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*2Topics Anesthesia Oral Boards > Monitors, Circuits, and Machines > Flashcards

Monitors, Circuits, and Machines Flashcards

1
Q

Standard ASA Monitors

A

Standard 1: qualified person

Standard 2:

a. Oxygenation - pulsox
b. Ventilation - ETCO2
c. Circulation - EKG, blood pressure, HR
d. Body Temp

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2
Q

What is a-ADO2?

What is the normal value?

A

Difference between ETCO2 and PaCO2

Nrml value: 2-5 mmHg

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3
Q

What causes an increase in a-ADO2?

A 
Age
Emphysema
Pulmonary embolism 
Decreasing CO 
Hypovolemia
Anesthesia
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4
Q

What causes a decrease in a-ADO2?

A

Large Tidal Volumes

Low Frequency Ventilation

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5
Q

Causes of Decreases ETCO2

A

A. Decrease in metabolic rate

  • Hypothermia
  • Hypothyroidism

B. Change in elimination

  • Increased dead space/COPD
  • Hyperventilation
  • Decreased CO/ cardiac arrest
  • Decreased CO2 production
  • Circuit leak or occlusion
  • PE

C. Other

  • Increased muscle relaxation
  • Increased depth of anesthesia
  • wedging of the PA catheter
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6
Q

Causes of Increased ETCO2

A

A. Increased metabolic rate

  • increased CO2 production (MH, thyrotoxicosis, hyperthyroidism)
  • hyperthermia
  • shivering or convulsions

B. Change in elimination

  • rebreathing (valve prolapse, failed CO2 absorber)
  • hypoventilation
  • depression of respiratory center with decrease in Tidal Volume
  • reduction of ventilation (partial paralysis, high spinal, weak respiratory muscles, acute respiratory distress)

C. Other

  • excessive catecholamine production
  • administration of blood or bicarb
  • release of aortic/arterial clamp or tournaquet
  • parenteral hyperalimentation
  • glucose in IV fluid
  • CO2 in peritoneal/thoracic/joint cavity
  • subcut Epi injection
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7
Q

Causes of minimal to zero ETCO2 or sudden drop to near zero

A
  • equipment malfunction
  • ETT disconnect, obstruction, or total occlusion
  • bronchospasm
  • no cardiac output
  • cardiac arrest
  • bilateral pneumothorax
  • massive PE
  • esophageal intubation
  • application of PEEP
  • cricoid pressure occluding tip of ETT
  • sudden, severe hypotension
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8
Q

Which type of heart block require cardiac pacing?

A

Second Degree (Mobiitz) Type 2

Third Degree

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9
Q

What is the most sensitive lead to diagnose ischemia?

A

V5

Next most sensitive is V4

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10
Q

What is the most sensitive lead to diagnose arrhythmia?

A

Lead II

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11
Q

ASA recommendations for pre-operative EKG

A
  1. Age greater than 50 y/o
    a. Good for 1 year if age 50-69
    b. Good for 6 months if >69 y/o
  2. H/o CV disease or HTN
    a. EKG only good for 6 weeks in pt w/ severe CV disease
    b. EKG mandatory if patient has chance in symptoms: SOB, chest pain
  3. H/o DM
    a. EKG required if pt > 40 y/o
    b. EKG required if pt has DM > 10 years
  4. Central nervous system disease
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12
Q

Indications for Arterial Line

A
  1. Continuous, real time blood pressure monitoring
  2. Planned pharmacologic or mechanical cardiovascular manipulation
  3. Repeated blood sampling
    a. ABG
    b. Hematocrit
    c. Glucose
  4. Failure of indirect arterial blood pressure measurement
  5. Supplementary diagnostic information from the arterial waveform
    a. Systolic pressure variation
    b. Pule Pressure Variation (PPV)
  6. Patient with end organ disease
  7. Patent with large fluid shifts
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13
Q

Complications of Arterial Line

A
  1. Distal ischemia 2/2 thrombosis, proximal emboli, or prolonged shock
  2. Pseudoaneurysm
  3. Arteriovenous fistula
  4. Hemorrhage
  5. Hematoma
  6. Infection
  7. Skin necrosis
  8. Peripheral neuropathy and damage to adjacent nerves
  9. Misinterpretation of data
  10. Cerebral air embolism 2/2 retrograde flow with flushing
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14
Q

Indications for a Central Line

A
  1. CVP Monitoring
  2. Transvenous cardiac pacing
  3. Required for insertion of PA catheter
  4. Temporary hemodialysis
  5. Drug administration: drugs that are irritating to peripheral veins
    a. Vasoactive drugs
    b. Hyperalimentation
    c. Chemotherapy
    d. Prolonged antibiotic therapy
  6. Rapid infusion of fluids: trauma, major surgery
  7. Major surgery w/ large fluid shifts
  8. Aspiration of a venous air embolus
  9. Inadequate peripheral access
  10. Sampling site for repeater blood testing
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15
Q

Complications of Central Venous Line

A
  1. Mechanical injury: arterial, venous, nerve injury and cardiac tamponade
  2. Respiratory compromise: airway compression by a hematoma or PTX
  3. Arrhythmias
  4. Thromboembolic events: venous or arterial thrombosis, PE, and catheter/guidewire embolus
  5. Infectious: infection at site, catheter infection, blood stream infection, and endocarditis
  6. Misinterpretation of data
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16
Q

CVP Waveform components

A

a wave: end diastole; atrial contraction

c wave: early systole; isovolumetric ventricular contraction tricuspid motion toward right atrium

v wave: late systole; systolic filling of atrium

x descent: midsystole; atrial relaxation, descent of the base, systolic collapse

y descent: early diastole; early ventricular filling, diastolic collapse

17
Q

Loss of a wave on CVP

A

A Fib/Flutter

18
Q

Cannon a wave

A

-Right ventricular hypertrophy
-Tricuspid/Pulmonary stenosis
-Acute or chronic lung disease associated with pHTN
junctional or nodal rhythm

19
Q

Large v wave

A

Tricuspid Regurgitation

Right ventricular papillary muscle ischemia

20
Q

Indications. for PA catheter

A
  1. Cardiac
    a. CHF
    b. Low EF
    c. Left sided, valvular heart disease
    d. CABG
    e. Aortic cross clamp
  2. Pulmonary
    a. COPD
    b. ARDS
  3. Complex fluid management
    a. Shock
    b. Burns
    c. Acute renal failure
  4. High risk obstetrical care
    a. Ecclampsia
    b. Placental abruption
  5. Neurological
    a. Sitting crani
    b. Venous air embolus
21
Q

Complications of PA catheter

A
  1. Venous access and PAC placement
    a. Arterial puncture
    b. Arrhythmias
    i. RBBB
    ii. Complete Heart Block
    iii. V-Fib/tachycardia
    c. Postoperative neuropathy
    d. Pneumothorax
    e. Air embolism
  2. Catheter residence
    a. Catheter knots
    b. Infection
    c. Thrombophlebitis
    d. Thromboembolism
    e. Pulmonary infarct
    f. Endocarditis
    g. Valvular injury
    h. Pulmonary artery rupture
    i. Pulmonary artery pseudoaneurysm
  3. Death
  4. Misinterpretation of data
22
Q

Causes of false INCREASE in Thermodilution CO reading

A
  1. Small injectate volume
  2. Increase temperature of inject ate
  3. Thrombus on thermister
  4. The patient is in a very low CO state
23
Q

Causes of false DECREASE in Thermodilution CO reading

A
  1. Large injectate volume
  2. Decrease temperature of inject ate
  3. Inflation cycle of lower limb sequential compression devices (SCDs)
  4. Either rapid or continuous infusion of IV fluid through PA catheter 2/2 cooling effect on blood
24
Q

RELATIVE Contraindications for TEE

A
  • Paraesophageal hernia
  • Cervical spine instability
  • Atlantooccipital Disease or Instability
  • Dysphagia
  • History of esophageal or UGI bleeding
  • Esophageal scarring from radiation
  • Esophageal surgery
  • Hiatal hernia
25
Q

ABSOLUTE Contraindications for TEE

A
  • Esophageal perforation
  • Esophageal strictures
  • Esophageal varacies
  • Esophageal diverticula
26
Q

How does PEEP work?

A

Recruits atelectatic, fluid-filled alveoli, decreasing intrapulmonary shunting and possibly increasing compliance

27
Q

What is MAC?

A

Spinal nociceptive reflex involving both sensory and motor components

28
Q

What is a dibucaine number?

A

The percentage that dibucaine inhibits the hydrolysis of benzoylcholine by pseudocholinesterase

29
Q

What are the adverse effects of hypothermia?

A
  1. Shivering-induced increase in O1 consumption by as much as 400%
  2. Leftward shif of oxygen-hemoglobin dissociation curve
  3. Decreased blood clotting ability (10% reduction of coagulation factor activity for every 1 degree Celsius decrease)
  4. Increased epinephrine and norepinephrine levels causing vasoconstriction
  5. Cardiac arrhythmias progressing to V Fib

*2Topics Anesthesia Oral Boards (10 decks)

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