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Apex > Hemodynamic Monitors And Equipment > Flashcards

Hemodynamic Monitors And Equipment Flashcards

1
Q

What is the first sound measured in a manual BP?

A

SBP

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2
Q

What is the last sound that disappears in a manual BP?

A

DBP

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3
Q

What method do automatic BP machines use to measure BP?

A

Oscillometric

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4
Q

What is the most accurate data provided by the oscillometric method of BP measurement?

A

MAP

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5
Q

What is the ideal length of the bladder in a BP cuff?

A

80% of the extremity circumference

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6
Q

What is the ideal width of the bladder for BP measurement?

A

40% of the extremity circumference

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7
Q

A cuff that is too small what?

A

Overestimates the BP. The cuff pressure required to occlude the artery is HIGHER with a cuff that is too small.

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8
Q

A cuff that is too large?

A

Underestimates the SBP. The cuff pressure required to occlude the artery is lower with a cuff that’s too large.

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9
Q

What are some causes of an over-dampened arterial line?

A

(Underestimated SBP and overestimated FBP)

Common causes are air bubbles, clot at the end of the catheter tip, and low flush bag pressure.

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10
Q

What does it mean for your arterial line to be optimally dampened?

A

Baseline is established after 1 second (of square test-flush)

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11
Q

What does it mean for your arterial line to be under-dampened?

A

Baseline is established after several oscillations (SBP is overestimated, DBP is underestimated) ~ MAP is accurate

Causes: stiff tubing; catheter whip

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12
Q

What does it mean for your arterial line to be over-dampened?

A

Baseline is re-established with NO oscillations.

SBP is underestimated; DBP is overestimated. ~ MAP is accurate

Causes: air bubble, clot in tubing, low flow flush bag, kinks, or loose tubing.

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13
Q

How far is the insertion site from the subclavian to the vena cava/Rt atrial junction?

A

10 cm

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14
Q

How far is the insertion site from the Rt IJ to the vena cava/rt atrial junction?

A

15 cm

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15
Q

How far is the insertion site from the left IJ to the vena Cava / rt atrial junction?

A

20 cm

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16
Q

How far is the insertion site from the femoral to vena cava / rt atrial junction?

A

40 cm

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17
Q

What is the distance from the vena cava / rt atrial junction to the Catheter tip in the rt atrium?

A

10 cm

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18
Q

How far is the distance from the vena cava to the art ventricle?

A

15 cm

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19
Q

How far is the distance from the vena cava to the Pulmonary artery?

A

15-30 cm

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20
Q

How far is the distance from the vena cava to the PAOP location?

A

35

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21
Q

What is the added risk of accessing from the Lt IJ for central line?

A

Puncturing the thoracic duct. (This can cause chylothorax)

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22
Q

When should you NOT float a PA cath?

A

If the patient has a current LBBB ~ if the PA catheter causes a RBBB ~ complete heart block could ensue.

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23
Q

What is the classic presentation of pulmonary artery rupture?

A

Hemoptysis

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24
Q

What are the 3 peaks in a CVP waveform?

A

a, c, and v

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25
Q

What does the a wave correlate with?

A

Atrial contraction

**just after atrial depolarization

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26
Q

What does the c wave correlate to?

A

Tricuspid valve elevation into the right atrium ~ RV pressure causes the valve to bulge (isovolumetric contraction)

**just after QRS complex (ventricular depolarization)

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27
Q

What does the v wave correlate to?

A

Atrium passive filling

**just after T wave begins (ventricular repolarization)

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28
Q

What are the two troughs of the CVP waveform?

A

x and y

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29
Q

What does the x part of the CVP waveform mean?

A

Downward movement is contracting RV

**ST segment

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30
Q

What does the y portion of the CVP waveform mean?

A

Atrium passively empties in the RV

**after T wave ends

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31
Q

Where should the CVP be zeroed?

A

Phlebostatic axis

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32
Q

Where is the phlebostatic axis?

A

Fourth intercostal space mid anteroposterior level

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33
Q

When should the CVP be measured?

A

End expiration

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34
Q

What are some factors that increase CVP?

A

Hypervolemia
RV failure
Tricuspid stenos
PEEP
VSD
Pulmonic stenosis
Cardiac tamponade
Constrictive pericarditis

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35
Q

What are some factors that decrease CVP?

A

Hypovolemia (hemorrhage)

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36
Q

What is the normal CVP?

A

0-10

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37
Q

In what conditions would you have a loss of the a wave in the CVP waveform?

A

Afib
V-pacing

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38
Q

In what conditions would you have a large/increased a wave in the CVP waveform?

A

Anytime the atrium has to contract against a high resistance

Tricuspid stenosis
Diastolic dysfunction
Myocardial ischemia
Rv hypertrophy
PVCs
AV dissociation

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39
Q

In what conditions would you have an increased/large v wave in the CVP waveform?

A

Tricuspid regurge
Acute increase in intravascular volume
RV papillary muscle ischemia

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40
Q

What are some traits of the PA waveform in the RV

A

Systolic pressure increased; diastolic pressure = CVP (valve is open)

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41
Q

How does the PA waveform change in the Pulmonary artery?

A

Diastolic pressure increases
Dicrotic notch appears

42
Q

how does the PA waveform change when is enters occlusion (PAOP) wedged?

A

This waveform is basically the CVP for the left side. The values mean the same (just on the left side)

43
Q

Where should the tip of the PA cath be placed?

A

Zone 3

In this zone, there is a continuous column of blood between the tip of the PAC and the left ventricle ~ provides the most accurate LVEDP

44
Q

What are some conditions that here PAOP overestimates LVEDP?

A

Impaired LV compliance
Mitral valve disease
Left to right cardiac shunt
Tachycardia
PPV
PEEP
COPD
pHTN

45
Q

What are some conditions that would cause the PA cath to underestimate LVEDV?

A

Aortic valve insufficiency

46
Q

(In thermodilution) If CO is high and the injectate rapidly travels towards the distal tip of the PA cath, the area under the curve (AUC) is what?

A

Smaller

Area is inversely proportional to cardiac output.

Better CO = small AUC

47
Q

(In thermodilution) If CO is low and the injectate slowly travels towards the distal tip of the PA cath, the area under the curve (AUC) is what?

A

Larger

Area is inversely proportional to cardiac output.

Worse CO = larger area under the curve

48
Q

What are some conditions that may underestimate your CO when using thermodilution?

A

Injectate volume is too high
Injectate volume is too cold

49
Q

What are some conditions that overestimate CO when using thermodilution?

A

Injectate volume is too low
Injectate solution too hot
Partially wedged PAC
Thrombus in tip of PAC

50
Q

What are two conditions that make it difficult to predict CO when using thermodilution?

A

Intracardiac shunt
Tricuspid regurgitation

51
Q

What is the equation for a mixed venous (and/or) SvO2?

A

SaO2 - VO2 / Q (CO) x 1.34 x Hgb x 10

52
Q

What is a normal SvO2?

A

65-75%

53
Q

When does SvO2 decrease?

A

Oxygen consumption increases or oxygen delivery decreases

54
Q

What are some conditions that will increase O2 consumption? ~ resulting in a decreased SvO2

A

Stress
Pain
Thyroid storm
Fever

55
Q

What are some conditions that result in a decreased O2 delivery? Thus decreasing SvO2?

A

Decreased PaO2
Decreased Hgb
Decreased CO

56
Q

What are some conditions that decrease O2 consumption, ~ thus resulting in an increased SvO2?

A

Hypothermia
Cyanide Toxicity

57
Q

What are some conditions that result in an increased O2 delivery ~ thus resulting in an increased SvO2?

A

Increased PaO2
Increased Hgb
Increased CO

58
Q

Why does sepsis cause an increased SvO2?

A

Even though sepsis creates a high cardiac output, oxygen bypasses tissues restyling in end-organ hypoxia

59
Q

Preload responsiveness is expected to be present if a 200-250 mL bolus increases stroke volume in excess of what?

A

10%

60
Q

(Pulse pressure variation)
During inspiration, what happens to RV pressure, LV pressure, and stroke volume?

A

A positive breath augments LV filling ~ compression of the pulmonary veins and pleural restriction impedes RV filling.

Increased LV filling increases stroke volume

61
Q

(Pulse pressure variation)
During expiration, what happens to RV filling and LV filling, and stroke volume?

A

LV filling decreases (decreased RV preload on previous beat reduces LV preload)

Decreased LV filling results in reduced stroke volume

62
Q

What are 6 situations where pulse contour analysis won’t provide reliable data?

A

Spontaneous breathing
PEEP
Small tidal volumes
Open chest
RV failure
Dysrhythmias

63
Q

Where should the esophageal Doppler be placed?

A

The tip should be placed 35 cm from the incisors or T5/T6

64
Q

(Esophageal Doppler)
What is peak velocity?

A

Index of contractility

65
Q

(Esophageal Doppler)
What is flow time?

A

Timing of flow from the left ventricle during systole

66
Q

(Esophageal Doppler)
What is mean acceleration?

A

The average speed on the upstroke of the waveform

67
Q

(Esophageal Doppler)
What is cycle time?

A

The time of one cardiac cycle

68
Q

(Esophageal Doppler)
What is stroke distance?

A

How far SV is pumped along the aorta per beat

(Area under the curve)

69
Q

What is a relative contraindication to the esophageal Doppler?

A

Esophageal disease l

70
Q

What are some limitations to the esophageal Doppler?

A

Aortic stenosis
Aortic regurgitation
Dx of thoracic aorta
Aortic cross-clamping
After CPB
Pregnancy

71
Q

What is the conduction velocities in the SA and AV nodes?

A

.02-.10 m/sec (slow conduction)

72
Q

What is the conduction velocities for myocardial muscle cells?

A

0.3 - 1 m/sec (intermediate conduction)

73
Q

What is the conduction velocities for the bundle of his, bundle branches, and purkinje fibers?

A

1-4 m/sec (fast conduction)

74
Q

Which accessory pathway connect the atrium to the AV node?

A

James fiber

75
Q

Which accessory pathway connects the atrium to His bundle?

A

Atrio-hisian fiber

76
Q

Which accessory pathway connects the atrium to the ventricle?

A

Kent’s bundle

77
Q

What accessory pathway connects the AV node to the ventricle?

A

Mahlon bundle

78
Q

In the ventricular action potential, what does phase 0 correlate with on the EKG?

A

Rapid depolarization (QRS)

** Na+ in

79
Q

In the ventricular action potential, what does phase 1 correlate with on the EKG?

A

Initial repolarization (QRS)

**Cl- in, K+ out

80
Q

In the ventricular action potential, what does phase 2 correlate with on the EKG?

A

Plateau phase (QT interval)

**Ca in, K+ out

81
Q

In the ventricular action potential, what does phase 3 correlate with on the EKG?

A

Final repolarization (T wave)

**K+ out

82
Q

In the ventricular action potential, what does phase 4 correlate with on the EKG?

A

Resting phase (T—> QRS)

**K+ leak

83
Q

What is the electrical event of the atria during by the P wave?

A

Depolarization begins

84
Q

What is the electrical activity of the atria during the PR interval?

A

Depolarization complete

85
Q

What is the electrical activity of the atria AND ventricle during the QRS?

A

Atria: repolarization
Ventricles: depolarization begins

86
Q

What is the electrical activity of the ventricle during the ST segment?

A

Depolarization complete

87
Q

What is the electrical activity of the ventricle during the T wave?

A

Repolarization begins

88
Q

What is the electrical activity of the ventricle after the T wave?

A

Repolarization complete

89
Q

What is the J point?

A

Where the QRS complex ends and the ST segment begins

(By measuring this point relative to the PR segment, we can quantify the amount of ST elevation or depression)

90
Q

As a rule, what elevation/depression of the J point is deemed significant?

A

+ 1 or - 1

91
Q

How does too low of potassium affect the EKG?

A

U wave
ST depression
Flat T wave
Long QT interval

92
Q

How does too high of potassium affect the EKG?

A

(In order of appearance ~ early to late)

Narrow and peaked T waves
Short QT
Wide QRS
Low P amplitude
Wide PR
Nodal block
Sine wave fusion of QRS and T ~ VF

93
Q

How does hypercalemia affect the EKG?

A

Short QT

94
Q

How does hypocalcemia affect the EKG?

A

Long QT

95
Q

How does hypermagnesia affect the EKG?

A

No effect unless very very high

Heart block
Cardiac arrest

96
Q

How does hypomagnesia affect the EKG?

A

No significant effect unless very low ~~

Long QT

97
Q

When does a positive deflection occur?

A

When the vector of depolarization travels towards the positive electrode

98
Q

When does a negative deflection occur?

A

Vector of depolarization travels away from the positive electrode

99
Q

When does a biphasic deflection occur?

A

When the vector of depolarization travels perpendicular to the positive electrode

100
Q

When the heart depolarizes, the direction of the vector goes from?

A

Base to apex

Endocardium to epicardium

101
Q

When the heart repolarizes, the direction of the vector goes from?

A

Apex to base

Epicardium to endocardium

Apex (47 decks)

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