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8361 Exam I > Mod1: Monitoring for Cardiac Surgery - EKG > Flashcards

Mod1: Monitoring for Cardiac Surgery - EKG Flashcards

1
Q

Monitoring for Cardiac Surgery

Why should invasive monitoring be consistently utilized in pts with significant CV dz?

A

Hemodynamic changes can occur rapidly

Corrective measures need to be instituted promptly.

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2
Q

Monitoring for Cardiac Surgery

True or False: ANESTHETIC MANAGEMENT should be tailored to allow for the measurement of physiologic parameters in order to maintain hemodynamic stability to reduce perioperative complications

A

True

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3
Q

Monitoring for Cardiac Surgery - ANESTHETIC MANAGEMENT

What are ASA minimal monitoring standards?

A

Oxygenation

Ventilation

Circulation

**Temperature

These standards could be exceeded

(You could use more than what’s required)

However the basic monitoring must always be continiously maintained

(with the exception of Temperature)

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4
Q

Monitoring for Cardiac Surgery - ANESTHETIC MANAGEMENT

Temperature does not necessarily need to be monitored continiously; except in which case?

A

When the anesthesia provider anticipates clinically significant changes in body temperature

Otherwise, it could just be measured regularly

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5
Q

Monitoring for Cardiac Surgery - ANESTHETIC MANAGEMENT

True or False: The most invasive form of monitoring is the preferred choice for the anesthesia plan of care

A

False

The least invasive forms of monitoring that will provide and idea of the total picture of the pt is considered safe for the anesthetic plan

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6
Q

Monitoring for Cardiac Surgery

Which factors make monitoring for Cardiac Surgery CHALLENGING?

A

Risk of placing monitors

(Pneumothorax, ischemic arm, bleeding etc.)

Acting on erroneous/incorrect results

Over treatment

Distraction d/t too many monitored variables

Cost

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7
Q

Monitoring for Cardiac Surgery

ULTIMATE GOALS:

A

Improve patient outcome

Minimize Risk

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8
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

What are the two meanings of “positive” and “negative” with regard to THREE-LEAD SYSTEM?

A
  1. Deflection of the EKG tracing
  2. Direction of depolarization
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9
Q

Electrocardiography- THREE-LEAD SYSTEM (Bipolar lead)

Upward deflection on isoelectric line means:

A

Positive deflection of the EKG tracing

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10
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

Downward deflection on EKG isoelectric line means:

A

Negative Deflection of the EKG tracing

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11
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

What does a Positive Direction (or deflection) of the electrical activity means?

A

Depolarization is going towards that electrode

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12
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

What does a negative Direction (or deflection) of the electrical activity means?

A

Depolarization is moving away from that electrode

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13
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

How does electricity moves in Lead I between RA and LA?

A

Lead I (-) RA => (+) LA

We know this because the atria depolarizes first, followed by the ventricles

The LA can be either (+) in lead I or (-) in lead III depending on which lead is used to measure

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14
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

How does electricity moves in Lead II between RA and LL?

A

Lead II (-) RA => (+) LL

The LL is always (+) because depolarization is always going towards it

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15
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

How does electricity moves in Lead III between LA and LL?

A

Lead III (-) LA => (+) LL

The LL is always (+) because depolarization is always going towards it

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16
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

How is the heart observed in Lead I?

A

The heart in observed from the LA, looking at the RA

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17
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

How is the heart observed in Lead II?

A

The heart in observed from the LL, looking at the RA

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18
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

How is the heart observed in Lead III?

A

The heart in observed from the LL, looking at the LA

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19
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

What’s the Standard of Care Monitor (AANA/ASA Monitoring Guidelines) with regards to Electrocardiography?

A

Every pt receiving anesthesia must have Electrocardiography continiuously monitored from the begining of care till the time they are prepared to leave the anesthetizing location

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20
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

Why is the use of THREE-LEAD SYSTEM (Bipolar lead) limited in myocardial ischemia

A

It provides a narrow picture of myocardial electrical activity

It uses a single positive electrode and a single negative electrode between which electrical potential is measured

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21
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

How many limb electrodes?

A

3 limb electrodes

RA (White)

LA (Black)

LL (Red)

Use of a single positive electrode and a single negative electrode between which electrical potential is measured.

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22
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

How many views (leads)

A

3 views (leads)

Lead I : RA -; LA +

Lead II: RA -; LL +

Lead III: LA -; LL +

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23
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

True or False: THREE-LEAD SYSTEM (Bipolar lead) monitors Inferior & lateral myocardial walls for ischemia

A

True

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24
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

True or False: THREE-LEAD SYSTEM (Bipolar lead) can also monitor ANTERIOR OR POSTERIOR walls

A

False

THREE-LEAD SYSTEM (Bipolar lead) cannot monitor ANTERIOR OR POSTERIOR walls

25
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

In the THREE-LEAD SYSTEM, what’s the more disirable lead and why?

A

Lead II is the more desirable lead, because

it is in line with the vector forces of the heart, resulting in

large p-waves and large QRS complexes, and making it

easier to dignose dysrhythmias

26
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

What’s the positive electrode in an Augmented Unipolar lead

A

Each of the limb lead

(RA, LA, LL)

•Augmented leads (aVR, aVL, aVF)

•Termed “unipolar” because the one positive pole is at each limb and the negative pole is the center of the heart

•“Augmented” because they have a low electrical potential and must be augmented 1.5 times

27
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

What’s the negative electrode in Augmanted Unipolar lead?

A

The center of the heart

(which is theoretically electrically neutral)

28
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

Which leads monitor inferior wall?

A

II, III, AVF

29
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

Which leads monitor the lateral wall?

A

I & AVL

30
Q

Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)

Which lead in the THREE-LEAD SYSTEM (I, II, II, avL, avF, avR) monitors the anterior or posterior walls?

A

None

31
Q

Electrocardiography - MODIFIED THREE-LEAD SYSTEM

What’s the other name for the MODIFIED THREE-LEAD SYSTEM, and why is it called that?

A

Lewis Lead (S5-Lead)

Because it was created by Thomas Lewis

32
Q

Electrocardiography - MODIFIED THREE-LEAD SYSTEM

Thomas Lewis created the MODIFIED THREE-LEAD SYSTEM for what purpose?

A

In response to decrease in p-wave amplitude with traditional EKG placement

The thinking was that by repositioning the lead, the p-wave height will be maximized, so that

Atrial arrhythmias could be quickly identified

33
Q

Electrocardiography - MODIFIED THREE-LEAD SYSTEM

How is the MODIFIED THREE-LEAD SYSTEM used in practice?

A

It’s a modification of standard bipolar limb lead system

Place LA electrode in the V1 position,

then select the lead I on the monitor

Rarely used in practice because more advanced technology has been discovered

34
Q

Electrocardiography - V1 FIVE-LEAD SYSTEM

Researchers began challenging the effectiveness of 3-lead EKG and their ability to diagnose and distinguish which two arrhythmias?

A

SVT and VT

SVT and VT were correctly identified only about a third of the time

35
Q

Electrocardiography - V1 FIVE-LEAD SYSTEM

Why was the 3-lead EKG not effectiveness in diagnosing or distinguish SVT vs VT?

A

The traditional EKG positions don’t offer enough amplitude on the p-wave to be able to distinguish SVT from VT

36
Q

Electrocardiography - V1 FIVE-LEAD SYSTEM

How frequently did the Use of a 12 lead EKG resulted in correct identification of SVT vs VT?

A

90% of the time

37
Q

Electrocardiography - V1 FIVE-LEAD SYSTEM

Which lead in the V1 FIVE-LEAD SYSTEM was found to be the single best lead in determining SVT from VT

A

Lead V1

Could be paired with the modified-lead placement

Came out superior in its ability to distinguish SVT from VT

The 5-lead with V1 position is most effective in viewing ventricular activity

When compared to modified lead placement, V1 more superior

38
Q

Electrocardiography - V1 FIVE-LEAD SYSTEM

Which lead position is most effective in viewing ventricular activity?

A. The 5-lead with V1 position

B. The modified lead placement

A

A. The 5-lead with V1 position

B. The modified lead placement

  • Because V1 is the best lead to view ventricular activity*
  • This is the reason why the modified lead placement isn’t used*
  • P-wave are also bigger and ….(inaudible!!!!)*
39
Q

Electrocardiography - V1 FIVE-LEAD SYSTEM

In the V1 FIVE-LEAD SYSTEM, where is the V1 lead placed?

A

4th ICS, RSB

40
Q

Electrocardiography - FIVE-LEAD SYSTEM

Which 7 leads can be viewed and recorded simultaneously with the FIVE-LEAD SYSTEM?

A

6 standard limb leads (I,II,III, aVR, aVF, aVL)

1 precordial/unipolar lead (brown lead - Could)

Brown lead could be placed in any precordial position, V1 through V5

41
Q

Electrocardiography - FIVE-LEAD SYSTEM

What does precordial lead placement depends on?

A

Depends on

“What needs to me monitored in the pt”

42
Q

Electrocardiography - FIVE-LEAD SYSTEM

What’s the standard precordial lead for cardiovascular surgery? why?

A

V5

Best to assess ST segment depression

43
Q

Electrocardiography - FIVE-LEAD SYSTEM

Where is V5 placed?

A

5 ICS anterior axillary line

44
Q

Electrocardiography - FIVE-LEAD SYSTEM

What is a major monitoring benefits of the FIVE-LEAD SYSTEM over the Three-lead system?

A

With the addition of only two electrodes in the ECG system, as opposed to the 3 electrodes in the Three-lead system, up to 7 different leads can be monitores simultatneously

This allows one to monitor several areas of the heart for ischemia

Monitors Lateral, inferior & ANTERIOR myocardial walls monitored for ischemia

or to establish a diagnosis between atrial and ventricular arrythmias

Diagnosis atrial or ventricular arrhythmias

45
Q

Electrocardiography - FIVE-LEAD SYSTEM

True or False: The FIVE-LEAD SYSTEM allows to monitor Posterior wall?

A

False

NOT POSTERIOR

46
Q

Electrocardiography - FIVE-LEAD SYSTEM

Which leads have the Greatest sensitivity in the detection of ischemia?

A

Lead V5 (75%)

Followed by Lead V4 (61%)

47
Q

Electrocardiography - FIVE-LEAD SYSTEM

Which is a benefit of Monitoring leads V4 & V5 simultaneously in the detection of ischemia

A

Increases sensitivity to ischemia to 80%

48
Q

Electrocardiography - FIVE-LEAD SYSTEM

Which is a benefit of Monitoring V5 & Lead II simultaneously in the detection of intraoperative ischemic events?

A

Enhances detection of intraoperative ischemic events (90%)

49
Q

Electrocardiography - FIVE-LEAD SYSTEM

Which is a benefit of Monitoring 3 leads (II, V4 & V5) simultaneously in the detection of intraoperative ischemic events?

A

Increases sensitivity (98%)

50
Q

Electrocardiography - FIVE-LEAD SYSTEM

True or False: Modern ECG monitors incapable of simultaneous display of more than one precordial lead

A

True

This is significant because lead II monitoring only recognizes ischemia in 35% of the cases

51
Q

Electrocardiography - FIVE-LEAD SYSTEM

True or False: This is significant because lead II monitoring only recognizes ischemia in 35% of the cases

A

True

52
Q

Electrocardiography - FIVE-LEAD SYSTEM

Which leads look at the inferior wall ischemia (RCA distribution), and at the superior wall for atrial arrhythmias

A

Lead II, III, & aVF

53
Q

Electrocardiography - FIVE-LEAD SYSTEM

Which leads look at the Lateral wall left ventricle (Circumflex)

A

Lead I & aVL

54
Q

Electrocardiography - FIVE-LEAD SYSTEM

Which leads look at the Anterior wall ischemia (LAD artery distribution)?

A

Lead V5

55
Q

Electrocardiography - 12 LEAD SYSTEM

Which leads constitute the 12 LEAD SYSTEM?

A

Precordial leads (V1 through V6), and

Unipolar leads that take a perpendicular look at the heart muscle directly underneath the leads

56
Q

Electrocardiography - 12 LEAD SYSTEM

Which leads look at the septum?

A

V1 & V2

57
Q

Electrocardiography - 12 LEAD SYSTEM

Which leads look at the Anterior wall?

A

V3 & V4

58
Q

Electrocardiography - 12 LEAD SYSTEM

Which leads look at the Lateral wall?

A

V5 & V6

59
Q

Electrocardiography - 12 LEAD SYSTEM

Since none of the leads in the 12 LEAD SYSTEM will monitor the posterior heart, how can we assess changes in the posterior heart?

A

Must look at reciprocal changes in V1 & V2

8361 Exam I (18 decks)

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