cuffs work.

Answer 29

oscillometry

Question 30

Cuff bladder width should be approximately ____% of the circumference of the extremity and length should encircle at least _____%.

Answer 30

40

80

Question 31

A falsely high BP could be from what 4 things?

Answer 31

Cuff too small, cuff too loose, extremity below the heart, arterial stiffness

Question 32

A falsely low BP could be from what 4 things?

Answer 32

cuff too large, extremity above the heart, poor tissue perfusion, too quick deflation

Question 33

The 6 sites possible for an Aline are?

Answer 33

radial, ulnar, axially, brachial, femoral, DP

Question 34

To test collateral flow for a radial a-line you would use ___________

Answer 34

allen’s test

Question 35

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

Answer 35

mid axillary line (right atrium)

ear (circle of willis)

Question 36

On an arterial waveform, the rate of upstroke represents ___________________

Answer 36

contractility

Question 37

On an arterial waveform, the rate of downstroke represents ______________

Answer 37

SVR

Question 38

Exaggerated variations in size with respirations on the Aline could mean ___________________

Answer 38

hypovolemia

Question 39

The area under the curve on an aline is the ___________

Answer 39

MAP

Question 40

The closure of the aortic valve on the aline waveform is the _____________

Answer 40

dicrotic notch

Question 41

The 6 parts on the arterial BP waveform are:

Answer 41

1. systolic upstroke
2. systolic peak pressure
3. systolic decline
4. dicrotic notch (aortic valve closure)
5. diastolic runoff
6. end- diastolic pressure

Question 42

*As arterial BP waveforms travel through the arterial tree to periphery have ______________________

Answer 42

distal pulse amplification