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671A - Anesthesia I > Week 1 - Basic Clinical Monitoring (Cardiovascular) > Flashcards

Week 1 - Basic Clinical Monitoring (Cardiovascular) Flashcards

1
Q

Systematic approach of anesthesia consists of (Sweeping)

A

Inspection, auscultation, and palpitation
* I Ate Pizza

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2
Q

Most common required diagnostic tool for monitoring the heart

A

ECG/EKG

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3
Q

Which leads are best for watching for ST changes

A

V2 and V3

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4
Q

How do you determine ST elevation or depression?

A

If the ST segment is above or below isoelectric line (PR segment)

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5
Q

How many ECG leads should ideally be monitored during operations?

A

Generally 3 (or more)
Viewing two or less can result in myocardial ischemia

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6
Q

How many cm must a PAC travel to reach the RA via the Right IJ vein

A

15-25 cm
From here each additional 10 cm should bring you to the next structure. 15 Junction of SVC/RA, 15-25 RA, 25-35 RV, 35-45 PA, and 40-50 for PA wedge pressure.

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7
Q

What might cause resistance during PAC removal?

A
  • Chordae tendineae entanglement needs CXR to rule this out.
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8
Q

A 12 lead ECG should be done for which patients?

A

those at risk for ischemic events

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9
Q

Which leads should be monitored for ST changes when a preoperative ECG was preformed?

A

Whichever leads showed ST changes

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10
Q

Which leads are ideal to observe during a case in which a patient has an unremarkable ECG reading?

A

V3, V4, V5, III, and aVF

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11
Q

Which lead should be monitored to observe narrow QRS readings

A

II

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12
Q

V3 lead detects _________ the earliest and most frequently

A

Ischemia

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13
Q

You advance a PAC 10 cm but don’t see a change in waveform, what could this mean?

A

Line coiling

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14
Q

Before withdrawing a PAC, what must you do?

A

Check balloon is fully deflated

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15
Q

What is a textbook PA pressure

A

25/10 (quarter over dime)

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16
Q

What do a, c, and v waves signify when a PAC is in the RA

A

a = RA contraction
c = Tricuspid valve closure
v = RA filling

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17
Q

Normal pressure waveform readings in the heart

A
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18
Q

What does the dicrotic notch represent in a PA pressure waveform?

A

Closure of the pulmonic valve.
Upstroke = Systole (RV ejection)
Downstroke = Diastole (RV filling), contains dicrotic notch.

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19
Q

How would you interpret a low RA and PA pressure?

A

Hypovolemia, transducer too high

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20
Q

What could be an explaination for a loss of “a” waves in a RA waveform tracing?

A

A-Fib or V pacing

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21
Q

When is the best time to determine the PA/PAOP pressures within a patient?

A

At end of expiration. Pleural pressure should = atmospheric pressure

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22
Q

What could be the causes of an elevated PA pressure?

A

Catheter whip, catheter coiling, dilated pulmonary artery, pulmonary HTN

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23
Q

What is a normal SVRI value

A

1760 - 2600 dynes/sec
represents LV after load, <1760 indicates dilation, >2600 indicates constriction

24
Q

What does cardiac index represent?

A

Cardiac output taking into account the patients height and weight. Normal 2.8-3.6 L/per min
Adequacy of tissue perfusion, BP, oxygen deliver, and waste removal.

25
Q

Which direction would you expect a lactate level to trend with a lowering cardiac index?

A

Elevating, above 2

26
Q

By which method is a cardiac index most frequently attained?

A

Thermodilution –> Injectate is usually D5W or .9NS (similar densities) and should be room temp.

Increased CI value = low injectate volume or is too warm, thrombus on PAC, partially wedged PAC
Decreased CI value = too much injectate or is too cold

27
Q

What is the goal of placement for a PAC?

A

West zone III of the lung

28
Q

What is Wests zone III of the lung?

A

Where Pa > Pv > PA
Pa = arterial pressure
Pv = venous pressure
PA = alveolar pressure

29
Q

What is SvO2

A

Mixed venous oxygen saturation
* Indirectly monitors O2 delivery. Normal values of 55-75%. Dependent on CO. Decreased values with decreased cardiac output besides sepsis and cyanide toxicity.

30
Q

What is ScvO2

A

Central Venous Oxygen Saturation
* Regional indicator of O2 delivery in the head and upper body. Usually 2-3% lower than SvO2.

31
Q

If lactate is greater than 2, how often should you draw levels

A

Q 2 hours

32
Q

What would you suspect with high RA, PA, and PAOP pressures?

A

Cardiac tamponade, ventricular interdependence, transducer is too low.

or left heart failure (although RA/ CVP could be normal-high)

33
Q

Why might you be seeing a overshooting arterial blood pressure waveform?

A

Too small of a catheter (Normal is 20 gauge), decreased arterial compliance, and pre-existing vascular disease

34
Q

What is considered the gold standard of blood pressure monitoring?

A

Arterial blood pressure, most common artery used is the radial artery

35
Q

Cons of an arterial BP catheter

A

More invasive than NIBP, infection, injury to nerves or veins around catheter, loss of limb due to poor collateral circulation

36
Q

How often should blood pressure be recorded during an operation?

A

Q5 mins during maintenance, Q1 min during induction

37
Q

Properly fitting BP cuffs should have bladder dimensions _________ of patients circumference of extremity

A

40%

38
Q

Loose BP cuff below the heart/too small of a cuff would have a ______ reading

A

falsely elevated

39
Q

What is a Transesophegeal Echo? (TEE)

A

Use of sound waves to define anatomic structures of the heart via probe placed in esophagus

40
Q

Abnormal wall motion of the heart can be described as what three terms?

A

Hypokinesia = Contraction less vigorous than normal, wall thickening decreased
Akinesia = Absence of wall motion, indicative of MI
Dyskinesia = Paradoxical movements, hallmark sign of MI or ventricular aneurysm.

41
Q

Causes of a dampened arterial pressure?

A

Flexed wrist, air bubbles in tubing, thrombus, catheter kinking.
Loss of the dicrotic notch with an underestimated BP

42
Q

How do you calculate MAP?

A

SBP +(DBP x 2)/ 3
Diastolic phase is 2x as long as systolic

43
Q

Sepsis, Cyanide toxicity, and hypothermia cause a ________ SvO2 reading

A

Elevated

44
Q

SvO2 is dependent on _________

A

Cardiac output

45
Q

What patient manifestations would cause a decreased Sv02?

A

Hyperthermia, shivering, seizures, and hemorrhage.
These things cause increased O2 demands, thus decreasing SvO2

46
Q

What could be the cause of an unpredictable CO value via thermodilution?

A

R –> L or L –> R ventricular septal defect, tricuspid regurgitation

47
Q

What are the disadvantages to CCO monitoring? (continuous cardiac output)

A

Can’t determine rapid changes. 3-6 minutes behind current CO. Also not accurate if CO is less than 2

48
Q

What does PVRI represent and what are the normal values?

A

RV after load, 40-225
Difference of pressure across the pulmonary circuit
Pulmonary artery pressure minus PAOP/CI X 80

49
Q

Precordial leads should be placed by __________ of the costae, not by gross visual examination

A

palpitation

50
Q

Why should the PAC with an inflated ballon only remain in the RV for as little amount of time as possible?

A

To reduce the incidence of ventricular ectopy

51
Q

What is RVEDP used for?

A

To estimate RVEDV, which is used to estimate RV preload, and less accurately LV preload

52
Q

On a CVP pressure, the A wave follows after _________ depolarization, and the C and V waves follow after ___________ depolarization

A

atrial, ventricular (C wave starts at the QRS, whereas V starts at the beginning of the ST segment)

53
Q

How can risks associated with placing a radial arterial line be minimized?

A
  • Position the hand and wrist on an arm board
  • Place a roll beneath the wrist
  • Fingers and the thumb should be taped securely across the board
54
Q

What needle gauge is used for an arterial line?

A

20 gauge (22 gauge is optional)

55
Q

What is the technique to placing an arterial line?

A

Bevel up, at a 45 degree angle insert toward the palpable pulse (if a bone is encountered, withdraw slightly and move laterally and re advance). Once blood is seen, reduce the angle of the needle to 30 degrees, and advance slightly.

56
Q

In regard to a TEE, what is the best angle to view SWMA (segmental wall motion abnormality) for myocardial ischemia?

A

Short axis at the mid papillary muscle level

671A - Anesthesia I (22 decks)

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