Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Monitoring > topic 13 > Flashcards

topic 13 Flashcards

1
Q

hypoxia

A

inadequate oxygen to tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ischemia

A

inadequate blood to tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

type 1 morbid neuroligical outcome

A

cerebral death, non fatal strokes, new tia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

type 2 morbid neuroligical outcome

A

new intellectual deterioration, new seizures upon discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

type 1 predictors

A

70 4-9%risk, aortic atherosclerosis, hisory of prior neurological events-15% carotid stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

type 2 predictors

A

Low cardiac output states  Atrial arrhythmias  Systolic Hypertension  Diabetes
 Pulmonary Disease  Excessive Alcoholism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

neuro impairment

A

6.1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

post op delireum

A

10-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

transient dysfunction

A

7-44%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

permanent complications

A

1.6-23%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

highest neurological risk during surgery

A

filling heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how do perfusionist contribute to neuro injury

A 
Focal  Embolism
 Air  Plaque  Microemboli  Left ventricular thrombus  Fat  Debris
 Hypoperfusion  Inflammation
 Global  Complete
 CardiacArrest  Deep Hypothermic
Circulatory Arrest  Incomplete
 Hypotension  Inadequate CPB flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

inflammation

A

ischemia reperfusion injury causes activation of leukocytes

vascular integrity causes foreign surface capillary plugging and liberation of free radical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

tailoring o2 delivery

A

MAP, CO2,CI AND pump flow, HCT, mechanical issue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

tailoring O2 consumption

A

anesthetic agent and depth temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

brain monitoring

A

neuro exam, BP monitoring, EEG, Bispectral index, transcranial doppler, intra cranial monitoring, sat. of jugular venous O, venous sat. global, regional sat. of O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

EEG

A

records elec. activity of brain, 10-20 eectrodes or 2-4 leads, FTPO, odd # left hemi., even right hemi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

alpha

A

8-13 hz. amp is medium,occipital, ralaxed awake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

beta

A

13-30 hz, amp is low, frontal, alert awake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

theta

A

4-8 hz., amp is high, diffuse, sleeping infant or child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

delta

A

0-4 hz. amp is high, diffuse, coma ischemia deep sleep, deep anesthesia

22
Q

clinical use of EEG

A

 Main Reason  Epilepsy
 BrainTumors  Stroke  Focalbraindisorders
 Secondary reason  Diagnosis of coma  Encephalopathies  Brain death
 Monitor depth of perfusion
 Indirect indicator of cerebral perfusion in carotid endarterectomy

23
Q

disadvantages in OR from EEG

A

EG signal information is generated from low voltages 50-100 μV in the electrically hostile operating room environment
 Analysis is complex  Distracting anesthesiologist from patient care  Electrode impedances
 Equal – interference is eliminated
 Different – appear as artifact  Electrical devises in OR
 Pacemakers  ECG  Electrocautery units
 Electrical activity in skeletal and cardiac myofibrils  Patients moving  Patients shivering
 Electromechanical devises  Heart lung machine

24
Q

BIS

A

Process EEG INFO. approved in 1996, info displayed every 10-15 sec, non invasive,graph and numerical trends, allows anesthesia ability to access eeg info during case. uses numbering system to identify depth of anesthesia

25
Q

how does bis work

A

processes signals and assesses relationships among signal components and captures synchronization within signals like eeg. then converts it to a digital # for easy interpretation

26
Q

bis index

A

1-100. 100 is fully awake 80 responds to loud commands or shaking, 60 general anesthesia unresponsive to verbal stimulus, 40 deep hypnotic state, 20 burst suppresion, 10 flat line eeg

27
Q

pet scan

A

100% bmr bis 95, 64% 66, 54% 62, 38% 34

28
Q

opiod anesthesia bis value

A

40-60

29
Q

opioid with volatile gas

A

25-35

30
Q

target to titrate

A

45-55

31
Q

BIS helps us

A

maintain hemodynamics

32
Q

benefits of bis

A

Reduction in primary anesthetic use
 Decrease incidence of intraoperative awareness and recall
 Reduction in emergence and recovery time  Improved patient satisfaction

33
Q

disadvantages of bis

A

It is a trending device  We can’t be responsible to treat the level of sedation  Often monitor only faces anesthesia

34
Q

transcranial cerebral oximetry

A

Transcranial cerebral oximetry is a non-invasive technique for monitoring changes in cerebral oxygen metabolism, which presents additive information when the conventional key variables (as peripheral oxygenation and/or systemic hemodynamics) would not be predictive.

35
Q

tco benefits

A

Noninvasive, continuous, direct, real time
 Site-specific (regional) measure vs systemic; often signals earlier warning of reversible ischemia
 Added ability to detect and correct oxygenation issues that can lead to complications and poor outcomes
 Not pulse, pressure or temperature dependent
 Immediately reflects patient reactions to each stage or event during surgery and the efficacy of interventions
Proven Clinical Value
Clinical Benefits – continued
 Simultaneous monitoring of vascular beds under different circulatory controls (cerebral and somatic/peripheral)
 Identifies patient-unique rSO2 baselines for customized care
 Enhances clinical assessment and decision making  Objective data vs subjective assessment

36
Q

major organ mortality

A

13.4%. invos drops MOMM TO 3%

37
Q

CVS COGNITIVE DECLINE

A

24-53%. `53% at discharge, 36% at 6 weeks, 24% at 6 months

and 42% at 5 years; indicating it is not transitory

38
Q

PROLONGED VENT FROM CVS

A

5.96% GREATER THAN 48 HOURS

39
Q

ADULT APPLICATION OF INVOS

A

Cardiac surgery  Pre-op, intra-op and post-op ICU  Traditional and robotic
 Vascular surgery  Cardiac cath lab  Neurology / Neurosurgery  ER / traumatic brain injury  General surgery  Spinal injury

40
Q

PEDIATRIC APP OF INVOS

A

Cardiac surgery  Pre-op, intra-op and post-op PICU  Traditional and robotic
 ECMO (Extracoporeal Membrane Oxygenation)
 Cardiac Cath lab (at times)
 Neurology / Neurosurgery
 Still being studied – must convince the caregivers that the data is useful
 Sensors are improving (much work to do)

41
Q

PLACEMENT OF INVOS SENSORS

A

Clean area with alcohol - let it dry • Attach sensors above the eye
brows • Connect to machine •SET BASELINE
Critically important to set the baseline before anesthesia induction and nasal oxygen

42
Q

LIGHT THAT CAN PENETRATE CRANIAL TISSUE

A

650-1100

43
Q

mechanical INFLOW issues to head

A

head Position • Heart Position
• Arterial Obstruction
Carotid Disease, Clamp, Hand, Sponge
• Cannula Malposition

44
Q

intervention for cerebral inflow

A

rule out mechanical causes like head and cannula position, increase supply by ncrease blood pressure Normalize CO2 to physiologic level Increase FiO2 Increase cardiac output (pump flow) Vasodilate cerebral blood vessels Increase hematocrit. decrease demand by increase anesthetic decrease temp.

45
Q

cerebral rso2

A

detects o2 supply issues associated with o2 delivery

46
Q

supply issues

A

low fio2, low hgb, low map, pump flow, spasm

47
Q

our steps to increaes o2

A

increase BP, increase fio2, increase co, increase hct

48
Q

baseline rso2 cardiac surgery patients and healthy

A

65 +-9, 70 +-6,

49
Q

intervention threshold

A

less than 50 or 20% drop,

50
Q

critical threshhold

A

less than 40 or 25% drop

Monitoring (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions