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Principles in Practice > Noninvasive - Kendall cards > Flashcards

Noninvasive - Kendall cards Flashcards

1
Q

AANA Standard V states to monitor

A

-ventilation

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2
Q

Pulse ox consists of

A

-two light emitting diodes (LEDs)

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3
Q

Pulse oximetry is calculated based on this law

A

Beer-Lambert

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4
Q

Beer-Lambert law determined that

A

oxygenated and reduced hemoglobin differ in their absorption of red and infrared light

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5
Q

Oxyhemoglobin (oxygenated) absorbs more

A

infrared light at 940-990nm wavelength

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6
Q

Deoxyhemoglobin (deoxygenated) absorbs more

A

red light at 660nm wavelength

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7
Q

Will pulse ox need recalibrated?

A

NO; LEDs provide monochromatic light, so they emit constant wavelength throughout life and never need recalibration

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8
Q

Noise artifact can arise on a pulse ox when

A

using electrocautery (saw, drill)

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9
Q

Risks when using pulse oximetry

A

-thermal injury from the little heat emitted

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10
Q

If finger has poor circulation you can perform a

A

-finger block with plain local anesthetic or intra-arterial vasodilators to restore circulation & perfusion

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11
Q

If patient is obese you can use this finger for pulse oximetry

A

little finger

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12
Q

If one extremity is above the other (ex: patient laying on side) pulse oximetry should go

A

-in the upper extremity

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13
Q

With epidural/spinal block you may have better pulse ox signal with the

A

toe than finger

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14
Q

Toe pulse ox will be

A

a slower signal, longer to equilibrate

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15
Q

If patient is in Trendelenburg avoid pulse ox in the

A

nose

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16
Q

With burn patients, pulse ox can be placed on

A

cheek

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17
Q

Other pulse ox sites

A

-palm of hand

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18
Q

Normal saturation decreases as

A

altitude above sea level increases

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19
Q

When pulse ox is between 90-100% saturation, the paO2 will be

A

>60 torr

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20
Q

These things will cause the oxyhemoglobin dissociation curve to shift to the left

A

-hypothermia

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21
Q

What on an a-line represents volume status?

A

The complete area under the curve

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22
Q

Carboxyhemoglobin exists to varying degrees in these populations

A

-smokers

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23
Q

Overread spO2 happens with carboxyhemoglobin becuase

A

it has an absorption spectrum similar to oxyhemoglobin (940-990nm)

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24
Q

What is a late sign of carboxyhemoglobin?

A

cherry-red appearance

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25
Q

Methemoglobin occurs in

A

-<1% of humans

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26
Q

Methemoglobin MOA

A

-binds with oxygen and won’t let that oxygen unload to the tissues

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27
Q

Treatment of methemoglobin

A

methylene blue; 1mg/kg

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28
Q

Pts with methemoglobinemia that have spO2>85% their pulse ox will read

A

falsely low

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29
Q

S&S of methemoglobinemia

A

-brownish-gray cyanosis

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30
Q

Pulse ox in sickle cell anemia

A

may have questionable accuracy

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31
Q

Fetal hemoglobin

A

does not affect spO2 readings at low levels

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32
Q

What might cause large decreases in spO2 transiently?

A

DYES:

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33
Q

What color nail polish could interfere with pulse ox?

A

-blue

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34
Q

What is the gold standard of ETT placement and verification?

A

End tidal CO2 measurement

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35
Q

PaCO2 vs EtCO2

A

PaCO2 will be 4-6mmHg higher

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36
Q

Capnometer

A

device that performs measurement and displays readings

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37
Q

Capnography

A

graphic record of CO2 concentration on a screen or paper

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38
Q

Capnograph

A

machine that generates a waveform and the capnogram is the actual waveform

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39
Q

EtCO2 works by

A

comparing a control gas sample of CO2 to the gas from the breathing circuit with infrared light of two different wavelengths (2600 and 4300nm)

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40
Q

CO2 samples for EtCO2 are obtained by two methods:

A

-mainstream (non-diverting)

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41
Q

Mainstream (non-diverting) capnograph

A

flow through in-line sample where CO2 is measured by passing through adaptor

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42
Q

Sidestream (diverting) analyzer

A

aspirating analyzer that transports gases through capillary tubing to chamber

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43
Q

On the capnogram, which letter corresponds with end-tidal concentration?

A

D

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44
Q

Which phase on the capnogram represents inhalation?

A

Phase IV

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45
Q

What finding on the capnogram greatly increases the chances that the EtCO2 reading is a reliable estimate of the level?

A

A good alveolar plateau

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46
Q

Slurred upstroke in capnogram indicates

A

bronchospasm

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47
Q

Plateaus on capnogram all drop is an indication of

A

hyperventilation

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48
Q

Possible causes of low EtCO2 waveform

A

-hyperventilation

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49
Q

Possible causes of elevated EtCO2 waveform

A

-decrease RR

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50
Q

What is the curare cleft on the capnogram waveform an indicator of?

A

-the patient beginning to breath on their own (muscle relaxants are subsiding)

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51
Q

Depth of the curare cleft is inversely proportional to

A

the degree of drug activity (paralytic)

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52
Q

Capnogram waveform that starts with a small breath and follows with subsequent breaths getting progressively higher peaks and gradual return to normal waveform indicates

A

spontaneous respirations

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53
Q

Cardiogenic oscillations of the capnogram waveform is

A

-mainly artifact

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54
Q

Plateaus starting to slur on the capnogram waveform indicate

A

progressive obstruction in the airway

55
Q

Obstructive EtCO2 waveform is classic in

A

-COPD

56
Q

Possible causes of obstructive EtCO2 waveform (that is not due to reactive airway condition)

A

-kinked or occluded artificial airway

57
Q

How to convert carbon dioxide in volumes % to mmHg

A

take atmospheric pressure (760 at sea level) and multiply by the %

58
Q

Possible causes of elevated EtCO2 baseline

A

*incompetent inspiratory valve

59
Q

Possible causes of abnormal descending limb of capnogram (D to E)

A

incompetent inspiratory unidirectional valve

60
Q

Irregular (wavy) plateau or baseline of capnogram

A

-leaky or deflated ETT

61
Q

Sudden drop in EtCO2 to zero causes

A

-missed intubation

62
Q

What other things could cause a decrease in EtCO2 from normal to a sudden low value?

A

-PE

63
Q

What is the advantage to mass spectrometry?

A

can monitor nitrogen

64
Q

Disadvantage to mass spectrometry?

A

-requires constant suction

65
Q

Usually monitor CV in two leads

A

-lead II

66
Q

Lead II recognizes

A

P waves easily and detects dysrhythmias

67
Q

Lead V5 views the

A

anterior and lateral portions of the LV

68
Q

Modified V5 lead (MCL) is used to detect

A

anterior and lateral wall ischemia if only using 3 lead electrodes

69
Q

Placement of electrodes in modified V5 lead (MCL)

A

-right arm in right midclavicular line

70
Q

Systole is

A

the peak pressure within vasculature

71
Q

MAP equation

A

(SBP+ (2*DBP))/3

72
Q

With manual BP listen for these sounds

A

Korotokoff

73
Q

As the BP cuff site becomes more peripheral the

A

-SBP increases

74
Q

BP cuff width should be ___ of the circumference of the limb

A

40-50%

75
Q

BP cuff should have a length that is ____ of the circumference

A

80-100%

76
Q

Too small of a BP cuff leads to

A

falsely high BPs

77
Q

Complications of non-invasive BP monitoring

A

-petechiae

78
Q

Thoracic bioimpedance technology (Cheetah NICOM) is a non-invasive monitoring of

A

CO, SV, CI

79
Q

Cheetah measures

A

-bioimpedance (resistance within thorax bc fluid level in aorta increases)

80
Q

Near-Infrared Spectroscopy (NIRS) measures

A

muscle Hgb O2 sat and muscle hydrogen ion concentration

81
Q

Continuous non-invasive hemodynamic monitoring

A

-Clearsight & nexfin

82
Q

Masimo technology

A

SpHb tech

83
Q

Compensatory Reserve Index (CRI) trends

A

-ciphor ox

84
Q

Ciphor ox (CRI) would be good for

A

trauma or larger surgeries

85
Q

Esophageal doppler technology

A

-measures descending aortic blood flow (70% of CO)

86
Q

Peripheral nerve stimulation

A

-used to determine neuromuscular blockade effect

87
Q

Why are muscle relaxants (paralytics) used?

A

To assure the best surgical field/environment

88
Q

Qualitative peripheral nerve stimulators

A

-TOF

89
Q

Quantitative peripheral nerve stimuator

A

-acceleromyography (AMG)

90
Q

Accelerometry can detect ___% residual NCM

A

97%

91
Q

Most common site of peripheral nerve stimulation

A

ulnar nerve; stimulating the adductor pollicus muscle

92
Q

Peripheral nerve stimulation response is greater when which electrode is distal?

A

negative (black)

93
Q

Facial nerve simulates which muscle

A

obicularis oculi muscle

94
Q

Which drugs are resistant to NMDR?

A

-facial muscles

95
Q

Posterior tibial nerve stimulation causes

A

plantar flexion of the foot and big toe

96
Q

Peroneal nerve stimulation causes

A

dorsiflexion of the foot

97
Q

Full onset of NMB muscle order

A

adductor pollicis, masseter muscle, and muscles of the foot

98
Q

Recovery of neuromuscular function is

A

in reverse order as the onset of blockade with adductor pollicis and foot muscles being last

99
Q

How does the diaphragm and laryngeal muscles react to sux?

A

-diaphragm is resistant

100
Q

Best site to monitor peripheral nerve stimulation for intubation?

A

facial nerve; orbicularis oculi muscle

101
Q

Best site to monitor peripheral nerve stimulation for extubation?

A

ulnar nerve; adductor pollicis

102
Q

What is the most sensitive clinical assessment test of neuromuscular function?

A

Head left

103
Q

Is adequate TV a good indicator of neuromuscular function?

A

NO

104
Q

What is the worst evaluation of extubation?

A

Clinical assessment

105
Q

Single twitch consists of

A

single pulse delivered every 1-10 seconds at 0.1-1.0 Hz, lasting 0.1-0.2 seconds

106
Q

TOF consists of

A

four twitch stimuli over 2 seconds (0.5 second intervals) at 2Hz

107
Q

3 twitches = ___blocked

A

75%

108
Q

2 twitches = __ blocked

A

80%

109
Q

1 twitch = __ blocked

A

90%

110
Q

0 twitches = __ blocked

A

100%

111
Q

How many twitches do you need before you can start to reverse the patient?

A

at least one or it will prolong the block!!!

112
Q

Surgical relaxation generally requires how much blockade?

A

75-90%

113
Q

Peripheral nerve stimulation will not produce fade with this muscle relaxant

A

Sux (depolarizing)

114
Q

Tetanus is

A

stimulus delivered at 50-100Hz for 5 seconds

115
Q

When performing tetanus in a patient on Sux the response will be

A

depressed but sustained

116
Q

When performing tetanus in a patient on NDMBs the response will be

A

depressed and also not sustained (there will be a fade)

117
Q

What is post-tetanic contraction (PTC)?

A

it is a single twitch (1Hz) that is given after tetanus

118
Q

Number of PTCs counted increases as

A

the depth of the NMB decreases

119
Q

PTC can be used when

A

no fade or twitches seen with TOF

120
Q

Double burst stimulation (DBS) consists of

A

-a short burst of 3 stimuli at 50Hz, 750ms pause and then the 3 short bursts repeated again

121
Q

Advantages of double burst stimulation (DBS)

A

-more sensitive than TOF

122
Q

Reversal of blockade can be influenced by:

A

-hypothermia

123
Q

Sux does not exhibit this with peripheral nerve stimulation

A

Fade

124
Q

Awareness monitoring

A

BIS and PSA 4000

125
Q

BIS monitoring ranges from

A

95-100 = awake, no drug effect

126
Q

BIS is more sensitive to

A

hypnotic components of anesthetic rather than analgesic/opiate components

127
Q

BIS should be in this range for general anesthesia

A

40-60

128
Q

BIS monitoring is useful with

A

anesthetic techniques that place patient at increased risk of awareness

129
Q

Other clinical situation that may lead to awareness under anesthesia

A

-emergency c-sections

130
Q

Attempt to maintain UOP >

A

0.5ml/kg/hr

131
Q

>50% of heat loss under anesthesia and surgery is through

A

radiation

132
Q

Best way to minimize heat loss

A

-keep room temp>21 C (69.8F)

133
Q

Most efficient way to rewarm a patient

A

forced air warming blanket (Bair Hugger)

134
Q

Esophageal stethoscope allows for

A

-core temp monitoring

Principles in Practice (19 decks)

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