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AP 1 > Test 1 part I (Clinical Monitoring) > Flashcards

Test 1 part I (Clinical Monitoring) Flashcards

1
Q

What are the AANA standards for monitoring and alarms?

A
  1. Monitor, evaluate, & document physiologic condition as appropriate for procedure & anesthetic technique
  2. Variable pitch & threshold alarms turned on & audible
  3. Document BP, HR, RR at least every 5 minutes for all anesthetics
  4. Oxygenation, Ventilation, Cardiovascular, Thermoregulation, Neuromuscular
  5. Inspection, Auscultation, Palpation
  6. Precordial Stethoscope (heart & breath sounds, all forms of anesthesia, Peds) or Esophageal Stethoscope (heart & breath sounds, temperature, only during GA)
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2
Q

What are the indications for ECG monitoring?

A

Measurement of HR, Diagnosis of arrhythmias, electrolytes imbalances, conduction defects, Diagnosis of ischemia, Pathologic Q waves

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3
Q

What is Heart Rate?

A

Electrical depolarization with systolic contraction

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4
Q

What is Pulse Rate?

A

Detectable peripheral arterial pulsation

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5
Q

Continuous ECG Monitoring =

A

Standard of care

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6
Q

Distorted ECG tracings

A

Artifact

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7
Q

What are the most common causes of Artifact?

A

ESU, IONM stimulation, shavers

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8
Q

Which part of the ECG waveform represents atrial depolarization?

A

P Wave

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9
Q

Which part of the ECG waveform represents the bridge between atrial and ventricular activation?

A

PR Interval

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10
Q

What is a normal PR Interval?

A

0.12-0.2 sec

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11
Q

Which part of the ECG waveform represents ventricular depolarization?

A

QRS Complex

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12
Q

What is the normal length of time for a QRS complex?

A

0.06-0.1 sec

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13
Q

Which part of the ECG waveform represents ventricular repolarization?

A

ST Segment

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14
Q

Which part of the ECG waveform represents ventricular repolarization?

A

T Wave

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15
Q

What are the standard limb leads and what direction is their waveforms?

A

I, II, and III; positive

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16
Q

What are Goldberger’s Augmented Leads?

A

aVR, aVL, and aVF

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17
Q

Which direction is the waveform for aVR?

A

Negative

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18
Q

Which direction is the waveform for aVL?

A

P&T Negative, QRS Biphasic

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19
Q

Which direction is the waveform for aVf?

A

Positive

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20
Q

What are the precordial chest leads?

A

V1-V6

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21
Q

What direction are the waveforms for the precordial leads?

A

P&T positive, QRS start negative and end positive

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22
Q

A common, simple, and inexpensive method of monitoring ECG.
-Inadequate for diagnosing complex arrhythmias & ST Segment analysis

A

3 Bipolar Leads

23
Q

A method of monitoring ECG that is the standard of care for at risk patients.

A

5 Lead

24
Q

Which lead is preferred for arrhythmia monitoring?

A

Lead II

25
Q

Which leads are preferred for ischemia monitoring?

A

V3-V5

26
Q

Which part of the ECG waveform is the most sensitive to myocardial ischemia?

A

ST Segment

27
Q

Indicates transmural ischemia (acute coronary occlusion or spasm)

A

ST segment elevation

28
Q

Indicates subendocardial ischemia (stable angina, significant but stable CAD)

A

ST Segment Depression

29
Q

What are ECG changes associated with Hypokalemia?

A
  1. ST depression with flat T waves
  2. Prolonged repolarization (long QT, Torsades de Pointes)
30
Q

What are ECG changes associated with Hyperkalemia?

A
  1. Narrow peaked T wave, short QT interval
  2. QRS widening, flat P wave, PR prolonged, 2nd/3rd degree heart blocks
  3. Ventricular flutter, asystole
31
Q

What are ECG changes associated with Hypocalcemia?

A

Prolonged QT

32
Q

What are ECG changes associated with Hypercalcemia?

A

Short QT, decreased T wave amplitude or inversion

33
Q

Routine assessment of BP q ____ minutes is essential for safe anesthesia.

A

5 minutes

34
Q

How to calculate MAP?

A

MAP = (SBP + DBPx2)/3

35
Q

What are contraindications for NIBP Monitoring?

A

Iatrogenic injury from repeated cycling

36
Q

What are limitations of NIBP monitoring?

A

Cuff about 40% circumference of extremity, detection of Korotkoff sounds, Requires pulsatile flow, Cuff movement, Shivering, Equipment failure

37
Q

Cuff too small, too tight, or extremity below heart would cause a falsely ____ pressure.

A

Falsely high

38
Q

Cuff too large, extremity above heart, or after quick deflation would cause a falsely ____ pressure.

A

Falsely low

39
Q

What all is measured by the ClearSight Finger Cuff?

A

Non-invasive continuous BP, SV, SVV, CO, SVR

40
Q

What is the gold standard for recording BP?

A

Invasive BP Monitoring

41
Q

What is the gold standard for recording BP?

A

Invasive BP Monitoring

42
Q

What is the most common location for invasive BP monitoring?

A

Radial artery (also ulnar, brachial, axillary, femoral, DP)

43
Q

What are the risks associated with arterial line insertion?

A

Infection, thrombus, hematoma, vasospasm, ischemia, but vigilance is paramount!!

44
Q

What are the indications for invasive BP monitoring?

A

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

45
Q

What does the Modified Allen Test predict?

A

It predicts ischemia risk with arterial line by assessing collateral flow to the hand

46
Q

How is the arterial waveform created?

A

Arterial waveform results from blood ejection from left ventricle into aorta during systole, followed by peripheral runoff during diastole

47
Q

What does the area under the curve of an arterial waveform approximate?

A

The MAP

48
Q

What does the Dicrotic Notch reflect?

A

Closure of the aortic valve

49
Q

Tests the dampening in the system or how rapidly a system comes to rest after being set in motion.

A

Square Wave Test

50
Q

What is a normal result on the Square Wave Test?

A

Distinct dicrotic notch, no more than 2 oscillations

51
Q

A square wave test with a lost dicrotic notch, and no more than 1 oscillation

A

Over damped (Systolic BP is underestimated)

52
Q

A square wave test with multiple artifacts, and many post flush oscillations

A

Under damped (Systolic BP is overestimated; MAP remains accurate)

53
Q

As the arterial wave travels from central to peripheral, what happens to the Upstroke, Systolic Peak, Dicrotic Notch, Diastolic Wave, and End Diastolic Pressure

A

Upstroke becomes steeper, Systolic peak increases, Dicrotic notch is later, Diastolic wave more prominent & end diastolic pressure decreases

AP 1 (32 decks)

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