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N928 - Basic Principles > Monitoring > Flashcards

Monitoring Flashcards

1
Q

Standard 9 for Nurse Anesthesia Practice

A

Monitoring, alarms

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2
Q

5 parts of Standard 9

A
  • Oxygenation (pulse ox)
    1. monitor ventilation (SpO2, ETCO2)
    2. monitor CV status continuously
    3. monitor thermoregulation continuously (MH triggers)
    4. monitor NM function (NMBs)
    5. monitor & assess patient positioning
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3
Q

Monitor alarms must:

A
  • variable pitch
  • reflect changes in patient or equipment status
  • threshold alarms on and audible
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4
Q

Pulse Ox uses what law?

A

Beer-Lambert

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5
Q

What is the wavelength of deoxyhemoglobin?

A

660nm

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6
Q

What is the wavelength of oxyhemoglobin?

A

940nm

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7
Q

Order of pulse ox sites

slowest → fastest

A

toe → finger → nose

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8
Q

What is the PaO2 of oxygen when SpO2 is 90%?

A

60mmHg

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9
Q

What is the PaO2 of oxygen when SpO2 is 80%?

A

50mmHg

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10
Q

What is the PaO2 of oxygen when SpO2 is 70%?

A

40mmHg

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11
Q

What are factors that alter SpO2?

A
  • CoHb (falsely high reading) or MetHb (false ↑ or ↓)
  • ambient light/high intensity
  • tremors/vibration
  • methylene blue (gives the largest DECREASE; pulse ox will overestimate), indigo carmine
  • decreased perfusion
  • deeply pigmented skin
  • fingernail polish
  • non-pulsatile flow (CBP, LVAD)
  • electrocautery
  • ## hypothermia
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12
Q

What are the two “methods/location” of ETCO2 monitoring?

A

Mainstream (in-line)

Sidestream (diverting)

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13
Q

Describe mainstream ETCO2

A

device attached to ETT

- increased dead space & weight

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14
Q

Describe sidestream ETCO2

A

device located outside of airway

- pumping mechanism & water trap

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15
Q

What occurs in phase 1 of capnogram?

A

exhalation of anatomic dead space- reading should be ZERO

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16
Q

What occurs in phase 2 of capnogram?

A

exhalation of anatomic dead space & alveolar gas;

beginning expiration

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17
Q

What occurs in phase 3 of capnogram

A

exhalation of alveolar gas;
should be horizontal with mild upstroke

  • steepness is function of respiratory resistance (COPD, Bronchospasm)
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18
Q

What occurs in phase 4 of capnogram

A

inspiration of fresh gas

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19
Q

Where are the alpha & beta angles of the capnogram located?

A

_______
/a b\
___/ \___

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20
Q

What is the degree of a normal alpha angle on the capnogram?

A

100-110degrees

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21
Q

What are 4 factors that will increase the alpha angle?

A

[prolonged upstroke]

  1. expiratory airflow obstruction
  2. COPD
  3. Bronchospasm
  4. Kinked ETT
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22
Q

What is the degree of a normal beta angle on the capnogram?

A

90degrees

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23
Q

What are 2 factors that will increase the beta angle of the capnogram?

A
  1. rebreathing

2. faulty unidirectional valve

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24
Q

What is a curare cleft?

A

spontaneous breathing during ventilation / inadequate muscle relaxation / dyssynchronous intercostal muscles & diaphragm

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25
Q

When does a low ETCO2 tracing occur?

A

hyperventilation
↓ CO2 production
↑alveolar dead space

 - light anesthesia metabolic acidosis, hypothermia, hypotension, PE
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26
Q

What are factors that will increase ETCO2

A

MH, sepsis, fever, hyperthyroidism, hypoventilation, narcotics

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27
Q

What causes an elevated baseline on the ETCO2 tracing?

A

rebreathing

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28
Q

How will an incompetent unidirectional valve present on the ETCO2 tracing?

A

increased beta angle

  • tracing may or may not reach baseline, depending on FGF
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29
Q

What will cause a “peak” in phase 3 of the ETCO2 tracing?

A

leak in the sample line during positive pressure ventilation

  • obesity
  • pregnancy
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30
Q

What electrical event coincides with the p-wave?

A

depolarization of the atria begins

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31
Q

What electrical event coincides with the PR interval?

A

depolarization of the atria is complete

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32
Q

What electrical event coincides with the QRS?

A

repolarization of the atria, depolarization of the ventricles begins

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33
Q

What electrical event coincides with the ST segment?

A

depolarization of the ventricles is complete

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34
Q

What electrical event coincides with the T wave

A

repolarization of the ventricles begins

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35
Q

What electrical event coincides with after the t wave

A

repolarization of the ventricles is complete

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36
Q

What are 5 pathologies that cause right axis deviation?

A 
COPD
Acute bronchospasm
Cor pulmonale
Pulmonary HTN
Pulmonary embolus
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37
Q

What are 5 pathologies that cause left axis deviation?

A 
Chronic HTN
LBBB
Aortic Stenosis
Aortic Insufficiency
Mitral Regurgitation
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38
Q

What degrees coincides with normal EKG axis?

A

-30 to 90

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39
Q

What degree coincides with left axis deviation?

A

-90 to -30

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40
Q

What degree coincides with right axis deviation?

A

90-180

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41
Q

What degree coincides with extreme right axis deviation?

A

180 to -90

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42
Q

What are 5 monitoring sites of invasive ABP?

A

radial, brachial, axillary, pedal, remoral

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43
Q

What indicates contractility on the ABP waveform?

A

upstroke

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44
Q

What on the ABP tracing indicates stroke volume?

A

area under the curve

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45
Q

What does the dicrotic notch indicate on the ABP tracing?

A

closure of the aortic valve

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46
Q

What partial pressure of oxygen correlates with 50% saturation?

A

25mmHg

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47
Q

Below what pulse ox number is it less reliable?

A

80-85%

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48
Q

What is the purpose of monitor alarms?

A

protect the patient by alerting the practitioner that the pt is at an increased risk and needs immediate assistance

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49
Q

What is the monitoring algorithm?

A

COVER-ABCD

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50
Q

What does COVER-ABCD (monitoring algorithm) stand for?

A 
C- circulation, color
O- oxygen, oxygen analyzer
V - ventilator, vaporizer
E- ETT
R- Review monitors & equipment

A- Airway
B- Breathing
C- Circulation
D- Drugs

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51
Q

AANA Standard 9

A

monitor, evaluate, document the pts physiological condition.

When a monitoring device is used, VARIABLE PITCH & THRESHOLD alarms should be turned on and audible.

document BP, HR, RESP at least every 5 minutes

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52
Q

What does the oxygenation portion of Standard 9 entail?

A

continuous monitor by observation & pulse oximetry

  • surgical or procedure team communicates & collaborates to mitigate risk of fire
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53
Q

Carboxyhemoglobin

A

90% oxyhemoglobin
10% deoxyhemoglobin

  • pulse ox OVER-estimates saturation (not as high as the monitor thinks)
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54
Q

Methemoglobin

A

hemoglobin has been OXIDIZED
Ferous to Feric state (2+ → 3+)

does not bind oxygen = cannot deliver

  • congenital (may be cyanotic) or acquired (can be severe or fatal; abrupt development of s/s. → hypoxia)

CAN CAUSE METHEMOGLOBINEMIA: Local anesthetics; topical sprays/creams; ped teething gel
Reglan; methylene blue
nitroglycerin

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55
Q

Monitoring of oxygenation includes which 4 devices/mechanism?

A
  1. oxygen analyzer
  2. clinical observation
  3. pulse oximeter
  4. arterial blood gas analysis
  5. color of blood
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56
Q

During clinical observation of oxygenation, what is assessed?

A
  • skin color
  • temperature
  • nail-bed perfusion
  • depth & rate of respirations
  • auscultation of breath sounds
  • upper airway patency [see-saw; rtxn; WOB; stridor]
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57
Q

What 2 things does the pulse oximeter measure?

A

HR & SPO2

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58
Q

What is the goal of ventilation monitoring?

A

ensure adequate minute ventilation

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59
Q

What is evaluated when assessing ventilation?

A

adequacy & efficiency of the air/gas exchange

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60
Q

Monitoring of ventilation includes which 8 devices/mechanisms?

A
  1. clinical observation
  2. stethoscope (precordial)
  3. RR
  4. Tidal volume
  5. ETCO2
  6. Pulse oximetry
  7. Oxygen analyzer
  8. disconnect alarms
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61
Q

During clinical observation of ventilation, what is assessed?

A
  • skin color
  • temperature
  • nail-bed perfusion
  • depth & rate of respirations
  • auscultation of breath sounds
  • upper airway patency
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62
Q

What is capnometry?

A

all means of measuring CO2

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63
Q

What is capnography?

A

recording of the CO2 measurement

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64
Q

What is a capnogram?

A

continuous display of CO2 during the phases of ventilation

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65
Q

What is the goal ETCO2 during CPR?

A

10mmHG

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66
Q

During ABP monitoring, the further the catheter gets from the aorta… (4)

A
  1. the taller the systolic peak
  2. the further the dicrotic notch
  3. the lower the end-diastolic pressure
  4. the later the arrival of the pulse
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67
Q

What is the a point of the CVP waveform?

A

RA contraction

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68
Q

What is the c point of the CVP waveform?

A

tricuspid valve elevation into RA

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69
Q

What is the x point of the CVP waveform?

A

downward movement of contracting RV

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70
Q

What is the v point of the CVP waveform?

A

RA passive filling

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71
Q

What is the y point of the CVP waveform?

A

RA emptying through the open tricuspid valve

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72
Q

What is normal RA pressure?

A

0-10mmHg

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73
Q

What is normal RV pressure?

A

15-20/0-8

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74
Q

What is normal PAP?

A

15-30/5-15

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75
Q

What is normal PAOP

A

5-15

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76
Q

What is the a wave on a PA waveform?

A

LA systole

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77
Q

What is the c wave on a PA waveform?

A

Mitral valve into LA during LV systole

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78
Q

What is the v wave on a PA waveform?

A

passive LA filling

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79
Q

What are 6 body temperature monitoring sites?

A 
bladder
pulmonary artery
esophageal
nasopharynx
tympanic
axillary
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80
Q

What nerve is best to measure onset of a NMBD?

A

orbicularis oculi

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81
Q

What muscle is best to measure onset of a NMBD?

A

facial nerve

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82
Q

What nerve is best to measure recovery from NMBD?

A

adductor pollicis

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83
Q

What muscle is best to measure recovery from NMBD?

A

ulnar nerve

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84
Q

TOF 4/4 indicates how much block?

A

<70%

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85
Q

TOF 3/4 indicates how much block?

A

75%

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86
Q

TOF 2/4 indicates how much block?

A

80%

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87
Q

TOF 1/4 indicates how much block?

A

90%

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88
Q

TOF 0/4 indicates how much block?

A

100%

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89
Q

Recovery from NMBD is defined as TOF > ___ at the adductor pollicis

A

0.9

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90
Q

What are 2 limitations of bispectral index?

A
  1. 20-30 second lag

2. ketamine

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91
Q

BIS of 100 is

A

fully awake

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92
Q

BIS of 80 is

A

light/moderate sedation

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93
Q

BIS of 40-60 is

A

GA

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94
Q

BIS of 40 is

A

deep hypnotic state

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95
Q

BIS of 20 is

A

burst suppression

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96
Q

BIS of 0 is

A

absence of cerebral activity

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97
Q

What are the 6 elements of cardiovascular monitoring?

A
  1. ECG rhythm
  2. circulation
  3. preload
  4. afterload
  5. contractility
  6. hemodynamic status
98
Q

What are 7 monitors/devices used in cardiovascular monitoring?

A
  1. stethoscope
  2. ECG
  3. BP cuff
  4. CVC
  5. Arterial catheter
  6. Pulmonary artery catheter
  7. TEE
99
Q

What are 3 things the ECG measures?

A
  1. HR
  2. rhythm
  3. ST segment
100
Q

What are benefits of monitoring lead II?

A
  1. assesses narrow QRS complex rhythms
  2. ST segment depression visible
  3. detects inferior wall ischemia

4th intercostal space right sternal border

101
Q

What is the benefit of monitoring lead V5?

A

detects anterior & lateral wall ischemia

5th intercostal space left anterior axillary line

102
Q

Electrode placement

A 
RA: 2nd inter Right MC line
LA: 2nd inter Left MC line
RL: 6-7 inter Right MC line
LL: 6-7 inter Left MCL
V: 4th inter Right sternal border
103
Q

BP cuff should measure ___ greater than the mean diameter of the extremity

A

20%

104
Q

A BP cuff that is too narrow will result in

A

high BP

105
Q

A BP cuff that is too wide will result in

A

low BP

106
Q

Normothermia is

A

37c

107
Q

Hypothermia is

A

<36c

108
Q

Hyperthermia is

A

> 38c

109
Q

What are the 4 mechanisms of heat loss?

A
  1. radiation
  2. evaporation
  3. convection
  4. conduction
110
Q

Who is at high risk of thermoregulation issues?

A
  • high ASA status
  • long duration of surgery
  • complex surgery
  • combining epidural & GA
  • advanced age
  • lean body mass
  • failure to monitor temperature
111
Q

What are risks of hypothermia

A
  • wound infection & delayed wound healing
  • ↑O2 consumption d/t shivering
  • ↑ cardiovascular incidents & MI
  • ↑sickling in sickle cell patients
  • prolonged PACU stay
112
Q

What are 7 locations of core temperature measurement

A
  1. tympanic membrane
  2. distal esophagus
  3. nasopharynx
  4. pulmonary artery
  5. bladder
  6. oral
  7. rectal
113
Q

3 techniques to keep a patient warm

A
  1. room temperature
  2. forced air warming blankets
  3. fluid warmers
114
Q

Radiation

A

1 loss of heat

Greatest heat loss is in the first hour.

transfer body heat into cooler environment

115
Q

Evaporation

A

loss of liquids on the skin

116
Q

Convection

A

Cool air moving over the body

117
Q

Conduction

A

contact with a cooler object

118
Q

How does the CRNA use inspection during monitoring?

A

LOOK

retractions, color, mucous membranes

119
Q

How does the CRAN use auscultation during monitoring?

A

heart and lung sounds, wheezing, continuous suction

120
Q

What does the CRNA evaluate with palpitation during monitoring?

A

pulses, edema, crepitus, muscle tension, resistance, compliance

121
Q

How does the CRNA use the sense of smell during monitoring?

A

smoke/burning, volatile anesthetics

122
Q

What are the 5 standard categories of monitoring?

A 
oxygenation
ventilation
cardiovascular 
thermoregulatory
neuromuscular function
123
Q

What is the AANA’s standard 11?

A

transfer of care to another qualified healthcare provider

124
Q

What is the most important aspect of anesthesia? per Dr. Simmons

A

AIRWAY

125
Q

What is the fundamental goal of anesthesia, per Dr. SImmons?

A

avoid hypoxia

126
Q

What does the O2 analyzer do?

A

measures FiO2 of inspired gas @ the inspiratory limb of the anesthesia circuit

127
Q

What is the low concentration alarm of the O2 analyzer?

A

30%

128
Q

The O2 analyzer is calibrated to what 2 oxygen percentages?

A

21% (room air)

100%

129
Q

What is the alveolar gas equation?

A

PAO2 = FiO2 * (Pb-47) - PaCO2

ie.
PAO2 = 0.5*713 - 40
PAO2 = 317

130
Q

What are the 2 mechanical parts of the oxygen analyzer called?

A

cathode

anode

131
Q

Where is the cathode located?

A

in the O2 analyzer

132
Q

Where is the anode located?

A

in the O2 analyzer

133
Q

The pulse oximeter provides what kind of a warning?

A

early & late

early: hypoxemia
late: cyanosis

134
Q

What is plethysmography?

A

pulsatile measurement tracing

135
Q

What is pleth variability? (Pvi)

A

indication of pulse strength of the pulse oximeter reading; 0-100

136
Q

What is the Pvi good for?

A

fluid directed therapy

137
Q

A SpO2 measurement of 60% is what partial pressure of oxygen?

A

PaO2 = 30mmHg

138
Q

What SpO2 is used to indicate hypoxia?

A

<90%

139
Q

What are the 2 components that make up ventilation?

A
  1. movement of volume (inhale/exhale)

2. elimination of CO2

140
Q

Where is a precordial stethoscope placed?

A

apex of lung or supra sternal notch

141
Q

A precordial stethoscope does what?

A

Allows a provider to detect rapid changes in breath sounds or heart sounds;
anesthetic depth, circuit disconnections, endobronchial intubation, ↑HR, contractility

142
Q

What is an esophageal stethoscope used for?

A

better quality heart and lung sounds;

incorporated temperature probe

143
Q

Where does an esophageal stethoscope placed?

A

intubated patients only,
through mouth or nose
ends at distal 1/3 of the esophagus

144
Q

What are 2 contraindications of an esophageal stethoscope?

A
  1. esophageal varices

2. esophageal strictures

145
Q

What does a respiratory gas analysis do?

A

rates the absorbance characteristics of the gas sample;

allows measurement of volatile anesthetics

146
Q

What is the most common type of respiratory gas analysis?

A

non-dispersive infrared (NDIR)

147
Q

Non-dispersive infrared respiratory gas analysis uses which type of sample collection?

A

side stream sampling

148
Q

What is the volume of gas that is moved through the gas sampling line?

A

50-250mL/minute

149
Q

Which monitor is the most effective in detecting circuit problems (ie. valves)?

A

ETCO2

150
Q

What are 2 things ETCO2 monitoring does?

A
  1. confirms ETT placement

2. used to assess if ventilation is adequate

151
Q

Contamination of the side stream sampling by H2O will change the reading, up or down?

A

falsely ↑ readings

152
Q

Rank arterial pp CO2, ETCO2, and alveolar CO2, from least to greatest

A

ETCO2 < alveolar CO2 < PaCO2

153
Q

What is the normal PACO2 - PaCO2 gradient?

A

2-10mmHg

154
Q

What are 7 causes of an abnormal PACO2-PaCO2 gradient?

A
  1. gas sampling errors
  2. prolonged expiratory phase
  3. V/Q mismatch
  4. airway obstruction
  5. embolic states
  6. COPD
  7. Hypoperfusion
155
Q

A low plateau on the capnography tracing indicates

A

↑ dead space, ↓Cardiac output

156
Q

A high plateau on the capnography tracing indicates

A

high CO2 production;

hypoventilation

157
Q

An integrated ___ allows tidal volume monitoring with the mechanical ventilator

A

spirometer

158
Q

What are 4 pressures that are monitored by the mechanical ventilator

A
  1. in circuit pressure (via gauge)
  2. peak inspiratory pressure
  3. sustained elevated pressure
  4. low airway pressure / disconnect alarm
159
Q

Which ECG lead yields max p wave voltage?

A

Lead II

160
Q

inferior wall ischemia is best detected by what lead?

A

Lead II

161
Q

Anterior and Lateral wall ischemia are best detected by which lead?

A

V5

162
Q

When do you hear Korotkoff sounds?

A

Manual BP

163
Q

Accuracy of BP measurements decreases at what pressure?

A

70mmHg

164
Q

What are 4 factors that can cause errors in BP reading?

A
  1. surgeon leaning on cuff
  2. inappropriate size
  3. shivering or excessive movement
  4. atherosclerosis/HTN (SYS reads low; DIA reads high)
165
Q

What arterial line site increases risk of pseudoaneurysm & atheroma formation?

A

femoral

166
Q

What arterial line site increases risk of increase difficulty?

A

Ulnar

167
Q

What arterial line site increases risk of kinking or complications risking limb

A

brachial

168
Q

What arterial line site increases risk of a distorted waveform?

A

dorsalis pedis

169
Q

What arterial line site increases risk of plexus/nerve damage from hematoma or traumatic cannulation?

A

axillary

170
Q

4 sites of insertion to monitor CVP

A
  1. IJ
  2. subclavian
  3. external jugular
  4. antecubital
171
Q

What EF is considered poor function?

A

40%

172
Q

What cardiac index is considered poor function?

A

2L/min/m^2

173
Q

What are 5 indications for a pulmonary artery catheter

A
  1. valvular heart dz
  2. recent MI
  3. ARDS
  4. Massive trauma
  5. major vascular surgery
174
Q

A 70kg patient receiving 1L of room temperature fluid will decrease their body temperature by how much?

A

0.4c

175
Q

A 70kg patient receiving one unit of room temperature blood will decrease their body temperature by how much?

A

0.2c

176
Q

Spinal/epidural anesthesia has what effect on thermoregulation?

A

vasodilation below block = redistribution of heat

177
Q

General anesthesia has what effect on thermoregulation?

A

inhibits central thermoregulation d/t disruption of hypothalamic function

178
Q

Phase II of anesthesia alters perception of what, leading to hypothermia?

A

dermetomes

179
Q

For each % isoflurane, the body’s vasoconstriction threshold is dropped by how much?

A

3c

180
Q

What is considered mild hypothermia?

A

33c-36c

181
Q

What occurs in mild hypothermia?

A
  • reduced enzyme function

- coagulopathy

182
Q

What is considered moderate hypothermia?

A

= 32c

183
Q

During anesthesia, the body temperature may drop by ___

A

1c-4c

184
Q

Who is at greatest risk of hypothermia intraoperatively?

A

elderly, neonates, burn patients, spinal cord injury

185
Q

Comorbidities that limit oxygen supply may not tolerate, what?

A

Increased MVO2 (ie. shivering)

186
Q

What are some causes of hyperthermia?

A 
MH (late sign)
endogenous pyrogens
thyrotoxicosis or pheochromocytoma (↑metabolism)
anticholinergic blockade of sweating
excessive environmental warming
187
Q

What are active warming modalities? (7)

A 
Bair hugger
warming blanket
radiant heat unit
heated liquids
IV fluid warmer (Hotline)
gastric lavage
peritoneal irrigation
188
Q

What are passive warming modalities? (

A

ambient temperature
insulation
heat & moisture exchanger (humidifier/”nose”)
coaxial breathing circuit (“King” circuit)

189
Q

Adequate NMB is what % of receptors

A

85-90%

190
Q

What are 4 factors that can alter the reading of the peripheral nerve stimulator?

A
  1. electrolyte imbalance
  2. hypothermia
  3. NM disorder
    4 drugs
191
Q

What are s/s of residual NMB?

A 
hypoxia
↓TV
stridor
weakness
↑O2 requirements
192
Q

During ulnar nerve monitoring, the black lead goes where?

A

flexor crease

193
Q

With paralysis at the ulnar nerve, patient can still have

A

coughing, breathing, vocal cord movement

194
Q

Facial nerve is CN ___

A

7

195
Q

The facial nerve lies within what gland?

A

parotid

196
Q

Is the facial nerve or ulnar nerve a better indicator of NMB of the diaphragm & airway?

A

facial

197
Q

Posterior tibial nerve is monitoring which muscle?

A

flexor hallucis brevis = flex of big toe

198
Q

Peroneal nerve is on the medial or lateral aspect of the leg?

A

lateral aspect of the knee/calf

199
Q

Stimulation of the peroneal nerve results in ___

A

dorsiflexion of the foot

200
Q

A normal twitch on TOF can be produced with up to what % of receptors blocked?

A

75%

201
Q

Single twitch TOF is ___ every ___

A

0.1Hz - 1Hz every 10 seconds

1Hz will decrease time of detection (use on induction)

202
Q

TOF is a __Hz stimulation every __

A

2Hz every 0.5 seconds (4 total = 2 seconds)

203
Q

RATIO between twitch 1 and 4 is a sensitive indicator of

A

NM block

204
Q

What type of blockade produces fade?

A

non-depolarizing

205
Q

Depolarizing block will produce fade, T/F?

A

F

206
Q

Tetanic stimulation is tetany at __ for ___

A

50-100Hz for 5 seconds

207
Q

When TOF ratio is >70%, what will occur?????

A

sustained response????

208
Q

Post-tetanic count

A

50Hz for 5 seconds
THEN
1Hz every second up to 20x

209
Q

less twitches in a post tetanic count means

A

more block

210
Q

Profoundly blocked is indicated by

A

no post-tetanic count
no single twitch
no TOF

211
Q

Double burst stimulation

A

3 short 50Hz impulses; 750ms pause; another 3 short 50Hz pulses

  • more sensitive than TOF and less painful than tetany
  • # 3 is most common, can use other
212
Q

What 2 NM monitoring test for induction

A

single twitch

TOF

213
Q

What 2 NM monitoring tests for maintenance

A

TOF

Post-tetanic count

214
Q

What 2 NM monitoring for emergence

A

TOF

Double burst stimulation

215
Q

What nerve do we monitor for NMB onset?

A

facial

216
Q

What nerve do we monitor for NMB recovery?

A

ulnar nerve

217
Q

TOF 1/4, reversal may take up to how long?

A

30 minutes

218
Q

TOF 2-3/4, reversal may take up to how long?

A

10-12 minutes following long-acting medication;

4-5 minutes following intermediate-acting medication

219
Q

TOF 4/4, adequate recovery is after how long?

A

within 5 minutes of neostigmine;

within 2-3 minutes of edrophonium

220
Q

6 unreliable signs of NMB recovery

A
  • sustained eye opening
  • tongue protrusion
  • arm lift to opposing shoulder
  • normal tidal volume
  • normal or near normal vital capacity
  • Max inspiratory pressure <40-50cmH2O
221
Q

4 “most” reliable signs of NMB recovery

A
  • sustained head lift x5 seconds
  • sustained leg lift x5 seconds
  • sustained hand grip x5 seconds
  • max inspiratory pressure 40-50cmH2O
222
Q

BIS monitor is used to assess:

A

the depth of anesthesia

223
Q

4 advantages of the BIS monitor

A
  • reduced risk of awareness
  • better management of response to surgical stim
  • faster wake up? (controversial)
  • more cost effective use of meds/anesthetics
224
Q

BIS >70

A

greater risk of recall

225
Q

BIS reading must be interpreted ALONG WITH ___- & ____

A

SQI (signal quality index)

EMG

226
Q

The best BIS reading, includes ↑ or ↓ SQI?

A

↑SQI

227
Q

The best BIS reading, includes ↑ or ↓ EMG?

A

↓EMG

228
Q

What are 5 factors that may affect the BIS reading?

A
  • patient movement
  • electrocautery
  • EMG
  • pacer spikes
  • EKG signal
229
Q

What are 4 factors that can ↓ BIS reading?

A
  • change in BP
  • partial pressure of CO2 in arterial blood
  • Hgb concentration
  • regional blood volume
230
Q

A patient with a falsely LOW BIS reading is:

A

moving, paced, anemic, hypotensive, hypercapnic, patient

231
Q

The brain consumes what % of oxygen in the body?

A

20%

232
Q

What is the goal cerebral oximetry reading?

A

MINIMUM is no less than 75% of baseline

233
Q

What does a cerebral oximeter detect?

A

decrease in CBF in relation to CMRO2

234
Q

More than 20% reduction in reading of the cerebral oximeter is correlated with what?

A

regional &/or global ischemia

235
Q

What are 5 different types of quantitative nerve monitoring?

A 
Acceleromyography (AMG)
Electromyography (EMG)
Kinemyography (KMG)
Mechanomyography (MMG)
Phonomyography (PMG)
236
Q

What is Acceleromyography (AMG) NM monitoring?

A

muscle acceleration

237
Q

What is Electromyography (EMG) NM monitoring?

A

muscle AP recorded;

monitoring electrical activity proportional to muscle movement

238
Q

What is Kinemyography (KMG) NM monitoring?

A

quantifies muscle movement with motion sensor strip

239
Q

What is Mechanomyography (MMG) NM monitoring?

A

detects contraction force & converts it to an electrical signal

↑amplitude = ↑strength

240
Q

What is Phonomyography (PMG) NM monitoring?

A

muscle contraction produces low frequency sounds; calculates muscle response

N928 - Basic Principles (22 decks)

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