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Anesthesia Techniques > Monitoring Cardiac/noncardiac > Flashcards

Monitoring Cardiac/noncardiac Flashcards

1
Q

what needs to be documented every 5 mins for all anesthetics

A

BP
HR
RR

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2
Q

what reading does methemoglobin give and why

A

85%, absorbs red and infrared light equally

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3
Q

what does an increased alfa angle suggest

A

expiratory airway obstruction
-copd, bronchospasm, kinked et tube

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4
Q

what can cause increased dead space causing low etco2

A

PE

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5
Q

what does an increased beta angle suggest

A

rebreathing due to faulty inspiration valve
soda lime

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6
Q

if you intubate too deep, where is tube most likely to go

A

right lung, shorter straighter

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7
Q

what needs to be monitored when giving neuromuscular blocking agents

A

neuromuscular function and status

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8
Q

how can temperature affect blood loss

A

big temp change can increase blood loss

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9
Q

what needs to be monitored continuously on all pediatric (<12) patients receiving general anesthesia and when indicated on other pts

A

body temp

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10
Q

what monitors are necessary

A

lung sounds-stethoscope
inspired o2 concentration- gas analysis
expired gas analysis
spo2
pulmonary/chest wall mechanical function

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11
Q

what does pulmonary chest wall mechanical function include

A

inspiratory pressures, respiratory volumes

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12
Q

what should be monitored continuously on all patients

A

oxyegnation

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13
Q

what are the three ways of verify intubation listed on standard 9

A

auscultation,
chest excursion,
confirmation of co2 in expired gas

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14
Q

what should be continuously monitored during controlled or assisted ventilation with any artificial airway support

A

ETCO2

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15
Q

what is recommended by standard 9 for alarms

A

have threshold and variable pitch audible alarms

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16
Q

how many breaths at minimum are needed for etco2 to avoid misinterpretation

A

6 breaths

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17
Q

what prevents 93% of anesthetic mishaps

A

pulse oximetry and capnography

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18
Q

how is co2 analysis helpful in gas monitoring

A

assesses ventilation and detects equipment/patient problems

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19
Q

what are advantages of side stream sampling

A

lightweight,
less chance of disconnect,
accurate <40 breaths/min,
no dead space

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20
Q

what are disadvantages of side stream monitoring

A

water/secretions may clog line,
flexible tube easily obstructed,
inaccurate >40 breath so no peds

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21
Q

describe side stream sampling

A

pump in monitor aspirates sample of gas through thin/flexible sampling line

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22
Q

what monitoring sampling measures gas directly in breathing system

A

mainstream aka non diverting

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23
Q

what are advantages of mainstream sampling aka non diverting

A

fast,
good fidelity,
water and secretions not an issue

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24
Q

which sampling method can increase etco2

A

mainstream sampling by increasing dead space

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25
Q

what are disadvantages of mainstream sampling aka non diverting

A

heavy in circuit,
increases dead space,
greater opportunity for disconnect,
gas options limited

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26
Q

what co2 analysis is ph sensitive, co2 presence changes color, and used most often by ems

A

colorimetric co2 analysis

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27
Q

if you intubate and get color change after 1 breath, what could be a problem

A

could be co2 from stomach

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28
Q

what is the measurement and numerical display of co2 concentrations during respiratory cycle

A

capnometry

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29
Q

what is a graphic record of co2 concentration on screen or paper

A

capnography

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30
Q

what is the actual waveform genered by capnometer

A

capnogram

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31
Q

what may be detected due to abnormalities in capnography

A

airway obstruction

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32
Q

what is produced by cells of body during metabolism into circulatory system and then is diffused into lungs

A

CO2

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33
Q

what is a better indicator of rosc during resuscitation

A

exhaled CO2

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34
Q

what cardiac changes can etco2 aid in detecting

A

decreased cardiac output,
pulmonary embolism,
reduced blood flow to lungs

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35
Q

what guides ventilator changes and can give a trend of anesthesia depth

A

CO2

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36
Q

what could a sudden increase in co2 represent during code

A

spontaneous cardiac function/output

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37
Q

what is difference between etco2 on monitor and blood

A

blood is usually 5 higher than monitor

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38
Q

What are some complications that can happen that etco2 can help alert to

A

esophageal intubation,
apnea,
extubation,
disconnection,
ventilator malfunction,
ett partial obstruction,
compliance vs resistance changes,
spontaneous resp w/muscle relaxant use,
poor lma fit,
leaking ett cuff

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39
Q

what is phase 1 in capnography (A)

A

inspiratory baseline- 0- low valley

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40
Q

what could be a problem if your co2 isn’t reading 0 during phase 1

A

co2 canister needs to be changed out

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41
Q

what is phase 2 in capnography and what letters are in it

A

initiating exhale- b- c

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42
Q

what is phase 3 in capnography and what letters are in it

A

plateau c-d
no plateau= not reading correctly

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43
Q

how is slope of phase 3 increased

A

kink,
ventilation perfusion status,

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44
Q

what is phase iv in capnography and what letters are in it

A

end tidal point down to zero (inhalation)
d-e

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45
Q

what is the letter with the highest co2 number on capnography

A

d- 35-40 torr

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46
Q

how wide is alpha angle and when is it increased

A

100-110 d,
increased with obstructive lung diseases because of increased dead space taking longer to exhale

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47
Q

in capnography what does gradual sloping indicating

A

taking alveoli longer to expel co2 from lungs= copd

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48
Q

what is beta angle degrees and when is it increased or decreased

A

90 d -
increased with rebreathing co2

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49
Q

in capnography, what does height depend on

A

etco2

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50
Q

what is the minute ventilation equation

A

tidal volume x respiratory rate

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51
Q

in capnography, what does frequency depend on

A

respiratory rate

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52
Q

what can shape of capnography indicate

A

lung compliance

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53
Q

what are some causes of etco2 and paco2 to be increased

A

age,
pulmonary disease,
pulmonary emboluse,
low cardiac output,
hypovolemia

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54
Q

what does the noninvasive estimate of paco2 assume

A

2-5 mmHg difference between etco2 and paco2

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55
Q

what could cause no co2 in gas line

A

obstruction,
disconnection,
esophageal intubation,
no blood circulation to lungs

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56
Q

what causes etco2 to increase

A

hypoventilation,
MH,
sepsis,
rebreathing,
bicarb administration,
extremity tourniquet/aortic clamp,
insufflation of co2 during laparoscopy

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57
Q

what causes of etco2 to decrease

A

hyperventilation,
hypothermia,
low cardiac output,
pulmonary embolism,
accidental disconnect,
tracheal extubation,
cardiac arrest

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58
Q

what are the kinds of volatile anesthetic measurement

A

infrared analysis,
refractometry,
piezoelectric analysis

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59
Q

what uses each anesthetic gas’s ability to absorb specific frequencies of emr in the infrared spectrum

A

infrared absorption analysis

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60
Q

what compares mass to charge ratio of gases and places them into a spectrum- most commonly used

A

mass spectrometry

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61
Q

what anesthesia gas monitoring compares ratios of Fi and et of o2, n2, co2, and n2o

A

mass spectrometry

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62
Q

what anesthesia gas monitoring has advantages of being fast, reliable, low cost, multiagent/multigas

A

mass spectrometry

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63
Q

what anesthesia gas monitoring has disadvantages of warm up time, space, must be scavenged, and measures only preprogrammed gases

A

mass spectrometry

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64
Q

what has a laser that interacts with gas molecule and measures the fraction of energy absorbed at different live wavelengths called scattering

A

raman spectrometry

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65
Q

what anesthesia gas monitoring is less accurate with pediatric cases, since they use high carrier gas flow rates and small tidal volumes

A

raman spectrometry

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66
Q

what are disadvantages of raman spectrometry

A

costly,
less accurate in pediatrics

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67
Q

what are advantages of raman spectrometry

A

no scavenging,
accurate,
fast multi-gas/agent

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68
Q

what do you need to do with o2 flow sensor (galvanic cell)

A

calibrate to room air,
degrade in 30 days

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69
Q

what does vaporizer output assess

A

detects incorrect agents
detect vaporizer turned off/empty
provides info on uptake and elim of agent in pt

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70
Q

what does a galvanic cell play a role in analyzing

A

o2 analysis

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71
Q

what law explains pulse oximetry

A

lambert beer law

72
Q

what instrument uses a mathematical means of expressing how light is absorbed by matter

A

pulse ox

73
Q

what are two main types of oximetry

A

fractional, functional

74
Q

what kind of oximetry measures arterial oxygen saturation (Sao2)

A

fractional oximetry

75
Q

what kind of oximetry is only measurable by arterial blood sample

A

fractional ox

76
Q

what absorbs more red light and what is the light wavelength

A

deoxyhemoglobin- 660

77
Q

what absorbs more infrared light and what is light wavelength

A

oxyhemoglobin - 940

78
Q

if you are seeing more red light than infrared light what is happening with oxygen

A

higher oxygen- more infrared light being absorbed means higher oxygen content

79
Q

if you are seeing more infrared light, what is happening to oxygen

A

decreasing oxygen- more red light being absorbed into deoxyhemoglobin means less oxygen content

80
Q

what is the formula for fractional oximetry

A

oxyhemoglobin/(oxyhemoglobin+deoxyhemogobin+methemoglobin+carboxyhemoglobin)

81
Q

in 100% pulse ox, which light will you see most of

A

red light- infrared has been absorbed into oxyhemoglobin

82
Q

what is the formula for functional oximetry

A

functional oximetry-oxyhemoglobin/(Oxhemoglobin+deoxyhemoglobin)

83
Q

what kinds of light flash hundreds of times per second in pulse ox

A

red and infrared light

84
Q

what does a pulse ox rapidly sample from each pulse wave

A

peak and trough

85
Q

what is a trough in pulse ox

A

vascular bed has arterial,
capillary,
venous blood,
and tissue density

86
Q

what is a peak in pulse ox

A

all of blood from trough + additional arterial blood

87
Q

when is pulse ox inaccurate

A

methemoglobin,
methylene blue,
carboxyhgb messes up pulse ox- do abg for real oxygen reading

88
Q

what is it called when neither red or infrared light is emitted from pulse ox

A

off period

89
Q

what are causes of low etco2

A

hyperventilation,
decreased co2 production,
alveolar dead space

90
Q

how does a cerebral oximeter work

A

does not require pulsatile flow, gets readings from vascular beds- also tries to measure arterial through
parabolic arch

91
Q

below what reading is pulse ox not reliable

A

below 70%

92
Q

what happens during off time in pulse ox

A

reading of ambient light is read and subtracted from sequences

93
Q

where do you put pulse ox probe to detect changes faster

A

centrally place
peripheral=slower

94
Q

what are some pulsatile vascular beds you can attach pulse ox to

A

finger, cheek, ear, toe, nose, penis

95
Q

what are some pulsatile vascular bed you can attach pulse ox to on infant

A

palm, forefoot, wrist

96
Q

when is pulse oximeter accurate to within 5%

A

70-100%

97
Q

what happens when pulse ox is below 70%

A

readings are extrapolated and unreliable

98
Q

what conditions affect accuracy of pulse ox

A

raynauds,
movement,
vasoconstriction,
poor circulation d/t low co,
improper placement,
hypothermia

99
Q

what are dyes that can cause false high/low readings in pulse ox

A

methylene blue, indigo carmine

100
Q

exposure to what can cause false high/low pulse ox reading

A

smoke or fire

101
Q

what causes fire/smoke to give overestimate of pulse ox

A

carboxyhemoglobin

102
Q

what can fluorescent light cause in pulse ox reading

A

false high- red light isn’t getting absorbed because of same wavelength 660

103
Q

what can drugs cause that makes pulse ox have false high/low reading

A

methemoglobinemia -doesn’t release oxygen
85% reading

104
Q

name some drugs that can induce methemoglobinemia

A

nitrates,
locals such as prilocaine,
chlorates,
sulfas,
metochlopramide

105
Q

what are two disease that can cause false high/low pulse ox reading

A

anemia,
sickle cell (vaso-occlusive crisis),
dyes

106
Q

what kind of light can interfere with pulse ox

A

fluorescent light

107
Q

what happens if esophageal stethoscope enters lungs

A

makes a leak in cuff, bellows collapse

108
Q

what can inhibit passage of light through finger

A

nail polish- black henna or dark blue

109
Q

what is placed in nasall/orally and is only used in intubated patients

A

esophageal stethoscope

110
Q

when is esophageal stethoscope contraindicated

A

esophageal varices/strictures

111
Q

what should baseline be on capnography

A

zero

112
Q

what measures depth of hypnosis

A

bispectral index (BIS)

113
Q

what is the BIS scale and what does its number mean

A

0-100, correlates to level of sedation

114
Q

what extrapolates via algorithm from EEG channel parameters

A

bis monitor

115
Q

What does recall correlate well with

A

level of anesthesia

116
Q

what can bis help prevent

A

recall under general anesthesia

117
Q

what are some effects of a patient having recall after general anesthesia

A

ptsd, sleep disturbances, nightmares

118
Q

what was used to predict recall before anesthesia

A

movement, increased hr/bp, pupillary changes, perspiration, tearing (which can be blocked by opiates/beta blockers)

119
Q

what is the goal bis values for general anesthesia

A

40-60- low incidence of recall

120
Q

at what bis value is a patient likely to have recall

A

greater than 70

121
Q

what is the bis range for burst suppression

A

1-20

122
Q

what is the bis rang for flat line eeg

A

0

123
Q

what is the bis range for deep hypnotic state

A

20-40

124
Q

what is the bis range for responding to loud commands or mild shaking

A

60-80

125
Q

what is the bis range for responding to normal voice

A

80-100

126
Q

what is the bis range for awake

A

100

127
Q

what can interfere with bis

A

shivering, electrocautery, forced air warmer, cardiac pacemaker spikes

128
Q

how does electrocautery interrupt bis

A

unipolar cautery overloads bis signal transmission

129
Q

when should temperature be carefully monitored according to standard 9

A

pediatric (<12), or when significant temp change is intended/anticipated/suspected

130
Q

what is a late sign of malignant hyperthermia

A

increased temperature

131
Q

what does hypothermia triple the incidences of

A

cardiac complications and surgical wound infections

132
Q

what impact does hypothermia have on blood loss

A

increase it

133
Q

what is heat production and how is it brought about

A

thermogenesis- shivering and non shivering

134
Q

what is heat loss

A

thermolysis

135
Q

what is normal range of temp

A

36-37.5 c

136
Q

where is thermoregulation controlled

A

hypothalamus

137
Q

what is total body heat a combination of

A

zone temperatures- peripheral and core zones

138
Q

what is more important than maintenance of individual temps

A

maintenance of total body heat

139
Q

what is the peripheral temp zone made up of

A

skeletal muscle, subcut tissue, skin

140
Q

what is core temp zone made up of

A

trunk and head- holds more heat and releases more heat

141
Q

how does body respond to cold exposure

A

increases heat production, reduces heat loss

142
Q

how does body reduce heat loss

A

vasoconstriction of peripheral vessels, increased metabolic rate, layering w/clothes

143
Q

Why do peds lose heat more quickly than an adult?

A

bigger core zone than peripheral zone-

144
Q

is hypothermia or hyperthermia more cmmon

A

hypothermia- body naturally vasoconstricts to increase temp but anesthetics gases cause vasodilation

145
Q

what can you give for shivering

A

demerol

146
Q

what is shivering indirectly controlled by

A

catecholamines

147
Q

how does non shivering thermogenesis work with fat

A

vessels run through brown adipose fat and skeletal muscle and blood gets heated as it moves

148
Q

how much heat can you lose in the first hour aka phase 1

A

1-1.5 degrees c

149
Q

what is phase 3 of heat loss

A

equilibrate, plateau, produce same heat you are losing after 4 hours

150
Q

what is phase 2 of heat loss

A

still declining but plateauing, losing more heat than you can generate for next 2-4 hrs

151
Q

what is most heat lost from most to least

A

radiation, convection, conduction, evaporation

152
Q

what is it called when body transfers kinetic energy to air molecules on surface of the skin

A

convection

153
Q

how much air around your body does your body heat and what is this called

A

1 inch, convection

154
Q

how does convection produce heat loss

A

molecules with greater kinetic energy rise and are replaced by colder air molecules (w/less kinetic energy)
-air currents removes heat from around body

155
Q

what is the #1 cause of loss of heat in or

A

radiation

156
Q

what is it called when body heat is transferred to something colder via infrared spectrum

A

radiation

157
Q

what does conduction require

A

physical contact- energy transfers from warm object to cold object- warm body on cold table

158
Q

where on body is greatest amount of heat lost from radiation

A

area of highest blood flow–patient’s head

159
Q

what does a blanket stop from happening in heat loss

A

conduction and convection

160
Q

what does a space blanket/emergency blanket stop in heat loss

A

radiation-
also force air warmer

161
Q

how can evaporation cause heat loss

A

sweating, warm air from lungs, liquid prep evaporation, open cavities

162
Q

what are complications of hypothermia

A

increases risk of post op infection, increases post op recovery, increases cardiac mobidity and myocardial ischemia, increase blood loss

163
Q

how can hypothermia influence ekg

A

increase pr/qrs/qt
increase or decrease st segment

164
Q

what is the extra wave from hypothermia in ecg

A

j wave aka osborn wave

165
Q

how does hypothermia affect blood loss

A

increases it by speeding impeding clotting, decreases platelet function (thromboxane a2 release)

166
Q

how does propofol/barbiturates/opioids/volatile anesthetics affect body temp

A

changes body’s set point- decreases temp when body kicks in to heat up

167
Q

what happens to bodies ability to regulate temp with the more gas you give

A

decreases with more gas

168
Q

why do patient’s lose the most heat in the first hour

A

more iv fluids because of getting sedation meds in, putting in volatile gases which decreases bodies set point, exposing patient to air=convection

169
Q

why do geriatrics have harder time regulating temp

A

unable to increase metabolism to increase heat

170
Q

temp monitoring accuracy from least to greatest

A

pulmonary artery, esophagus, tympanic, nasopharyngeal, bladder

171
Q

how much can a single layer of passive insulation can reduce cutaneous heat loss

A

30%-
1 cotton blanket- adding more blankets does not equal less heat loss

172
Q

what helps decrease redistribution heat loss

A

forced air warming 30 minutes preop
-decreases core to periphery gradient by causing peripheral vasodilation

173
Q

what are cvp distances to right atria

A

subclavian=10cm
right ij= 15
left ij= 20
femoral vein= 40
right median basilic= 40
left median basilic= 50

174
Q

what are parts of cvp waveform

A

a= atrial contraction
c= tricuspid closure
v= filling of r atrium

175
Q

how does a cerebral oximeter work

A

skull is translucent to infrared light
travels in arch like (parabolic pattern)
reflects venous return (doesn’t need pulse aka artery)

176
Q

what is key in cerebral oximeter

A

look for a change in 20% below baseline
-big drop could mean stroke

177
Q

how can you increase cerebral oxygenation

A

-decrease minute ventilation to cause more co2 to cause vasodilation to increase blood flow

Anesthesia Techniques (11 decks)

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