Monitoring Flashcards
How do we assess physiological status?
-observation
-measuring physiological parameters such as HR, RR
How do we assess level of consciousness?
-testing reflex responses that vary according to the depth of anaesthesia
What body systems are monitored?
-cardiovascular, respiratory and central nervous system
-parameters include HR, RR, BP, temp, MM, CRT
What can be used to monitor cardiovascular function?
-heart rate
-pulse rate
-stethoscope
-feeling pulse
-pulse oximeter
-blood pressure
-MM and CRT
-body temp
-ECG
What can cause tachycardia?
-some drugs (ketamine)
-inadequate anaesthesia causing pain
-low levels of oxygen (hypoxemia)
-excess bodily fluid loss (hypovolemia)
What can cause bradycardia?
-hypothermia
-some drugs (lidocaine)
-excessive anaesthetic depth
-head injuries
-increased vagal tone
What do pale/white MM indicate?
-anaemia
-haemorrhage
-poor perfusion
What do blue MM indicate?
-cyanosis (lack of oxygen)
-respiratory difficulty
What do yellow MM indicate?
-jaundice (liver disease)
-haemolysis (increased RBC destruction)
What do red MM indicate?
-sepsis
-fever
-extensive tissue damage
-excitement
What do brown MM indicate?
-poisoning
How can we monitor pulse, which is lost last when crashing?
-dorsopedal artery
-coccygeal artery
-metacarpal/metatarsal artery
-lingual artery
-femoral artery
How can we monitor respiration?
-observing chest rise
-auscultation (listening to chest)
-watching reservoir bag
-MM colour
-pulse oximeter
-capnograph
-arterial blood gases
What can cause apnoea?
-obstruction or blockages
-excessive anaesthetic depth
-lack of oxygen
What can cause panting?
-inadequate anaesthesia
Why are patients under anaesthesia prone to hypothermia?
-anaesthesia abolishes temperature regulation due to blood loss, an open cavity, shaved hair or lack of movement
What consequences can hypothermia cause?
-delayed waking up from anaesthetic
-takes longer to metabolise drugs
-causes peripheral vasoconstriction (delays wound healing)
-increased recovery time
What happens to palpebral reflex during anaesthesia?
-present when patient in light plane
-generally lost when a surgical plane of anaesthesia is achieved
What happens to eye position during anaesthesia?
-eyes begin centrally when light
-eyes roll ventromedial at surgical plane
-return to central position as anaesthesia deepens
-pupil diameter tends to become dialled as anaesthesia becomes deep
What happens to pharyngeal reflex during anaesthesia?
-lost as patient becomes anaesthetised
(why we intubate)
What happens to jaw tone reflex during anaesthesia?
-progressively lost as patient approaches adequate anaesthesia
What happens to pedal withdrawal reflex during anaesthesia?
-lost at surgical plane
What happens to lacrimation reflex during anaesthesia?
-reduces as anaesthesia deepens
(why we apply eye drops)
What happens to corneal reflex during anaesthesia?
-can be present after cardiac arrest for a short time
-not a great indicator
What signs are seen at stage 1 of anaesthesia?
(induction to loss of consciousness)
-pulse increases
-respiration increases
-dilated pupils
-skeletal muscle tone increased
-vomiting or salivation
What signs are seen at stage 2 of anaesthesia?
(unconsciousness to rhythmic breathing)
-cranial nerve reflexes present
-eye wide open
-pupil dilated
-eye rotated ventromedial
-withdrawal reflex brisk
-breathing irregular, becoming regular
What signs are seen at stage 3 plane 1 of anaesthesia?
(suitable depth for minor surgery)
-breathing regular
-limb movement absent
-pinch reflex brisk
-eye is ventromedial
-brisk corneal reflex
-slight cardiovascular depression
What signs are seen at stage 3 plane 2 of anaesthesia?
(adequate for most procedures)
-eye ventromedial
-palpebral reflex sluggish then stops
-corneal reflex persists
-pupils constricted
-muscles are relaxed
-pedal reflex sluggish then lost
-tidal volume reduced
-HR/RR slightly reduced
What signs are seen at stage 3 plane 3 of anaesthesia?
(deep anaesthesia)
-eyes central
-eyelids open and pupil size increases
-respiratory rate reduced
-tidal volume reduced
-pedal reflex lost
-HR reduced
What signs are seen at stage 4 of anaesthesia?
(overdose)
-progressive respiratory failure
-pulse either very high or very low
-eyes are central with eyelids open
-pupils are dilated
-cornea is dry (corneal reflex absent)
-MM are cyanotic to grey and CRT is increased
