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SRNA4TopicsAnesthesia > MONITORING: Cardiac Sidenotes > Flashcards

MONITORING: Cardiac Sidenotes Flashcards

1
Q

In which lung is pulmonary capillary flow continuous and proportional to the arterial venous pressure gradient, and where the pulmonary catheter tip should be ?

A

Zone III

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2
Q

Zone I what pressure dominates

A

PA>Pa>Pv (ALVEOLAR PRESSURE

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3
Q

Zone I is considered

A

pure alveolar dead space

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4
Q

Zone II what pressure dominates

A

Pa> PA> Pv

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5
Q

Zone III what pressure dominates

A

Pa>Pv> PA

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6
Q

Zone III and alveolar perfusion

A

Alveoli well perfused

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7
Q

To obtain accurate PCWP, the reading should be taken

A

At the end of expiration because the pressure within thest chest should be zero.

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8
Q

What is the most common complication of attempted IJ cannulation?

A

Carotid Artery puncture

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9
Q

Left IJ cannulation carries increased risk for

A

pneumothorax and potential damage to the thoracic duct.

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10
Q

When does the “a”waveform represent on CVP tracing?

A

Contraction of RA

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11
Q

Corresponds to contraction of RA

A

A wave

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12
Q

Bulging tricuspid valve into RA during onset of ventricular contraction, after the QRS

A

C wave

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13
Q

Atrial relaxation

A

x descent

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14
Q

Right atrium filling with closed tricupid valve

A

V wave

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15
Q

Opening of tricuspid valve, blood to RV

A

Y descend.

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16
Q

No a wave associated with

A

Afib

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17
Q

Large a wave associated with

A

Tricuspid stenosis
Pulmonary stenosis
Pulmonary HTN

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18
Q

Giant a or CANNON a

A

Right atrium contracts against closed Tricuspid valve,

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19
Q

No X descend

A

TR

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20
Q

LARGE v or cannon v wave

A

Tricuspid regurgitation

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21
Q

What are potential locations for insertion of an arterial line?

A 
Radial
ulnar
brachial
femoral 
axillary 
Dorsalis pedis
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22
Q

Exception of arterial line insertion

A

Subclavian

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23
Q

Which of the following are complications associated with arterial line?

A 
Vasospasm
Embolus
Infection 
Thrombosis
Hematoma
AV fistula
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24
Q

What are the contour and the area under the arterial waveform representative of?

A

Estimates of body fluid volume

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25
Q

When does the dicrotic notch of the arterial waveform occur?

A

When the AORTIC VALVE SHUTS (closure)

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26
Q

WHat does the dicrotic notch mark?

A

closure of the aortic valve that mark end of the systole and start of diastole

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27
Q

As the arterial waveform moves PERIPHERALLY, the waves become

A

TALLER>

28
Q

Which of the following is the first upstroke in the arterial waveform an index of?

A

Inotropic state of LV

29
Q

The transducer will be raised to the ear to approximate

A

The BP at the brain level (circle of willis) to recognize the pressure being measures is at the level of the trasnducer at the ear not at the level of the aortic root.

30
Q

The ear is about

A

30cm higher than the brachial cuff

31
Q

Ear is about 30cm higher than brachial cuff therefore if the patients Mean BP is 74mmHg the mean BP of the circle of willis would be

A

51.5 mmHg

MAP - (30cm x 0.75mmHg) =

32
Q

Substract ________ for each cm of high difference from the known Mean BP

A

0.75mmHg

33
Q

For a patient in a sitting position, you must maintain a mean blood pressure of

A

> 70 mmHg at the brain level.

34
Q

During a mediastinocopy, compression of the innominate artery can be detected by which of the following method.

A

Monitoring R radial artery waverform or pulse.

35
Q

During a mediastinoscopy, what can be easily pressed by the score and block blood flow to both the right arm and the right carotid?

A

Innominate artery (aka Brachiocephalic trunk)

36
Q

The brachiocephalic artery comes off the ________ then divides into

A

Aorta; subclavian artery and the Right common carotid artery.

37
Q

Which of the following are potential risks associated with use of TEE>

A

Esophageal perforation
Bleeding
Pharyngeal abrasions
Hoarseness.

38
Q

Does not typically occur due to TEE use

A

Dysrhythmias

39
Q

A precordial doppler can detect air bubbles as small as

A

0.25ml

40
Q

2 most sensitive monitors for detecting a VAE

A

TEE

precordial doppler US

41
Q

Which of the following is the most sensitive invasive monitor for detecting a VAE?

A

TEE

42
Q

The most sensitive NONINVASIVE for detection of VAE

A

Precordial DOPPLER

43
Q

Most to least sensitive in identifying VAE

A

TEE > precordial doppler > increased PAP > Decreased EtCo2 > mass spectometry (presense of ETN2)

44
Q

What is your patient’s CO if her HR is 70bpm her LVEDP is 18 and her stroke VOLUME is 65ml?

A

4.6L

45
Q

During EKG monitoring, Lead II typically detects ischemia in which region of the heart?

A

Inferior wall

46
Q

Detects ischemia to anteroseptal myocardial tissues from the LAD coronary artery?

A

V1 - V4.

47
Q

Monitor Inferior heart

A

II, III, avF

48
Q

The lateral EKG leads are

A

I, avL, V5, V6

49
Q

The lateral EKG leads monitor which artery

A

left Circumflex artery.

50
Q

Which of the following is a normal mixed venous blood oxygen saturation (SvO2) ?

A

75%

51
Q

Normal tissue oxygen extraction is

A

25%

52
Q

Pulse ox is based on which law

A

Beer-Lambert law

53
Q

State the Beer-lambert Law

A

States that the concentration of an unknown solute in a solvent can be determined by light absorption.

54
Q

Factors that can reliably affect pulse ox

A

Low perfusion states
Dyshemoglobinemias
Methylene blue
external light sources

55
Q

Does anemia affect pulse oximetry?

A

NO because high oxygen levels can be in the hemoglobin that is present.

56
Q

Pulse oximetry utilizes 2 wavelengths of light, the red light at _______and the infrared light

A

660; 940 nm

57
Q

Analyzed by pulse ox is the

A

Ratio of absorbed light for each wavelength is analyzed to provide the oxygen saturation of arterial blood.

58
Q

Red light = _____Wavelengths

A

940nm

59
Q

Red light :

A

Deoxyhemoglobin absorbs more red light, but not much infrared light

60
Q

Infrared ________wavelengths

A

660nm

61
Q

Infrared light: IO

A

Oxyhemoglobin absorted more INFRAred light and deflects red light.

62
Q

Placing an IV in a larger vein is preferred. this is assocaited with which law?

A

Poiseuille’s

63
Q

What does POISEUILLE’s LAW STATES?

A

Doubling the radius results in 16-fold in change in flow

64
Q

Poiseuilles equation

A

8nl/ PI, r^4,change in P

65
Q

Cuff size should be ____% of the circumference of the extremity

A

40%

66
Q

A cuff that is too small will give a

A

Falsely high reading

67
Q

A cuff that is too large will give a

A

Falsely low reading.

SRNA4TopicsAnesthesia (47 decks)

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