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LANCE > Miscellaneous Monitors > Flashcards

Miscellaneous Monitors Flashcards

1
Q

febrile definition

A

> 38 degrees C

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2
Q

hypothermia defintion

A

<36 degrees C

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3
Q

room temp

A

23 degrees C

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4
Q

what is the recommended room temperature for the OR

A

between 20-24 degrees C

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5
Q

what are the 6 temperature monitoring sites?

A 
blood (swan) 
esophageal
rectal
nasal
bladder
skin/ axillary
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6
Q

which temp monitoring location is the best estimate of core temp?

A

swan ganz

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7
Q

which temp monitoring site is the most consistently reliable estimate of core body temp

A

esophageal

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8
Q

when is the esophageal temp probe less reliable?

A

open chest cases

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9
Q

when would the rectal temp probe be less reliable?

A

if rectum isnt clear

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10
Q

What is a good temp probe choice during open heart surgery?

A

nasal bc the chest is open so esophageal will not be accurate

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11
Q

what does the accuracy of the bladder temp probe rely on?

A

urine output being normal

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12
Q

what are the 4 causes of intraop temp loss?

A

IV fluids
vasodilation
blood products
volatile agents

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13
Q

how much does 1 unit of blood or 1 L of crystalloids decrease the mean body temp by?

A

0.25 degrees C

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14
Q

how does vasodilation cause temp loss?

A

redistributes heat from warm central compartments to cooler peripheral tissues

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15
Q

how dose the volatile agents cause temp loss?

A

interferes with hypothalamic thermoregulation

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16
Q

what blood products are stored at cool temps and should be given through a blood warmer?

A

PRBC
cryo
FFP

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17
Q

what blood product is not given through a fluid warmer?

A

platelets

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18
Q

4 adverse cardiovascular effects of hypothermia

A

platelet dysfunction/bleeding
decreased SV
bradycardia/arrhythmia
increased blood viscosity

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19
Q

for every 1 degree C drop in body temp the cerebral blood flow decreases how much?

A

5-7%

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20
Q

what is the adverse neurologic effect of hypothermia

A

increased cerebral vascular resistance

decreased cerebral blood flow

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21
Q

adverse renal effects of hypothermia

A

decreased GFR

impaired renal tubular function

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22
Q

adverse respiratory effects of hypothermia

A

respiratory depression

left shift of the HbO2 dissociation curve

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23
Q

adverse metabolic effects of hypothermia

A

decreased drug metabolism & delayed emergence
decreased wound healing
shivering

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24
Q

how much does shivering increase oxygen consumption?

A

five fold

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25
what pts should we be extremely concerned with shivering?
pts with CAD
26
When is shivering more likely? 3
lower intraop temp longer surgery higher volatile agent
27
what are the two treatments for shivering?
warm the pt | demerol 25mg
28
4 types of heat loss in the OR (in order of most heat loss to least, with %)
radiation 60% evaporation 20% convection 15% conduction 5%
29
radiation definition
losing heat to the colder temp of atmosphere (requires no contact) 60%
30
evaporation definition
body loses heat through the loss of water (when the body is opened up) 20%
31
convection definition
air flow over exposed surfaces (moving air currents in OR) 15%
32
conduction definition
transfer of heat between adjacent surfaces (laying on the cold metal table) 5%
33
2 purposes of an esophageal stethoscope
measure temp | listen to heart and lung sounds
34
precordial stethoscope function, where is it popular?
constant heart/lung sounds | popular in peds
35
BIS monitor reading 65-85 indicates?
sedation
36
BIS monitor reading 40-65 indicates?
general anesthesia
37
BIS monitor reading <40 indicates?
too deeply anesthetized
38
what drug can actually increase the BIS number?
ketamine
39
What is a BIS monitor?
bispectral index monitor that uses EEG to monitor awareness
40
3 common situations for the BIS monitor
paralyzed pt pt undergoing TIVA that are paralyzed sick pts that require less anesthesia
41
Are sick pts always able to mount a sufficient sympathetic response to alert anesthetist of light anesthesia?
NO, this is why BIS should be used on these pts, may not be HTN and tachy
42
when are the two exceptions of when we cannot trust vital signs to monitor awareness?
beta blockers were not given | pts arent healthy enough to mount normal sympathetic response
43
should an anesthetist need a BIS monitor if the patient is not paralyzed?
if a patient is deep enough to not move, they should be deep enough to not have awareness probably no BIS
44
what is urine output an indicator of?
adequate cardiac output and renal perfusion
45
what is the common goal for urine output?
>0.5-1.0 mL/kg/hr
46
What is a TEE?
transesophageal echocardiography: ultrasound of cardiac structures with probe resting in the esophagus posterior to heart
47
what can a TEE estimate?
EF CO patency of heart valves (stenosis/regurg) PAP
48
What is the best monitor for diagnosing venous air embolism?
TEE
49
Evoked potentials definition
monitor nerves that are close to the surgical site | monitor waves are warn if nerve is ischemic or damaged
50
evoked potentials method 2
1 nerve is electrically stimulated and produce waveform | 2 ischemic/damaged nerve abnormal wave
51
evoked potential wave amplitude
height of the wave
52
evoked potential wave latency
time from the onset of the wave to the peak of the response
53
effect of nerve damage and ischemia on waves
decreased amplitude and increased latency
54
when can the surgeon be lad to believe that ischemia is present when it is not?
when our anesthetics also cause a decrease in amplitude and increase in latency
55
how can an anesthetist intervene if the amplitude decreases or latency increases?
increase the patients BP
56
which two drugs increase amplitude?
ketamine | etomidate
57
which two drugs cause no change to latency?
nitrous oxide | versed
58
what effect do opiods have on amplitude and latency?
minimal effect
59
which drugs have the greatest effect on SSEPs?
volatile agents and nitrous oxide
60
4 types of evoked potentials?
somatosensory evoked potentials (SSEPs) motor evoked potentials (MEPs) brainstem auditory evoked potentials (BAEPs) visual evoked potentials (VEPs)
61
which type of evoked potential can you not use a muscle relaxant?
motor evoked potentials
62
what do SSEPs monitor?
the integrity of sensory nerves | peripheral nerve stimulated and travel through dorsal nerve roots
63
Can you use a muscle relaxant during SSEP?
yes
64
What do MEPs monitor?
integrity of motor nerve
65
where do the motor nerves travel through in spinal cord?
anterior and lateral pathways
66
are MEPs or SSEPs more sensitive to volatile agents?
MEPs
67
what do BAEPs monitor?
integrity of the vestibulocochlear (CN7) and brainstem | uses earphones
68
which evoked potential is least affected by anesthetics?
BAEPs
69
what do VEPs monitor?
the integrity of the optic nerve
70
when are VEPs used?
during pituitary tumor resection
71
What EP is most effected by anesthetics?
VEPs
72
3 steps to anesthetic management with EPs
<0.5 MAC keep anesthetic level constant avoid muscle relaxant if MEPs
73
what are the two supplements for the volatile agent on cases with EPs?
``` propofol drip narcotic drip (remi) ```
74
does bolused or infused propofol have a larger effect on EPs?
bolused propofol

LANCE (17 decks)

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