Week 12 Handout-Flipped 3 - part 2 Flashcards
What does PAP stand for in medical monitoring?
Pulmonary artery pressure
What is the purpose of SvO2 monitoring?
Provides insight into oxygen delivery and consumption
What is the Swan-Ganz catheter used for?
Measures pressures in the right heart and pulmonary artery
What are the clinical indications for using a PA catheter?
- Severe heart failure or cardiogenic shock
- Complex cardiac and major surgeries
- Pulmonary hypertension and ARDS management
- Hemodynamically unstable patients
List some relative contraindications for PA catheter use.
- Left bundle branch block
- Severe coagulopathy or bleeding disorders
- Tumors or masses of the right side of the heart
What are the risks associated with PA catheter placement?
- Arrhythmias
- PA rupture
- Infection
- Thrombosis
- Catheter migration
How is a PA catheter typically inserted?
Via internal jugular or subclavian vein
What are the distance markers for PA catheter placement?
- Right atrium: ~15 cm
- Right ventricle: ~25 cm
- Pulmonary artery: ~35 cm
What does a normal right atrial pressure (RAP) range?
2-8 mmHg
What is the normal range for pulmonary artery pressure (PAP)?
15-30/8-15 mmHg
What is the normal range for pulmonary capillary wedge pressure (PCWP)?
6-12 mmHg
What does a low SvO2 indicate?
Inadequate oxygen delivery
What are the advantages of PA catheter use?
- Real-time monitoring of hemodynamic status
- Allows titration of fluids, inotropes, and vasopressors
- Important in complex cardiac and critical care patients
What are some disadvantages of PA catheter use?
- Invasive, risk of complications
- Alternatives include:
- Echocardiography (ECHO/TEE)
- Transpulmonary thermodilution
- Pulse contour analysis
What is Transesophageal Echocardiography (TEE)?
Semi-invasive diagnostic tool for monitoring various cardiac parameters
What is the frequency range for TEE ultrasound?
3.5-7.5 MHz
What imaging technique provides a 3D view of the heart’s structure?
3D imaging
What is the purpose of Doppler ultrasound in TEE?
To determine direction and velocity of blood flow and tissue movement
What does color-flow Doppler indicate?
Different colors indicate RBCs moving in different directions
What is the normal range for mixed venous oxygen saturation (SvO2)?
65-77%
What could increased SvO2 indicate?
- Left-to-right shunts
- Hypothermia
- Cyanide toxicity
- Increased cardiac output
What are the key responsibilities of CRNAs regarding PA catheters?
Monitor and interpret data to adjust anesthetic management intraoperatively
What does the right ventricular waveform typically show?
Steep systolic upstroke, diastolic downstroke (normal: 15-30/0-8 mmHg)
What does the pulmonary artery waveform’s dicrotic notch represent?
Closure of the pulmonary valve
What is the Doppler effect used for in echocardiography?
It gives different colors to RBCs moving in different directions and helps visualize abnormal blood flow.
Red indicates movement towards the transducer, while blue indicates movement away.
What can high velocity in Doppler ultrasound cause?
Aliasing, which indicates turbulent or abnormal flow.
What is the probe depth for an Upper Esophageal (UE) probe?
25 cm.
What is the probe depth for a Midesophageal (ME) probe?
30-35 cm.
What is the probe depth for a Transgastric (TG) probe?
40 cm or more and requires anteflexion of the probe.
What does turning the probe to the right refer to?
Manually turning the probe clockwise.
What does anteflexing the probe mean?
Flexing the probe transducer anteriorly toward the sternum with the large wheel.
Define hypokinesia in terms of wall motion abnormalities.
Contraction is less vigorous than normal, and wall thickening is decreased.
What does akinesia refer to?
Absence of wall motion, often associated with myocardial infarction (MI).
What is dyskinesia?
Paradoxic movement, where the wall moves outward during systole, hallmark of MI and ventricular aneurysm.
What is the normal tissue velocity in echocardiography?
8-15 cm/s.
What does the Bernoulli equation estimate?
Pressure differences when blood moves through a narrowed area and its velocity increases.
What is the Continuity Equation used for in echocardiography?
It is based on the conservation of mass, indicating that the amount of blood flowing through one part of the heart must equal the amount flowing through another.
What is the best view for routine monitoring for segmental wall motion abnormalities?
Short axis at midpapillary muscle level.
What is the primary advantage of TEE?
It can diagnose the source of hemodynamic instability and estimate hemodynamic parameters.
When is TEE recommended for cardiac surgery?
In cases of unexplained hemodynamic instability during all open chamber, thoracic aortic, and transcatheter procedures.
What are some contraindications for TEE?
- Perforated viscus
- Pathologic conditions of the esophagus
- Recent suture lines.
What are the complications associated with TEE?
- Esophageal perforation
- Gastrointestinal hemorrhage
- Oral/lip damage or injury.
What is the effect of inhalation agents on myocardial function?
They cause dose-dependent myocardial depression, vasodilation, and hypotension.
What is the preferred induction agent for patients with reduced LV function?
Etomidate, due to minimal myocardial depression.
What is a key role of the CRNA during TEE?
Ensure airway security and anesthesia.
