Patient Monitoring Flashcards

1
Q

Why do we monitor patients under anesthesia

A

dramatically reduces morbidity and mortality; improves the quality of anesthesia and analgesia

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2
Q

when do we monitor patients

A

immediately following sedation, during anesthesia, post-anesthesia until normal physiological variables and stable

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3
Q

what period is associated with the highest morbidity and mortality? what can you do to avoid it?

A
  • Recovery period is associated with the highest morbidity and mortality therefore don’t stop monitoring after you extubate your patient!
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4
Q

what do we typically measure during anesthesia

A

depth and physiological variables

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5
Q

in general, what is the relationship between depth and physiological variables

A

as you depress the CNS (get deeper), physiological variables lower

linear relationship

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6
Q

how often do we monitor and record variables related to depth and physiology

A

every 5 minutes

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7
Q

how should we go about determining/assessing patient depth and physiological variables and why?

A
  • Multiple variables are considered
    when assessing a patient’s depth
    of anesthesia and physiologic
    status
  • A patient’s status can change
    quickly therefore we monitor
    continuously and record data
    every 5 minutes to monitor
    trends
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8
Q

what are ways to monitor patient depth using:
- physical exam
- monitors

A

physical exam:
- physiologic variables
- eye position and movement
- eyelid movement
- reflexes
- tear production
- jaw tone

monitors:
- EEG

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9
Q

in general, as patients become deeper what happens to eye position

A

moves ventromedially

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10
Q

what does eyelid movement tell us about patient depth and what is the exception

A
  • During inhalant anesthesia = patient too light
  • During injectable anesthesia with ketamine (equine in particular) = patient may be adequately anesthetized
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11
Q

if an animal has nystagmus what does that tell us

A

they are too light

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12
Q

how can we determine depth with palpebral in companion animals

A

-Assess Medial and Lateral Palpebral
-Lateral palpebral reflex is lost at a lighter plane of anesthesia

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13
Q

what is specific to horses regarding palpebral reflex

A

as one reflex (fan eyelids)

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14
Q

what is tearing a sign of in horses

A

-tearing is a sign of a light plane of
anesthesia irrespective of anesthetic protocol (injectable or inhalant)

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15
Q

jaw tone is a very helpful indicator of depth in what species? what does it tell us?

A

cats

lack of muscle relaxation = too light plane of anesthesia

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16
Q

how do signs related to depth of anesthesia in dogs and cats differ between inhalant and injectable anesthesia

A

jaw tone: tight in a medium light plane of anesthesia with injectable

eye position: stays central regardless of depth with injectable

palpebral reflex: present in a medium light plane and slow in a medium deep plane with injectable

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17
Q

CVS and respiratory variables and depth of anesthesia

A

HR; increases = light
BP; increases = light
RR; increases = light
resp effort/pattern; increases = light

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18
Q

what are the components of the physical exam (manual) to monitor physiological variables in an anesthetized patient

A

observe:
- mm rolour
- RR

palpate:
- pulse (or auscult)
- CRT
- temperature of extremities

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19
Q

what types of monitors can we use to monitor pulse rate

A

pulse oximeter
pulse minder
doppler BP monitors
oscillometric BP monitors

20
Q

what types of monitors can we use to monitor BP

A

doppler BP monitor
oscillometric BP monitor
invasive (direct)

21
Q

why is EKG not a heart PERFORMANCE indicator

A

it is just measuring electrical activity

22
Q

purpose, advantages and disadvantages of a pulse minder

A
  • Detects perfusion and displays pulse rate
  • Advantages: easy and fast,
  • Disadvantage: limited to just pulse rate vs new equipment (ex. Pulse oximeter)
22
Q

why can EKG be misleading

A

-may not have good contact of the leads
-it reads deflection from baseline so may get two deflections on a single beat or other artifacts making the rate inaccurate

23
Q

advantages of EKG (2)

A

HR and rhythm displayed

24
components of a doppler (4)
1. Piezoelectric crystal 2. Box that converts ultrasound waves to audible signal 3. Cuff to place proximal to probe 4. Sphingomanometer
25
cuff size in small animals should be ?
35-40% of the circumference of the placement site for a Doppler and 30-40% of the circumference of the placement site for an oscillometric monitor
26
T/F Doppler gives accurate BP regardless of extremes (hypo or hypertension) in all species
F; it does give reliable pressure readings but only useful in dogs and cat
27
pressure determined using a doppler represents _______ pressure in the dog and __________ pressure in the cat
systolic.... mean
28
advantages of a doppler (4)
* Non-invasive * Audible pulse signal * Less interference of arrhythmias on blood pressure measurement * Reliable with extremes in blood pressure
29
disadvantages of a doppler (3)
* It requires manual placement of the probe * Electrical interference = noisy! * Useful in small animal patients only
30
what information will an oscillometric bp monitor display
systolic diastolic mean pulse rate
31
if you had a hypo/hypertensive patient or a patient with an arrhythmia is it better to use a doppler or oscillometric monitor
doppler baby
32
what can we use to measure: - oxygenation (O2) - ventilation (CO2)
Oxygenation: - pulse oximeter - arterial blood gas Ventilation: - arterial blood gas - capnograph (ETCO2)
33
advangtes and disadvantages of direct blood pressure measurement
Advantages: * Accurate * Continuous data * Useful in a range of species Disadvantages: * Requires arterial catheter-potential for complications * Skill required to place * Require monitor capable of displaying direct arterial pressure
34
how does a pulse oximeter work and what info does it give us
uses red and infrared light to measure hemoglobin oxygen saturation SpO2; heart rate/pulse rate
35
what do we want to see on a SpO2 reading
> 90% (normally 90-100 in arteries)
36
advantages vs disadvantages of pulse oximeter
Advantages: * easy and fast to use, * non-invasive Disadvantages: * it requires light transmission through tissue therefore pigmentation alters its ability to transmit light * vasoconstriction can interfere with its ability to read * less accurate in large animals due to thickness of suitable tissue (ie. Tongue) * Only telling you hemoglobin saturation not oxygen content
37
what is a major disadvantage of pulse oximeters
only telling you hemoglobin saturation not oxygen content so it assumes normal hemoglobin levels…
38
T/F vasoconstriction and skin pigmentation can interfere with pulse oximeter readings
T
39
what can blood gas analyzers be used to measure
* Can measure pH, PaCO2, PaO2, electrolytes, Hb, * Can measure glucose, lactate etc....
40
advantages and disadvantages of blood gas analyzers
Advantages: * Accurate Disadvantages: * Cost * Maintenance requirements
41
why do we measure END tidal CO2
at the end of an exhale there is less expired CO2 mixing with inspired O2, making the reading a more accurate indicator of arterial CO2 concentration…
42
how is capnography and pulse oximetry similar
both use infrared
43
advantages and disadvantages of capnography
Advantages -Non-invasive -Continuous information on adequacy of ventilation (ie. Elimination of CO2) Disadvantages * Adds to dead space-important in small patients * Moisture can clog sampling line
44
temperature changes during anesthesia meaning
-Changes in body temperature are common -Can change normal physiologic function (contribute to bradycardia, hypotension) -Can alter pharmacodynamics and pharmacokinetics of drugs
45
temperature changes during anesthetic recovery meaning
Shivering dramatically increases oxygen consumption It is UNPLEASANT and UNCOMFORTABLE