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SA Anesthesiology > L2: Monitoring In Anesthesia (Shih) > Flashcards

L2: Monitoring In Anesthesia (Shih) Flashcards

1
Q

Shark fin capnograph means:**

A

Upper airway obstruction!

  • p having hard time breathing OUT
  • asthma, kinked ETT, mucus plug in ETT, etc.
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2
Q

What does it mean when capnograph baseline doesn’t go to 0?

A

1) bad valve (rebreathing)
2) low o2 flow (non-rebreathing)
3) bad soda scrub

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3
Q

Most important monitor during CPR***

A

Capnograph

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4
Q

Capnograph useful for detecting LOW PERFUSION TO LUNG, like for ex:***

A

CO and PTE

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5
Q

Types of metabolism that –> low CO2

A

Coma
Hypothyroidism
Low temperature

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6
Q

How can pulmonary perfusion –> low CO2?

A

Decreasing CO, MAP
Hypovolemia
CPR
PTE

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7
Q

What changes in ventilation –> low CO2?

A

Hyperventilation
Apnea
Pulmonary edema

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8
Q

What changes in metabolism –> high CO2?

A

Fever
Tourniquet
Seizure
Hypermetabolism (MH)

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9
Q

What changes in pulmonary perfusion –> high CO2?

A

Increase CO

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10
Q

What changes in ventilation –> high CO2?

A

Hypoventilation

Rebreathing

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11
Q

What does it mean when capnograph has normal waves in gradually increasing height?

A
  • build up of CO2 (due to hypoventilation or hypermetabolism)
  • tx: ventilate the patient
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12
Q

What does it mean when capnograph has normal waves with gradually decreasing height?

A

-hyperventilation, low blood flow, PTE, low CO

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13
Q

What does it mean when capnograph has normal waves with gradually decreasing height and reaching flatline?

A
  • disconnection
  • apnea
  • total obstruction
  • cardiac arrest
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14
Q

Capnograph is extremely sensitive to heart stopping***

A

Able to tell you if you are doing a good job w/ CPR or not, for ex.

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15
Q

What is #1 thing to gain from ECG?

A

RHYTHM of the heart, ie. How fast or slow it is

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16
Q

Pulse oximetry measures:***

A
  • Hemoglobin saturation
  • not reliable for alerting hypoxia
  • only alerts if PaO2 below 60 mmHg! (Or 90% saturation)***
17
Q

Advantages/disadv. of Oscilometric blood pressure machine

A

Adv:

  • gives systolic, diastolic, mean
  • good for routine anesthesia

Disadv.:

  • only reads q3 mins.
  • has more margin of error the more hypotensive the patient becomes
18
Q

Advantages/disadv. of Dopper blood pressure machine

A

Adv:

  • robust, reliable
  • best for ER env. W/ sick animals

Disadv:
-only gives systolic

19
Q

Advantages/disadv. of PetMap blood pressure machine

A

Very quiet, good for GP for awake cats/dogs

Disadv: not good for sick animals

20
Q

Blood flow (Q) =

A

Q = BP/SVR

21
Q

Tx of low BP during anesthesia

A
  • fluid support
  • inotropes (MOA: alter the energy of muscular contractions)
  • decrease inhalants
22
Q

Pulse alternans def. and causes and tx

A

Alternating strong and weak pulse. Causes:

  • LV systolic impairment
  • cardiac tamponade (reduced ventricular filling due to pericardial fluid)
  • aortic valve dz

Tx: give fluids (heart is getting emptied of blood and lungs are compressing heart)

23
Q

CO =

A

CO = BP/SVR

*always consider if p is vasoconstricted or not in relation to BP

24
Q

Tx for hypotension***

A
  • decrease inhalant
  • fluids
  • inotropes
25
Q

Blood pressure does not always tell you about PRE LOAD***

A

:)

26
Q

Pre load monitoring

A
  • CVP
  • Echo - gold standard
  • Pulse pressure variation - the up and down of the flow; pulse ox can give
27
Q

normal Central venous pressure

A

0-12 cmH2O

Low:too low of volume; needs fluids
High: too much volume for heart to handle

*can use pulse ox to get pulse variation index, then gauge how much fluids you need to give off that. Higher the PVI, more fluids you need.

28
Q

CVP is NOT accurate to tell you about pre-load***

A

:)

29
Q

Value of lactate in anesthesia

A
  • has prognostic, therapeutic, and diagnostic value
  • can dx septic abd
  • cleared by LIV normally
  • indicates balance of O2 delivery and O2 consumption
30
Q

Lactate drop correlates with better prognostic***

A

:)

31
Q

Capnograph –> resp. And cardio info

BP –> adequate after load
Pulse variation –> fluid response
Lactate –> tissue oxygen

A

:)

32
Q

See oxygen consumption graph

A

:)

33
Q

2 types of capnographs

A

1) mainstream (sensor in ETT)
2) sidestream (sensor in machine)
- less fragile, good for academia/exotics

SA Anesthesiology (12 decks)

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