Monitoring Study Questions Flashcards
How do analgesia and hypnosis differ?
- analgesia: absence of pain
- hypnosis: physiological state of sedation –> can easily be awakened from stimuli and feel pain
How are oxygenation and ventilation assessed:
a) subjectively? b) objectively?
i) What types of equipment are used to measure each?
ii) What are the normal values for the parameters you are monitoring?
iii) Is it possible to be well oxygenated but poorly ventilated? Explain.
Subjective: reflex activity, eye position, muscle relax, hr, pulse quality, rr, mm, crt
- equipment: none necessary
- normal values: stage 3 anesthesia (medium plane), stable rr, abolished laryngeal reflexes and response to toe pinch, sluggish palpebral, strong corneal reflex, relaxed jaw tone, ruminants central pupil (not dilated)
Objective: ECG, bp, pulse ox
- normal parameters: dogs (60-160), cats (120-220), bp 100-160/60-90
List 3 causes of pulse ox artifact
- vasoconstriction
- probe motion
- hypotension
- misleading with severe anemia (must have PCV of 15%)
What does the ECG represent? Is it a good stand alone monitor device?
Produces continuous waveform representing summation of electrical activity of the heart for a given axis
- not good stand alone, no info on cardiac pumping activity, limited to assessment of changes in x axis
What are the differences between direct and indirect blood pressure methods
- direct: invasive, requires skill
- indirect: non-invasive, easy
2 methods to indirectly measure blood pressure are ____ and ______
Doppler and oscillometric
Accuracy of any indirect bp method is directly related to _____
Cuff fit
- too large: bp will be overestimated
- too small: bp will be underestimated
List 3 differentials for absence of a CO2 waveform following ET intubation
- improper ET placement and patency
- lack of circulation and CO2 delivery to lungs
- malfunctioning anesthetic circuit
Adequacy of ventilation is defined solely by what objective parameter
EtCO2 (capnograph) which is a predictor of arterial CO2 in ventilated patients
List 7 subjective methods for assessing depth of anesthesia. What is the most useful sign?
- reflex activity
- eye position
- muscle relaxation
- hr
- rr
- mm
- response to noxious stimuli
List 4 guidelines for monitoring by the ACVA
- assessment of circulation
- assessment of ventilation
- maintenance of anesthetic record of events
- assignment of a responsible person to be aware of patient’s status and prepared to intervene
Describe Guedel’s stages of anesthesia and subjective signs for each
1: voluntary movement (may be awake, can be aroused)
2: involuntary excitement: loss of consciousness to onset of regular breathing
3: surgical anesthesia: light, medium, deep
4: medullary depression: death
Differential list for tachycardia
- inadequate anesthetic depth
- drug induced (anticholinergic, thiobarbiturate, ketamine, catecholamine)
- pain
- hypotension
- hypoxemia/hypercarbia
- hypokalemia
- hyperthermia
- anemia
- fever
- anaphylaxis
Differential list for bradycardia
- excessive sympathetic depression
- increased vagal tone
- hypothermia
- hyperkalemia
- elevated intracranial pressure
- hypoxemia
- drugs (opioids, alpha2 agonists)
Differential list for tachypnea
- sympathetic stimulation or pain
- hypotension
- hypovolemia
- hypoxemia
- hypercarbia
- hyperthermia
- acute anaphylactid response
- drugs
- electrolyte disturbances
