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Hemodynamic Monitoring Flashcards

1
Q

Purpose of hemodynamic monitoring

A

Assess homeostasis, trends, Observe for adverse reactions, Assess therapeutic interventions, Manage anesthetic depth, Evaluate equipment function

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2
Q

How we monitor oxygenation

A

Pulse ox, skin color, ABGs, 02 analyzer on machine

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3
Q

How we monitor ventilation

A

End tidal, breath sounds, flow volume loop, chest rise, movement of respiratory bag

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4
Q

How we monitor circulation

A

Pulse ox, capillary refill, pulses, a line, skin color, BP, HR, heart sounds

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5
Q

Minimal standard for monitoring

A

Ecg, bp, pulse ox, 02 analyzer, end tidal co2

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6
Q

Minimal standard on graphic display

A

Ecg, bp, hr, ventilation status, o2 sat

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7
Q

Considerations when choosing monitoring

A

Indications, contraindications, risks/benefits, techniques, alternatives, complications, cost

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8
Q

Hemodynamic monitoring

A

Stethoscope, ecg, bp (invasive or not), cvp, pap, PCwp, tee

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9
Q

What is precordial stethoscope

A

Continuous heart and breath sounds, goes into esophagus of intubated pts 28 cm, monitors bronchospasm and peds changes

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10
Q

Purpose of ecg

A

Arrythmia detection, monitor HR, detect ischemia, detect lyte changes, monitor pacemaker function

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11
Q

3 lead ecg electrodes, leads, views

A

RA, LA, LL. Leads I, II, III. 3 views, no anterior. No LAD view

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12
Q

5 lead ecg electrodes, leads, views

A

RA, LA, LL, RL, chest. I, II, III aVR, aVL, aVF, V. 7 views

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13
Q

Best lead for arrythmia, for ischemia

A

II. V5.

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14
Q

What gain and filtering capacity should be set at

A

Standardization. Diagnostic mode

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15
Q

What filtering capacity is

A

Filters out unwanted noise/artifact

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16
Q

Indicators of acute ischemia on ECG

A

ST elevation >1 mm, T wave inversion, Q waves, ST depression, flat or downslope >1 mm. Peaked T waves

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17
Q

Where posterior/inferior wall ischemia shows, artery

A

RCA. II, III, AVF

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18
Q

Where lateral wall ischemia shows, artery

A

Circumflex of LCA. I, AVL, V5-V6

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19
Q

Where anterior wall ischemia shows, arty

A

LCA. I, AVL, V1-4

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20
Q

Where anteroseptal ischemia shows, artery

A

LAD, V1-V4

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21
Q

What SBP and DBP correlate with

A

Myocardial o2 requirement changes. Coronary perfusion pressure

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22
Q

MAP calculation

A

SBP + 2DBP/3

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23
Q

What oscillometry does

A

Senses fluctuations in cuff pressure made by arterial pulsation when deflating bp cuff. 1st correlates w SBP, max at MAP, cease at DBP. How automatic cuffs work

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24
Q

What bladder width of bp cuff should be

A

40% of circumference of extremity

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25
What bladder length should be
Encircles 80% of extremity
26
What creates a falsely high BP
Cuff too small or loose, extremity below heart, arterial stiffness in htn or PVD.
27
What creates a falsely low bp
Cuff too big, above heart, poor tissue perfusion, too quick of deflation
28
Complic of NIBP
Edema of arm, bruising, ulnar neuropathy, interferes IV flow, pain, compartment syndrome
29
Indications for arterial line bp
Elective hypotension, wide swings or rapid bp changes intra op, fluid shifts, titrate vasoactives, end organ disease, blood sampling
30
How to improve accuracy of a line
Remove air bubbles, limit tube length, limit stop cocks, small mass of fluid, stiff tubing, calibrate at heart
31
Where to zero a line when supine or sitting
Supine- mid axillary line (RA). Level of ear (circle of Willis)
32
A line wave forms: what rate of upstroke and downstroke show. Variations in size. Area under curve. Dicrotic north
Contractility. SVR. Hypovolemia. MAP. Aortic valve closure
33
Points on a line waveform 1-6
Systolic upstroke, systolic peak pressure, systolic decline, dicrotic notch, diastolic runoff, end diastolic pressure
34
Distal pulse amplification does what
For a line. SBP peak increases, DBP wave decreases, MAP same. Dicrotic notch becomes less and appears later
35
IABP complications
Nerve damage, hematoma, bleeding, thrombosis, air embolus, necrosis, loss of digits, vasospasm, arterial aneurysm, retained guidewire
36
Indications for CVL
Measure R heart filling p, assess fluid status, rapid admin fluids, give vasoactives, remove air emboli, insert transcutaneous pacing leads, vascular access, sample blood, PA cath
37
CVL: size, length, where tip should be
7 French, 20 cm length skin to RA junction. 15 if left side. 10 if subclavian. Within SVC above vena cava and RA. Below inferior border of blavice, above 3rd rib, T4/5 interspace,
38
Contraindications to CVL
RA tumor, infection at site
39
Risks of CVL
Air or thromboembolism, dysrhythmias, hematoma, carotid puncture, pneumo/hemothorax, vascular damage, tamponade, infection, guidewire embolism
40
What RA P should be. What happens w vent
1-7. 3-5 rise w vent
41
What a wave on CVP is
Peak coincides w max filling of RV. Used to measure RVEDP. Should be measured at end expiration
42
What wave form points are in CVP: a
A- diastole of ventricle (p wave right after, atria contracting
43
What c wave is cvp
Closure of tricuspid valve and isovolemic ventricular contraction. Tricuspid valve bulges back into atrium. Right ventricle contraction. Early suystole after QRS
44
What x wave is cvp
Atrial pressure decreases during ventricular contraction. Mid systole.
45
What v wave is cvp
Venous return against a closed tricuspid valve. Pt of RV systole (late). Right after t wave
46
What y descent is CVP
After ventricle relaxes, tricuspid valve opens d/t venous pressure, blood flows from atrium into ventricle. Diastolic collapse
47
Wave on cvp: end diastole, early systole, late systole, mid to late diastole, mid systole, early diastole
A wave, c wave, v wave, h wave, x descent, y descent
48
What PA pressure used for
CVP/PAP/PCWP, LV filling P and function, CO, mixed venous O2 sat, PVR, SVR, pacing option
49
PA size, length, lumens
7 or 9 French. 110 cm. Distal port, 2nd port 30 cm more proximal, 3rd lumen balloon, 4th wires for temp
50
Indications for PA monitoring
LV dysfunction, valvular disease, pulm htn, CAD, ARDS, Resp fail, shock, sepsis, ARF, cardiac/aortic/OB procedures
51
Complications of PA Catheter
Arrhythmias (V fib, RBBB, heart block), catheter knotting, balloon rupture, thrombo/air embolism, ptx, pulm infarct, PA rupture, endocarditis, damage to valves
52
Contraindications to PA insertion
Wpw syndrome, complete LBBB
53
What happens to wave form as PA inserted
CVP wave in RA, more turbulent and higher P in RV, SBP same and DBP rises in PA, more compact pressure when wedged
54
Distance from right IJ to : RA junction, RA, RV, PA, PA wedge
Cm. 15, 15-25, 25-35, 35-45, 40-50
55
PCWP a wave
contraction of the left atrium. small deflection unless there is resistance in moving blood into the left ventricle as mitral stenosis.
56
What c wave is PCWP
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.
57
What v wave is PCWP. Prominent wave means what
Blood enters LA in late systole. Prominent reflects mitral insufficiency causing large amts of blood to reflux into LA in systole
58
How to monitor CO
Thermodiluton, continuous thermodilution, mixed venous oximetry, ultrasound, pulse contour
59
What can cause loss of a waves in CVP/PAOP.
A fib, ventricular pacing
60
What can cause large v waves cvp and paop
Mitral regurg and acute inc in IV volume
61
What can cause giant a waves cvp and paop
Junctional rhythm, complete HB, mitral stenosis, diastolic dysfunction, myo ischemia, ventricular hypertrophy
62
What TEE observes
Ventricular wall traits/motion, valve structure/function, EF, CO, blood flow, intracardiac air or masses
63
Uses of TEE
Unusual causes of acute hypotension, tamponade, PE, aortic dissections, myo ischemia, valvular dysfunction
64
TEE complicaitons
Mostly in awake pts. Esophageal trauma, dysrhythmias, hoarseness, dysphagia

Anesthesia Basics (10 decks)

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