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summer CV > quiz 2 > Flashcards

quiz 2 Flashcards

1
Q

ASA Standards

A
  1. qualified personnel
  2. oxygenation: SaO2, FiO2
  3. ventilation: ETCO2, stethoscope, disconnect alarm
  4. circulation: BP, pulse, ecg
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2
Q

complications of A-line

A

vasospastic dz, prolonged shock, high-dose vasopressors, prolonged cannulation

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3
Q

as you go up the arm more proximally, the biggest risk of complications is

A

thrombosis (embolic or occlusive dz)

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4
Q

2 advantages of fem a-line

A

assessment of central arterial pressure and appropriate access should placement of IABP become necessary during the surgical procedure

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5
Q

Systolic pressure variation measures what

A

diff between maximal and minimal values of systolic BP during PPV

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6
Q

what is a normal SPV

A

5 mmHg

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7
Q

an SPV of 15mmHg suggests what

A

hypovolemia

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8
Q

CVP wave abnormalities

A

[still need to look up]

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9
Q

where is the IJ vein located in terms of muscles

A

lies in groove between sternal and clavicular heads of sternocleidomastoid muscle

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10
Q

what kind of ekg abnormalities can central line insertion cause

A

PVC’s, VT

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11
Q

what kind of ekg abnormalities can central line insertion cause

A

PVC’s, VT

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12
Q

which subclavian should you try first and why

A

left. even though risk of thoracic duct, right side acute angle is difficult.

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13
Q

which CVC site has great risk for vascular avulsion

A

EJ

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14
Q

what are the complications of double cannulation of the same vein

A

vein avulsion (most common), catheter entanglement, catheter fracture.

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15
Q

why shouldn’t you cannulate both sides of the neck

A

limits venous drainage

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16
Q

CVP reflects pressure at

A

junction of vena cava and RA

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17
Q

CVP provides estimate of what two things

A

intravascular blood volume and RV preload

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18
Q

CVP should be measured at

A

end-expiration

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19
Q

CVP is zeroed at

A

mid-axillary line

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20
Q

PA catheter- how do you know youre in the RV

A

spike in systolic pressure

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21
Q

PA catheter - how do you know youre in the PA

A

spike in diastolic pressure

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22
Q

if patient has a preexisting LBBB and you put in a swan, you should also do what

A

externally pace

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23
Q

what is the most common complication of PA cath insertion

A

arrhythmia

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24
Q

in what condition does PAOP underestimate LVEDV

A

aortic insufficiency

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25
Q

in what conditions does PAOP overestimate LVEDP (and by extension LVEDV)

A

impaired LV compliance (ischemia)

mitral valve dz (stenosis or regurg)

L->R shunt
tachycardia
PPV
PEEP
COPD
Pulm htn
non west zone III placement of PAC
26
Q

Thermodilution technique

A

inject fixed volume, 10ml of room temp or iced D5W) into CVP port at end-expiration and measure resulting change in blood temp at distal thermistor

27
Q

CO relationship to area under the curve

A

indirectly proportional

28
Q

what makes CO measurements inaccurate

A

variations in respiration (use avg of 3 measures)

blood clot over thermistor tip: inaccurate temp

shunts: LV + RV outputs unequal, CO invalid

TR: recirculation of thermal signal, CO invalid

computation constants : varies for each OAC

29
Q

If what two things remain constant, SVO2 is indirect indicator of CO

A

O2 sat, VO2+Hg (sat and delivery)

30
Q

how can we measure CO

A

swan or CVP, or blood gas from PA/CVP

31
Q

normal SvO2 value

A

65%

32
Q

What is the most common reason for an elevated mixed venous sat?

A

over wedged or advanced PA cath….. think because it is further into the pulm circulation so higher O2 content.

33
Q

what are the 2 broad things that cause an increase in SVO2

A

hyper oxygenated state or inability to extract oxygen

34
Q

an increased SVO2 is what percentage

A

> 75%

35
Q

high cardiac output (sepsis, burns, L–>R shunt, AV fistulas) causes an increase or decrease in svO2?

A

increase

36
Q

carbon monoxide causes a high or low SVO2

A

high

37
Q

SVO2 varies directly with

A

SaO2, Hg, CO

38
Q

SVO2 varies indirectly with

A

VO2 (consumption)

39
Q

bleeding/shock causes high or low SVO2?

A

low

40
Q

fever, agitation, thyrotoxic, shivering causes high or low SVO2

A

low

41
Q

MI, CHF, hypovolemia causes high or low SVO2

A

low (think decreased CO)

42
Q

hypothermia causes high or low SVO2

A

high (think decreased demand)

43
Q

general anesthesia causes high or low SVO2

A

high (think decreased demand)

44
Q

NMB causes high or low SVO2

A

high (think decreased demand)

45
Q

sepsis causes high or low SVO2

A

high (think high cardiac output)

46
Q

burns causes high or low SVO2

A

high (high cardiac output)

47
Q

left to right shunt causes high or low SVO2

A

high (high cardiac output)

48
Q

in patients with CAD what are the best leads for detecting myocardial ischemia

A

II and V5

49
Q

an under dampened system will ___estimate systolic BP and ___diastolic BP

A

overestimate systolic, underestimate diastolic

50
Q

an over dampened system will not oscillate at all but will settle to baseline slowly, thus ____ systolic and ____ diastolic pressures.

A

underestimating systolic and overestimating diastolic

51
Q

advantage of brachial A-line found by cleveland clinic

A

the elimination of the pressure discrepancy seen with radial a-lines in the immediate post bypass period

52
Q

what two things cause a narrow pulse pressure on the arterial waveform

A

pericardial tamponade and hypovolemia

53
Q

increase in pulse pressure may be a sign of

A

worsening aortic valvular insufficiency or mild hypovolemia

54
Q

a dicrotic notch appearing high on the downslope of the pressure trace suggests ____ vascular resistance

A

high

55
Q

highest rate of pneumothorax is with which approach

A

subclavian

56
Q

what causes most pressure monitoring errors?

A

air within a catheter or transducer

57
Q

T/F ? the radial artery pressure may be significantly lower than the aortic pressure at the completion of CPB and for 5-30 min following CPB

A

true

58
Q

what is the current consensus on benefit of PAC

A

placement may have benefit in high-risk patients, or those with special indications. however, in routine CABG patients, the PAC has little, if any, benefit.

59
Q

T/F: in cardiac surgical patients with ascending aortic atheroma identified by epiaortic scanning, modification of the surgical technique and neuroprotective strategies have been reported to reduce the incidence of neurologic complications from ~60% to 0%

A

true

60
Q

t/f: though low serum calcium may affect myocardial pumping function, admin of ca during potential neural ischemia or repercussion may likely worsen the outcome and should be avoided

A

T

summer CV (1 decks)

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