Hemodynamics Flashcards
What is your first duty as an anesthesia care provider
-vigilance
Electrocardiogram
- monitors HR and rhythm
- detects arrhythmias, electrolyte disturbances, myocardial ischemia
- be mindful of many sources of interference in the OR
3 lead ECG
- lead I, II, and III (RA, LA, LL) (black, white, red)
- lateral and inferior views
- detects HR and Vfib
What leads are most sensitive to ischemia?
-precoridal leads
5 lead ECG
- I, II, III, aVR, aVL, aVF, V (7 views)
- RA, LA, LL, RL, V
What lead monitors for special arrhythmias
V1: distinguishes between RBBB and LBBB
What leads are preferred for monitoring for ischemia
-V3 through V5
What is the standard for monitoring patients who are at higher risk for perioperative ischemia detection?
-Lead II and V5
Where does V5 lead get placed
-
What should your gain and filtering capacity be set to?
Gain = 1mV
Filtering Capacity = diagnostic mode
What are some indicators of ischemia
- ST segment elevation >1.0 mm
- T wave flattening or inversion
- presence of Q waves
- ST segment flattening or downslope of >1.0mm
- peak t-waves
- arrhythmias
ST elevation vs ST depression
- ST elevation usually signals a poor supply (thrombus, block etc.)
- ST depression usually means ischemic demand.
- ST elevation specific to occluded artery;
- ST depression not specific to artery, just indicates demand ischemia
- ST elevation = transmural ischemia; coronary artery occlusion or arterial vasospasm; reciprocal ST depression contralateral leads = coronary thrombosis; subendocardial ST depression ischemia = stable angina occurs in tachycardia
What does the ST segment mean?
-ventricular repolarization
Baseline ST depression
- find baseline
- set alarms between 1/2mm elevation and depression
-antidysrythmics, prior ischemia
Changes in II, III, AVF insinuate
- inferior wall ischemia
- Right Coronary Artery
Changes in I, aVL, V5-V-6 insinuate:
- Lateral wall ischemia
- Left circumflex
Changes in V3-V4
- Anterior Wall ischemia
- Left Coronary Artery
Changes in Lead V1-V2
- Septal Ischemia
- Left Anterior Descending
What leads are most sensitive for exercise induced ischemia?
-leads V4-V5
What do you do in the OR if you suspect your patient is having a ischemic event
1) regulate supply/demand: lower HR, increase BP, lower catecholamine response
2) order TEE to check for RWMA
Left axis deviation
,
Right axis deviation
.
Changes in SBP correlate with
-myocardial oxygen requirements
Changes in DBP
-changes in coronary perfusion pressure
MAP
-time weighted average of blood pressure during cardiac cycle
Auscultation of blood pressure relies on
-Korotkoff sounds
Oscillatory method measures
- oscillations or pressure fluctuations that occur in response to arterial pulsation
- DBP mathematically calculated
- requires pulsatile flow; cannot be done with VAD or ECMO
- usually underestimates SBP and overestimates DBP
What issues will give you a falsely high BP
- too small cuff
- extremity below heart
- stiff blood vessels (atherosclerotic dx)
What issues will give you a false low BP
- cuff too big
- too quick deflation
- extremity level above heart
- poor tissue perfusion
- dysrythmias, tremors, shaking
Indications for arterial line
- continuous real time blood pressure monitoring
- planned pharmacological CV manipulation
- repeated blood sampling
- failure of indirect arterial blood pressure monitoring
- severe end organ disease
- anticipated or induced hypotension