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Quarter 3 > Monitoring Final > Flashcards

Monitoring Final Flashcards

1
Q

2 Basic Modes of US for vascular access

A

Doppler and B-mode

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2
Q

Doppler US

A

audible sound

  • arteries and veins sound different
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3
Q

B-Mode US

A

2D mode

Generates a 2D picture in a gray scale that is applied based on the amplitude of the signal

  • B stands for brightness
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4
Q

B-Mode US appearance

A

fluid filled = black or dark grey

soft tissue (muscle) = gray

Solid structures

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5
Q

Technical Tricks for IV access

A

T-berg and valsalva manuever

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6
Q

Controls to know on US machine

A
  • gain adjust
  • depth
  • freeze
  • contrast/brightness
  • print
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7
Q

4 manuevers for a good US image

A
  • pressure
  • alignment
  • rotation
  • tilting
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8
Q

Color Doppler

A

represent the direction of low relative to transducer

  • Red: flow towards transducer
  • Red does not always mean artery
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9
Q

When is a provider considered competent in CVC placement

A

after 50 times

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10
Q

US guidance for regional usually uses what probes?

A

linear probes and dynamic (B-mode) setting

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11
Q

Different frequencies for regional anesthesia

A

Higher frequency for superficial (upper extremity) blocks

Lower frequency needed for deeper blocks (infraclavicular, femoral)

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12
Q

CFNB

A

continuous femoral nerve block

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13
Q

US vs. nerve stimulator

A

US has decreased time to placement and no conversion to general anesthesia

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14
Q

What does an implantable pacemaker treat?

A

bradycardia and conduction abnormalities

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15
Q

What does AICD treat?

A

SVT and fibrillation

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16
Q

What battery is commonly used in a pacemaker?

A

lithium-iodide

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17
Q

How long does a pacemaker/AICD usually last?

A

5-8 years

  • output voltage decreases gradually
  • sudden battery failure unlikely
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18
Q

Pacemaker lead system

A
  • endocardial leads placed via central access

- fix on the endocardium

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19
Q

Endocardial Leads

A

active fixation: metal scews

passive fixation: rubber fins or tines

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20
Q

Epicardial Leads

A

screw-in or sew-on

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21
Q

Polarity of pacing leads

A

unipolar - highest reliability
bipolar - improved rejection for better sensing
multipolar - special purpose leads

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22
Q

Types of lead tip of pacing leads

A
  • steroid eluting
  • non-steroid eluting
  • carbon
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23
Q

Synchronous Pacemaker (basics)

A
  • Demand mode
  • Sensing circuit searches for intrinsic depolarization potential
  • If absent, a pacing response is generated
  • Can mimic intrinsic electrical activity pattern of the heart
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24
Q

Anti-tachycardic functions are only used in which type of pacer?

A

AICDs

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25
Q

1 in pacemaker classification

A

What does it pace?

V – Ventricle
A – Atrial
D – Both
0 – None

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26
Q

2 in pacemaker classification

A

What does it sense?

V– Ventricle
A – Atrial
D – Both
0 – None

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27
Q

3 in pacemaker classification

A

How does it respond?

I – Inhibited
T – Triggered
D – Inhibited & Triggered
0 – None

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28
Q

Inherent rate of SA node

A

60-100 bpm

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29
Q

inherent rate of AV node

A

40-60 bpm

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30
Q

Inherent rate of His and Purkinje

A

20-40 bpm

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31
Q

(6) Absolute indications for a Pacemaker

A
  • sick sinus syndrome
  • symptomatic sinus bradycardia
  • tachy-brady syndrome
  • a-fib with slow ventricular response
  • 3rd degree heart block
  • chronotropic incompetence
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32
Q

Chronotropic incompetence

A

inability to increase heart rate to match exercise

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33
Q

Programability Function “R”

A

rate responsive

device is capable of a rate responsive function

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34
Q

Programability Function “C”

A

Communicating

capable of transmitting or receiving data

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35
Q

Programability Function “M”

A

multi-programmable

device can be programmed in more than 3 parameters
rate, sensing, output, refractory periods, mode hysteresis

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36
Q

Programability Function “P”

A

simple programmable

limited to 3 or fewer programmable parameters

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37
Q

Programability Function “O”

A

None

not programmable

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38
Q

Most bradycardia devices are ____

A

O

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39
Q

Most AICDs are ____

A

D

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40
Q

AOO

A

fixed atrial pacing

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41
Q

VOO

A

fixed ventricular pacing

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42
Q

DOO

A

fixed AV sequential pacing

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43
Q

Asynchronous Modes

A

during application of a magnet

  • does not mean you are turning off pacemaker
  • AOO, VOO, DOO
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44
Q

VVI

A

single chamber pacing

  • if native activity is sensed, pacemaker will not fire (inhibit)
  • Also has a clock to prevent firing during refractory period
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45
Q

DDD

A

paces atria and ventricle

  • senses atria and ventricle
  • atrial triggered and ventricular inhibited
  • EKG shows 2 spikes
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46
Q

what does AICD stand for?

A

Automatic Implantable Cardio-Defibrillator

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47
Q

What can and AICD do?

A
  • antitachycardia pacing
  • cardioversion
  • defibrillation
  • bradycardia pacing
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48
Q

Joules applied to biphasic vs. monophasic

A

biphasic - 150J

monophasic - 300J

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49
Q

Anti-Tachycardia Pacing (ATP)

A

overdrive pacing in an attempt to terminate ventricular tachycardias

  • fires during refractory period
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50
Q

Magnets and pacemakers

A

closes an internal reed switch

  • causes sensing to be inhibited
  • asynchronous mode
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51
Q

Anesthesia for Patient with Pacemaker

A
  • know what type and what the magnet does
  • set to fixed rate pacing unless bipolar
  • continuous ECG and peripheral pulse
  • pulse ox with plethysmography to see mechanical heart output
  • defibrillator and crash cart available
  • external pacer available
  • external converter magnet available
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52
Q

Essential information to ask CIED team

A
  • indication for device placement
  • current programming
  • is the patient pacemaker-dependent?
  • device response to magnet
  • perioperative recommendation/prescription
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53
Q

How do you know if a magnet is working on a pacer?

A

if it goes to 60bpm and stays there

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54
Q

Bipolar vs Electrocautery and pacemakers

A

Bipolar - OK

Electrocautery may interfere with pacer

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55
Q

Cardiac arrest with AICD

A

start CPR and defibrillate immediately

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56
Q

IABP

A

Intra-Aortic Balloon Counterpulsation

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57
Q

Intra-Aortic Balloon Counterpulsation

A

used to reduce left ventricular systolic work, LVED pressure, and wall tension

58
Q

Benefits of IABP

A
  • decreases O2 consumption
  • increases CO, perfusion
  • increases pressure to coronary arteries
59
Q

Where is an IABP placed through and position?

A

placed through femoral artery into the descending aorta

tip should be 1-2cm below the origin of the left subclavian artery and above the renal arteries

60
Q

Balloon volume in IABP

A

30 - 50 mL

61
Q

Drive gas in IABP

A

helium or carbon dioxide

62
Q

Hemodynamic affects of IABP

A 
- increase coronary perfusion
     \+ increase diastolic BP
     \+ decrease atrial pressure
- decrease afterload on left ventricle
     \+ decrease aortic systolic pressure
- decreases LVEDV and LVEDP
63
Q

IABP balloon inflation

A

triggered to inflate immediately after aortic valve closure

  • augments diastolic coronary perfusion pressure
64
Q

IABP balloon deflation

A

triggered to deflate with opening of the aortic valve

  • reduce left ventricular work
  • creates a “potential space” in the aorta
    + reduces aortic volume and pressure
65
Q

Indications for IABP

A
  • cardiac failure after surgery
  • refractory angina
  • cardiogenic shock
  • mitral regurgitation
  • perioperative treatment of complications due to MI
  • failed PTCA
  • bridge to cardiac transplantation
66
Q

Contraindications for IABP

A
  • severe aortic insufficiency
  • aortic aneurysm
  • aortic dissection
  • limb ischemia
  • thromboembolism
67
Q

CPB

A

cardio pulmonary bypass

68
Q

(3) Functions of CPB

A
  • oxygenation of venous blood
  • elimination of CO2
  • maintenance of system perfusion
69
Q

main components of CPB

A
  • blood reservoir
  • oxygenators and gas exchangers
  • pumps
  • heat exchangers
  • filters
  • cardioplegia system
70
Q

3 processes in urine formation

A
  • glomerular filtration
  • tubular reabsorption
  • tubular secretion
71
Q

Normal urine output

A

> 1 mL/kg/hr

  • daily output of 400-500 is required to excrete nitrogenous wastes
72
Q

most likely cause of oliguria

A

decreased renal perfusion

  • hypotension
  • hypovolemia
  • decreased CO
73
Q

red urine

A

hemoglobinuria, myoglobinuria, hematuria, beets, rifampin

74
Q

orange urine

A

bilirubin or pyridium

75
Q

brown urine

A

bilirubin or methemoglobin

76
Q

black urine

A

melanin, hemoglobinuria, and homogentistic acid

77
Q

Blue urine

A

amitriptyline and methylene blue

78
Q

white urine

A

chyluria

79
Q

magnetic strength of MRI

A

1.5 to 4 Tesla

60,000x Earth’s field

80
Q

How are MRI magnets cooled

A

liquid helium and nitrogen

81
Q

ferromagnetic

A

materials that form permanent magnets or are attracted to magnets

82
Q

Paramagnetic

A

only attracted when in the presence of an externally applied magnetic field

83
Q

diamagnetic

A

materials repelled by magnetic fields

84
Q

Gauss Line

A

5 gauss

  • ‘safe’ level of magnetic exposure
85
Q

Magnetic Force in MRI

A

Attractive Force = M * (1/D)^2

M = mass
D = distance
86
Q

Quench

A

(emergency stop)

destruction of superconducting state and a change to increased magnet resistance

87
Q

Where is the superimposed potential greatest in ECG?

A

ST-segment and the T waves of leads I, II, V1, and V2

88
Q

which vectors maximize QRS and minimize artifact in an ECG

A

V5 and V6

89
Q

temperature monitoring in MRI

A

liquid crystal strips

90
Q

Medication patches that need to be removed for MRI

A
  • Androderm
  • transderm-Nitro and Deponit
  • Habitrol, Nicoderm, and Nicotrol
  • Scopolamine
  • Catapres-tts (clonidine)
91
Q

Blood in 4x4

A

10 mL

92
Q

blood in ray-techs

A

10-20mL

93
Q

blood in lap sponges

A

100 mL

94
Q

Primary physiologic response to blood loss

A
  • Increased HR
  • Hyperventilation
  • Vasoconstriction
  • Increased RV filling
95
Q

Secondary physiologic response to blood loss

A

BP increase by hormones and catecholamines

96
Q

Tertiary physiologic response to blood loss

A

redistribution of water from extravascular to intravascular space

97
Q

Intrinsic coagulation factors

A

8, 9, 11, 12

98
Q

What measures intrinsic coagulation

A

aPTT and ACT

  • Heparin
99
Q

What measures extrinsic coagulation

A

PT and INR

  • coumadin
100
Q

Common coagulation can be measured by ____

A

PT and INR

101
Q

Extrinsic coagulation factors

A

3 and 7

102
Q

Which coagulation pathway releases tissue factors

A

Extrinsic

103
Q

Normal platelet value

A

150k - 400k /mm^3

104
Q

Thrombocytopenia

A
105
Q

Thrombocytosis

A

> 400,000 platelets

106
Q

Petechiae

A

small red or purple spots caused by bleeding into the skin

  • Thrombocytopenia
107
Q

DIC

A

Disseminated Intravascular Coagulation

  • accelerated platelet consumption
  • caused by sepsis, trauma, burn…
  • high levels of FSP
108
Q

ACT

A

Activated Clotting Time

  • measures the amount of time required for whole blood to clot in a test tube
  • monitors Heparin
109
Q

Normal ACT

A

70-180 sec

CPB > 400 seconds

110
Q

2 Types of ACT

A
  • Hemochron
    + uses a magnet
  • HemoTec
    + photodetector
111
Q

PTT

A

Partial Thromboplastin Time

  • measures the clotting time via factor 7, 9, 11, and 12
  • intrinsic (Heparin)
112
Q

Prolonged PTT

A
  • cirrhosis
  • DIC
  • hemophilia
  • malabsorption
  • von Willebrand’s disease
    lupus
113
Q

Prothrombin Time (PT)

A

measures 7 (extrinsic) and common

  • normal 10-14 seconds
114
Q

Increased PT times

A
  • bile duct obstruction
  • cirrhosis or hepatitis
  • vitamin K deficiency
  • Coumadin therapy
115
Q

INR

A

International Normalized Ratio

  • mathematical calculation that corrects for PT variability due to sensitivities (ISI) of the thromboplastin agents
116
Q

ISI

A

International Sensitivity Index

117
Q

Normal INR

A
  1. 0

- 2-3 is recommended for prophylaxis

118
Q

TEG

A

Thromboelastogram

  • measure of the time it takes for a blood clot to form, consolidate, and lyse
  • R, k, alpha angle, MA, and MA60
119
Q

TEG variables

A 
R - period of time
k - dynamics of clot formation 
alpha angle - acceleration of fibrin build up and cross-linking
MA - maximum amplitude
MA60 - stability of the clot
120
Q

Low MA on TEG

A

platelets indicated

  • MA is a function of platelet count, function, and fibrinogen level
121
Q

High MA60 on TEG

A

antifibrinolytics indicated

122
Q

Prolonged R on TEG

A

FFP indicated

123
Q

Absolute Blood Loss (ABL)

A

ABL = EBV * [(HCTi - HCTf)/(HCTi)]

124
Q

Estimated blood volumes

A

Adult male - 70 mL/kg
thin female - 65
Muscular - 75
Obese - 60

125
Q

Estimate blood volumes in pediatrics

A

Premie 90-100 ml/kg

Term 80-90

126
Q

Type and Screen

A

Recipient’s blood has been typed for A, B, and Rh antigens and screened for common antibodies

127
Q

Type and Cross

A

Recipient’s blood is incubated with the donor blood product

128
Q

Type A blood

A

Contains an A antigen

Anti-B antibodies present

129
Q

Type O blood

A

No antigens present

Both A and B antibodies

130
Q

PRBC

A

Packed Red Blood Cells

  • 1 unit contains 250-300mL with 70-80% hematocrit
  • Hemoglobin increases 1 g/dL
  • Hct will increase by 3%
131
Q

Platelets

A
  • mostly used in CPB
  • 6 units will increase platelet 25,000
  • DO NOT warm
  • use filter
132
Q

Fresh Frozen Plasma

A

Fluid portion obtained form a single unit of whole blood

  • indicated when PT, PTT, or both are at least 1.5 times longer than normal
133
Q

Cryoprecipitate

A

Fraction of plasma that precipitates when FFP is thawed

  • 200mg fibrinogen and 100 units of Factor VIII
  • used in hemophilia A or hypofibrinogenemia
134
Q

Incidence of Hepatitis B in blood transfusion

A

1 in 205,000

135
Q

Incidence of Hepatitis C in blood transfusion

A

1 in 1.9 million

136
Q

Incidence of HIV in blood transfusion

A

1 in 2.1 million

137
Q

POC

A

Point of Care

138
Q

Are creatinine and hematocrit POC tests?

A

No

139
Q

POC hemoglobin

A

photometer uses 570 and 880 wavelength

  • erythrocytes are trasformed into methemoglobin and then into azidemethemoglobin
  • range 0-25.6 g/dL
140
Q

Hemocue

A

Detects anemia

- 75% sensitivity, 100% specificity
missed event likely to occur when anemic

141
Q

Main POCTs

A
  • blood gas analysis
  • glucose
  • hemoglobin
  • ACT

Quarter 3 (12 decks)

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