Monitoring

Question 1

AANA Standard 9

Answer 1

Monitoring:

• Ventilation
• Oxygenation
• CV status
• Body temp
• Neuromuscular function
• Position

Question 2

Ulnar Nerve

Answer 2

Adductor policis → thumb adduction
Best site to monitor RECOVERY
Only quantitative site

Question 3

Facial Nerve

Answer 3

Cranial nerve VII
Temporal branch
Orbicularis occuli → eyelid closure
Corrugator supercilli → eyebrow twitch
Best site to monitor ONSET

Question 4

Posterior Tibial

Answer 4

Flexor hallucis → big toe flexion

Used to monitor recovery

Question 5

Qualitative Nerve Monitoring

Answer 5

Subjective measurement

Muscle responses visible or palpated

Question 6

Quantitative Nerve Monitoring

Answer 6

TOF ratio
Ulnar nerve
Requires baseline prior to paralysis
Assess waveform

Question 7

Single Twitch

Answer 7

0.1-1 Hz

Requires baseline

Question 8

TOF

Answer 8

4 twitches at 2Hz every 0.5 sec for 2 sec
Reflects blockade at 70-100%
Ratio compares T1-T4
0/4 100%
1/4 90%
2/4 80%
3/4 75%
4/4 70%

Question 9

Double-Burst Suppression

Answer 9

Two short bursts at 50Hz

Easier to detect fade

Question 10

Tetanus

Answer 10

Rapid delivery 30, 50, 100Hz stimulus for 5 sec

Painful - use sparingly for deep block assessment

Question 11

Post-Tetanic Count

Answer 11

50Hz for 5 sec followed by 3 sec pause then single twitches at 1Hz
Useful only when TOF or double-burst absent

Question 12

Pulse Oximetry

Answer 12

Requires pulsatile blood flow
SaO2 90 PaO2 60
Cyanosis = late sign

Question 13

Interfere w/ Pox

Answer 13

High intensity light
Movement
Electrocautery
Peripheral vasoconstriction
Hypothermia
CPB
Methemoglobin
Carboxyhemoglobin
Methylene blue
Hemoglobin <5

Question 14

PACO2-PaCO2

Answer 14

2-10mmHg

Question 15

Capnograph

Answer 15

X-axis (seconds)
Y-axis (ETCO2 mmHg)

Phase 1 baseline
2 upstroke
3 plateau
4 downstroke

α
β end expiration

Question 16

Capnograph Phase 1

Answer 16

Inspiratory baseline

Zero unless re-breathing

Question 17

Capnograph Phase 2

Answer 17

Expiratory upstroke

Anatomic dead-space (no CO2) mixed w/ alveolar gas

Question 18

Capnograph Phase 3

Answer 18

Expiratory plateau

Alveolar expired CO2

Question 19

Capnograph Phase 4

Answer 19

Expiratory downstroke

Fresh gas inspiration → return to baseline

Question 20

Capnograph β Angle

Answer 20

Where ETCO2 read

Question 21

Lead II

Answer 21

MEA
Detects atrial dysrhythmias
Inferior ischemia or ST depression

Question 22

V5

Answer 22

5th ICS anterior axillary line

Detects anterior & lateral ischemia

Question 23

Pulmonary Artery Catheter

Answer 23

RAP 5mmHg
RVP 25/5
PAP 25/10
PCWP 10

Question 24

Heat Loss Mechanisms

Answer 24

Radiation - radiates from patient into room
Convection - heat loss d/t air velocity
Conduction - contact w/ cold OR table
Evaporation - dry inspired gases

Question 25

Hypothermia S/S

Answer 25

<36°C

Shivering, dizziness, nausea, rapid & shallow breathing, confusion, fatigue, drowsiness, rapid & weak pulse

Question 26

Hypothermia RISK

Answer 26

Elderly
Burn patients
Neonates
Spinal cord injuries

Question 27

Temperature Monitoring

Answer 27

Esophagus lower 1/3 = accurately reflects core blood temp

Nasopharynx, rectum, bladder, tympanic, skin