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Principles > Monitoring > Flashcards

Monitoring Flashcards

1
Q

AANA monitoring standard

A

9

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2
Q

Oxygenation monitoring standards

A

Clinical observation
Pulse oximetry; continuous
ABG’s as indicated

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3
Q

Ventilation monitoring standards

A

Auscultation after placement
Chest excursion; rise and fall
ETCO2; MAC case(salter canula)
Pressure monitors as indicated
Monitor RR every 5 minutes

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4
Q

CV monitoring standards

A

Electrocardiogram
Auscultation as needed
BP and HR every 5 minutes

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5
Q

Thermoregulation monitoring standards

A

When clinically significant changes in body temp are anticipated or suspected
Peds, elderly
Cases more than 20 min.

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6
Q

Neuromuscular monitoring standards

A

When neuromuscular blocking agents are administered
Chart q15 min
Chart when administering nm blocker
Chart when redosed

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7
Q

Causes of L shift on oxygb curves

A

Alkalosis
hypocarbia
hypothermia
decreased COhB
Fetal Hb

L shift = higger affinity for O2

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8
Q

Causes of R shift on oxyhb dissociation curve

A

acidosis
hypercarbia
hyperthermia
increased 2,3 dpg

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9
Q

Beer-Lambert

A

Law of absorption
Relates the transmission of light through a solution to the concentration of the solute in the solution
Light absorption must be measured at wavelengths that are proportional to the number of solutes

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10
Q

More concentrated solution absorbs _____ light than a less concentrated solution

A

more

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11
Q

Pulse ox low concetration

A

low absorption

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12
Q

Pulse ox high concnetration

A

high absorption

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13
Q

Pulse ox shorter light path length

A

Less absorbed = more through the other side

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14
Q

Pulse ox more light path length

A

more absorption

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15
Q

Co-oximetry

A

looks at all 4 wave lengths

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16
Q

Gold standard if oximetry is inaccurate

A

co-oximetry

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17
Q

Red wavelengths of light

A

660

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18
Q

Infrared wavelengths of light

A

940 nm

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19
Q

Deoxyhemoglobin (deO2Hb) absorbs more______ light than oxyhb

A

Red

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20
Q

Oxyhemoglobin (O2Hb) absorbs more——- light than deoxygb

A

infrared

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21
Q

Pulse ox operating principles

A

Ratio of AC (alternating current) and DC (direct current) light absorption
AC: Pulsatile expansion of the artery increases length of light path which Increases absorbency
DC looks at non pulsatile
Pulsatile component divided by non-pulsatile component for each wavelength

(AC(660)/DC(660))/ AC(940)/DC(940)

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22
Q

What Absorbs as much light in the 660 nm range as oxyhemoglobin does

A

carboxyhb
Falsely elevates SpO2

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23
Q

Each 1% increase of COHb will increase SpO2 by …..

A

1%

Many smokers have >6% COHb

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24
Q

Venous blood pulsations does what to the pulse ox?

A

Detection of venous O2Hb sat, results in reduction of presumed arterial SpO2

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25
Q

Disadvantages of Pulse ox

A

Inaccuracy with dyes
Inaccuracy with different hemoglobin
Poor function with poor perfusion
Delayed hypoxic event detection

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26
Q

What finger to not put pulse ox on

A

index finger

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27
Q

Pulse ox placement for epidural block

A

Toes may be more reliable with epidural blocks because of dilation

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28
Q

Pulse ox sites that are less affected by vasoconstriction, reflects desaturation quicker

A

Tongue, Cheek, Forehead

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29
Q

Phases of Korotkoff sounds that measure BP

A

Phase I: the most turbulent/audible (SBP)
Phase II: softer and longer sounds
Phase III: crisper and louder sounds
Phase IV: softer and muffled sounds
Phase V: sounds disappear (DBP)

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30
Q

Map equation

A

map = SBP + (2x DBP) / 3

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31
Q

ideal bp Cuff bladder

A

40% of arm circumference
80% of length of upper arm
Centered over an artery

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32
Q

Automatic Non-invasive bp Techniques

A

Based on oscillometry
The maximal amplitude of oscillations = MAP
SBP and DBP calculated from algorithm
SBP – the least agreement with invasive BP

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33
Q

BP Cuff too large

A

Low bp

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34
Q

BP cuff too small

A

High bp

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35
Q

Atherosclerosis, edema, obesity, and chronic HTN produces what bp read out?

A

Low SBP and high DBP

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36
Q

BP average deviations

A

Average difference must be < +/- 5 mm Hg
Deviations up to 20 mm Hg are “acceptable”

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37
Q

When to use BP with caution…..

A

Severe coagulopathies
Peripheral neuropathies; use side with less neuopathies
Arterial/venous insufficiency
Recent thrombolytic therapy

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38
Q

Examiner compresses radial and ulnar arteries

A

Examiner compresses radial and ulnar arteries
Examiner releases ulnar artery
Color of palm should return in seconds
Severely reduced collateral flow > 10 seconds

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39
Q

Art line procedure

A

insert needle
pass guidwire through needle
remove needle
insert catheter over guidewire

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40
Q

Art line Transfixion Technique

A

Front and back walls are punctured intentionally
Needle removed
Catheter withdrawn until pulsatile blood flow appears and then advanced

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41
Q

Level and zeroing for artline

A

Zeroing; References pressures against atmospheric air;

Leveling; Aortic root; midaxillary line

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42
Q

Art line wave forms

A

1: systolic upstroke
2: systolic peak pressure
3: systolic decline
4: dicrotic notch- aortic valve closing
5: diastolic runoff
6: end-diastolic pressure

BP measured at 2 and 6
systolic waveform happens after the R wave

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43
Q

looking at blood flow and stiffness of arteries and distance from the heart and harmonic resonance along the vascular tree

A

Impedance

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44
Q

As pressure wave moves TO periphery:

A

Arterial upstroke steeper
Systolic peak higher (PP wider)
Dicrotic notch later
End-diastolic pressure lower

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45
Q

How are arterial waveforms made?

A

Summation of sine waves
Fundamental wave + harmonic wave = typical pressure wave

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46
Q

how many harmonic waves are required for most arterial pressure waveforms

A

6-10

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47
Q

analysis of the summation of multiple sine waves

A

Fourier analysis

mathmatical recreation of the pressure wave that’s transmitted.

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48
Q

Underdamped art wave

A

Systolic pressure elevated
Too many Oscilations
Shouldn’t have more than 2 or greater than 1/3 of the previous oscillation

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49
Q

Overdamped art wave form

A

Systolic pressure decreased
Absent dicrotic notch
Loss of detail
Falsely narrowed pulse pressure, MAP accurate

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50
Q

What contributes to Pressure Gradient Changes with bp?

A

Age: lack of distensibility (wider pulse pressure)
Atherosclerosis
Peripheral vascular resistance changes
Septic shock - femoral artery pressure can exceed radial artery pressure by 50mmhg
Hypothermia; constriction/ dilation

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51
Q

Cyclic arterial BP variations d/t respiratory-induced changes in intra-thoracic pressure

A

Pressure Wave Form Analysis

have to be;
Positive pressure ventilation (PPV)
closed chest and stomach
Lung volume change

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52
Q

PPV Effects on Pressure; inspiration

A

During inspiratory phase
⬆️ in intra-thoracic pressure, simultaneously ⬇️ LV afterload
⬆️ in total lung volume
Displaces pulmonary venous blood into left side of the heart…. ⬆️ LV preload

⬆️ LV preload and ⬇️ LV afterload….
⬆️ LV stroke volume, CO, and systemic arterial pressure

Increasing intra-thoracic pressure… ⬇️ systemic venous return and RV preload
⬆️ RV afterload by ⬆️ PVR

RV stroke volume drops during early phase of inspiration

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53
Q

PPV effect on pressure; expiratory phase

A

Decreased RV stroke volume… travels through pulmonary vascular bed to enter the left heart
⬇️ Reduced LV filling, ⬇️ LV stroke volume, and ⬇️ systemic arterial BP

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54
Q

Cycle of increasing and decreasing SV and systemic arterial BP in response to end-expiratory pressure

A

Systolic Pressure Variation (SPV)

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55
Q

Normal SPV

A

Mechanically ventilated patients, normal SPV = 7 - 10 mm Hg
Normal ΔUp = 2 – 4 mm Hg
Normal ΔDown = 5 – 6 mm Hg

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56
Q

Increased SPV =

A

Volume responsive or have residual preload reserve
Possible early indicator of hypovolemia
Critically ill - dramatic increase SPV (ΔDown component)

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57
Q

Utilizes maximum and minimum pulse pressures over entire respiratory cycle

A

Pulse pressure variation

Maximal difference in arterial pulse pressure
Divided by average of maximum and minimum pulse pressures

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58
Q

Normal and abnormal PPV

A

Normal <13 – 17%
>13 - 17% = Positive response to volume expansion

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59
Q

When to give volume for PPV

A

> 13% = gets volume
<9% = do not get volume

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60
Q

Computer analysis of arterial pulse pressure waveform
Correlates resistance and compliance based on age, gender
Computes SV

A

Stroke Volume Variation (SVV)

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61
Q

SVV formula

A

SVV = (SV max – SV min) / SV mean

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62
Q

Normal SVV

A

Normal: 10 - 13%
>10 - 13% = Positive response to volume expansion

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63
Q

What makes a SVVV reading accurate

A

mech vent w/ VT 8-10 ml/kg
PEEP > 5mmhg
NSR
Normal Intra abd pressure
closed chest

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64
Q

What is a side stream or diverting analyzer

A

Gas must be brought to the analyzer

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65
Q

what is a Mainstream or non-diverting analyzer

A

The analyzer brought to the gas in the airway

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66
Q

A fuel cell oxygen analyzer is an example of what gas sampling system?

A

mainstream or non-diverting analyzer

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67
Q

Rise time

A

time taken by the analyzer to react to the change in gas concentration

faster with non diverting = shorter rise time
longer with side stream

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68
Q

Side-stream responses is dependent on

A

dependent on sampling tubing inner diameter, length, and gas sampling rate

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69
Q

Normal gas sampling rate

A

200ml/min - 250 ml/min

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70
Q

Adding tubing does what to the gas sampling response time

A

longer transit time
longer rise time

narrower tubing= takes longer for gas to be removed from the system
wider tubing= more gas is sucked

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71
Q

Transit time

A

time lag for the gas sample to reach the analyzer

will be short in mainstream or non diverting

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72
Q

Dalton’s Law

A

The total pressure exerted by a mixture of gases is equal to the sum of the partial pressures exerted by each gas in the mixture

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73
Q

atm pressure

A

760 mmhg

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74
Q

Mass Spectrometry

A

Breath by breath basis to ID 8 gasses.

Abundance of ions at specific mass/charge ratios is determined and r/t the fractional composition of the gas mixture

Concentration determined according to mass/charge ratio

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75
Q

Infrared Analysis

A

Measurement of energy absorbed from narrow band of wavelengths of IR radiation as it passes through a gas sample

Measures the concentrations of gases

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76
Q

Infrared measures;

A

Measures CO2, nitrous oxide, water, and volatile anesthetic gases

O2 does not absorb IR radiation (use fuel cell)

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77
Q

Strong absorption of IR light occurs at …..

A

specific wavelengths for each gas (ex: CO2 at 4.3 microns)

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78
Q

IR light is transmitted through a gas sample over a range of frequencies, then is filtered via ….. for infrared analysis

A

a narrow-band pass filter

79
Q

Amount of IR light that reaches the detector is inversely related …..

A

concentration of the gas being measured

Less light going through = high concentration

80
Q

Saturated H2O vapor

A

47 mmhg

81
Q

Oxygen battery that measures the current produced when oxygen diffuses across a membrane

A

Fuel or Galvanic Cell

short life span
slow rsp time

82
Q

Best to monitor O2 concentration in the …. with an fuel oxygen analyzer

A

inspiratory limb

83
Q

Paramagnetic oxygen analyzers

A

Detects the change in sample line pressure resulting from the attraction of oxygen by switched magnetic fields

Signal changes during switching correlates with O2 concentration

use with side stream
faster; breath by breath / rapid response

84
Q

Oxygen sampling in the inspiratory line

A

Ensures oxygen delivery
Analyzes hypoxic mixtures

85
Q

Oxygen sampling inside the expiratory limb

A

Sampling inside the expiratory limb
Ensure complete pre-oxygenation “denitrogenation”

ET O2 above 90% adequate. lower = something is wrong

86
Q

causes of High O2 alarm = toxic

A

Premature infants
Patients on chemotherapeutic drug (ex: bleomycin)

87
Q

Patients on Bleomycin may have what hemodynamic change

A

High O2 alarm

88
Q

Cause of low O2 alarms

A

Pipeline crossover; If line plugged in wrong
Incorrectly filled tanks
Failure of a proportioning system; Nitrous and oygen turn on at the same time.

89
Q

Airway Pressure Monitoring detects

A

Detects circuit disconnections, ETT occlusions, kinking in the inspiratory limb, fresh gas hose kink or disconnection, circuit leaks, sustained high circuit pressure, and high and low scavenging system pressures

90
Q

airway pressure alarm Required by AANA/ASA standards

A

Breathing circuit low pressure alarm

91
Q

What airway pressure monitor requires no power, is always on and have a high reliability

A

Mechanical pressure gauges

92
Q

Primary purpose of the breathing circuit low pressure alarm

A

Primary purpose is identification of circuit disconnection or leaks

Does not detect some partial disconnections
May not detect misconnections or obstructions (70% at Y piece)

93
Q

Breathing circuit Low-pressure limit should be set just below the normal_______

A

Peak airway pressure

94
Q

Measure and alerts negative circuit pressure and potential for reverse flow of gas

A

Sub atmospheric pressure alarm (subambient alarm)

95
Q

Normal peak airway pressure

A

18-20 mmhg

96
Q

Negative pressures can cause …..

A

cause pulmonary edema, atelectasis, and hypoxia

97
Q

Causes of Sub atmospheric pressure alarm (subambient alarm)

A

Active (suction) scavenging system malfunctions (high vacuum pressure)
Pt inspiratory effort against a blocked circuit
Inadequate fresh gas flow - low flow
Suction to misplaced NGT/OGT
Moisture in CO2 absorbent

98
Q

Activated if the pressure exceeds a certain limit

A

High-pressure alarms

User-adjustable or automated
Valuable in pediatrics

99
Q

Causes of high-pressure alarms

A

obstructions, reduced compliance, coughing/straining, kinked ETT, endobronchial intubation

100
Q

Triggered with circuit pressure exceeding 10 cm H2O for >15 seconds

A

Continuing pressure alarms

Fresh gas continues to enter the circuit but cannot leave

101
Q

Causes of continuing pressure alarms

A

malfunctioning adjustable pressure relief valve, scavenging system occlusion, activation of oxygen flush system, malfunctioning PEEP

102
Q

types of PNM

A

Electrical and magnetic
Electrical nerve stimulation most commonly used

103
Q

The reaction of single muscle fiber to a stimulus follows an all-or-none pattern

A

supramaximal stimulation

The response of the whole muscle depends on how many muscle fibers are activated

104
Q

Gold standard for PNM

A

Ulnar nerve-adductor pollicis muscle easily accessible
Lowest risk of direct muscle stimulation

105
Q

most resistant to depolarizing and nondepolarizing NMBDs….

A

Diaphragm

Shorter onset than adductor pollicis, recovers quicker than peripheral muscles

106
Q

can be accessed when arms are unavailable …..

A

Facial nerve-orbicularis oculi (7; close eye) and facial nerve-corrugator supercilii muscle- (eyebrow wrinkle)

107
Q

What reflects extent of neuromuscular block of laryngeal adductor and abdominal muscles better

A

Corrugator supercilii > adductor pollicis

108
Q

Hz for single twitch

A

1.0 Hz (every second) to 0.1 Hz (every 10 seconds)

Reference value mandatory prior to NMBD

109
Q

TOF stimuli

A

Four supramaximal stimuli every 0.5 seconds – evaluate TOF count or fade in the muscle response
TOF ratio – 4th response/1st response

110
Q

Partial nondepolarizing block - TOF ratio

A

decreases (fade) and is inversely proportional to degree of block

111
Q

Partial depolarizing block - TOF

A

No fade, ratio is 1.0
If fade, phase II block developed

112
Q

Double Burst Stimulation htz

A

2 short bursts of 50 Hz tetanic stimulation separated by 750 ms w/ 0.2 ms duration of each square wave impulse in the burst

113
Q

DBS3,3 mode

A

3 impulses in each of the 2 bursts

114
Q

DBS3,2 mode

A

1st burst has 3 impulses and 2nd has 2 impulses

115
Q

Tetanic Stimulation

A

Tetanic stimulation given at 50 Hz for 5 seconds

116
Q

Tetanic stim with non depol

A

one strong sustained muscle contraction with fade after stimulation

117
Q

tetanic stim with depol

A

strong sustained muscle contraction w/o fade
Phase II block – fade occurs

118
Q

Post-tetanic Stimulation composition

A

tetanic stimulation (50 Hz for 5 sec) followed by 10 to 15 single twitches (1 Hz after 3 sec post tetanic stimulation)

Perform every 6 minutes
Deep and surgical blockade assessment

119
Q

Post-tetanic stim dependent on

A

Degree of blockade
Frequency and duration of tetanic stimulation
Length of time between the end of tetanic stimulation and first post-tetanic stimulus
Frequency of the single-twitch stimulation
Duration of single-twitch stimulation before tetanic stimulation

120
Q

intense non depol blockade and treatment

A

period of no response, 3 – 6 minutes after intubating dose of non-depolarizing NMBD

Neostigmine reversal impossible; high dose of sugammadex (16 mg/kg) for reversal

121
Q

Deep non depol blockade and treatment

A

absence of TOF but presence of at least one response to post-tetanic count stimulation

Neostigmine reversal usually impossible; dose of sugammadex (4 mg/kg) for reversal

122
Q

Suggammadex side effects

A

asystole / bradycardia

123
Q

moderate non depol blockade and treatment

A

gradual return of the 4 responses to TOF stimulation appears

Neostigmine reversal after 4/4 TOF; dose of sugammadex (2 mg/kg) for reversal

124
Q

Depolarizing Blockade- phase 1

A

No fade or tetanic stimulation; no post-tetanic facilitation occurs

All 4 responses are reduced, yet equal and then all disappear simultaneously in TOF (ratio is 1.0)

Normal plasma cholinesterase activity

125
Q

Depolarizing Blockade- phase 2

A

Fade present in response to TOF and tetanic stimulation; occurrence of post-tetanic facilitation

Response is similar to non-depolarizing blockade

Abnormal plasma cholinesterase activity

126
Q

Keep pt warm to prevent ….

A

delaying nerve conduction

127
Q

level of blockade is sufficient for surgery

A

moderate ; 1 or two responses on TOF

128
Q

Reverse blockade when ….

A

all 4 responses present to TOF

129
Q

Reliable clinical signs for nm recovery prior to extubation port reversal

A

Sustained head lift for 5 sec
Sustained leg lift for 5 sec
Sustained handgrip for 5 sec
Sustained ‘tongue depressor test’
Maximum inspiratory pressure

130
Q

Summation of excitatory and inhibitory post-synaptic potentials in the cerebral cortex

A

EEG monitoring

131
Q

EEG Electrodes placed so that surface anatomy relates to….

A

cortical regions

Uses at least 16 channels of information

132
Q

EEG identifies

A

Consciousness, unconsciousness, seizure activity, stages of sleep, and coma
Inadequate oxygen delivery to the brain (hypoxemia or ischemia)

133
Q

EEG Amplitude

A

size or voltage of recorded signal

134
Q

EEG frequency

A

number of times per second the signal oscillates or crosses the 0-voltage line

135
Q

EEG time

A

duration of the sampling of the signal

136
Q

EEG peri-op uses

A

Identifies inadequate blood flow to cerebral cortex

Guides an anesthetic-induced reduction of cerebral metabolism

Used to predict neurologic outcome after a brain insult

Gauges the depth of the hypnotic state of patients under GA

137
Q

EEG Beta waves

A

Beta (> 13 Hz): Awake
Alert attentive brain

138
Q

EEG alpha waves

A

Alpha (8 - 13 Hz): Eyes closed
Anesthetic effects

139
Q

EEG theta waves

A

Theta (4 - 7 Hz)

140
Q

EEG delta waves

A

(< 4Hz):

141
Q

Depressed eeg waves

A

Theta and delta

deep anesthesia

142
Q

What Contains artifact along with desired EEG signal

A

Processed EEG/ BIS

Uses < 4 channels of information
2 channels per hemisphere

143
Q

Bis necessary to display….

A

activity of both hemispheres
Delineates unilateral from bilateral changes

Not an adequate number of studies comparing EEG (gold standard) vs processed EEG

144
Q

BIS 100

A

awake - resonds to normal voice

145
Q

BIS 80

A

response to loud commands or mild prodding/shaking

146
Q

BIS 60

A

general anesthesia

low probabilty of explicit recall
unresponsive to verbal stimulus

147
Q

BIS 40

A

deep hypnotic state

148
Q

BIS 20

A

Burst suppression

149
Q

BIS 0

A

Flat line EEG

150
Q

Most common type of evoked potentials monitored intra-op

A

Sensory-Evoked Responses (SER)

151
Q

Sensory-Evoked Responses is….

A

Electric CNS responses to electric, auditory, or visual stimuli

Sensory system stimulus with responses recorded at various sites along the sensory pathway to the cerebral cortex
Cortical or subcortical

152
Q

SER are described in terms of…..

A

latency and amplitude

Need baseline reading

153
Q

SER latency

A

time measured from the application of the stimulus to the onset or peak of the response

154
Q

SER amplitude

A

size or voltage of recorded signal

155
Q

Monitor the responses to stimulation of peripheral mixed nerves (contain motor and sensory nerves) to the sensorimotor cortex ….

A

Somatosensory-Evoked Potentials

156
Q

SSEP resonses consist of….

A

short-latency and long-latency waveforms

Short-latency SSEPs are most commonly recorded intra-op; less influenced by changes in anesthetic drug levels

157
Q

Things that may alter appearance of SSEPs

A

Induction, neurological disease or age, and use of different recording electrode locations

158
Q

Monitors the responses to click stimuli that are delivered via foam ear inserts along the auditory pathway from the ear to the auditory cortex……

A

Brainstem Auditory-Evoked Potentials (BAEPS)

159
Q

Monitors the responses to flash stimulation of the retina using light-emitting diodes embedded in soft plastic goggles through closed eyelids or contact lenses

A

Visual-Evoked Potentials (VEPS)

160
Q

Most common MEP

A

Transcranial motor-evoked potentials

161
Q

Monitors stimuli along the motor tract via transcranial electrical stimulation overlying the motor cortex….

A

Transcranial motor-evoked potentials

162
Q

Monitors the responses generated by cranial and peripheral motor nerves to allow early detection of surgically induced nerve damage and assessment of the level of nerve function intra-op

A

Electromyography

Assesses the integrity of cranial or peripheral nerves at risk during surgery

163
Q

Monitoring the integrity of the motor tracts along the spinal column, peripheral nerves, and innervated muscle

A

Motor-Evoked Potentials

164
Q

Primary thermoregulatory control center is the ….

A

hypothalamus

165
Q

heat and warmth receptors

A

Unmyelinated C fibers

166
Q

cold receptors

A

A-delta fibers

167
Q

Thermoregulatory response characterized by:

A

Threshold – temperature at which a response will occur
Gain – the intensity of the response
Response – sweating, vasodilation, vasoconstriction, and shivering

168
Q

Temperature control varies based on….

A

Vary by anesthesia, age, menstrual cycle, drugs, alcohol, and circadian rhythm

169
Q

Hypothermia in GA

A

Initially: rapid decrease of approx. 0.5 to 1.5°C
-occurs over 30 min
Slow linear reduction: approx. 0.3°C per hour
- GA decreases metabolic rate by 20-30% lasts 1-2 hours after anesthesia
Plateau phase
-Thermal steady state, Heat loss equals heat production, Occurs 3-4 hours after anesthesia, Vasoconstriction prevents loss of heat from core, but peripheral heat continues to be lost

170
Q

Hypothermia does not cause much thermal discomfort in…

A

neuraxial anesthesia

Pts do not complain of feeling cold
no plateau d/t inhibition of peripheral vasoconstriction

171
Q

Central thermoregulatory control is inhibited by….

A

neuraxial anesthesia
Decreases the thresholds that trigger peripheral vasoconstriction and shivering

172
Q

heat loss to the environment, approx. 40% of heat loss in pt

A

Radiation
BSA exposed to environment

Infants: high BSA/body mass ratio makes them vulnerable

173
Q

loss of heat to air immediately surrounding the body, approx. 30%

A

Convection

Clothing or drapes decrease heat loss
Greater in rooms with laminar air flow

174
Q

latent heat of vaporization of water from open body cavities and respiratory tract, approx. 8-10%

A

Evaporation
Sweating is main pathway

175
Q

heat loss due to direct contact of body tissues or fluids with a colder material, negligible

A

Conduction

Ex: contact between skin and OR table; intravascular compartment and an infusion of cold fluid

176
Q

Coagulopathy Hypothermia Complications by…

A

Impairs platelet aggregation and activity of enzymes involved in coagulation cascade

177
Q

Hypothermia Complications

A

Increases need for transfusion by 22%; blood loss by 16%
Decreases oxygen delivery to tissues
3x the incidence of morbid cardiac outcomes
Shivering
Decreased drug metabolism (inc duration of nmb)
Post-op thermal discomfort

178
Q

Meds to reduce shivering

A

demerol, meperidine, clonidine, dexmetadomidine, ketamine

179
Q

Benefits of Hypothermia

A

Protective against cerebral ischemia
Reduces metabolism… 8% per degree Celsius
Improved outcome during recovery from cardiac arrest
Neurosurgery when brain tissue ischemia is expected
More difficult to trigger MH

180
Q

Peri-Op Temperature Management

A

airway heating and humidification
warm IV fluid and blood
Cutaneous warming
forced air warming

181
Q

Forced air warming prevents heat los from….

A

radiation

Uses convection to transfer heat to pt

182
Q

Gold standard temp monitoring

A

Pulmonary artery

Correlates well with tympanic membrane, distal esophageal, and nasopharyngeal temperatures

183
Q

Morbind cardiac outcomes associated with hypothermia

A

Increased BP, HR, and plasma catecholamine levels

184
Q

Tympanic membrane temperature approximates temp at the….

A

Hypothalamus

Placement risks perforation

185
Q

Nasopharyngeal temperature reflects…..

A

Reflects brain temperature, more prone to error

Risk of epistaxis

186
Q

Placement of esophageal temp probe

A

Placement in distal esophagus, lower 1/3 to ¼ of esophagus

187
Q

Single blanket reduces loss by…

A

30%
Doesn’t increase body temperature

188
Q

surgeries with increased room temp

A

liver transplants, major trauma, pediatrics

189
Q

Oxyhemoglobin (O2Hb) absorbs more infrared light than …….

A

deoxyhemoglobin

190
Q

Art line procedure

A

insert needle
pass guidwire through needle
remove needle
insert catheter over guidewire

191
Q

Art line Transfixion Technique

A

Front and back walls are punctured intentionally
Needle removed
Catheter withdrawn until pulsatile blood flow appears and then advanced

192
Q

how many harmonic waves are required for most arterial pressure waveforms

A

6-10

193
Q

Computer analysis of arterial pulse pressure waveform
Correlates resistance and compliance based on age, gender
Computes SV

A

Stroke Volume Variation (SVV)

194
Q

A fuel cell oxygen analyzer is an example of what gas sampling system?

A

mainstream or non-diverting analyzer

Principles (34 decks)

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