Hemodynamics Flashcards
What is the AANA standard for monitoring and alarms?
Standard 9: when monitoring device used, variable pitch and threshold alarms are set and audible, vitals q5 min, cont. pulse ox, etCO2, cont HR monitor, twitch monitor - paralytics, use temperature monitoring and regulation bc pt at risk for MH d/t exposure to anesthetic gas
First duty as CRNA
vigilance
Describe Precordial/Esophageal Stethoscope, whats it used for, wheres it placed?
continuous monitoring of heart and breath sounds and minimally invasive. use to assess for windmill murmur (VAE) or bronchospasm (peds). Precordial on chest. Esophageal 28-30 cm into esophagus.
Normal PRI
0.12-0.2s
Normal QRS
0.08 - 0.1s
Normal QT
0.4-0.43
Normal RR
0.6-1s
What can ECGs detect? (5)
arrhythmias, HR (based on R-R wave), ischemia, electrolyte changes, monitor pacemaker function
What view is missing in a 3 lead EKG?
anterior view
What are the limitations (4) of a 3 lead EKG and what is needed to be able to detect them?
ST monitoring, BBBs, VT, SVT - need a true V1 lead to detect arrhythmias
Majority of dysrhythmias and ischemia can be detected via what two leads?
II and V5
Gain should be set at what?
standardization, 1 mV produces 10 mm pulse, able to monitor 1 mm ST change
What should filtering capacity be set to, and why?
diagnostic mode, filtering out low end can distort ST segment
If monitoring ST segment, what should be done before pt is anesthetized?
get baseline ST segment
What are 6 indicators of ischemia?
st elevation > 1mm, T wave flat/inverted, q wave, st depression/flat/downslope > 1mm, peaked t wave, arrhythmias
Most common ST change and why?
ST depression, indication of demand problem bc heart stressed decreased HR, increased O2 demand
ST elevation is an indication of what?
blockage
What are some common causes of ST changes other than ischemia (4)?
drugs (digitalis), temp changes (hypo - depression), hyperventilation (elevation), position changes (elevation)
The leads that monitor ST changes in the inferior, lateral, anterior, and septal walls including the artery are:
Inferior: II, III, AVF - RCA
Lateral: I, AVL, V5, V6 - CxA (LCA)
Septal: V1, V2 - LCA
Anterior: V3, V4 - LCA
Exercise-related ischemia is most sensitively detected in what leads?
V4 V5
When is peak SBP generated?
ventricular contraction
Changes in SBP correlate with what?
changes in myocardial O2 requirements
DBP is a trough pressure and is generated during
ventricular relaxation
Changes in DBP indicate what?
coronary perfusion pressure