Monitoring Detailed Flashcards
How can oxygenation be monitored in anesthesia practice?
Through clinical observation, pulse oximetry, and ABGs as indicated.
What are the methods used for monitoring ventilation in anesthesia practice?
Auscultation, chest excursion assessment, ETCO2 measurement, pressure monitors as indicated, and RR monitoring every 5 minutes.
What are the cardiovascular monitoring standards during anesthesia?
Include electrocardiogram, BP and HR checks every 5 minutes, and auscultation as needed.
How is thermoregulation monitored during anesthesia?
By monitoring for clinically significant changes in body temperature.
When should neuromuscular monitoring be emphasized during anesthesia practice?
Especially when neuromuscular blocking agents are administered.
What factors determine additional monitoring standards in anesthesia practice?
Patient needs, surgical techniques, or specific procedures.
Why is it important to chart any omission of monitoring with a reason?
To ensure transparency, accountability, and a complete record of care provided.
What is pulse oximetry used for in anesthesia practice?
To monitor oxygen saturation levels in the blood.
What is the Absorbance of Light principle in monitoring standards?
It involves light transmission through matter and measurement of light absorption at specific wavelengths.
What are the operating principles of monitoring adult blood in anesthesia practice?
Involves co-oximetry with 4 wavelengths, measuring different hemoglobin types like Oxyhemoglobin, Reduced Hb, Methemoglobin, Carboxyhemoglobin.
How does 660 nm light behave in pulse oximetry?
It is absorbed more by deoxyhemoglobin than oxyhemoglobin.
What is the role of 940 nm light in pulse oximetry?
It is absorbed more by oxyhemoglobin than deoxyhemoglobin.
How does the pulsatility of arterial blood flow help estimate SaO2 in pulse oximetry?
The pulsatile expansion of the artery increases the length of the light path, enhancing absorbency.
Why is the ratio of AC and DC light absorption important in pulse oximetry?
It allows for the differentiation of the pulsatile component (arterial blood) from the non-pulsatile component.
How does carboxyhemoglobin affect SpO2 readings in pulse oximetry?
Carboxyhemoglobin absorbs light like oxyhemoglobin, leading to falsely elevated SpO2 readings.
What impact does a 1% increase in COHb have on SpO2 readings?
Each 1% increase in carboxyhemoglobin leads to a 1% increase in SpO2 readings.
What are the causes of signal artifact in pulse oximetry?
Signal artifact in pulse oximetry can be caused by ambient light interference, low perfusion, and venous blood pulsations.
How can signal artifacts be resolved in pulse oximetry?
Signal artifacts can be resolved by using alternating red/infrared light, detecting venous O2Hb saturation, and incorporating additional light absorbers.
What is the advantage of pulse oximetry in terms of accuracy?
Pulse oximetry is accurate within +/- 2% when compared to arterial blood gases (saturation > 70%).
What are some advantages of pulse oximetry in terms of monitoring?
Pulse oximetry offers noninvasive and continuous monitoring, indicating decreased cardiac output and being convenient with various probe options.
What are the disadvantages of pulse oximetry related to poor perfusion?
Pulse oximetry poorly functions with poor perfusion, leading to inaccuracies in oxygen saturation readings.
How does pulse oximetry perform with dysrhythmias?
Pulse oximetry shows erratic performance in the presence of dysrhythmias, affecting the accuracy of oxygen saturation readings.
What can cause inaccuracy in pulse oximetry readings related to hemoglobin?
Pulse oximetry may show inaccuracy with different types of hemoglobin, affecting the precision of oxygen saturation measurements.
What is a potential issue for pulse oximetry with dyes?
The presence of dyes can interfere with pulse oximetry readings, leading to inaccuracies in the measurement of oxygen saturation.
Why can nail polish and coverings pose a problem for pulse oximetry?
Nail polish and coverings can cause issues with pulse oximetry readings by obstructing accurate measurement of oxygen saturation.
What is a common challenge in pulse oximetry related to motion?
Motion artifact poses a challenge in pulse oximetry, potentially causing inaccuracies in oxygen saturation readings.
Why should the device not be placed on the index finger during pulse oximetry?
It is advised to avoid placing the pulse oximetry device on the index finger to avoid corneal abrasion from patient rubbing eyes upon emergence.
Where might one get more reliable pulse oximetry readings with epidural blocks?
Toes may provide more reliable pulse oximetry readings, especially in the context of epidural blocks.
What areas are less affected by vasoconstriction and reflect desaturation quicker in pulse oximetry?
The tongue, cheek, and forehead are less affected by vasoconstriction and can reflect desaturation quicker in pulse oximetry.
What information can be found in the reference materials for blood pressure monitoring?
Reference materials like Ehrenwerth and Miller provide detailed information on blood pressure monitoring techniques.
What causes the production of Korotkoff sounds during blood pressure measurement?
Korotkoff sounds are produced by turbulent flow beyond the partially occluded cuff during blood pressure measurement.
How is mean arterial pressure calculated using Korotkoff sounds?
Mean arterial pressure is calculated by adding DBP with one-third of the difference between the systolic pressure and diastolic pressure.
MAP= DBP + 1/3 (SBP - DBP)
What can affect the accuracy of blood pressure auscultation?
Conditions like shock, vasoconstriction, vessel compliance changes, edema, and atherosclerotic vascular changes can impact the accuracy of blood pressure readings.
What guidelines should be followed for cuff placement in blood pressure monitoring?
Cuff bladder size should be 40% of arm circumference and 80% of upper arm length, centered over an artery for accurate blood pressure measurement.
What challenge does obesity present in blood pressure monitoring?
Obesity can make obtaining accurate blood pressure readings challenging due to cuff size limitations and potential inaccuracies.
What is the maximal amplitude of oscillations referred to as in oscillometry?
It is referred to as MAP.
How are SBP and DBP calculated in oscillometry?
They are calculated using algorithms.
In oscillometry, which blood pressure component shows the least agreement with invasive blood pressure?
SBP shows the least agreement.
What are some factors that can introduce errors in oscillometry readings?
Errors can be introduced by atherosclerosis, edema, obesity, and chronic hypertension.
What happens if the cuff used in oscillometry is too large?
It results in a low blood pressure reading.
What is the specified average difference criteria in oscillometry readings?
The average difference must be less than +/- 5 mm Hg.
When is the forearm considered a preferable site for blood pressure estimation?
The forearm may be preferable in obese individuals.
What are some advantages of automatic non-invasive techniques like oscillometry?
Advantages include eliminating clinician subjectivity, improving quality, and being noninvasive.
In invasive blood pressure monitoring, what are the indications for its use?
Indications include continuous monitoring, pharmacologic manipulation, blood sampling, volume responsiveness, and IABP timing.
What is the most common site for invasive blood pressure monitoring?
The radial artery is the most common site.
What is the procedure for Allen’s Test?
The examiner compresses radial and ulnar arteries, and the patient exsanguinates the palm by making a fist and then releases the ulnar artery.
What is the normal outcome of Allen’s Test?
Normal response: Color of palm should return in seconds.
What is the abnormal outcome of Allen’s Test?
Abnormal response: Severely reduced collateral flow if color change takes more than 10 seconds.
What is the accuracy of Allen’s Test?
Approximately 80% accurate.
How do pulse oximetry and ultrasound affect the accuracy of Allen’s Test?
They do not improve accuracy.
What are the key steps in the Transfixion Technique?
Similar to Allen’s Test preparation, intentionally puncturing front and back walls with a needle to advance a catheter with pulsatile blood flow.
Are there frequent complications associated with the Transfixion Technique?
It is not associated with more frequent complications.
What are the functions of an arterial line?
Provides automatic flush to the nervous system, prevents thrombus formation with an infusion rate of 1 - 3 ml/hr, and requires lack of dextrose and heparin.
How is calibration of an arterial line performed?
Zeroing references pressures against atmospheric air, and leveling ensures accurate readings.
What optimization strategies are recommended for arterial line placement?
Positioning in the aortic root for waveform maximization, using non-distensible tubing, and limiting stopcocks and tubing length.
What are the components of arterial waveforms?
Include systolic upstroke, systolic peak pressure, systolic decline, dicrotic notch, diastolic runoff, and end-diastolic pressure.
What are the characteristics of distal pulse amplification?
Arterial pressures vary at different sites with distinct morphologies, influenced by impedance and harmonic resonance along the vascular tree.
What changes occur in the pressure wave as it moves towards the periphery?
Arterial upstroke becomes steeper, systolic peak increases, dicrotic notch delays, and end-diastolic pressure decreases.
How are arterial waveforms generated?
Through the summation of sine waves, combining fundamental and harmonic waves, utilizing Fourier analysis for waveform analysis.
What are the characteristics of underdamped systems in arterial pressure dynamics?
Underdamped systems exhibit elevated systolic pressure.
What are the characteristics of overdamped systems in arterial pressure dynamics?
Overdamped systems exhibit decreased systolic pressure, absence of dicrotic notch, loss of detail in pressure waveform, and falsely narrowed pulse pressure with MAP accuracy.
How does age affect pressure gradients in clinical settings?
Age-related reduced distensibility impacts pressure gradients.
In what way does atherosclerosis influence pressure gradients in clinical settings?
Atherosclerosis alters peripheral vascular resistance affecting pressure gradients.
What impact do septic shock and hypothermia have on pressure gradients?
Septic shock and hypothermia can influence pressure gradients in clinical settings.
What are some potential complications associated with arterial lines?
Complications include distal ischemia or pseudoaneurysm, hemorrhage, hematoma, arterial embolization, local infection, and peripheral neuropathy.
Why is pressure waveform analysis important in clinical settings?
It helps identify residual preload reserve, understand cyclic arterial blood pressure variations, and assess effects of positive pressure ventilation on lung volume changes.
How does positive pressure ventilation (PPV) affect pressure during the inspiratory phase?
PPV increases intra-thoracic pressure, impacts LV afterload, lung volume, LV preload, stroke volume, CO, systemic arterial pressure, systemic venous return, RV preload, afterload, and PVR.
What effects does positive pressure ventilation (PPV) have on pressure during the expiratory phase?
Expiratory phase effects include decreased RV stroke volume, reduced LV filling, stroke volume, and systemic arterial blood pressure, introducing Systolic Pressure Variation (SPV).
What is the normal range for Systolic Pressure Variation (SPV)?
The normal SPV range is 7 - 10 mm Hg, with the ‘Up’ component ranging from 2 - 4 mm Hg and the ‘Down’ component ranging from 5 - 6 mm Hg.
What does an increased Systolic Pressure Variation (SPV) indicate in mechanically ventilated patients?
An increased SPV suggests volume responsiveness or residual preload reserve, and it can be an early indicator of hypovolemia.
How do critically ill patients often exhibit Systolic Pressure Variation (SPV)?
Critically ill patients may show a dramatic increase in SPV, especially in the Down component.
What does Pulse Pressure Variation (PPV) measure?
PPV uses the maximum and minimum pulse pressures across the respiratory cycle, with a normal range below 13 - 17%.
What does a Pulse Pressure Variation (PPV) value of >13 - 17% indicate?
PPV >13 - 17% suggests a positive response to volume expansion in mechanically ventilated patients.
How is Stroke Volume Variation (SVV) calculated?
SVV is calculated as (SV max - SV min) / SV mean, with a normal range of 10 - 13% in determining volume responsiveness.
What factors does Stroke Volume Variation (SVV) correlate with in mechanically ventilated patients?
SVV correlates with resistance and compliance based on age, gender, and hemodynamic status.
What conditions are necessary for predicting accurate results with hemodynamic parameters in mechanically ventilated patients?
Accurate predictions require mechanical ventilation with 8 to 10 mL/kg tidal volume, 5 mm Hg PEEP, regular cardiac rhythm, normal intra-abdominal pressure, and a closed chest.
What is the purpose of gas mixture analysis in gas sampling systems?
Gas must be transported to the analyzer for analysis.
How does a side-stream or diverting analyzer function in gas sampling systems?
The analyzer is brought to the gas in the airway.
Provide an example of a mainstream or non-diverting analyzer in gas sampling systems.
One example is the fuel cell oxygen analyzer.
What does ‘total response time’ refer to in gas sampling systems?
It refers to the transit time, which is the time lag for the gas sample to reach the analyzer.
Define ‘rise time’ in the context of gas sampling systems.
It is the time taken by the analyzer to react to the change in gas concentration.
What factors influence side-stream responses in gas sampling systems?
Side-stream responses are dependent on sampling tubing inner diameter, length, and gas sampling rate.
What challenges are associated with mainstream gas sampling systems?
Challenges include dealing with water vapor, secretions, blood, and more interfaces for disconnections.
What are some challenges faced in side-stream gas sampling systems?
Challenges involve kinking of sampling tubing, water vapor, failure of sampling pump, leaks in the line, and slow response time.
Explain Dalton’s Law and its relevance in gas mixtures.
Dalton’s Law states that the total pressure of a gas mixture equals the sum of the partial pressures exerted by each gas in the mixture.
What units of measurement are used for anesthetic gases at sea level?
At sea level, anesthetic gases are measured in total pressure (760 mm Hg), partial pressure (mm Hg), and volumes %.
How is the oxygen content in room air expressed in units of measurement?
Oxygen in room air has a partial pressure of 160 mm Hg, equivalent to 21 volumes %.
How is concentration determined in Mass Spectrometry?
Concentration in Mass Spectrometry is determined based on mass/charge ratio.
What does Abundance Analysis in Mass Spectrometry determine?
Abundance Analysis in Mass Spectrometry determines the fractional composition of gas mixtures at specific mass/charge ratios.
How many different gases can Mass Spectrometry calculate concentrations for?
Mass Spectrometry is capable of calculating concentrations of up to eight different gases.
What is the principle behind Raman Spectroscopy?
Raman Spectroscopy involves a high powered argon laser generating photons that interact with gas molecules in a sample.
How are scattered photons used in Raman Spectroscopy?
Scattered photons in Raman Spectroscopy are analyzed in a spectrum to identify each gas and its concentration.
