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APA > SRNA Presentations: Part 2 > Flashcards

SRNA Presentations: Part 2 Flashcards

1
Q

What is piezoelectricity?

A

Ability of certain materials to generate AC voltage when subjected to stress or vibration-or vibrate when subjected to AC voltage
- most common piezoelectric material is quartz

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2
Q

Who is considered the “father of echocardiography”?

A

Dr Ingle Edler

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3
Q

How does ultra sound work?

A

An ultra sound beam is generated by oscillating crystals
- crystals are excited by electrical impulses (piezoelectric effect)
- U.S. waves sent from transducer, through tissues, return to transducer as reflected echos
- waves reflected at tissue surfaces of different density
* If no difference in tissue density—> no echos produced
(Homogenous fluids like blood, urine, ascites are seen as echo free structures)

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4
Q

What angle provides optimal ultrasound reflection?

A

90 degrees

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5
Q

What is M-mode echocardiography?

A
  • simplest type of echo
  • image is similar to a tracing
  • useful in measuring size of heart structures, thickness of heart walls and size of heart itself
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6
Q

What is doppler echo?

A

Assesses blood flow through chambers and valves

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7
Q

What is color Doppler?

A
  • enhanced form of Doppler echo

- different colors used to designate direction of blood flow

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8
Q

What is 2-d echo?

A

Used to view motion of heart structures in real time

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9
Q

What is 3-d echo?

A

View of heart structure in greater depth

Also in real-time

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10
Q

What do the different colors mean in color Doppler?

A 
Blue= away from probe
Red= toward probe
Green= turbulence
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11
Q

Advancing probe into esophagus allows for what types of views?

A

Upper, mid and transgastric

-probe can then be turned right and left

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12
Q

What can be viewed from an ME4 chamber view?

A 
Chamber size
Ventricle function
MVD
TVD 
Atrial-septal defect
Pericardial effusion
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13
Q

Unless contraindicated, TEE should be used:

A

In all open heart and thoracic aortic procedures

  • should be considered in CABGs
  • case by case basis for kids—> unique risks
  • use in non-cardiac surgery if suspected CV pathology ay result in severe hemodynamic, pulmonary, or neuro. Compromise
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14
Q

What is the primary use of TEE?

A

Diagnose hemodynamic instability caused by MI, heart failure, valve abnormalities, hypovolemia, tamponade

  • estimates SV, CO, intracavitary pressures
  • dx structural hart disease (PE)
  • guides surgical interventions/medications
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15
Q

What are absolute contraindications for TEE?

A
  • esophageal stenosis
  • large esoph. Diverticuli
  • recent esoph. Surgery/sutures
  • know esoph. Interruptions
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16
Q

Why is TEE especially risky for children?

A

Even a probe of appropriate size may cause airway obstruction, or compress descending aorta

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17
Q

What is blood pressure?

A

The driving force of blood against arterial walls

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18
Q

What are the ranges form hypertension and hypertensive crisis?

A

HTN= >_ 140/90

Hypertensive crisis= >_ 180/120

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19
Q

How do you calculate MAP?

A

SVR x CO

1/3 (SBP -DBP) + DBP

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20
Q

How does the size of BP cuff effect the BP measurement?

A

Cuff too large will not restrict flow properly (underestimates BP)
Cuff too small cuts off too much blood flow (overestimates BP)
** make sure 1 fingertip can fit beneath cuff **

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21
Q

What are indications for using an arterial line?

A

When beat to beat monitoring is required for:

  • multiple comorbidities (anticipate instability)
  • certain surgeries: cardiothoracic, neuro, neurovascular—>prolonged surgery of any type
  • need for frequent arterial sampling
22
Q

When is an arterial line contraindicated?

A

When arterial supply compromised

- Reynaud’s, thromboangitis obliterans (Buerger’s disease)

23
Q

What does the art line wave form tell you about MAP?

A

AUC = MAP

24
Q

How can you assess hypovolemia from an art line waveform?

A

Will have shorter height during inhalation while on mechanical ventilation

25
Q

What method of measurement does an automatic NIBP machine use?

A

Oscillometric

26
Q

What part of waveform represents diastole?

A

After the dicrotic notch

27
Q

What sounds are heard during auscultation of manual BP?

A

Kortokoff sounds (turbulence) are heard when an artery is partially constricted

28
Q

What are some risks of cannulation of an artery?

A

Limb ischemia, hematoma, air emboli

29
Q

What situation indicates the need for art line BP monitoring?

A

Pt with metabolic acidosis, scheduled for a lengthy procedure

30
Q

What type of feedback system is thermoregulation?

A

Negative feedback system

31
Q

How does thermoregulation work in the body?

A

Thermo-sensitive receptors send info to hypothalamus when excited

 - excited when temperature is sensed outside of threshold
 - brain sends messages to modify behavior in order to modify temp (shivering, removing clothing, etc)
32
Q

What plays the most effective role in thermoregulation?

A

Behavior: clothing, changing environment, changing body position, voluntary movement
* a pt under GA cannot “behave”

33
Q

What are the types of heat loss and percentages they account for in the body?

A

Convection: 30%
Conduction: 20%
Radiation: 40%
Evaporation: 10%

34
Q

Hypothermia can cause:

A
  • cardiac arrhythmias and ischemia—> j wave
  • increased peripheral vascular resistance
  • left shift
  • reversible coagulopathies
  • AMS
  • impaired renal function
  • increased post-op catabolism and stress response
  • delayed drug metabolism
  • impaired wound healing/increased risk of infection
35
Q

What is a J wave (Osborne wave)?

A

Associated with hypothermia

  • slow upright deflection at the end of QRS and early part of ST segment
    • ST elevation often reported with ‘J’ waves
36
Q

What are anesthetics that interfere with thermoregulation?

A
  • inhaled gases: vasodilation
  • spinal/epidural: vasodilation, altered perception of temperature
  • GA: vasodilation, heat redistribution
  • opioids: depress sympathetic response and decrease threshold for cold response
37
Q

What is phase 1 of hypothermia?

A

1st hour of GA
Core temp drops 1-2 degrees C
Vasodilation and heat redistribution

38
Q

What is phase 2 of hypothermia?

A

3-4 hours of surgery
Gradual decline (linear) in core temp
From pt to environment

39
Q

What is phase 3 in hypothermia?

A

Plateau

Core temp reaches a steady state

40
Q

What is malignant hyperthermia?

A

Caused by anesthetic gases or succinylcholine
- agents cause Ca release, but stop reabsorbing Ca back —> continuous reaction of muscle contraction—> hypermetabolic state

41
Q

How do you recognize malignant hyperthermia?

A

Seen ~ 1 hour after receiving inhaled gas or succinylcholine

    • WILL SEE A HUG (RAPID) SPIKE IN ETCO2 *** drastically elevated
  • tachycardia, fever, muscle rigidity
    • NMB reversal agents will do nothing to reverse MH
  • it’s a hypermetabolic state with increased sympathetic activity
    • metabolic acidosis, cyanosis, mottling
42
Q

What is the only treatment for MH?

A 
Dantrolene 2.5mg/kg      
     - mix with 60mL sterile water
Or
Ryanadex 2.5mg/kg
     - mix with less volume 
* both require multiple doses *
Treatment involves getting Ca reabsorbed
43
Q

What is MH caused by?

A

A mutation of Ryanodine (Ryr 1) receptor on chromosome 19–> GENETICS

44
Q

What is the most common condition confused for MH?

A

Elevated CO2 caused by insuflation

  • important to recognize early and rule out other cases—> start treating ASAP
  • dantrolene will not harm pt if given outside of MH (may cause muscle weakness afterwards)
45
Q

What are other conditions that mimic MH?

A
  • neuroleptic malignant syndrome (NMS):
    • pts receiving antidopaminergic agents
      • elevated temp, muscle rigidity, dyskinesia
      • reversing non-depolarizer will reverse rigidity in NMS
  • thyroid storm:
    • tachycardia/tachyarrythmias, elevated temp, hypotension, CHF
      • hypokalemia is common
  • drug induced hyperthermia
    • serotonin syndrome or from elicit drugs
  • environmental hyperthermia
    • not uncommon in peds from excessive warming devices
  • brainstem/hypothermic injury
  • sepsis
  • transfusion reaction
46
Q

What does the pneumonic “Some hot dude better give iced fluids fast” mean?

A 
Stop triggering agents
Hyperventilate/Hunderd percent o2
Dantrolene (2.5mg/kg) up to 10 mg/kg
Bicarbonate
Glucose and Insulin
IVF and cooling blanket
Fluid output monitoring/furosemide
Fast HR-tachycardia
47
Q

What are some active warming devices?

A
  • Kim Clark vest: with warm water running through it
  • bear hugger
  • IVF warmer
  • warm blankets are NOT active warmers—> they do not produce heat
48
Q

What type of reaction is the CO2/soda lime reaction?

A

Exothermic

49
Q

Where is the optimal location to place an esophageal temp probe?

A

Lower 1/4 of esoph. Is warmest and most stable site

50
Q

What are common temp. Monitors in the OR?

A
  • axilla, oral, rectal, or esophageal probes
  • skin- forehead sticker
  • swan-ganz thermistor

APA (8 decks)

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