Lecture 6 Intro to Clinical Monitoring

Question 1

Which parameters should be continually monitored during anesthetics?

Answer 1

oxygenation, ventilation, circulation, temperature

Question 2

What methods measure oxygenation?

Answer 2

inspired gas oxygen analyzer, pulse oximetry, illumination and exposure to assess color

Question 3

What are the limitations of pulse oximetry?

Answer 3

pigmented markers (especially methylene blue), dysfunctional abnormal hemoglobin species (carboy, met, fetal, etc), patient movement, low perfusion states, electrocautery, ambient light

Question 4

What methods can be used to measure ventilation?

Answer 4

qualitative clinical signs: chest excursion, observation of reservoir bag, auscultation of breath sounds. Quantitative measurement: end tidal carbon dioxide, volume of expired gas, continuous circuit disconnect monitor

Question 5

What are the applications for capnography?

Answer 5

confirmation of intubation, monitoring for circuit disconnection, identification of airway obstruction, rebreathing/metabolic monitoring

Question 6

How does hyperventilation affect pCO2?

Answer 6

lowers pCO2

Question 7

DDx for hypercarbia?

Answer 7

increased CO2 production, increased ventilatory dead space, decreased ventilation

Question 8

How is circulation monitored?

Answer 8

continuous ECG, arterial blood pressure and heart rate q 5 min, and one of the following: palpation of pulse, auscultation of breath sounds, intra-arterial pressure trace, doppler peripheral pulse, pulse plethysmography, pulse oximetry

Question 9

Which leads on ECG are used for ischemia monitoring?

Answer 9

II and V5 are 90% sensitive, II, V5, and V4 up to 98% sensitive

Question 10

If a cuff size on a noninvasive blood pressure cuff is too large the measurement is likely…

Answer 10

too low