Mod 1 - Monitoring 1 8/22 Flashcards
Quiz 2
why do we monitor patients?
to maximize the safety of the anesthetic procedure
T/F - anesthesia records are legal documents and one person should be dedicated to monitoring the patient to maintain accurate records.
True
what is the lowest appropriate range for the intraoperative mean arterial pressure (MAP)?
60-80 mmHg
what is the highest appropriate range for the intraoperative partial pressure of CO2 (PaCO2) in dogs?
40-60 mmHg
we use an ECG to monitor what 2 things?
- HR
- heart rhythm
how can we directly measure blood pressure?
arterial catheter (connected to a pressure transducer)
what 2 ways do we indirectly monitor blood pressure?
- oscillotonometry
- Doppler
mean arterial pressure = 1 x 2
MAP = CO x systemic vascular resistance
cardiac output = 1 x 2
HR x stroke volume
what 3 things can affect CO?
- HR
- stroke volume
- contractility
if CO inc., what happens to MAP?
inc. (& vice versa)
vasoconstriction causes MAP to (inc./dec.), and therefore, BP (inc./dec.)
inc.
inc.
vasodilation causes ?, which causes MAP to (inc./dec.), and therefore, BP (inc./dec.)
relative hypovolemia
dec.
dec.
what is the normal HR for:
1. large dog
2. small dog
- 60-120 bpm
- 80-160 bpm
what is the normal HR for cats?
120-220 bpm
what is the normal HR for horses?
35-45 bpm
what is the normal HR for ruminants?
70-90 bpm
when should you treat bradycardia in:
1. large dogs
2. small dogs
- <50 bpm
- <60 bpm
when should you treat bradycardia in cats?
<90 bpm
when should you treat bradycardia in horses?
<25 bpm
when should you treat bradycardia in ruminants?
<55 bpm
T/F - when horses are bradycardic (<25 bpm), we almost always treat it.
False - worried about dec. GI motility
The decision to treat bradycardia in a patient should always be based on what value?
MAP
what are 3 common (overall) causes of bradycardia in a patient?
- inc. vagal tone
- hypothermia
- heart disease
what class of drugs is used to treat bradycardia?
A. sympatholytics
B. anticholinergics
C. Ca++ channel blockers
D. local anesthetics
E. GABA agonists
B (like atropine or glycopyrrolate)
what are 3 common (overall) causes of tachycardia?
- not enough anesthesia/analgesia
- drugs
- metabolic
what are 3 metabolic causes of tachycardia?
- hypovolemia
- hypoxemia
- hypercapnea
T/F - a light plane of anesthesia required immediate attention.
True!
What percentage of the induction drug dose should you give to treat a light plane of anesthesia?
10-20%
If HR is inc. while BP is dec., what are 4 possible problems that you should consider?
- hypovolemia
- sepsis
- cardiovascular collapse
- poor perfusion
what class of drugs is used to treat tachycardia associated with atrial fibrillation?
A. anticholinergics
B. beta blockers
C. local anesthetics
D. GABA agonists
E. neuromuscular blockers
B.
T/F - if HR is inc. and BP is dec., it’s more important to dec. HR than to worry about BP.
False - BP is already low - dec. HR will make it worse!
what are 5 causes of anesthesia-related arrhythmias?
- hypoxemia
- poor perfusion
- direct drug effects
- “sensitization” by anesthetics
- electrolyte distrubances
T/F - differently shaped VPC means different parts of the ventricle are firing each time. This should be treated immediately.
True
what are the 4 classes of antiarrhythmic drugs?
- Na+ channel blockers
- beta blockers
- action potential duration prolongers (previously K+ channel blockers)
- Ca++ channel blockers
a BP cuff width should be ?% of the tail diameter in elephants?
40%
the point of maximum oscillations read by an oscillometric monitor has the most accurate reading of what value?
MAP
when using a Doppler, what are you reading when you start to hear sound when letting off cuff pressure?
systolic pressure
what are 4 common (overall) causes of hypotension?
- low venous return
- heart disease
- arrhythmias
- low systemic vascular resistance
what are the 5 steps (in order) for troubleshooting hypotension?
- assess anesthetic conc.
- assess HR
- assess crystalloid fluids given over last 1hr
- consider giving hypertonic saline or colloid
- re-evaluate MAP
what receptor does dobutamine act on?
A. cholinergic
B. beta-1
C. alpha-1
D. GABA
E. dihydropyridine
B.
what receptor does norepinephrine act on?
A. cholinergic
B. beta-1
C. alpha-1
D. GABA
E. dihydropyridine
C.
NE is a vaso(constrictor/dilator) and has a use in ?. otherwise, it is difficult to control effects.
vasoconstrictor
cardiac arrest
what does it mean if you give a breath to a patient and the cardiac waveform squishes down?
patient is still hypovolemic
what are packed red blood cells?
what does it contain? (3)
RBCs spun down in refrigerated centrifuge
- RBCs
- WBCs
- some plasma & anticoagulant
what is fresh frozen plasma?
what does it contain? (3)
supernatant from FWB centrifugation
- plasma
- stable clotting factors
- labile clotting factors (5, 8, vWF)
how long does fresh frozen plasma last?
1yr @ -20C
what is frozen plasma?
what does it lack?
outdated fresh frozen plasma or not frozen within 8hrs
labile clotting factors (5, 8, vWF)
frozen plasma is a source of ? for oncotic support.
albumin
