MONITORING: Cardiac Sidenotes Flashcards
In which lung is pulmonary capillary flow continuous and proportional to the arterial venous pressure gradient, and where the pulmonary catheter tip should be ?
Zone III
Zone I what pressure dominates
PA>Pa>Pv (ALVEOLAR PRESSURE
Zone I is considered
pure alveolar dead space
Zone II what pressure dominates
Pa> PA> Pv
Zone III what pressure dominates
Pa>Pv> PA
Zone III and alveolar perfusion
Alveoli well perfused
To obtain accurate PCWP, the reading should be taken
At the end of expiration because the pressure within thest chest should be zero.
What is the most common complication of attempted IJ cannulation?
Carotid Artery puncture
Left IJ cannulation carries increased risk for
pneumothorax and potential damage to the thoracic duct.
When does the “a”waveform represent on CVP tracing?
Contraction of RA
Corresponds to contraction of RA
A wave
Bulging tricuspid valve into RA during onset of ventricular contraction, after the QRS
C wave
Atrial relaxation
x descent
Right atrium filling with closed tricupid valve
V wave
Opening of tricuspid valve, blood to RV
Y descend.
No a wave associated with
Afib
Large a wave associated with
Tricuspid stenosis
Pulmonary stenosis
Pulmonary HTN
Giant a or CANNON a
Right atrium contracts against closed Tricuspid valve,
No X descend
TR
LARGE v or cannon v wave
Tricuspid regurgitation
What are potential locations for insertion of an arterial line?
Radial ulnar brachial femoral axillary Dorsalis pedis
Exception of arterial line insertion
Subclavian
Which of the following are complications associated with arterial line?
Vasospasm Embolus Infection Thrombosis Hematoma AV fistula
What are the contour and the area under the arterial waveform representative of?
Estimates of body fluid volume
When does the dicrotic notch of the arterial waveform occur?
When the AORTIC VALVE SHUTS (closure)
WHat does the dicrotic notch mark?
closure of the aortic valve that mark end of the systole and start of diastole
As the arterial waveform moves PERIPHERALLY, the waves become
TALLER>
Which of the following is the first upstroke in the arterial waveform an index of?
Inotropic state of LV
The transducer will be raised to the ear to approximate
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.
The ear is about
30cm higher than the brachial cuff
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
51.5 mmHg
MAP - (30cm x 0.75mmHg) =
Substract ________ for each cm of high difference from the known Mean BP
0.75mmHg
For a patient in a sitting position, you must maintain a mean blood pressure of
> 70 mmHg at the brain level.
During a mediastinocopy, compression of the innominate artery can be detected by which of the following method.
Monitoring R radial artery waverform or pulse.
During a mediastinoscopy, what can be easily pressed by the score and block blood flow to both the right arm and the right carotid?
Innominate artery (aka Brachiocephalic trunk)
The brachiocephalic artery comes off the ________ then divides into
Aorta; subclavian artery and the Right common carotid artery.
Which of the following are potential risks associated with use of TEE>
Esophageal perforation
Bleeding
Pharyngeal abrasions
Hoarseness.
Does not typically occur due to TEE use
Dysrhythmias
A precordial doppler can detect air bubbles as small as
0.25ml
2 most sensitive monitors for detecting a VAE
TEE
precordial doppler US
Which of the following is the most sensitive invasive monitor for detecting a VAE?
TEE
The most sensitive NONINVASIVE for detection of VAE
Precordial DOPPLER
Most to least sensitive in identifying VAE
TEE > precordial doppler > increased PAP > Decreased EtCo2 > mass spectometry (presense of ETN2)
What is your patient’s CO if her HR is 70bpm her LVEDP is 18 and her stroke VOLUME is 65ml?
4.6L
During EKG monitoring, Lead II typically detects ischemia in which region of the heart?
Inferior wall
Detects ischemia to anteroseptal myocardial tissues from the LAD coronary artery?
V1 - V4.
Monitor Inferior heart
II, III, avF
The lateral EKG leads are
I, avL, V5, V6
The lateral EKG leads monitor which artery
left Circumflex artery.
Which of the following is a normal mixed venous blood oxygen saturation (SvO2) ?
75%
Normal tissue oxygen extraction is
25%
Pulse ox is based on which law
Beer-Lambert law
State the Beer-lambert Law
States that the concentration of an unknown solute in a solvent can be determined by light absorption.
Factors that can reliably affect pulse ox
Low perfusion states
Dyshemoglobinemias
Methylene blue
external light sources
Does anemia affect pulse oximetry?
NO because high oxygen levels can be in the hemoglobin that is present.
Pulse oximetry utilizes 2 wavelengths of light, the red light at _______and the infrared light
660; 940 nm
Analyzed by pulse ox is the
Ratio of absorbed light for each wavelength is analyzed to provide the oxygen saturation of arterial blood.
Red light = _____Wavelengths
940nm
Red light :
Deoxyhemoglobin absorbs more red light, but not much infrared light
Infrared ________wavelengths
660nm
Infrared light: IO
Oxyhemoglobin absorted more INFRAred light and deflects red light.
Placing an IV in a larger vein is preferred. this is assocaited with which law?
Poiseuille’s
What does POISEUILLE’s LAW STATES?
Doubling the radius results in 16-fold in change in flow
Poiseuilles equation
8nl/ PI, r^4,change in P
Cuff size should be ____% of the circumference of the extremity
40%
A cuff that is too small will give a
Falsely high reading
A cuff that is too large will give a
Falsely low reading.
