Monitoring the CV patient Flashcards
All of our monitors measure one thing, what is it?
Energy metabolism (i.e. a comparison of oxygen supply to oxygen demand)
What are the four ASA standards for monitoring a patient during an anesthetic?
- Qualified personnel (MDA, CRNA, AA)
- Oxygenation: SaO2, FiO2
- Ventilation: ETCO2, stethoscope, disconnect alarm
- Circulation: BP, Pulse, EKG.
What must be present when inserting an radial arterial catheter?
Collateral circulation
T/F: A femoral artery catheter must be placed below the inguinal ligament?
Below the inguinal ligament
Why must a femoral arterial catheter be placed below the inguinal ligament?
Easier to compress if required
Why is there a slight difference/variation with systolic BP during positive pressure ventilation?
Roughly 5 mmHg difference due to decrease in venous return with inspiration
What are the limitations to systolic pressure variation measurments?
- Arrhythmias
- AI
- Requires mechanical ventilation
Describe the Seldinger technique of CVL placement?
- 22 G finger needle
- 18 G needle
- Guidewire
- Scalpel blade
- dilator
- Catheter
The IJ runs in groove between what two muscles?
Sternal head and clavicular head of sternoclediomastoid muscle
How can you increase the caliber of the IJ prior to CVL placement?
Trendelenburg
What type of CVL should be placed in patient with c-spine precautions?
Subclavian
What two things does CVP provide an estimate of?
- RV preload
2. Intravascular blood volume
What three factors were most specifically associated with proper management of PAC?
- MD familiarity
- Type/culture of ICU
- Nursing education
What are complications of PAC placement?
- Arrhythmias
- Transient RBBB
- Misinformation
- Knotting
- Pulmonary infarction
- PA rupture
- Endocarditis
- Structural heart damage
- Death
T/F: CO is inversely proportional to area under the curve for PAC thermodilution?
True
What are technical problems with PAC?
- Variations in respirations
- Blood clot on thermistor tip
- Shunts (LV + RV outputs unequal)
- Tricuspid regurgitation
- Computation constants for each different catheter
What must remain constant in order for SvO2 to be a good indirect indicator of CO?
O2, VO2, and Hgb
What would make SvO2 >75%?
- Wedged PAC
- Low VO2 (hypothermia, GA, NMBA)
- Unable to release O2 (CO poisoning)
- High CO states (sepsis, burns, AV fistulas)
What would make SvO2 <60%?
- Decreased CO: MI, CHF, hypovolemia
- Low Hgb (bleeding/shock)
- Low SaO2: hypoxia, resp distress
- Increased VO2: Fever, agitation, thyrotoxic
