Week 3- Hemodynamic Monitoring Flashcards

Question

Automated BP Cuffs work by what mechanism?

Answer 1

Oscillometry: measure changes in oscillatory amplitude electronically, derives MAP, SBP, DBP by using algorithms.

Answer 2

-Bladder width is approximately 40% of the circumference of the extremity - Bladder length should be sufficient to encircle at least 80% of the extremity

Answer 3

- Cuff too small - Cuff too loose - Extremity below level of heart - Arterial stiffness- HTN, PVD

Answer 4

- Cuff too large - Extremity above level of heart - Poor tissue perfusion - Too quick deflation

Answer 5

Involves percutaneous insertion of catheter into an artery, which is then transduced to convert the generated pressure into an electrical signal to provide a waveform - Generates real-time beat to beat BP - Allows access for arterial blood samples  - Measurement of CO/ CI/ SVR

Answer 6

* *Ensures collateral blood flow to hand prior to Aline placement*** RADIAL MOST COMMON - Place pressure to occlude both radial, and ulnar arteries - While holding=make a fist (exsanguination) - Let go of the ulnar artery and ensure the t blood flow returns in case you trash radial blood flow

Answer 7

-->continuous flush device --> 1-3 mL/hour NS, prevents thrombus formation --> Allows rapid flushing

Answer 8

correct calibration and zeroing

Answer 9

- Mid axillary line in supine pts (right atrium) - Level of the ear (circle of Willis) in sitting pts.

Answer 10

Closure of Aortic Valve

Answer 11

``` 1, Systolic upstroke 2, systolic peak pressure 3, systolic decline 4, dicrotic notch aortic valve closure 5, diastolic runoff 6, end-diastolic pressure ```

Answer 12

When Arterial BP waveforms travel through the arterial tree to periphery - ------>SBP peak increases - ------>DBP wave decreases - ------>MAP not altered - ------>Dicrotic notch becomes less and appearslater

Answer 13

```  Nerve Damage  Hemorrhage/ Hematoma  Infection  Thrombosis  Air embolus  Skin necrosis  Loss of digits  Vasospasm  Arterial aneursym  Retained guidewire ```

Answer 14

- Method of measuring hemoglobin saturation (Spo2) - MUST ALWAYS have variable pitch tone when in use *****BOARD Question=HOW does it work?---->Pulses red and intrared LEDs on and off several hundred times per second  Absorption of intrared light in blood (uses an algorithm to compute a ratio of infrared signal and saturation)

Answer 15

SpO2: Measuring Hemoglobin saturation of oxygen in blood via Oximeter SaO2: Functional oxygen saturation (SaO2) is the ratio of oxyhemoglobin to all functional hemoglobin via Blood test

Answer 16

``` - Measure right heart filling pressures - Assess fluid status/blood volume - Rapid administration of fluids - Administration of vasoactive drugs - Removal of air emboli - Insertion of transvenous pacing leads - Vascular access - Sample central venous blood - Pulmonary artery catheters ```

Answer 17

``` ****Right internal jugular vein  Left internal jugular vein  Subclavian veins  External jugular veins  Femoral veins ```

Answer 18

SI 7 french  20 cm length  Multiport catheters most common 

Answer 19

*** Ideally, tip within the SVC, just above junction of venae cavae and the RA*** - parallel to vessel walls - positioned below the inferior border of clavicle and above the level of 3rd rib, the T4/T5 interspace, the carina, or takeoff right main bronchus

Answer 20

-Placement usually not confirmed by XRAY in OR - Aspirate blood from all ports - After surgery, XRAY

Answer 21

``` Usually due to poor technique - Air or thromboembolism - Dysrhythmia (during placement= tickle SA node) - Hematoma- RIJ - Carotid puncture - Pneumo/hemothorax - Vascular damage - Cardiac tamponade - Infection - Guidewire embolism ```

Answer 22

 R atrial tumor |  Infection at site

Answer 23

results from ebbs and flows of blood in the right atrium.

Answer 24

RAP= RV preload

Answer 25

``` 3 Peaks: 1. A wave- MOST IMPT- coincides with point of maximal filling of R ventricle = RVEDP 2. C wave 3. V wave 2 Descents: 1. X 2. Y ```

Answer 26

- should be done at end-expiration | - Machine= average of measurement

Answer 27

- Volume Overload - Right Heart failure (pump failure= P increases) - Tension Pneumo - Tamponade

Answer 28

- Hypovolemia | - Shock

Answer 29

- Caused by atrial contraction (follows the P-wave on EKG) - End diastole - Corresponds with “atrial kick” which causes filling of the right ventricle **Peak is where you get the CVP measurement from**

Answer 30

-Atrial pressure decreases after the “a” wave as a result of atrial relaxation -due to right ventricular contraction - tricuspid valve closed bulges back into the right atrium - Occurs in early systole after the QRS on EKG)

Answer 31

- Atrial pressure continues to decline during ventricular contraction due to atrial relaxation - “Systolic collapse in atrial pressure” - Mid-systolic event (Tricuspid valve now closed)

Answer 32

-Last atrial pressure increase is caused by filling of the atrium with blood from the vena cava - Occurs in late systole with the tricuspid still closed - Occurs just after the Twave on EKG

Answer 33

``` - Decrease in atrial pressure as the tricuspid opens and blood flows from atrium to ventricle - “Diastolic collapse in atrial pressure” ```

Answer 34

Tricuspid Stenosis Pulm HTN Decreased RV compliance (Stiff)

Answer 35

Afib (no pressure, No Kick)

Answer 36

Volume Overload Tricuspid Regurgitation -Anything causing more pressure/ squeezing pf the heart (ex. Tamponade, Pericarditis)

Answer 37

``` - Intracardiac pressures (CVP, PAP, PCWP/ PAWP) - Estimate LV filling pressures - Assess LV function - CO - Mixed venous oxygen saturation - PVR and SVR - Pacing options ```

Answer 38

``` -SIZE 7 or 9 french -LENGTH: 110 cm length marked at 10 cm intervals ***Rarely used anymore*** - 4 lumens 1. distal port PAP  2. port 30 cm more proximal CVP 3. lumen balloon  4. wires for temp thermister ```

Answer 39

- LV dysfunction - Valvular disease - Pulmonary HTN - CAD - ARDS/ resp failure - Shock/sepsis - ARF - Surgical procedure: cardiac, aortic, OB

Answer 40

**Arrhythmias (including V-fib, RBBB, complete heart block) - Catheter knotting - Balloon rupture - Thromboembolism; air embolism - Pneumonthorax - Pulmonary infarction *** PA rupture *** Infection (endocarditis)- MOST COMMON - Damage to cardiac structures (valves, etc.) - Relative Contraindications– WPW syndrome, Complete LBBB

Answer 41

Slide 57 pic - A wave - C wave - V wave

Answer 42

-represents contraction of the left atrium (Normally it is a small deflection unless there is resistance in moving blood into the left ventricle as in mitral stenosis)

Answer 43

-due to a rapid rise in the left ventricular pressure in early systole -causing the mitral valve to bulge backward (closure) into the left atrium -so that the atrial pressure increases momentarily

Answer 44

-produced when blood enters the left atrium during late systole.

Answer 45

- reflects mitral insufficiency causing large amounts of blood to reflux into the left atrium during systole.

Answer 46

``` -Thermodilution - Continuous thermodilution - Mixed venous oximetry - Ultrasound - Pulse Contour ```

Answer 47

 A fib |  Ventricular pacing

Answer 48

``` - Junctional rhythms - Complete HB - Mitral stenosis - Diastolic dysfunction - Myocardial ischemia - Ventricular hypertrophy ```

Answer 49

-  Mitral regurgitation | -  Acute increase in intravascular volume

Answer 50

1.  Ventricular wall characteristics and motion 2. Valve structure and function 3.  Estimation of end-diastolic and end-systolic pressures and volumes (EF) 4. CO 5. Blood flow characteristics 6. Intracardiac air 7.  Intracardiac masses

Answer 51

``` - Unusual causes of acute hypotension - Pericardial tamponade - Pulmonary embolism - Aortic dissection - Myocardial ischemia - Valvular dysfunction -Volume status -Ischemia (wall motion and valvular function) ```

Answer 52

-  Esophageal trauma -  Dysrhythmias -  Hoarseness -  Dysphagia * *Most complications in awake pt**