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Comprehensive Exam > Monitoring > Flashcards

Monitoring Flashcards

1
Q

relative contraindications to each A-line location

A
  • radial artery
    • inadequate collateral blood flow
  • femoral artery
    • prior vascular surgery
    • skin infection
  • dosalis pedis
    • diabetes
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2
Q

A-line and EKG comparison

A
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3
Q

(4) events determinig arterial waveform

A
  • ejection of blood
  • runoff of blood into peripheral vessels
  • reflectance from peripheral circulation
  • interaction with transducer system
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4
Q

Central locations for A-line

A

aortic arch

descending thoracic aorta

abdominal aorta

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5
Q

peripheral locations for A-line

A
  • axillary artery
  • brachial artery
  • radial artery
  • femoral artery
  • dosalis pedis artery
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6
Q

Central vs Peripheral arterial waveforms

A

Central:

  • narrower pulse pressure
  • eariler upstroke
  • earlier dicrotic notch
  • muted diastolic wave
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7
Q

the dicrotic notch recorded directly from the central aorta is termed the _____

A

incisura

  • related to aortic valve closure
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8
Q

periperal pressures have a ____ systolic and a ____ diastolic compared to central pressures

A

higher systolic

lower diastolic

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9
Q

study comparing central and peripheral pulse pressures

A

22.6 mmHg pressure difference

  • most extreme in aortic insufficiency
  • smallest difference in AS
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10
Q

A-line catheter size for infants

A

24g

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11
Q

A-line catheter size for adults

A

20g

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12
Q

radial artery lies between which two tendons?

A

branchioradialis

flexor carpi radiallis

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13
Q

murmur heard in aortic stenosis

A

systolic ejection murmur

crescendo-decrescendo

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14
Q

pulsus tardus

A

slurred upstroke with delayed systolic peak

  • seen in aortic stenosis
  • caused by increased compliance fo the post-stenotic vessel wall
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15
Q

Anesthetic management in Aortic Stenosis

A

avoid tachycardia and bradycardia

  • maintain an increased afterload
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16
Q

Aortic Regurgeitation

A

flow of blood from aorta into left ventricle during diastole

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17
Q

aortic insufficiency is normally caused by _____

A

aortic root abnormalities

  • connective tissues diseases
    • Marfan’s
    • Ellers-Danlos syndrome
  • Aortic dissection
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18
Q

anesthetic management in Aortic Insufficiency

A

elevated to normal HR with slight afterload reduction

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19
Q

what hemodynamics should be avoided in aortic insufficiency?

A

bradycardia and increased afterload

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20
Q

Pulsus Bisferiens

A

wide pulse pressures with double systolic peak

  • occurs in aortic regurge
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21
Q

FloTrac measurements

A

CO, SV, SVV, and SVR

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22
Q

normal stroke volume variation

A

< 15%

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23
Q

normal Cardiac Output

A

4.0 - 8.0 L/min

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24
Q

normal Cardiac Index

A

2.8 - 4.2 L/min/m2

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25
Q

normal Stroke Volume

A

60 - 90 mL/beat

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26
Q

normal Systemic Vascular Resistance

A

900 - 1400 dynes*sec/cm5

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27
Q

normal Systemic Vascular Resistance Index

A

1900 - 2400 dynes*sec/cm5

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28
Q

normal ScvO2

A

> 70%

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29
Q

Dampening in A-lines

A

lower systolic and higher diastolic

falsely low CO

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30
Q

SVV is a reliable indicator of ______

A

preload responsiveness

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31
Q

required conditions for SVV

A
  • mechanical ventilation with VT > 8 mL/kg
  • no SIMV or PSV
  • Normal sinus rhythm
  • closed chest
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32
Q

SVV greater than _____ will respond to fluid bolus

A

13

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33
Q

Indications for Central Venous Access

A
  • monitoring
    • central venous pressure
    • pulmonary artery catheterization
  • Therapeutic
    • hemodialysis
    • aspiration of air emboli
    • repeated blood sampling
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34
Q

phlebitis

A

vein inflammation

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35
Q

drugs likely to induce phlebitis

A
  • calcium chloride
  • potassium
  • NE
  • vasopressin
  • Epi
  • Dopamine
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36
Q

absolute contraindications to Central line

A
  • inexperienced operator
  • overlying skin infection
  • thrombophlebitis
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37
Q

(4) Types of central venous access devices

A
  • non-tunneled
  • tunneled
  • PICC
  • implanted ports
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38
Q

Types of Tunneled central lines

A

hickman, broviac, leonard, and groshong

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39
Q

PICC

A

peripherally inserted central catheter

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40
Q

PICC is usually placed in the _____

A

brachial vein

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41
Q

3.0 Fr = _____

A

20g

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42
Q

5.0 Fr = _____

A

16 g

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43
Q

7.0 Fr = ____

A

12g

44
Q

sizes of double lumen

A

5 and 6 Fr

45
Q

Sizes of triple lumen central line

A

5.5 and 7 Fr

46
Q

colors for distal, medial, and proximal central line

A

distal - red or brown

medial - blue

proximal - white

47
Q

preferred site for central line during emergencies

A

femoral

48
Q

Advantage vs Disadvantage of IJ central line

A
  • advantage
    • easy to recognize bleeding
    • less risk of pneumo
  • disadvantage
    • risk of carotid puncture
49
Q

Advantage vs Disadvantage of subclavian central line

A
  • advantage
    • most comfortable
  • disadvantage
    • highest risk of bleeding
    • highest risk of pneumo
50
Q

Advantage vs Disadvantage of femoral central line

A
  • advantage
    • easy to find
    • preferred for emergencies
  • disadvantage
    • infection risk
    • DVTs
    • not good for ambulatory patients
51
Q

preferred side for IJ insertion

A

right

lower pleural dome and no thoracic duct

52
Q

CVP waveform

A
53
Q

mechanical event during a-wave of CVP waveform

A

atrial contraction

54
Q

mechanical event during c-wave of CVP waveform

A

isovolumic ventricular contraction

55
Q

mechanical event during x-descent of CVP waveform

A

atrial relaxation

56
Q

mechanical event during v-wave of CVP waveform

A

systolic filling of the atrium

57
Q

mechanical event during y-descent of CVP waveform

A

opening of atrioventricular valve

58
Q

Cannon A waves

A

represents right atrium contracting against closed tricuspid valve

  • juntional rhythm
  • complete heart block
  • ventricular arrhythmias

or

increases resistance to right atrium to right ventricle flow

59
Q

loss of the A-wave in CVP waveform

A

loss of coordination of right atrium contraction

  • a-fib
  • a-flutter
60
Q

Cannon V-waves

A

severe tricuspid regurge

61
Q

slow Y-descent in CVP waveform

A

tricuspid stenosis

  • impaired right ventricle filling during diastole
62
Q

what does CVP measure?

A

pressure of blood in the thoracic vena cava near the right atrium

  • reflects the balance of intravascular volume, venous tone, and RV function
63
Q

normal CVP in spontaneously breathing patients

A

1 - 7 mmHg

64
Q

CVP is ____ proportional to compliance in thoracic veins

A

inversely

65
Q

CVP significance

A

approximation of right atrium pressure, which determines right ventricle filling, and therefore right ventricular preload

66
Q

what can increase CVP?

A
  • pulmonary hypertension
  • protamine
  • acidosis
  • PEEP
  • RV failure
67
Q

indications for PAC

A
  • ASA IV and V
  • high risk procedures
  • assess volume status
  • assess right or left ventricular failure
  • assess pulmonary hypertension
68
Q

absolute contraindications to PAC

A
  • tricuspid stenosis
  • pulmonic valve stenosis
  • RA or RV mass
  • tetralogy of fallot
  • h/o LBBB
69
Q

standard PAC

A

110 cm

7 - 8 Fr

3-5 lumens

70
Q

distal lumen of CVP

A

measures PA pressures

71
Q

proximal lumen of PAC

A

measures right atrium pressures )CVP)

injection for thermodilution

72
Q

waveform for PAC

A
73
Q

distance to right atrium using PAC

A

25 cm

74
Q

distance to pulmonary artery using PAC

A

45 cm

75
Q

Insertion complications using PAC

A
  • transient arrhythmia
  • complete heart block
  • catheter knotting
  • valvular damage
  • ventricular perforation
  • incorrect placement
76
Q

most common arrhythmia with PAC

A

PVC

77
Q

Indwelling complications of PAC

A
  • endobronchial hemorrhage
  • pulmonary infarction
  • thrombus
  • balloon rupture
78
Q

normal pulmonary artery pressure

A

15-30 over 6-15 mmHg

79
Q

normal pulmonary artery occlusion pressure

A

5 - 12 mmHg

80
Q

normal right ventriuclar ejection fraction

A

40-60%

81
Q

normal left atrial pressure

A

4 - 12 mmHg

82
Q

what causes Giant V-waves

A

mitral regurgitation or MI leading to decreased LV compliance

83
Q

cause of large A-waves

A

severe aortic stenosis or mitral stenosis

84
Q

(4) mechanisms that result in decreased SvO2

A
  • decrease CO, Hgb, SaO2
  • increased O2 extraction
85
Q

functions of TEE

A
  • regional wall motion
  • ventricular volume and function
  • valve gradients and regurgitation
  • air embolism
86
Q

(5) Modes of TEE

A
  • M-mode echocardiography
  • 2D echocardiography
  • pulsed-wave doppler
  • continuous-wave
  • color-flow
87
Q

Contraindications of TEE

A
  • perforated viscous
  • esophageal pathology
    • trauma, tumor, scleroderma
  • active upper GI bleeding
  • recent upper GI surgery
  • esophagectomy
88
Q

—Ultrasound waves transmitted from the transducer interacts with the patient’s tissues in four ways:

A
  1. Reflection
  2. Refraction
  3. Scattering
  4. Attenuation
89
Q

velocity of transmitted US through soft tissue

A

1,540 m/s

90
Q

depth to visualize great vessels

A

upper esophagous

20 - 25cm

91
Q

depth to visualize valvular and systolic function

A

mid-esophageal

30-40 cm

92
Q

depth to visualize EF, volume status, and wall motion

A

transgastric

40-45 cm

93
Q

depth to visualize AV valve

A

deep transgastric

45-50cm

94
Q

ME 4 chamber view

A

probe at 30 - 40cm

  • can view
    • chamber enlargement, LV function, MV/TV pathology, ASD, and pericardial effusion
95
Q

LAD supplies:

A
  • anterior right ventricle
  • anterior left ventricle
  • LV apex
  • anterior 2/3 of interventricular septum
96
Q

Coumadin Ridge

A

tissue that separates left atrial appendage and left pulmonary vein

  • important in A-fib
  • blood will fillup in this area and eventually form clots
97
Q

Anatomical Structures in ME 2 view

A
  • left atrium and left atrial appendage
  • mitral valve
  • left ventricle
  • coumadin ridge
  • coronary sinus
  • circumflex coronary artery
98
Q

how to convert ME4 view to ME2

A

increase omniplane angle to 80-100 degrees

  • mitral valve should be center of screen
99
Q

ME2 assessment

A

left ventricle size and function

MV pathology and annulus

100
Q

ME LAX anatomical structures

A
  • left atrium and ventricle
  • mitral valve
  • right ventricle
  • aortic valve
  • proximal ascending aorta
101
Q
A

ME LAX view

mitral and aortic valve in the same view

102
Q

how to convert ME4 to ME LAX

A

increase omniplane angle to 120-140o

rotate probe slightly to the right

103
Q

TG mid SAX anatomical structures

A

LV cavity and it’s segments

papillary muscles

right ventricle

104
Q

how to convery ME4 view to TG mid SAX

A

set omniplane angle to 0

advanve probe into stomach (40-45cm)

105
Q

which view has the best assessment of volume status?

A

TG mid SAX

Comprehensive Exam (6 decks)

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