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Cardiac Anesthesia - Constable > Monitoring - Quiz 2 > Flashcards

Monitoring - Quiz 2 Flashcards

1
Q

What causes the most pressure monitoring errors?

A

air within a catheter or transducer

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2
Q

What is the recommended mode of monitoring temp on a cardiac surgical pt? (CSP)

A

One core site (nasal) AND

One shell site (bladder or rectal)

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3
Q

True or False. Although low serum Ca may affect myocardial pumping fx, admin of Ca during potential neural ischemia or repercussion may likely worsen the outcome and should be avoided.

A

True

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4
Q

Which EKG leads are most useful for monitoring the inferior wall of the heart?

A

II, III, aVF

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5
Q

Which EKG leads are most useful for monitoring the lateral wall of the heart?

A

I, aVL

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6
Q

Where is the precocial unipolar lead placed to best monitor the LV?

A

V5 position along the anterior axillary line in the 5th intercostal space

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7
Q

The best single lead in diagnosing myocardial ischemia in a pt w CAD

A

V5

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8
Q

> 90% of ischemic episodes will be detected by EKG is which 2 leads are analyzed simultaneously?

A

leads II and V5

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9
Q

How can one monitor for posterior wall ischemia?

A

7- lead system or esophageal lead

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10
Q

most useful leads in the post-op dx of complex conduction problems and dysrhythmias

A

AV pacing wires (epicardial electrodes)

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11
Q

None of the standard EKG leads can detect ischemia in which 2 locations?

A

posterior wall

RV

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12
Q

How well do noninvasive monitoring devices function when pulsatile blood flow is absent (during CPB or LVAD use)

A

They don’t.

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13
Q

True or false: Correct damping of a pressure-monitoring system should not affect the natural frequency of the system

A

true

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14
Q

A system that overestimates SBP and underestimates DPB would be ____damped

A

Underdamped

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15
Q

A system that underestimates SBP and overestimates DBP would be ____damped

A

Overdamped

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16
Q

An optimally or critically damped system will exhibit a ________ frequency response in the range or frequencies up to the natural frequency of the system

A

constant/flat

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17
Q

critical part of a transducer that acts to link fluid wave to electrical input

A

diaphragm

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18
Q

True or False: most transducer systems used in clinical anesthesia can be described as underdamped systems with low natural frequency

A

true

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19
Q

Systolic pressure measured in a radial A line may be up to ___ - ___ mmHg higher than aortic pressure. WHY?

A

20-50 mmHg

because of decreased peripheral arterial elastance and wave summation

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20
Q

What is the most common site used for arterial cannulation? Why?

A

Radial artery

  1. it is convenient
  2. it provides a reasonably accurate estimation of the true aortic pressure
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21
Q

What indicates limited collateral ulnar artery flow into the hand?

A

positive Allen’s test

even w a positive Allen’s test, radial artery cannulation still has had very few ischemic complications

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22
Q

True or False: The distal location of DP and PT arterial line sites leads to increased distortion of the arterial wave.

A

True.

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23
Q

Factors that may cause a narrow pulse pressure on an A-line

A

pericardial tamponade

hypovolemia

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24
Q

factors that may cause an increased pulse pressure on an A-line

A

worsening aortic valvular insufficiency

hypovolemia

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25
Q

A decreased SBP with PPV suggests….

A

Hypovolemia

Positive intrathoracic pressure impedes venous return to the heart w a more pronounced effect in a hypovolemic pt

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26
Q

Rate of pressure rise during systole can reflect…

A

contractility

HR, preload, and after load can affect it tho

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27
Q

area under the aortic pressure wave from the onset of systole to the dicrotic notch can reflect….

A

Stroke volume

28
Q

Position of the dicrotic notch on the A-line wave form correlates w….

A

SVR

high notch = high SVR; low notch = low SVR

29
Q

What has more risk of thrombus development, A-lines or central venous catheters? Why?

A

A-lines because they are not heparin bonded

30
Q

Why is radial artery pressure significantly lower than aortic pressure at completion of CPB?

A
  1. forearm vasodilation secondary to rewarming may lead to A-V shunting, resulting in steal phenomenon 5-30 min longer in duration
    OR
  2. hypovolemia and vasoconstriction
31
Q

most common IV access route in cardiac anesthesia

A

internal jugular vein

32
Q

Relative contraindications for IJ central line placement

A
  1. presence of carotid dz
  2. recurrent cannulation of IJV (thrombus risk)
  3. contralateral diaphragmatic dysfunction
  4. Thyromegaly or prior neck surgery
33
Q

What site is recommended as the first option for PAC placement?

A

L subclavian

34
Q

A “Cannon A wave” on a CVP indicates ________

A

AV dissociation

RA is contracting against a closed tricuspid valve

35
Q

Abnormal V wave on CVP indicates _______

A

tricuspid valve insufficiency

retrograde flow through the incompetent valve –> increased RA pressure during systole

36
Q

PA pressure reflects….

A
  1. RV fx
  2. PVR
  3. LA filling pressure
37
Q

PCWP is a more direct estimate of

A

LA filling pressure

a valveless hydrostatic column exists b/t the distal port and the LA at end-diastole

38
Q

2 indications that cannot be performed w CVP alone

A
  1. differentiation of L vs R ventricular fx

2. assessment of intracardiac filling pressures during cardioplegia administration

39
Q

Increase in CVP
Decrease in CVP to mean PA gradient
Low CO

…all indicate _______

A

RV failure

40
Q

hallmarks of LV failure

A

simultaneous readings of high PA pressures and PCWP in the presence of systemic HoTN and low CO

41
Q

if the PA diastolic and wedge pressures do not agree closely with one another, what would you suspect is occurring?

A

Pulm HTN

42
Q

Primary diagnostic modality for tricuspid and pulm valve stenosis in adults

A

TEE

43
Q

increase in PA pressure or increase in PCWP reflects a decrease in ventricular compliance. What would this be associated with?

A

Significant ischemia

44
Q

The established convention is to evaluate PA pressures during which part of the breathing cycle?

A

end expiration

45
Q

4 mechanisms that may result in decreased SvO2

A
  1. decreased CO
  2. Decreased hgb concentration
  3. decreased arterial O2 sat
  4. increased O2 utilization
46
Q

True or False: Changes in SvO2 usually precede hemodynamic changes by a significant period of time.

A

True

47
Q

most common complication associated w PAC insertion

A

dysrhythmias

48
Q

Which approach offers the most direct route to the RA and thus results in the highest rate of successful PA catheterization?

Which approach is next most effective?

A

R IJ

L subclavian

49
Q

most common arrhythmia during PAC placement

A

PVCs

usually resolved with either catheter withdrawal or with advancement of the catheter tip from the RV into the PA

50
Q

The PAC should not be advanced more than _______ from the RIJ approach because this increases the risk for PA rupture or catheter knotting

A

60 cm

51
Q

Although thrombus formation of PACs has been noted at 24h, the incense of thrombogenicity substantially increases by ________

A

72 hrs

52
Q

How is a CO measurement altered with R sided valvular lesions when using the thermodilution method?

How is it altered with mitral or aortic valve lesions?

A

CO is underestimated w RV valvular lesions

CO remains accurate for forward LV CO for LV valvular lesions

53
Q

5 factors that may alter the CO reading from normal when using the thermodilution method

A
  1. Volume of injectate (less volume = falsely higher CO volume and vice versa)
  2. Temp of injectate (increase 1*C = 3% overestimation of CO
  3. Shunts
  4. Timing with resp cycle
  5. Catheter position (must be in PA but not wedged)
54
Q

practical gold standard for evaluating CO

A

PAC

thermodilution method is most commonly utilized

55
Q

True or False: Adequacy of perfusion is likely when a pulse oximeter shows a saturation reading.

A

True

because the pulse ox utilizes plethysmography as part of its basic operation

56
Q

3 factors for which EtCO2 offers evidence

A
  1. endotracheal intub
  2. ventilation
  3. perfusion
57
Q

What does core temperature represent?

A

The temp of the vital organs

58
Q

How does hypercarbia affect PA pressures and RV fx?

A

increases PA pressures

worsens RV fx

59
Q

Why should an esophageal temp probe not be routinely used for cases involving CPB?

A

the esophagus will be greatly affected by the temp of the blood returning from the extracorporeal pump

60
Q

Shell temperature represents

A

the temp of the majority of the body (musc, fat, bone) which receives a smaller portion of the blood flow

61
Q

single most important monitor of renal rx during surgical cases involving CPB

A

Urinary catheter

62
Q

Which 2 electrolytes typically decline during CPB?

A

K and Mg

63
Q

What is the basic principle of clinical EEG monitoring?

A

cerebral ischemia causes slowing of the electrical activity of the brain, as well as a decrease in signal amplitude

64
Q

True or False: Microshock cannot occur unless the skin resistance has been bypassed.

A

True

65
Q

Most common means of monitoring adequate heparin effect

A

ACT (activated clotting time)

66
Q

What ACT level is adequate during CPB?

A

> 400s

(if off pump CABG cases using partial heparinization, ACT target is ~300s

67
Q

How often should blood glucose be measured during cardiac surgery, and at what level should an insulin gtt be started?

A

q 30-60 min

200 mg/dL

Cardiac Anesthesia - Constable (1 decks)

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