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Gen Exam 2 > Monitoring > Flashcards

Monitoring Flashcards

1
Q

AANA has 5 Standards for Anesthesia Monitoring

A

all 5 are needed for general
Temp & NMB maybe not for non-general

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2
Q

BP checked Q____min regardless of anesthetic

A

5

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3
Q

Temp Q

A

15 min

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4
Q

NM monitoring Q

A

15 min

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5
Q

most important monitor

A

Vigilance

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6
Q

⭐️
Monitoring FiO2 (Oxygen Sensor)

A

oxygen sensor is distal to the CG outlet
as close to pt as possible
determine the concentration of oxygen moving to pt

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7
Q

⭐️
only monitor that can detect a hypoxic mixture of gases

A

Oxygen Sensor

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8
Q

If the machine does not have a working O2 sensor…

A

get a new machine
do not start the case without one

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9
Q

All analyzers must have

A

low-level alarms, which are active while the machine is on

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10
Q

T/F
The Low O2 alarm can be temporarily silenced

A

False

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11
Q

Required at all times when the anesthesia machine is in use

A

Oxygen Sensor

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12
Q

polarographic (Clark electrode) & galvanic (fuel cell) are used to measure

A

Oxygen

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13
Q

T/F
Oxygen is diamagnetic

A

false
O2 = paramag
other gases = diamag

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14
Q

Oxygen + magnetic field

A

O2 molecules are attracted & agitated

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15
Q

Oxygen Sensor: Paramagnetic
pressure difference is ____ to O2 partial pressure

A

proportional

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16
Q

Why is O2 a magnetic gas?

A

2 unpaired electrons

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17
Q

When did Pulse Ox become a standard of care

A

‘86

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18
Q

Pulse Oximetry (SPO2)

A

-Pulse rate
-Estimate Oxygen (SaO2) saturation of Hgb
-time-delayed reading

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19
Q

Pulse Oximetry (SPO2) estimates ___.

A

Oxygen (SaO2)
saturation of Hgb

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20
Q

measures light absorbance

A

Spectrophotometry

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21
Q

solute concentrations measured by light transmitted through a solution

A

Lambert-Beer Law

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22
Q

3 assumptions made for programming all pulseox devices:

A

-only oxyhemoglobin & reduced Hgb absorb light
-pulsations are d/t pulsatile arterial flow
-empirical experimental oxygen dissociation calibration curve for all humans

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23
Q

An LVAD pt’s SpO2 will look like…

A

little oscillations
typically no pulse ox b/c they have no pulsatile flow

rely more on etCO2 and skin color

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24
Q

⭐️
Pulse Oximeter (SpO2)
2 wavelengths of light

A

Red light: 660 nm (unoxygenated Hgb)
Infrared light: 940 nm (oxygenated Hgb)

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25
Q

Pulse Oximeter (SpO2)
algorithm

A

compares how 660 nm & 940 nm wavelengths are absorbed by deoxyhemoglobin and oxyhemoglobin, and calculates the SpO2 value

using oxyhgb dissoc. curve

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26
Q

⭐️
T/F
A high SpO2 is a sign that the tissues are utilization O2 properly.

A

False
DOES NOT guarantee delivery of or utilization of O2 by the tissues

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27
Q

Can SpO2 indicate good ventilation?

A

No

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28
Q

apnea after preoxygenating with 100% FiO2 prior to induction = ___ min before SpO2 drops

A

6-8 min

(Exam 1 material: at least 8 mins; 10 min if healthy)

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29
Q

IV Dyes that mess w/ SpO2 reading

A

Methylene Blue, Indigo Carmine, Indocyanine Green(ICG)

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30
Q

Will give us false high SaO2

A

Carboxy & methemo hgb

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31
Q

Methylene blue will give us a SaO2 reading that is….

A

much lower than actual

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32
Q

Which binds greater to hgb?
O2
carboxyhgb

A

carboxyhgb (will push O2 off)

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33
Q

Cerebral Pulse Ox

A

-Beer–Lambert law
-balance between cerebral oxygen delivery and consumption
NR: 60-75%

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34
Q

⭐️
Pulse ox uses which law?

A

Beer Lambert

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35
Q

🔴
Cerebral Pulse Ox
Changes greater than __% indicate potential neurological events due to decreased cerebral oxygenation

A

25

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36
Q

Cerebral Pulse Ox
We want to see ___ between the two values

A

closeness
not equal

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37
Q

Best to detect Ischemia or Infarction

A

Leads II or V5

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38
Q

arrhythmias & inferior wall ischemia

A

Lead II

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39
Q

anterior/lateral wall ischemia

A

V5

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40
Q

____ Lead monitor both II & V5 simultaneously

A

5 Lead

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41
Q

EKG leads contain

A

Silver Chloride

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42
Q

Which mode for:
decreasing artifact?
diagnosing ischemia?

A

Filtering mode

Diagnostic mode

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43
Q

Lead V5
location

A

5th intercostal space at anterior axillary line

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44
Q

True V5 only possible with

A

5 Lead

can do modified V5 with 3 lead

45
Q

T/F
Gases/volatiles
The % we give to the pt will be higher than the expired %.

A

True
some is always going to be absorbed

46
Q

T/F
The inspired % we give to the pt reflects how much is going into the brain.

A

False
the expired % reflects this

47
Q

IR Gas Analyzer is located…

A

on inspi & exp limbs

48
Q

IR Gas Analyzer detects….

A

CO2, N2O & potent volatile anesthetics simultaneously

using unique light absorption of the gases

49
Q

Why is an appropriate level of - pressure matter for patient safety?

A

Negative pressure + emerging pt biting on ETT –> negative pressure pulmonary edema

50
Q

Sub-atmospheric/Negative Pressure Alarm

A
  • Neg pressure/reverse gas flow in circuit
51
Q

Negative pressure can cause…(3)

A

pulmonary edema
atelectasis
hypoxia

52
Q

High-Pressure Alarm
causes

A

peak pressures > 40cm H2O
Mainstem intubation
APL valve closed with high gas flows

53
Q

Continuous Pressure Alarm

A

obstruction or malfunctioning expiratory valve

ie: APL closed w/ gas flow & ballooning anesthesia bag

54
Q

Breathing Circuit Low-Pressure Alarms
PRIMARY cause & other causes

A

circuit disconnect (70% of the time =Y-piece)

-Faulty/leaking circuit
-Faulty Ventilation Bag
-Leaking from Bellows housing
-Leaking ETT cuff
-Accidental Extubation
-Anesthesia Bag disconnected
-Leaking or disconnected anesthesia machine hose

55
Q

most serious cause of Low-Pressure Alarm

A

Leaking ETT cuff
Accidental Extubation

(70% of the time, its a circuit disconnect)

56
Q

measures the tidal ventilation in anesthesia breathing circuits

A

flowmeters (not the fresh gas ones)

57
Q

Flowmeter monitors

A

Vt in circuit

Real-time flow metering
Ultrasonic
Flapper valves
Mini turbine spirometer
Range: 0-2.5 L/sec

58
Q

Apnea Detection Alarm
is associated with ___

A

flowmeters (not the FGF ones)

59
Q

Apnea Detection Alarm

A

High-level alert
must always be on

60
Q

What causes the “upswing” (phase IV/terminal upswing)

A

-dec. compliance & FRC

preg/obese (decreased FRC) don’t ventil8 well

retained CO2 @ end expiration is pushed out by extra weight

61
Q

Which part of this graph is the airway deadspace?

A
62
Q

Which part of this graph is the alveolar deadspace?

A
63
Q

Where can we find the etCO2?

A
64
Q

⭐️
Which part of the etCO2 capnog. is not always present?

A

Phase IV terminal “upswing”

65
Q

⭐️
alpha angle increase

A

expiratory outflow obstruction
COPD, bronchospasm, kinked ETT

66
Q

⭐️
beta angle increase

A

rebreathing CO2 from faulty inspiratory valve

67
Q

If etCO2 baseline is elevated….

A

breathing CO2
change absorbent canister

68
Q

etCO2 waveform phases

A

Phase I: INSP Ends
Phase II: EXP (deadspace & Upper Alveoli)
Phase III: EXP (lower lung)
Phase IV terminal “upswing”: (if present)
Phase IV: INSP (fresh gas w/o CO2)

69
Q

Phase IV should return to ___ with each new breath

A

0

70
Q

which one detected CO2?

A

Right (turns yellow when exposed to CO2)
semi-quantitative device

71
Q

T/F
Bicarbonate Administration can increase etCO2

A

True
bicarb breaks down into CO2 & expired
see slight elevation in 10-12 mins

72
Q

MH will ____ etCO2

A

increase
(remember: unexplained etCO2 rise is first sign of MH)

73
Q

Sepsis/fever ____ etCO2

A

increase

74
Q

Pulm. Emb ____ etCO2

A

decreases

75
Q

A circuit disconnect ___ etCO2

A

decreases

76
Q

Hyperventilation will ___ etCO2, but hypoventilation will ___ it.

A

hypervent= decrease etCO2
hypovent = increase

77
Q

Low CO will ___ etCO2

A

decrease

less blood circulation = less CO2 production

78
Q

A pt will exhibit ___ etCO2 in cardiac arrest

A

decreased

(good compressions & circulation will produce some etCO2, but very low; so none=dead)

79
Q

waz gud anesthesia?

A

nm, just some airway obstruction, hbu?

80
Q

NIBP

A

Ejection of pulsatile blood flow from the left ventricle causes pulsatile arterial pressures

81
Q

Systolic (SBP)

A

peak pressure from left ventricle during systole

82
Q

Diastolic (DBP)

A

lowest arterial pressure during diastole

83
Q

Pulse Pressure

A

SBP – DBP

84
Q

⭐️
Mean Arterial Pressure (MAP)

A

time - weighted average of arterial pressures during pulse cycle

85
Q
A

get your mind out of the gutter….sheeesh

86
Q

most accurately reflects hemodynamic status

A

R atrium

87
Q

phlebostatic axis corresponds to

A

the right atrium

88
Q

Accurate SVV fluid responsiveness/fluid challenge

A

-baseline bolus 200-250 ml
-perform prior to fluid loss
-helps determine what fluid they will respond to

89
Q

FloTrac

A

-CO & SVV using arterial waveform (also CI)
-connect to A-line
-use for intraop fluid mgmt

90
Q

Central Venous Pressure Monitoring (CVP)

A

Monitors R side of the heart (preload)
&
vascular volume

sits above R atrium

91
Q

⭐️
Must know a, c, v, x & y

A
92
Q

CVP NR

A

2-6 mmHg

93
Q

T/F
CVP measures blood volume directly.

A

False
estimate

94
Q

Risks of Central Line Placement

A

Microshock hazard
Pneumothorax
Hemothorax
Thrombus
Thromboembolus
Arterial Puncture
Hematoma
Infection **
Knotting/Breakage of Catheter
Retained Wire
Erosion through vessel/heart

95
Q

temperature maintained by

A

balancing heat production (metabolism) & heat loss

96
Q

T/F
Anesthesia does not affect temp control mechanisms

A

False
inhibits many of them

97
Q

types of anesthesia that impair temp control

A

General & neuraxial

98
Q

⭐️
Temp MONITORING STANDARD

A

Q15 min

99
Q

General Anesthesia Temp decrease (3 phases):

A
  1. rapid decrease over 30 min (0.5-1.5 ℃) – redistribution heat from core-to- peripheral tissue
  2. Slow linear reduction phase of 0.3 ℃ / hr from heat loss exceeding heat production
  3. Plateau phase (~thermo-regulatory vasoconstriction)
100
Q

T/F
All volatiles and gases impair thermoregulatory control

A

False
N2O does not

101
Q

T/F
Neuraxial anesthesia impairs temp control to the same extent as GA

A

True

102
Q

Which monitors both sides of the brain?
sedline
BIS

A

sedline

103
Q

BIS monitor

A

-monitors only 1 side of frontal lobe
-Composite analyzed EEG tracing

104
Q

BIS ranges

A

65-85: sedation
40-65: general anesthesia

105
Q

BIS limiting factors

A

-Variable Indexes per agent
-Age – brain maturation affects EEG
-Hypothermia (slows brain activity)
-Neurological Impairment (unreliable measuring)
-Interference from medical devices

(same for sedline)

106
Q

SedLine Monitor

A

-4 waves of EEG
-both hemispheres of frontal lobe

107
Q

SedLine Monitor general anesthesia

A

30-45

108
Q

AMG vs EMG

A

AMG: hand, toe, face
EMG: better if tucked

109
Q

NMB – Quantitative Monitoring

A

-safe extubation and prevention of residual paralysis

-Uses both:
AMG (acceleromyography) & EMG (electromyography)

Gen Exam 2 (7 decks)

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