SEE Exam

Question 1

Where do you place the CVP transducer?

Answer 1

Phlebostatic Access

Question 2

Which IJ is preferred for CVC placement?

Answer 2

Right IJ - b/c left has the thoracic duct

Question 3

What do large A-waves on a CVP tracing indicate? (3)

Answer 3

tricuspid/pulmonary stenosis
pulmonary HTN
decreased RV compliance

Question 4

What do large V waves on a CVP tracing indicate?

Answer 4

tricuspid regurgitation
RV papillary muscle ischemia
pericarditis
tamponade

Question 5

Where do you place a multiorifice catheter vs single orifice?

Answer 5

multi = 2 cm below SVC
single = 3 cm above SVC

Question 6

Explain the bainbridge reflex.

Answer 6

Located in RA and great veins

Stretch of RA –> increased HR with inspiration via vagus nerve

Question 7

Where are the arterial baroreceptors located?

Answer 7

Aortic arch –> vagus nerve (afferent, r/t stretch)
Carotid body –> glossopharyngeal nerve “Hering’s” (afferent)

Efferent via vagus and T1-T4

Question 8

Swan-Ganz RA pressure/depth

Answer 8

1 - 8 mmHg

20 cm

Question 9

Swan-Ganz RV pressure/depth

Answer 9

15 - 25/ 0 - 8

30 cm

Question 10

Swan-Ganz PA pressure/depth

Answer 10

15-25/8-15

45 cm

Question 11

PCWP pressure/depth

Answer 11

6-12

45-50

Question 12

Swan-ganz LA and LV pressure

Answer 12

LA = 2 - 12
LV = 100 - 140/ 0 - 12

Question 13

When is PAWP > PADP

Answer 13

MS
alveolar pressure increased
pulmonary venous obstruction

Question 14

High transducer for an A-Line =

Answer 14

Lower blood pressure

Question 15

How much higher is invasive BP than non-invasive

Answer 15

20 mmHg

Question 16

SV normal

Answer 16

60 - 90

Question 17

SI normal

Answer 17

40 - 60

Question 18

PVR normal

Answer 18

50 - 150 dynes

Question 19

CoPP

Answer 19

ADBP - PCWP = 60 - 160

Question 20

RBB

Answer 20

V1 = RSR, broad R wave
V6 = qRS, broad S wave

Question 21

LBBB

Answer 21

V1= no R wave, wide negative S wave
V6= no Q wave, wide notched R wave

Question 22

SA or AV nodal dysrythmias

Answer 22

d/t obstruction of RCA or circumflex

i.e., inferior/posterior MI

Question 23

anterior MI dysrythmia

Answer 23

wide complex rhythms

BBB, complete heart block, mobitz type II, idioventricular

Question 24

ECG electrodes

EEG electrodes

Answer 24

ECG = 1 mV or 1000 microvolts
EEG = .1 mv or 100 microvolts

Question 25

how do you modify V5 lead?

Answer 25

place LA over the anterior axillary line at the level of 5th ICS, and select lead I as monitoring lead

Question 26

What is the U wave?

Answer 26

small positive wave following T wave
associated with high calcium, low potassium,
OR : quinidine, dig, epi
OR: ICH, papillary muscle dysfunction

Question 27

CO to organs

Answer 27

Lungs = 100%
Liver = 27%
Kidneys = 22%
CNS = 15% (750 mL)
Heart = 5% (225 mL)

Question 28

when should you do a thoractomy?

Answer 28

initial drainage > 1,000 mL or > 200 mL/hr or white out on CXR or large air leak

you can do VATS if HD stable and bleeding is < 150mL/hr

Question 29

Chylothorax risk associated with CVC insertion

Answer 29

Especially the left side, b/c the thoracic duct empties the lymph into the left subclavian vein