Monitoring ECG

Question 1

Why monitor?

Answer 1

provide better patient care via early diagnosis and treatment
prevent mortality and morbidity
protect the anesthetist (record keeping)

Question 2

How often should you monitor intra-operatively?

Answer 2

every 5 mins

Question 3

4 key things to monitor

Answer 3

circulation
oxygenation
ventilation
temperature

Question 4

T/F: only monitor blood pressure in high risk patients

Answer 4

False, monitor BP in all patients

Question 5

2 ways to monitor circulation

Answer 5

ECG and blood pressure

Question 6

3 things to consider when assessing a pulse

Answer 6

rate, rhythm, quality

Question 7

T/F: use arteries proximal to the heart to measure a pulse

Answer 7

false, use a distal artery (if it feels strong, likely indicates good CO)

Question 8

3 arteries for pulse palpation in large animals

Answer 8

auricular
transverse facial
facial

Question 9

T/f: an ECG detects a heart’s contractility

Answer 9

false - records heart’s electrical activity from the surface of the body but doesn’t indicate the heart is actually contracting

Question 10

Describe type A cardiac innervation

Answer 10

purkinje fibres excite endocardium and excitation spreads via muscle fibers
current flow is base to apex
ECG: positive R wave
small animals, humans

Question 11

Describe type B cardiac innervation

Answer 11

purkinje fibers deeply penetrate myocardium and most muscle fibres are excited simultaneously, most vectors cancel each other
current flow is apex to base
ECG: negative S wave
horses, ruminants, pigs

Question 12

which lead is preferred in healthy small animals?

Answer 12

lead 2 - yields tallest R wave

Question 13

which lead is preferred for animals with type B innervation?

Answer 13

lead 1

Question 14

T/F: it is safe to replace ECG gel with alcohol

Answer 14

false, may burn in flames if you need to defibrillate patients

Question 15

4 steps for systematic examination of ECG

Answer 15

1. determine HR (ventricular rate)
2. evaluate rhythm
3. assess complexes and intervals
4. determine mean electrical axis

Question 16

Best way to determine HR?

Answer 16

auscultate

Question 17

2 common arrhythmias seen under anesthesia

Answer 17

sinus bradycardia and tachycardia
AV blocks (1st and 2nd degree)

Question 18

First line of treatment for ventricular arrhythmias?

Answer 18

Lidocaine IV

Question 19

T/F: when HR is high, BP sky rockets

Answer 19

false, it plummets because there is not enough time for ventricular filling

Question 20

T/F: always treat a ventricular arrhythmia during anesthesia

Answer 20

False, essentially only treat if it is affecting hemodynamics