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Hemodynamic Monitoring Flashcards

1
Q

Purpose of hemodynamic monitoring (5 items)

A
  1. Assess homeostasis, trends
  2. Observe for adverse reactions
  3. Assess therapeutic interventions
  4. Manage anesthetic depth
  5. Evaluate equipment function
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2
Q

How we monitor oxygenation (4 items)

A
  1. Pulse ox
  2. Skin color
  3. ABGs
  4. 02 analyzer on machine
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3
Q

How we monitor ventilation (5 items)

A
  1. End tidal CO2
  2. breath sounds,
  3. flow volume loop,
  4. chest rise,
  5. movement of respiratory bag
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4
Q

How we monitor circulation (7 items)

A
  1. Pulse ox,
  2. capillary refill,
  3. pulses,
  4. a line,
  5. skin color,
  6. BP,
  7. HR, heart sounds
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5
Q

Minimal standard for monitoring (5 items)

A
  1. ECG,
  2. bp,
  3. pulse ox,
  4. 02 analyzer,
  5. end tidal co2
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6
Q

Minimal standard on graphic display (5 items)

A
  1. ECG
  2. BP
  3. HR
  4. Ventilation Status
  5. O2 Sat
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7
Q

Considerations when choosing monitoring (7 items)

A
  1. Indications
  2. Contraindications
  3. Risks/benefits
  4. Techniques
  5. Alternatives
  6. Complications
  7. Cost
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8
Q

Hemodynamic monitoring tools (6 items)

A
  1. Stethoscope
  2. EKG
  3. BP
  4. CVP
  5. PAP
  6. 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 EKG (5 items)

A
  1. Monitor HR
  2. Arrythmia detection
  3. detect ischemia
  4. detect lyte changes
  5. monitor pacemaker function
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11
Q

3 lead EKG:

  1. Electrodes
  2. Leads
  3. Views
A

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

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12
Q

5 lead EKG

  1. Electrodes,
  2. Leads
  3. Views
A

RA, LA, LL, RL, chest lead (ususally V1 or V5).
I, II, III aVR, aVL, aVF, V.
7 views

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13
Q

Best lead for

  1. Arrythmia,
  2. 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 (5 items)

A
  1. ST elevation >1 mm,
  2. T wave inversion,
  3. Q waves,
  4. ST depression, flat or downslope >1 mm.
  5. Peaked T waves
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17
Q

Where inferior wall ischemia shows, artery

A

II, III, AVF

Supplied by RCA

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18
Q

Where lateral wall ischemia shows, artery

A

I, AVL, V5-V6

Circumflex of LCA.

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19
Q

Where anterior wall ischemia shows, artery

A

V3-4

Left Coronary Artery

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20
Q

Where anteroseptal ischemia shows, artery

A

V1-V2

LDA

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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

Proper NIBP cuff width

A

40% of circumference of extremity

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24
Q

Proper NIBP cuff length

A

Must encircle at least 80% of extremity

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25
Q

What creates a falsely high BP (3 items)

A
  1. Cuff too small or loose,
  2. extremity below heart,
  3. arterial stiffness in htn or PVD.
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26
Q

What creates a falsely low bp (4 items)

A
  1. Cuff too big,
  2. above heart,
  3. poor tissue perfusion,
  4. too quick of deflation
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27
Q

Complication of NIBP (6 items)

A
  1. Edema of arm,
  2. bruising,
  3. ulnar neuropathy,
  4. interferes IV flow,
  5. pain,
  6. compartment syndrome
28
Q

Indications for arterial line bp (7 items)

A
  1. Elective hypotension,
  2. wide swings or rapid bp changes intra op
  3. fluid shifts,
  4. titrate vasoactives,
  5. end organ disease,
  6. blood sampling
  7. NIBP failure
29
Q

How to improve A-line accuracy (6 items)

A
  1. Remove air bubbles,
  2. limit tube length,
  3. limit stop cocks,
  4. small mass of fluid,
  5. stiff tubing,
  6. calibrate at heart
30
Q

Where to zero a line when monitoring:

  1. BP
  2. CPP
A
  1. Supine- mid axillary line (RA).

2. Meatus of ear (circle of Willis)

31
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

32
Q

Points on a line waveform 1-6

A

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

33
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

34
Q

Arterial Line Complications (6 items)

A
  1. Hematoma
  2. Nerve Damage
  3. Infection
  4. Thrombosis/embolus
  5. Vasospasm
  6. Retained Guide Wire
35
Q

Indications for CVL (6 items)

A
  1. Measure R heart filling
  2. assess fluid status,
  3. rapid admin fluids,
  4. give vasoactives,
  5. remove air emboli,
  6. insert transcutaneous pacing leads
36
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,

37
Q

Contraindications to CVL (3 items)

A
  1. Contralateral pneumo
  2. RA tumor
  3. Infection at site
38
Q

Risks of CVL (8 items)

A
  1. Air or thromboembolism
  2. Dysrhythmias,
  3. Hematoma,
  4. Carotid puncture, vascular damage
  5. Pneumo/hemothorax,
  6. Tamponade,
  7. Infection,
  8. Guidewire embolism
39
Q

Normal RAP/Vented RAP

A

1-7.

3-5 rise w vent

40
Q

CVP Waveform: A wave (High/Low causes)

A 
Atrial contraction (follows EKG P); atrial kick; End of diastole
High: tricuspid regurg, fluid overload
Low: a-fib, fluid deficit
41
Q

CVP Waveform: C wave

A

Tricuspid valve bluges into atrium during ventricle contraction; occurs early in systole (after QRS on EKG)

42
Q

CVP Waveform: X descent

A

Systolic collapse in atrial pressure; mid-systolic even

43
Q

CVP Waveform: V wave

A

Filling of the atrium from the VC; occurs late systole while tricuspid closed (after T wave on EKG)

44
Q

CVP Waveform: Y descent

A

Diastolic collapse in atrial pressure; drop in atrial pressure as tricuspid opens

45
Q

CVP Wave to Cardiac Cycle:

  1. A Wave
  2. C Wave
  3. X Descent
  4. V Wave
  5. Y Descent
A
  1. End diastole
  2. Early Systole
  3. Mid Systole
  4. Late Systole
  5. Early Diastole
46
Q

Pulmonary Artery Assessments (6 items)

A
  1. Intracardiac pressures (PAP, PCWP)
  2. Estimate LV pressures
  3. Assess LV function
  4. CO
  5. Mixed venous saturation
  6. PVR/SVR
47
Q

PA Catheter:

  1. French
  2. Length
  3. Lumens (4)
A
  1. 7 French (introducer 8.5)
  2. 110 cm
  3. Distal, Proximal, Balloon, Thermistor
48
Q

Indications for PA monitoring (5 items)

A
  1. LV dysfunction,
  2. valvular disease,
  3. pulm htn,
  4. CAD, ARDS, Resp fail, shock, sepsis, ARF,
  5. cardiac/aortic/OB procedures
49
Q

Complications of PA Catheter (6 items)

A
  1. Arrhythmias (V fib, RBBB, heart block),
  2. catheter knotting,
  3. balloon rupture,
  4. thrombo/air embolism,
  5. ptx, pulm infarct, PA rupture,
  6. endocarditis, damage to valves
50
Q

Contraindications to PA insertion (2 items)

A

Wpw syndrome, complete LBBB

51
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

52
Q

Distance from right IJ to :

  1. RA junction,
  2. RA,
  3. RV,
  4. PA,
  5. PA wedge
A
  1. 15,
  2. 15-25,
  3. 25-35,
  4. 35-45,
  5. 40-50
53
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.

54
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 atrialpressure increases momentarily.

55
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

56
Q

How to monitor CO

A

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

57
Q

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

A

A fib, ventricular pacing

58
Q

What can cause large v waves cvp and paop

A

Mitral regurg and acute inc in IV volume

59
Q

What can cause giant a waves cvp and paop

A

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

60
Q

What TEE observes

A

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

61
Q

Uses of TEE

A

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

62
Q

TEE complicaitons

A

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

63
Q

Types of NIBP (4 items)

A
  1. Palpation
  2. Doppler
  3. Auscultation
  4. Oscillometry
64
Q

NIBP Palpation:

  1. Technique
  2. Considerations
A
  1. Palpating a pulse while deflating cuff

2. Only measures SBP but usually underestimates; is cheap, simple

65
Q

NIBP Doppler:

  1. Technique
  2. Considerations
A
  1. Use doper on artery w/ cuff

2. Measures only SBP reliably

66
Q

NIBP Auscultation:

  1. Technique
  2. Considerations
A
  1. Listen for Korotkoff sounds

2. Can estimate SBP and DBP; usually underestimates in HTN patients

67
Q

NIBP Oscillometry:

  1. Technique
  2. Considerations
A 
1. Senses oscillations:
    1st is SBP
    Max is MAP
    Cease at DBP
2. Can have false highs/lows

Positioning (6 decks)

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