Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia Basics > Hemodynamic Monitoring > Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How we monitor oxygenation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How we monitor ventilation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How we monitor circulation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Minimal standard for monitoring

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Minimal standard on graphic display

A

Ecg, bp, hr, ventilation status, o2 sat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Considerations when choosing monitoring

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hemodynamic monitoring

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Purpose of ecg

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

3 lead ecg electrodes, leads, views

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

5 lead ecg electrodes, leads, views

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Best lead for arrythmia, for ischemia

A

II. V5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What gain and filtering capacity should be set at

A

Standardization. Diagnostic mode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What filtering capacity is

A

Filters out unwanted noise/artifact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where posterior/inferior wall ischemia shows, artery

A

RCA. II, III, AVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where lateral wall ischemia shows, artery

A

Circumflex of LCA. I, AVL, V5-V6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where anterior wall ischemia shows, arty

A

LCA. I, AVL, V1-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where anteroseptal ischemia shows, artery

A

LAD, V1-V4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What SBP and DBP correlate with

A

Myocardial o2 requirement changes. Coronary perfusion pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MAP calculation

A

SBP + 2DBP/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What bladder width of bp cuff should be

A

40% of circumference of extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What bladder length should be

A

Encircles 80% of extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What creates a falsely high BP

A

Cuff too small or loose, extremity below heart, arterial stiffness in htn or PVD.

27
Q

What creates a falsely low bp

A

Cuff too big, above heart, poor tissue perfusion, too quick of deflation

28
Q

Complic of NIBP

A

Edema of arm, bruising, ulnar neuropathy, interferes IV flow, pain, compartment syndrome

29
Q

Indications for arterial line bp

A

Elective hypotension, wide swings or rapid bp changes intra op, fluid shifts, titrate vasoactives, end organ disease, blood sampling

30
Q

How to improve accuracy of a line

A

Remove air bubbles, limit tube length, limit stop cocks, small mass of fluid, stiff tubing, calibrate at heart

31
Q

Where to zero a line when supine or sitting

A

Supine- mid axillary line (RA). Level of ear (circle of Willis)

32
Q

A line wave forms: what rate of upstroke and downstroke show. Variations in size. Area under curve. Dicrotic north

A

Contractility. SVR. Hypovolemia. MAP. Aortic valve closure

33
Q

Points on a line waveform 1-6

A

Systolic upstroke, systolic peak pressure, systolic decline, dicrotic notch, diastolic runoff, end diastolic pressure

34
Q

Distal pulse amplification does what

A

For a line. SBP peak increases, DBP wave decreases, MAP same. Dicrotic notch becomes less and appears later

35
Q

IABP complications

A

Nerve damage, hematoma, bleeding, thrombosis, air embolus, necrosis, loss of digits, vasospasm, arterial aneurysm, retained guidewire

36
Q

Indications for CVL

A

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
Q

CVL: size, length, where tip should be

A

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
Q

Contraindications to CVL

A

RA tumor, infection at site

39
Q

Risks of CVL

A

Air or thromboembolism, dysrhythmias, hematoma, carotid puncture, pneumo/hemothorax, vascular damage, tamponade, infection, guidewire embolism

40
Q

What RA P should be. What happens w vent

A

1-7. 3-5 rise w vent

41
Q

What a wave on CVP is

A

Peak coincides w max filling of RV. Used to measure RVEDP. Should be measured at end expiration

42
Q

What wave form points are in CVP: a

A

A- diastole of ventricle (p wave right after, atria contracting

43
Q

What c wave is cvp

A

Closure of tricuspid valve and isovolemic ventricular contraction. Tricuspid valve bulges back into atrium. Right ventricle contraction. Early suystole after QRS

44
Q

What x wave is cvp

A

Atrial pressure decreases during ventricular contraction. Mid systole.

45
Q

What v wave is cvp

A

Venous return against a closed tricuspid valve. Pt of RV systole (late). Right after t wave

46
Q

What y descent is CVP

A

After ventricle relaxes, tricuspid valve opens d/t venous pressure, blood flows from atrium into ventricle. Diastolic collapse

47
Q

Wave on cvp: end diastole, early systole, late systole, mid to late diastole, mid systole, early diastole

A

A wave, c wave, v wave, h wave, x descent, y descent

48
Q

What PA pressure used for

A

CVP/PAP/PCWP, LV filling P and function, CO, mixed venous O2 sat, PVR, SVR, pacing option

49
Q

PA size, length, lumens

A

7 or 9 French. 110 cm. Distal port, 2nd port 30 cm more proximal, 3rd lumen balloon, 4th wires for temp

50
Q

Indications for PA monitoring

A

LV dysfunction, valvular disease, pulm htn, CAD, ARDS, Resp fail, shock, sepsis, ARF, cardiac/aortic/OB procedures

51
Q

Complications of PA Catheter

A

Arrhythmias (V fib, RBBB, heart block), catheter knotting, balloon rupture, thrombo/air embolism, ptx, pulm infarct, PA rupture, endocarditis, damage to valves

52
Q

Contraindications to PA insertion

A

Wpw syndrome, complete LBBB

53
Q

What happens to wave form as PA inserted

A

CVP wave in RA, more turbulent and higher P in RV, SBP same and DBP rises in PA, more compact pressure when wedged

54
Q

Distance from right IJ to : RA junction, RA, RV, PA, PA wedge

A

Cm. 15, 15-25, 25-35, 35-45, 40-50

55
Q

PCWP a wave

A

contraction of the left atrium. small deflection unless there is resistance in moving blood into the left ventricle as mitral stenosis.

56
Q

What c wave is PCWP

A

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
Q

What v wave is PCWP. Prominent wave means what

A

Blood enters LA in late systole. Prominent reflects mitral insufficiency causing large amts of blood to reflux into LA in systole

58
Q

How to monitor CO

A

Thermodiluton, continuous thermodilution, mixed venous oximetry, ultrasound, pulse contour

59
Q

What can cause loss of a waves in CVP/PAOP.

A

A fib, ventricular pacing

60
Q

What can cause large v waves cvp and paop

A

Mitral regurg and acute inc in IV volume

61
Q

What can cause giant a waves cvp and paop

A

Junctional rhythm, complete HB, mitral stenosis, diastolic dysfunction, myo ischemia, ventricular hypertrophy

62
Q

What TEE observes

A

Ventricular wall traits/motion, valve structure/function, EF, CO, blood flow, intracardiac air or masses

63
Q

Uses of TEE

A

Unusual causes of acute hypotension, tamponade, PE, aortic dissections, myo ischemia, valvular dysfunction

64
Q

TEE complicaitons

A

Mostly in awake pts. Esophageal trauma, dysrhythmias, hoarseness, dysphagia

Anesthesia Basics (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions