Monitoring The CV Patient

Question 1

What are the 4 ASA standards of monitoring?

Answer 1

1 Qualified personnel
2 Oxygenation (FiO2)
3 Ventilation (ETCO2, disconnect alarm, stethoscope)
4 Circulation (BP, pulse, ECG)

(Not standard: Temp, Vt, ABG)

Question 2

Arterial Line

Answer 2

Beat to beat monitoring 
Access for blood draws
Burn and obese pts
Never Ulner (use Radial)
Need good collateral circulation

Question 3

As site for A-line placement becomes more proximal, what > risk to be concerned of?

Answer 3

Thrombosis

Question 4

Systolic Pressure Variation can help indicate what with > 15mmHg up or down?

Answer 4

Hypovolemia

Question 5

Where to place CVP on trauma / c-spine precaution patient?

Answer 5

Subclavian

Question 6

When to measure the CVP?

Answer 6

At end-expiration

Question 7

When wedging swan cath, what cange will you see as cath passes from RV to PA?

Answer 7

> diastolic measurement

Question 8

Mixed Venous Oximerty is an indirect indicator of what?

Answer 8

CO

Question 9

What is a normal mixed venous oximetry?

Answer 9

65% (60-75)

Question 10

What is the MOST common reason for an > mixed venous O2 saturation?

Answer 10

PA-cath is advanced too far in the PA

>75%

Question 11

What are other reasons for a > mixed venous oxygen saturation? (>75%)

Answer 11

< VO2 (hypothermia, NMB, general anesthesia)

Unable to extract O2 (carbon monoxide)
High CO (sepsis, burns, L->R shunt, AV fistulas)

Question 12

What causes a < mixed venous O2 saturation? (<60%)

Answer 12

< CO (MI, CHF, Hypovolemia)

VO2 (fever, agitation, thyrotoxic, shivering)

Question 13

What is Dr Constable’s gold standard for LV (volume) measurements?

Answer 13

TEE