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AP 1 > Test 1 part II (CM) > Flashcards

Test 1 part II (CM) Flashcards

1
Q

Shows a pulsus parvus (narrow pulse pressure) & pulsus tardus (delayed upstroke) on the arterial waveform

A

Aortic Stenosis

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2
Q

Shows a bisferines pulse or double peak with wide pulse pressure on the arterial waveform

A

Aortic Regurgitation

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3
Q

Shows a spike & dome (mid-systolic obstruction) on the arterial waveform

A

Hypertrophic Cardiomyopathy

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4
Q

Shows pulsus alternans (alternating pulse pressure amplitude) on the arterial waveform

A

LV Failure

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5
Q

Shows pulsus paradoxus (decrease in SBP during inspiration) on the arterial waveform

A

Tamponade & Hypovolemia

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6
Q

What are the indications for CVP and PAC monitoring?

A
  1. Vascular access
  2. Volume assessment (CVP) & administration (rapid volume replacement)
  3. Insertion of transvenous pacing wires
  4. Treatment of VAE (aspiration)
  5. Drug/Parenteral nutrition
  6. Lack of peripheral access
  7. Sampling for repeated blood draws
  8. Temporary Hemodialysis
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7
Q

What is a PAC used to differentiate between?

A

Cardiogenic and Noncardiogenic Shock

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8
Q

Which sites should you use US guided techniques for insertion?

A

Femoral, subclavian, internal jugular

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9
Q

What is the preferred site for CVP/PAC insertion?

A

Right IJ (consistent, predictable, prominent landmarks, high success)

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10
Q

What are the problems associated with insertion via the Left IJ?

A

Potential for thoracic duct injury or difficulty moving catheters

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11
Q

What are the complications associated with CVP/PAC insertion?

A
  1. Unintentional puncture of nearby arteries
  2. Bleeding
  3. Neuropathy
  4. Pneumothorax
  5. Air embolism
  6. Dysrhythmias
  7. Pulmonary artery rupture
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12
Q

How to calculate CO?

A

HR x SV

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13
Q

What is the gold standard for CO monitoring?

A

PAC

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14
Q

How does PAC monitoring work? (What is the principle)

A

Fick Principle - thermodilution method

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15
Q

What are indications for an invasive arterial BP monitor? (FloTrac, PiCCO, LidCO)

A

Large fluid shifts, intravascular volume, less invasive than CVP/PAC

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16
Q

A safe, noninvasive diagnostic tool that can identify:
1. systolic wall motion
2. blood flow within chambers/across valve
3. vascular aneurysms
4. calculate EF
5. preload
6. detect VAE
7. assess cardiac anatomy
8. myocardial ischemia

A

Transesophageal Echocardiography (TEE)

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17
Q

What two components make up Tidal Volume?

A

Tidal Volume = alveolar gas + dead space

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18
Q

What does the presence of CO2 indicate on a capnogram?

A

Ventilation, pulmonary blood flow, and aerobic metabolism

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19
Q

On Capnogram:
Baseline → sample contains no CO2, from the anatomic dead space (A-B)

A

Phase 1

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20
Q

On Capnogram:
Expiratory upstroke → sample is a mix of dead space + alveolar gas and contains CO2 (B-C)

A

Phase 2

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21
Q

On capnogram:
Expiratory plateau → the alveolar emptying of CO2 (C-D)

22
Q

On capnogram:
Descent to original baseline → inspiration of air or O2 (D-E)

23
Q

Where on the capnogram do you measure EtCO2?

A

At the end of the expiratory plateau (D)

24
Q

What is a normal EtCo2?

25
Q

What are some things that would cause a sudden loss of CO2 on the capnogram?

A
  1. esophageal intubation
  2. circuit disconnect
  3. ETT kink
  4. ventilator malfunction
26
Q

What are some things that would cause Rebreathing CO2 on the capnogram? (waveform fails to return to baseline during phases 1 & 4)

A
  1. inadequate fresh gas flow in non-rebreathing system
  2. depleted/exhausted soda lime
  3. faulty expiratory valve
27
Q

What would cause Cardiac Oscillations on the capnogram? (Regular sawtooth waves within the expiratory phase equal to heart rate)

A

Contraction of the heart & great vessels forcing gas exchange, common in pediatrics

28
Q

What would cause a Curare Cleft on the capnogram (spontaneous respiratory effort during mechanical ventilation)

A
  1. Insufficient anesthetic depth
  2. Return of spontaneous ventilation after NMB
  3. hiccups
29
Q

What would cause a Shark Fin Appearance on the Capnogram?

A

Obstruction (bronchospasm, asthma, COPD)

30
Q

What is the final value of exhaled PCO2 curve at end of expiratory phase?

31
Q

If measured during flat and undistorted phase III, it is well correlated with PaCO2.

32
Q

EtCO2 may not accurately reflect PaCO2 if patient:

A

Is spontaneously ventilating through NC or Face Mask.

33
Q

In the healthy population, difference between PaCO2 and EtCO2 is:

34
Q

What are the 3 ways that can lead to Increased EtCO2?

A
  1. Increased CO2 production & delivery
  2. Decreased Alveolar Ventilation
  3. Equipment Malfunction
35
Q

What are some things that lead to an increased CO2 production and delivery?

A
  1. ↑ metabolic rate
  2. Fever
  3. Sepsis
  4. Seizures
  5. ↑ cardiac output
  6. Bicarbonate administration
36
Q

What are some things that lead to a decreased alveolar ventilation?

A
  1. Hypoventilation
  2. Partial muscular paralysis
  3. High spinal anesthesia
  4. COPD
37
Q

What are some things that can cause equipment to malfunction, leading to INCREASED EtCO2?

A
  1. Rebreathing
  2. Exhausted CO2 absorber
  3. Circuit leak
  4. Faulty inspiratory/expiratory valve
38
Q

What are three things that cause decreased EtCO2?

A
  1. Decreased CO2 production & delivery
  2. Increased Alveolar Ventilation
  3. Equipment Malfunction
39
Q

What are some things that can lead to decreased CO2 production & delivery?

A
  1. Hypothermia
  2. Pulmonary hypoperfusion
  3. Cardiac arrest
  4. Pulmonary embolism
  5. Hemorrhage
  6. Hypotension
40
Q

What causes an increase in alveolar ventilation?

A

Hyperventilation

41
Q

What are some examples of equipment malfunction that lead to decreased EtCO2?

A
  1. Ventilator disconnect
  2. Esophageal intubation
  3. Complete airway obstruction
  4. Poor sampling
  5. ETT leak
42
Q

What is the standard of care for monitoring oxygenation?

A

Pulse Oximetry

43
Q

Detects hypoxemia, measures pulse rate, estimates the arterial oxygen saturation of hemoglobin

A

Pulse oximetry

44
Q

Pulse ox transmittance technology is based on the _____.

A

Beer-Lambert Law

45
Q

What is the accuracy of Pulse Oximetry?

A

Accurate within 2% between 80-100% and within 5% when below 80%

46
Q

What are the limitations associated with Pulse Oximetry?

A
  1. SpO2 accuracy & reliability can vary between different probes, sites, and clinical condition (vasoconstriction), such as Inadequate circulation, low perfusion, cold temperatures, motion artifact. It may be improved moving sites closer to central circulation
  2. Does not measure O2 delivery to tissues or CO2 elimination
  3. Can under or overestimate O2 saturation
47
Q

What are some conditions that would cause the pulse oximetry to underestimate O2 saturation?

A

Methemoglobin, methylene blue, indocyanine green, anemia

48
Q

What are some conditions that would cause the pulse oximetry to overestimate O2 saturation?

A

Carboxyhemoglobin

49
Q

What conditions would cause a Right shift on the Oxyhemoglobin Dissociation Curve?

A
  1. Increase Temperature
  2. Increase PCO2
  3. Increase 2,3 DPG
  4. Decrease pH (acidosis)
50
Q

A right shift on the oxyhemoglobin dissociation curve causes what?

A

Right = Release
(Decreased affinity)

51
Q

What conditions would cause a Left shift on the Oxyhemoglobin Dissociation Curve?

A
  1. Decreased temperature
  2. Decreased PCO2
  3. Decreased 2,3 DPG
  4. Increased pH (Alkalosis)
52
Q

A left shift on the oxyhemoglobin dissociation curve causes what?

A

Left = Latch
(Increased affinity)

AP 1 (32 decks)

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