quiz 2

Question 1

ASA Standards

Answer 1

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

Question 2

complications of A-line

Answer 2

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

Question 3

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

Answer 3

thrombosis (embolic or occlusive dz)

Question 4

2 advantages of fem a-line

Answer 4

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

Question 5

Systolic pressure variation measures what

Answer 5

diff between maximal and minimal values of systolic BP during PPV

Question 6

what is a normal SPV

Answer 6

5 mmHg

Question 7

an SPV of 15mmHg suggests what

Answer 7

hypovolemia

Question 8

CVP wave abnormalities

Answer 8

[still need to look up]

Question 9

where is the IJ vein located in terms of muscles

Answer 9

lies in groove between sternal and clavicular heads of sternocleidomastoid muscle

Question 10

what kind of ekg abnormalities can central line insertion cause

Answer 10

PVC’s, VT

Question 11

what kind of ekg abnormalities can central line insertion cause

Answer 11

PVC’s, VT

Question 12

which subclavian should you try first and why

Answer 12

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

Question 13

which CVC site has great risk for vascular avulsion

Answer 13

EJ

Question 14

what are the complications of double cannulation of the same vein

Answer 14

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

Question 15

why shouldn’t you cannulate both sides of the neck

Answer 15

limits venous drainage

Question 16

CVP reflects pressure at

Answer 16

junction of vena cava and RA

Question 17

CVP provides estimate of what two things

Answer 17

intravascular blood volume and RV preload

Question 18

CVP should be measured at

Answer 18

end-expiration

Question 19

CVP is zeroed at

Answer 19

mid-axillary line

Question 20

PA catheter- how do you know youre in the RV

Answer 20

spike in systolic pressure

Question 21

PA catheter - how do you know youre in the PA

Answer 21

spike in diastolic pressure

Question 22

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

Answer 22

externally pace

Question 23

what is the most common complication of PA cath insertion

Answer 23

arrhythmia

Question 24

in what condition does PAOP underestimate LVEDV

Answer 24

aortic insufficiency

Question 25

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

Answer 25

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 ```

Question 26

Thermodilution technique

Answer 26

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

Question 27

CO relationship to area under the curve

Answer 27

indirectly proportional

Question 28

what makes CO measurements inaccurate

Answer 28

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

Question 29

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

Answer 29

O2 sat, VO2+Hg (sat and delivery)

Question 30

how can we measure CO

Answer 30

swan or CVP, or blood gas from PA/CVP

Question 31

normal SvO2 value

Answer 31

65%

Question 32

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

Answer 32

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

Question 33

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

Answer 33

hyper oxygenated state or inability to extract oxygen

Question 34

an increased SVO2 is what percentage

Answer 34

>75%

Question 35

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

Answer 35

increase

Question 36

carbon monoxide causes a high or low SVO2

Answer 36

high

Question 37

SVO2 varies directly with

Answer 37

SaO2, Hg, CO

Question 38

SVO2 varies indirectly with

Answer 38

VO2 (consumption)

Question 39

bleeding/shock causes high or low SVO2?

Answer 39

low

Question 40

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

Answer 40

low

Question 41

MI, CHF, hypovolemia causes high or low SVO2

Answer 41

low (think decreased CO)

Question 42

hypothermia causes high or low SVO2

Answer 42

high (think decreased demand)

Question 43

general anesthesia causes high or low SVO2

Answer 43

high (think decreased demand)

Question 44

NMB causes high or low SVO2

Answer 44

high (think decreased demand)

Question 45

sepsis causes high or low SVO2

Answer 45

high (think high cardiac output)

Question 46

burns causes high or low SVO2

Answer 46

high (high cardiac output)

Question 47

left to right shunt causes high or low SVO2

Answer 47

high (high cardiac output)

Question 48

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

Answer 48

II and V5

Question 49

an under dampened system will ___estimate systolic BP and ___diastolic BP

Answer 49

overestimate systolic, underestimate diastolic

Question 50

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

Answer 50

underestimating systolic and overestimating diastolic

Question 51

advantage of brachial A-line found by cleveland clinic

Answer 51

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

Question 52

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

Answer 52

pericardial tamponade and hypovolemia

Question 53

increase in pulse pressure may be a sign of

Answer 53

worsening aortic valvular insufficiency or mild hypovolemia

Question 54

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

Answer 54

high

Question 55

highest rate of pneumothorax is with which approach

Answer 55

subclavian

Question 56

what causes most pressure monitoring errors?

Answer 56

air within a catheter or transducer

Question 57

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

Answer 57

true

Question 58

what is the current consensus on benefit of PAC

Answer 58

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.

Question 59

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%

Answer 59

true

Question 60

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

Answer 60

T