Test 1 part I (Clinical Monitoring) Flashcards
What are the AANA standards for monitoring and alarms?
- Monitor, evaluate, & document physiologic condition as appropriate for procedure & anesthetic technique
- Variable pitch & threshold alarms turned on & audible
- Document BP, HR, RR at least every 5 minutes for all anesthetics
- Oxygenation, Ventilation, Cardiovascular, Thermoregulation, Neuromuscular
- Inspection, Auscultation, Palpation
- Precordial Stethoscope (heart & breath sounds, all forms of anesthesia, Peds) or Esophageal Stethoscope (heart & breath sounds, temperature, only during GA)
What are the indications for ECG monitoring?
Measurement of HR, Diagnosis of arrhythmias, electrolytes imbalances, conduction defects, Diagnosis of ischemia, Pathologic Q waves
What is Heart Rate?
Electrical depolarization with systolic contraction
What is Pulse Rate?
Detectable peripheral arterial pulsation
Continuous ECG Monitoring =
Standard of care
Distorted ECG tracings
Artifact
What are the most common causes of Artifact?
ESU, IONM stimulation, shavers
Which part of the ECG waveform represents atrial depolarization?
P Wave
Which part of the ECG waveform represents the bridge between atrial and ventricular activation?
PR Interval
What is a normal PR Interval?
0.12-0.2 sec
Which part of the ECG waveform represents ventricular depolarization?
QRS Complex
What is the normal length of time for a QRS complex?
0.06-0.1 sec
Which part of the ECG waveform represents ventricular repolarization?
ST Segment
Which part of the ECG waveform represents ventricular repolarization?
T Wave
What are the standard limb leads and what direction is their waveforms?
I, II, and III; positive
What are Goldberger’s Augmented Leads?
aVR, aVL, and aVF
Which direction is the waveform for aVR?
Negative
Which direction is the waveform for aVL?
P&T Negative, QRS Biphasic
Which direction is the waveform for aVf?
Positive
What are the precordial chest leads?
V1-V6
What direction are the waveforms for the precordial leads?
P&T positive, QRS start negative and end positive
A common, simple, and inexpensive method of monitoring ECG.
-Inadequate for diagnosing complex arrhythmias & ST Segment analysis
3 Bipolar Leads
A method of monitoring ECG that is the standard of care for at risk patients.
5 Lead
Which lead is preferred for arrhythmia monitoring?
Lead II
Which leads are preferred for ischemia monitoring?
V3-V5
Which part of the ECG waveform is the most sensitive to myocardial ischemia?
ST Segment
Indicates transmural ischemia (acute coronary occlusion or spasm)
ST segment elevation
Indicates subendocardial ischemia (stable angina, significant but stable CAD)
ST Segment Depression
What are ECG changes associated with Hypokalemia?
- ST depression with flat T waves
- Prolonged repolarization (long QT, Torsades de Pointes)
What are ECG changes associated with Hyperkalemia?
- Narrow peaked T wave, short QT interval
- QRS widening, flat P wave, PR prolonged, 2nd/3rd degree heart blocks
- Ventricular flutter, asystole
What are ECG changes associated with Hypocalcemia?
Prolonged QT
What are ECG changes associated with Hypercalcemia?
Short QT, decreased T wave amplitude or inversion
Routine assessment of BP q ____ minutes is essential for safe anesthesia.
5 minutes
How to calculate MAP?
MAP = (SBP + DBPx2)/3
What are contraindications for NIBP Monitoring?
Iatrogenic injury from repeated cycling
What are limitations of NIBP monitoring?
Cuff about 40% circumference of extremity, detection of Korotkoff sounds, Requires pulsatile flow, Cuff movement, Shivering, Equipment failure
Cuff too small, too tight, or extremity below heart would cause a falsely ____ pressure.
Falsely high
Cuff too large, extremity above heart, or after quick deflation would cause a falsely ____ pressure.
Falsely low
What all is measured by the ClearSight Finger Cuff?
Non-invasive continuous BP, SV, SVV, CO, SVR
What is the gold standard for recording BP?
Invasive BP Monitoring
What is the gold standard for recording BP?
Invasive BP Monitoring
What is the most common location for invasive BP monitoring?
Radial artery (also ulnar, brachial, axillary, femoral, DP)
What are the risks associated with arterial line insertion?
Infection, thrombus, hematoma, vasospasm, ischemia, but vigilance is paramount!!
What are the indications for invasive BP monitoring?
Beat to beat continuous assessment of BP, Arterial blood sampling, Acute/gross changes in hemodynamics, Anticipated vasoactive meds, Significant comorbidities, Diagnostic waveform analysis, Failure of NIBP
What does the Modified Allen Test predict?
It predicts ischemia risk with arterial line by assessing collateral flow to the hand
How is the arterial waveform created?
Arterial waveform results from blood ejection from left ventricle into aorta during systole, followed by peripheral runoff during diastole
What does the area under the curve of an arterial waveform approximate?
The MAP
What does the Dicrotic Notch reflect?
Closure of the aortic valve
Tests the dampening in the system or how rapidly a system comes to rest after being set in motion.
Square Wave Test
What is a normal result on the Square Wave Test?
Distinct dicrotic notch, no more than 2 oscillations
A square wave test with a lost dicrotic notch, and no more than 1 oscillation
Over damped (Systolic BP is underestimated)
A square wave test with multiple artifacts, and many post flush oscillations
Under damped (Systolic BP is overestimated; MAP remains accurate)
As the arterial wave travels from central to peripheral, what happens to the Upstroke, Systolic Peak, Dicrotic Notch, Diastolic Wave, and End Diastolic Pressure
Upstroke becomes steeper, Systolic peak increases, Dicrotic notch is later, Diastolic wave more prominent & end diastolic pressure decreases
