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NIBP Flashcards

1
Q

Perfusion =

A

Pressure and flow

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2
Q

When you give phenylephrine to treat low BP then what are you effecting?

A

TPR (total peripheral resistance)

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3
Q

When you give ephedrine to treat low BP then what are you effecting?

A

TPR , HR, CO

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4
Q

All drugs for induction effect what two parameters?

A

Coronary blood flow

Cardiac sympathetic discharge

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5
Q

What induction agents effect venous capacity?

A

Propofol, fent, inhaled gases

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6
Q

What induction agents are vasodilator substances?

A

Propofol, inhaled gases

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7
Q

What is the normal CO?

A

5 L / min

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8
Q

What is the normal blood volume ?

A

5 L / min

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9
Q

When a pt is in sepsis, what physiological status must you account for?

A

Increased norepi usage
Low BP
CO 2-3x normal
Decreased perfusion to peripheries

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10
Q

What is the mean circulating filling pressure?

A

Pressure anywhere where flow is stopped

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11
Q

What do baroreceptors do?

A

Provide the driving pressure that permits local autoregulation of all vascular beds

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12
Q

What are the 2 main baroreceptors used to regulate central blood pressure?

A

Carotid sinus

Aortic arch baroreceptors

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13
Q

When using auscultation as the means for measuring BP manually, what sounds do you hear?

A

Korotkoff Sounds

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14
Q

What does NIBP mean?

A

Non invasive blood pressure

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15
Q

What artery is most used for listening for Korotkoff sounds?

A

Brachial

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16
Q

What is the most common technique used for measuring NIBP?

A

Oscillometric

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17
Q

When using oscillometric technique for NIBP, which pressure is most accurate?

A

Mean

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18
Q

Remember in Biggs class, we measure VARIABLES and not PARAMETERS

A

DUH

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19
Q

What law do you use when talking about wall pressure and and blood vessels?

A

Laplace’s law

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20
Q

NIBP overestimates at what state? (HTN, or hypotension?)

A

Hypotensive

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21
Q

NIBP underestimates at what state?

A

Hypertensive

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22
Q

Which parameter describes tissue perfusion?

A

Mean pressure

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23
Q

What is the calculation used to determine perfusion pressure?

A

PP = arterial P - venous P

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24
Q

Mean pressure is also known as what?

A

Pressure of perfusion

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25
Q

The majority of blood flow to the LV occurs during what?

A

Diastole

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26
Q

What is the term that describes the formula we use to calculate Mean Pressure? (formula is M = {(S - D) / 3} + D

A

Wiggers Estimate

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27
Q

When using wiggers estimate, where must the pressures be derived from?

A

Cuff must be on Upper arm

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28
Q

What is the k value for the brachial artery?

A

0.33

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29
Q

When using k values what is the formula you must use to determine mean pressure?

A

MP = D + k (pulse pressure)

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30
Q

What is the k value for the aorta?

A

0.41

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31
Q

What is the k value for the femoral artery?

A

0.30

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32
Q

Define pulse pressure

A

Difference between systolic and diastolic pressures

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33
Q

What is pulse pressure used for in the clinical setting?

A

Indicator of stroke volume

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34
Q

When under anesthesia, does your O2 requirement increase or decrease?

A

Decrease

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35
Q

What is the minimum required blood pressure for a patient?

A

20% of the systolic pressure

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36
Q

What is the minimum required BP for the brain?

A

60 mm Hg

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37
Q

CPP stands for what

A

Cerebral perfusion pressure

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38
Q

What is formula for CPP?

A

CPP = MAP - ICP

You can assume ICP is close to CVP so can assume 8 - 12 mmHg

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39
Q

Who’s cuff system used an occlusive counter-pressure system to measure BP in 1896?

A

Scipione Riva-Rocci’s

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40
Q

What size of the limb’s circumference should the cuff width be?

A

40%

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41
Q

The length is nearly how many times larger than the width of the cuff?

A

2 times

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42
Q

Which is more critical to the accuracy of the measurement, length or width?

A

Width

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43
Q

When your cuff size is too small, what will happen to the NIBP reading?

A

Will be falsely high

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44
Q

What is wrong with the cuff when you are getting falsely low blood pressure readings?

A

Cuff is too large

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45
Q

What other problem with the cuff can be associated with falsely high BP readings?

A

Cuff being applied too loosely

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46
Q

When using the return to flow method of determining a BP, what is the only pressure that can be obtained?

A

Systolic

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47
Q

What is the kind of doppler used when determining pressure by the return to flow method?

A

Parks doppler

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48
Q

What artery is most used when using the return to flow method for BP?

A

Radial

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49
Q

What is the return to flow method of determining BP?

A

Where you apply pressure to a blood vessel above systolic, then decrease the pressure until the first pulse is detected distally from the occluded vessel
(ie pressure applied to upper arm, doppler device placed over radial artery at hand to detect pulse)

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50
Q

What technique is similar to oscillometric but is a continuous recording of the pulse waveform while applying only mean pressure to the vessel?

A

Vascular unloading

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51
Q

When using the auscultation method, how much pressure do you let off and how often?

A

3 mmHg for every heart beat

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52
Q

How many phases are there in the ausultatory method of determining BP?

A

5 phases

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53
Q

What is phase 1 of auscultatory method?

A

Snapping tones heard

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54
Q

Murmurs are heard during what phase of the auscultatory method?

A

Phase 2

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55
Q

The auscultatory gap is found in which phase of the auscultatory method?

A

Phase 2

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56
Q

What is phase 3 of auscultatory method?

A

Thumping

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57
Q

What is phase 4 of auscultatory method?

A

Muffling

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58
Q

Phase 5 of the auscultatory method consist of what?

A

SILENCE

it really is golden

59
Q

What phase does the ASA recommend for determining diastolic pressure when using the auscultatory method?

A

Phase 5

60
Q

The auscultatory gap phenomenon comes about by what cause?

A

Inflation of the cuff too slowly. This causes venous engorgement which does not allow for artery to be heard due to the inadequate runoff capacity

61
Q

Are systolic pressures higher or lower as you move farther away from the heart?

A

Higher, this drops mean pressure

62
Q

What is the term for laying down?

A

Recumbent

63
Q

What does DINAMAP stand for?

A

Device for Indirect Noninvasive automatic mean arterial pressure

64
Q

Which pressure is most accurate on a DINAMAP?

A

Diastolic

65
Q

What are the 2 main errors attributed to the observer?

A

Causing systematic errors
—–Having prejudice for normal readings
Causing random errors
—–Mental concentration / hearing acuity

66
Q

What are the true variations in blood pressure?

A

1) unknown factors
2) Recent physical activity
emotional state
position of subject

67
Q

What method of NIBP do you not want to use when the patient is in Atrial fib?

A

Oscillometric methods

68
Q

What order of anatomical locations if the preferred order of placing the cuff?

A

Biceps
Forearm
Calf
Thigh

69
Q

What is petechiae?

A

Pinpoint blood spot

70
Q

What is ecchymoses?

A

Bruising

71
Q

What is PAT? And what does it do?

A

Peripheral arterial tonometry

Uses an indirect continuous non-invasive blood pressure by using a transducer to detect intra-arterial pressure changes

72
Q

Name one well known version of a PAT?

A

Medwave

73
Q

Direct arterial cannulation will give you which BP measurements?

A

S, D, M

74
Q

Oscillometric will give you which BP measurements?

A

Calculated S, calculated D, M

75
Q

Return to flow will give you which BP measurements?

A

S

76
Q

Vascular unloading and PAT will give you which BP measurements?

A

S, D , M

77
Q

What do baroreceptors do?

A

Provide the driving pressure that permits local autoregulation of all vascular beds

78
Q

What are the 2 main baroreceptors used to regulate central blood pressure?

A

Carotid sinus

Aortic arch baroreceptors

79
Q

When using auscultation as the means for measuring BP manually, what sounds do you hear?

A

Korotkoff Sounds

80
Q

What does NIBP mean?

A

Non invasive blood pressure

81
Q

What artery is most used for listening for Korotkoff sounds?

A

Brachial

82
Q

What is the most common technique used for measuring NIBP?

A

Oscillometric

83
Q

When using oscillometric technique for NIBP, which pressure is most accurate?

A

Mean

84
Q

Remember in Biggs class, we measure VARIABLES and not PARAMETERS

A

DUH

85
Q

What law do you use when talking about wall pressure and and blood vessels?

A

Laplace’s law

86
Q

NIBP overestimates at what state? (HTN, or hypotension?)

A

Hypotensive

87
Q

NIBP underestimates at what state?

A

Hypertensive

88
Q

Which parameter describes tissue perfusion?

A

Mean pressure

89
Q

What is the calculation used to determine perfusion pressure?

A

PP = arterial P - venous P

90
Q

Mean pressure is also known as what?

A

Pressure of perfusion

91
Q

The majority of blood flow to the LV occurs during what?

A

Diastole

92
Q

What is the term that describes the formula we use to calculate Mean Pressure? (formula is M = {(S - D) / 3} + D

A

Wiggers Estimate

93
Q

When using wiggers estimate, where must the pressures be derived from?

A

Cuff must be on Upper arm

94
Q

What is the k value for the brachial artery?

A

0.33

95
Q

When using k values what is the formula you must use to determine mean pressure?

A

MP = D + k (pulse pressure)

96
Q

What is the k value for the aorta?

A

0.41

97
Q

What is the k value for the femoral artery?

A

0.30

98
Q

Define pulse pressure

A

Difference between systolic and diastolic pressures

99
Q

What is pulse pressure used for in the clinical setting?

A

Indicator of stroke volume

100
Q

When under anesthesia, does your O2 requirement increase or decrease?

A

Decrease

101
Q

What is the minimum required blood pressure for a patient?

A

20% of the systolic pressure

102
Q

What is the minimum required BP for the brain?

A

60 mm Hg

103
Q

CPP stands for what

A

Cerebral perfusion pressure

104
Q

What is formula for CPP?

A

CPP = MAP - ICP

You can assume ICP is close to CVP so can assume 8 - 12 mmHg

105
Q

Who’s cuff system used an occlusive counter-pressure system to measure BP in 1896?

A

Scipione Riva-Rocci’s

106
Q

What size of the limb’s circumference should the cuff width be?

A

40%

107
Q

The length is nearly how many times larger than the width of the cuff?

A

2 times

108
Q

Which is more critical to the accuracy of the measurement, length or width?

A

Width

109
Q

When your cuff size is too small, what will happen to the NIBP reading?

A

Will be falsely high

110
Q

What is wrong with the cuff when you are getting falsely low blood pressure readings?

A

Cuff is too large

111
Q

What other problem with the cuff can be associated with falsely high BP readings?

A

Cuff being applied too loosely

112
Q

When using the return to flow method of determining a BP, what is the only pressure that can be obtained?

A

Systolic

113
Q

What is the kind of doppler used when determining pressure by the return to flow method?

A

Parks doppler

114
Q

What artery is most used when using the return to flow method for BP?

A

Radial

115
Q

What is the return to flow method of determining BP?

A

Where you apply pressure to a blood vessel above systolic, then decrease the pressure until the first pulse is detected distally from the occluded vessel
(ie pressure applied to upper arm, doppler device placed over radial artery at hand to detect pulse)

116
Q

What technique is similar to oscillometric but is a continuous recording of the pulse waveform while applying only mean pressure to the vessel?

A

Vascular unloading

117
Q

When using the auscultation method, how much pressure do you let off and how often?

A

3 mmHg for every heart beat

118
Q

How many phases are there in the ausultatory method of determining BP?

A

5 phases

119
Q

What is phase 1 of auscultatory method?

A

Snapping tones heard

120
Q

Murmurs are heard during what phase of the auscultatory method?

A

Phase 2

121
Q

The auscultatory gap is found in which phase of the auscultatory method?

A

Phase 2

122
Q

What is phase 3 of auscultatory method?

A

Thumping

123
Q

What is phase 4 of auscultatory method?

A

Muffling

124
Q

Phase 5 of the auscultatory method consist of what?

A

SILENCE

it really is golden

125
Q

What phase does the ASA recommend for determining diastolic pressure when using the auscultatory method?

A

Phase 5

126
Q

The auscultatory gap phenomenon comes about by what cause?

A

Inflation of the cuff too slowly. This causes venous engorgement which does not allow for artery to be heard due to the inadequate runoff capacity

127
Q

Are systolic pressures higher or lower as you move farther away from the heart?

A

Higher, this drops mean pressure

128
Q

What is the term for laying down?

A

Recumbent

129
Q

What does DINAMAP stand for?

A

Device for Indirect Noninvasive automatic mean arterial pressure

130
Q

Which pressure is most accurate on a DINAMAP?

A

Diastolic

131
Q

What are the 2 main errors attributed to the observer?

A

Causing systematic errors
—–Having prejudice for normal readings
Causing random errors
—–Mental concentration / hearing acuity

132
Q

What are the true variations in blood pressure?

A

1) unknown factors
2) Recent physical activity
emotional state
position of subject

133
Q

What method of NIBP do you not want to use when the patient is in Atrial fib?

A

Oscillometric methods

134
Q

What order of anatomical locations if the preferred order of placing the cuff?

A

Biceps
Forearm
Calf
Thigh

135
Q

What is petechiae?

A

Pinpoint blood spot

136
Q

What is ecchymoses?

A

Bruising

137
Q

What is PAT? And what does it do?

A

Peripheral arterial tonometry

Uses an indirect continuous non-invasive blood pressure by using a transducer to detect intra-arterial pressure changes

138
Q

Name one well known version of a PAT?

A

Medwave

139
Q

Direct arterial cannulation will give you which BP measurements?

A

S, D, M

140
Q

Oscillometric will give you which BP measurements?

A

Given M, calculated S , D

Systolic is 0.5 amplitude of MAP
(Diastolic is 0.625 amplitude of MAP)

141
Q

Return to flow will give you which BP measurements?

A

S

142
Q

Vascular unloading and PAT will give you which BP measurements?

A

S, D , M

143
Q

In the hypertensive range of BP, indirect methods of BP do what to actual readings?

A

Underestimate direct measurements

144
Q

In the hypotensive range of BP, indirect NIBP methods of BP do what to actual readings?

A

Overestimate direct measurements

I & M (37 decks)

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