Module 9 Part 2 Flashcards
at minimum, BP should be recorded at least once every ___ minutes
5 minutes
According to ATLS, if only the patient’s carotid pulse ispalpable, the systolicblood pressureis ___-___ mm Hg
60-70mmHg
According to ATLS, if carotid and femoral pulses arepalpable, the systolicblood pressureis ___-___ mm Hg
70-80mmHg
According to ATLS, and if the radial pulse is alsopalpable, the systolicblood pressureis more than ___ mmHg
80mmHg
What is a Korotkoff sound?
auscultation of arterial pulsation when taking a manual BP
Automated noninvasive blood pressure monitors (also known as automated sphygmomanometers) employ the ________ methodto estimate the arterial blood pressure.
oscillometric
With peripheral NIBP measurements, as the site of measurement is moved more peripherally, the measured SP tends to ________, and the DP tends to _______
Increase
Decrease
The correlation between calf and upper arm blood pressures was found to be poor in this patient population.
cesarean section pts
These sounds are produced by turbulent blood flow within an artery during cuff deflation.
Korotkoff sounds
Equation for MAP calculation
[SBP + (DBP × 2)]/3
Calculate the MAP of a BP of 120/80
93mmHg
_________ comprises approximately two-thirds of a normal cardiac cycle.
diastole
The American Heart Association recommends that the bladder width for indirect blood pressure monitoring should approximate ___% of the circumference of the extremity
40%
Bladder length should be sufficient to encircle at least ___% of the extremity
80%
List the contraindicated scenarios (4) of NIBP use on an extremity
AV fistula
Local bone fractures
Open injury
PICC lines
Falsely _____ BP estimates result when cuffs are too small, when cuffs are applied too loosely, or when the extremity is below heart level.
High
Falsely _____ BP estimates result when cuffs are too large, when the extremity is above heart level, or after quick deflations
Low
What is the name of the non-invasive finger cuff that gives continuous SBP, DBP, MAP & advanced data such as SV, SVV, CO, SVR
ClearSight finger cuff
The gold standard for measuring BP is through ______
Art lines
Where should the A-line transducer be leveled to?
phlebostatic axis
Quick deflations can lead to a falsely ____ BP
Low
After intubation, ALWAYS verify _______
Placement
Presence of _____ reflects ventilation, pulmonary blood flow, aerobic metabolism
CO2
measurement and quantification of CO2
Capnometry
recording of the capnometry measurement
Capnography
continuous display of CO2 during phases of ventilation
Capnogram
______ capnography is most commonly used in the perioperative setting.
Time
How many phases are in a normal capnogram tracing?
4
__-__represents baseline CO2
A-B
__-__represents expiratory upstroke
B-C
__-__represents expiratory plateau
C-D
__represents end-tidal concentration of CO2
D
__-__represents descent to original baseline
D-E
This portion in a normal capnogram should approximate zero
Phase 1 (or A-B)
This sample from phase 1 of a normal capnogram comes from the anatomic ________ and contains no CO2
deadspace
This phase represents the rapid passing of initial expired gas through the upper airways
Phase 2 (or B-C)
ETCO2is measured at the end of the ______ just prior to the beginning of phase ____
plateau
phase 4
The _____ phase represents the plateau and records alveolar emptying of CO2
3rd phase
The _____ phase is displayed as the rapid decrease in CO2concentration of sampled gas as a result of inspiration of air or O2
4th phase
In a normal capnogram, phase ____ records a mixture of anatomical deadspace and alveolar gas
Phase 2
What is the normal range for ET CO2?
35-45 mmHg
Is the 3rd phase of a capnogram shorter or longer in a spontaneously breathing pt vs a mechanically vented pt?
Shorter
What two co-morbidities are associated with a “shark fin” appearance on a capnogram?
Asthma
COPD
During CPR, you should aim for an ET CO2 goal of ____ mmHg
10 mmHg
This tracing pattern reflects ET tube disconnection, obstruction, kinked, or loss of circulatory function
Sudden loss of waveform
In a hypoventilatory pt, will you see a low or high ET CO2 on your capnogram tracing?
High
(T/F) The capnogram tracing reads 0 during peak expiration
False (peak inspiration)
ET CO2 is measured at the end of the _______ phase
Expiratory (or 3rd phase, or C-D phase)
In healthy population, difference between PaCO2 and EtCO2 < __ mmHg
5 mmHg
EtCO2 may not accurately reflect PaCO2 if pt spontaneously ventilating through ____ or ________
NC
Face mask
Will you see increased or decrease ET CO2 with: decreased alveolar ventilation increased CO2 production/delivery Exhausted CO2 absorber Rebreathing
Increased ET CO2 (be familiar with PP slide 35)
Will you see increased or decrease ET CO2 with: increased alveolar ventilation decreased CO2 production/delivery hyperventilation complete airway obstruction
Decreased ET CO2 (be familiar with PP slide 35)
ETT cuff leak will give you high or low ET CO2?
Low
Complete airway obstruction = high or low ET CO2?
Low
Circuit leak will give you a high or low ET CO2 reading?
High
Hypothermic pt will have high or low ET CO2?
Low
___________ is the standard of care for monitoring oxygenation
Pulse oximetry
Pulse ox transmittance technology is based on the ____________ Law
Beer - Lambert Law
The relationship of SaO2 and PaO2 is described by the __________ __________ curve
Oxyhemoglobin dissociation curve
High SaO2 values cannot distinguish between normo-hyper oxygenation, which is very important in _________ patients
neonate
Variations in pulse ox amplitude in the plethysmographic waveform may predict _______ __________
fluid responsiveness
The incidence of hypoxemia ranges from ___ to ___ times less in patients monitored with pulse oximetry.
1.5-3 times
When SpO2 is 80-100%, readings from the pulse ox will be within approximately -+ __%
+- 2%
When SpO2 is <80%, readings from the pulse ox will be within approximately -+ __%
+- 5%
Pulse oximeter readings are inaccurate when SpO2 is below ___%
70%
According to recent studies, is nail polish still a problem with pulse ox readings?
Nope
What are 2 examples of dyes that can cause a falsely low SpO2 reading?
methylene blue
indigo carmine
methemoglobin absorbs light equally to oxyhemoglobin. As a result, pulse oximeter measurements are falsely _____-estimated when oxygen saturation is above 85% and _______-estimated when oxygen saturation is below 85%
under-estimated
over-estimated
High levels of carboxyhemoglobin will cause an _____-estimation of SpO2
over-estimation
