Hemodynamic Monitoring Flashcards
Purpose of hemodynamic monitoring (5 items)
- Assess homeostasis, trends
- Observe for adverse reactions
- Assess therapeutic interventions
- Manage anesthetic depth
- Evaluate equipment function
How we monitor oxygenation (4 items)
- Pulse ox
- Skin color
- ABGs
- 02 analyzer on machine
How we monitor ventilation (5 items)
- End tidal CO2
- breath sounds,
- flow volume loop,
- chest rise,
- movement of respiratory bag
How we monitor circulation (7 items)
- Pulse ox,
- capillary refill,
- pulses,
- a line,
- skin color,
- BP,
- HR, heart sounds
Minimal standard for monitoring (5 items)
- EKG
- BP
- Temperature
- SaO2
- ETCO2
Considerations when choosing monitoring (7 items)
- Indications
- Contraindications
- Risks/benefits
- Techniques
- Alternatives
- Complications
- Cost
Hemodynamic monitoring tools (6 items)
- Stethoscope
- EKG
- BP
- CVP
- PAP
- TEE
Types of stethoscopes:
- Precordial
- Esophageal
- Placed on surface of chest to read continuously; placement depends on what structure of the heart you want to hear
- Only used with intubated pts; goes down esophagus 28-30cm; sensitive for brochospams, obsturction, changes in HR/rhythm
Purpose of EKG (5 items)
- Monitor HR
- Arrythmia detection
- detect ischemia
- detect lyte changes
- monitor pacemaker function
3 lead EKG:
- Electrodes
- Leads
- Views
RA, LA, LL.
Leads I, II, III.
3 views, no anterior. No LAD view
5 lead EKG
- Electrodes,
- Leads
- Views
RA, LA, LL, RL, chest lead (ususally V1 or V5).
I, II, III aVR, aVL, aVF, V.
7 views
Best lead for
- Arrythmia,
- Ischemia
II.
V5.
Monitor settings for:
- Gain
- Filtering Capacity
- Standardization: 1mv signal produces 10mm calibration pulse; will accurately depict 1mm ST changes
- Diagnostic Mode: filters out low ECG bandwith, electrical interference
Indicators of acute ischemia on ECG (5 items)
- ST elevation >1 mm,
- Peak T wave/ inversion,
- Pathological Q waves,
- ST depression, flat or downslope >1 mm.
- Arrhythmias
Where inferior wall ischemia shows, artery
II, III, AVF
Supplied by Right Coronary Artery
Where lateral wall ischemia shows, artery
I, AVL, V5-V6
Circumflex of Left Coronary Artery
Anterior wall ischemia:
- Leads
- Artery
- V3-4
2. Left Coronary Artery
Where anteroseptal ischemia shows, artery
V1-V2
Left Anterior Descending
Blood pressure correlations:
- SBP
- DBP
- PP
- MAP
- Peak systolic contraction; changes correlate with myocardial O2 demand
- Trough pressure during diastole; changes correlate with coronary perfusion pressure
- SBP-DBP; correlates with conraction force; narrows in tamponade, widens in hypovolemia
- Correlates with organ perfusion; weighted arterial pressure during cardiac cycle
MAP calculation
SBP + 2DBP/3
Proper NIBP:
- Width
- Length
- Placement
- Limitations
- 40% of circumference of extremity
- Must encircle at least 80% of extremity
- Snugly, bladder centered over artery w/ residual air removed
What creates a falsely high BP (3 items)
- Cuff too small or loose,
- extremity below heart,
- arterial stiffness in htn or PVD.
What creates a falsely low bp (4 items)
- Cuff too big,
- above heart,
- poor tissue perfusion,
- too quick of deflation
Complication of NIBP (6 items)
- Edema of arm,
- bruising,
- ulnar neuropathy,
- interferes IV flow,
- pain,
- compartment syndrome
Indications for Arterial Line (7 items)
- Elective hypotension
- Unstable BP
- Severe fluid shifts
- Titration of vasoactive drugs
- End Organ Disease
- Frequent ABG sampling
- NIBP failure
How to improve A-line accuracy (6 items)
- Remove air bubbles,
- limit tube length,
- limit stop cocks,
- small mass of fluid,
- Use stiff tubing,
- calibrate at heart
Where to zero a line when monitoring:
- BP
- CPP
- Supine- mid axillary line (RA).
2. Meatus of ear (circle of Willis)