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WEEK 4-FLIPPED CLASS Flashcards

1
Q

What does ECG stand for?

A

Electrocardiography

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2
Q

What is the primary purpose of ECG monitoring in anesthesia?

A

Real-time assessment of cardiac function

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3
Q

Which ECG lead is standard for rhythm analysis?

A

Lead II

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4
Q

What is the role of the V5 lead in ECG monitoring?

A

Enhances detection of anterior ischemia

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5
Q

List the three types of ECG systems mentioned

A
  • 3-Lead ECG System
  • 5-Lead ECG System
  • 12-Lead ECG System
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6
Q

What does the P wave in an ECG represent?

A

Atrial depolarization

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7
Q

What does the QRS complex in an ECG reflect?

A

Ventricular depolarization

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8
Q

What does the T wave in an ECG indicate?

A

Ventricular repolarization

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9
Q

What are common sources of artifacts in ECG monitoring?

A
  • Patient movement
  • Lead-wire displacement
  • Electrocautery use
  • 60-Hz interference
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10
Q

Fill in the blank: Lead II and V5 monitoring improves _______

A

detection capability.

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11
Q

What is the significance of ST depression (>1 mm, 80 msec after J-point)?

A

High likelihood of myocardial ischemia

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12
Q

What does the J-point signify in an ECG?

A

The point where the QRS complex ends and the ST segment begins

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13
Q

What is the preferred method of noninvasive blood pressure monitoring in the US?

A

Oscillometry

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14
Q

What is Mean Arterial Pressure (MAP) formula?

A

MAP = DP + (SP - DP)/3 or ((DP x 2) + SP)/3

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15
Q

What factors can contribute to inaccurate blood pressure readings?

A
  • Cuff position relative to the heart
  • Cuff size
  • Patient movement
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16
Q

What is a contraindication for using a blood pressure cuff?

A
  • Bone fractures
  • Open injuries
  • Arteriovenous fistulas
  • Previous lymph node dissection
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17
Q

What is the purpose of a precordial stethoscope?

A

Auscultating heart and breath sounds

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18
Q

What is the function of the balloon on an esophageal stethoscope?

A

Covers the distal tip for placement in the esophagus

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19
Q

True or False: Continuous intraoperative ECG monitoring is optional for patients under general anesthesia.

A

False

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20
Q

Fill in the blank: The 5-lead ECG system is particularly advantageous for _______ patients.

A

high-risk

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21
Q

What are the phases of Korotkoff sounds used in blood pressure measurement?

A
  • Phase 1: Systolic measurement
  • Phase 5: Diastolic measurement
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22
Q

What does arterial tonometry measure?

A

Arterial blood pressure

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23
Q

What is a common complication of repeated blood pressure cuff use?

A

Limb ischemia

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24
Q

What should be done if a patient’s blood pressure cuff is positioned 12 inches below the heart?

A

Adjust the reading by -24 mmHg

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25
Q

What is the purpose of using conductive gel in ECG monitoring?

A

Enhance electrode-skin conductivity

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26
Q

What should be done to minimize artifacts in ECG monitoring?

A
  • Proper lead placement
  • Stable electrode contact
  • Minimize patient movement
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27
Q

What is the recommended cuff size for accurate blood pressure measurement?

A

Cuff bladder should encircle ≥ 50% of the patient’s extremity

28
Q

What is the primary function of a precordial stethoscope?

A

To auscultate heart and lung sounds by placing the metallic bell on the patient’s chest.

29
Q

How should an esophageal stethoscope be inserted?

A

Dip the ballooned tip in lubricant, then insert the catheter into the mouth or nose through the pharynx into the esophagus.

30
Q

What is a key benefit of using esophageal stethoscopes?

A

Higher quality detection of turbulent breath sounds not identifiable with electric monitoring.

31
Q

What are the risks associated with esophageal stethoscopes?

A

Insertion can cause trauma and bleeding, misplacement can create a cuff leak.

32
Q

True or False: Esophageal stethoscopes can be used on non-ventilated patients.

33
Q

What is capnography?

A

The continuous monitoring of end-tidal carbon dioxide (EtCO2).

34
Q

What is the normal range for mean PaCO2 in adults?

A

35-45 mmHg.

35
Q

What are the two types of devices used to monitor EtCO2?

A
  • Non-diverting (mainstream) * Diverting (side stream)
36
Q

What is the primary use of capnography in anesthesia?

A

Monitoring patient ventilation and confirming endotracheal tube placement.

37
Q

What are the three phases of capnography?

A
  • Phase I - Dead Space * Phase II - Mixture of dead space and alveolar gas * Phase III - Alveolar gas plateau
38
Q

What does an elevated EtCO2 indicate?

A

Increased CO2 delivery/production or hypoventilation.

39
Q

What is the Beer-Lambert Law in relation to pulse oximetry?

A

It relates changes in absorbed light intensity transmitted through blood to the concentration of hemoglobin.

40
Q

What is the clinical significance of pulse oximetry for CRNAs?

A

Provides real-time monitoring of oxygenation, detects hypoxemia and hypoventilation.

41
Q

Fill in the blank: Pulse oximeters do not measure the quantity of _______.

A

hemoglobin.

42
Q

What is the normal range for SpO2 accuracy in modern pulse oximeters at 70% - 100% saturation?

A

Within 2% to 3%.

43
Q

What is a limitation of pulse oximetry?

A

Poor indicator of adequate ventilation, may take time to detect desaturation.

44
Q

What can interfere with pulse oximetry readings?

A
  • Carboxyhemoglobin * Methemoglobin * Electrocautery * Ambient light sources
45
Q

True or False: The function of pulse oximeters with ventricular assist devices depends on the patient’s residual cardiac function.

46
Q

What is the effect of hypoxemia during anesthesia?

A

Low arterial oxygen levels (PaO2 < 60 mmHg) can lead to complications.

47
Q

What is indicated by a depression during phase III of the EtCO2 waveform?

A

Spontaneous respiratory effort.

48
Q

What should be done if CO2 absorbent exhaustion is suspected?

A

Monitor for elevated EtCO2 and consider early signs of respiratory acidosis.

49
Q

What should be done before radial artery cannulation to test for adequate perfusion?

A

Utilize pulse oximetry instead of the Allen’s test.

50
Q

What strategies can minimize interference in pulse oximetry?

A

• Secure placement
• Choosing appropriate sites

Recognizing and troubleshooting signal artifacts or false readings is also important.

51
Q

What is the significance of moving the oximetry site centrally in low perfusion states?

A

It helps improve accuracy of readings when peripheral blood flow is compromised.

Suggested sites include the nose, ear, and forehead.

52
Q

What advances have been made in pulse oximetry technology?

A

• Multi-wavelength technology for accurate measurement of carboxyhemoglobin and methemoglobin
• Pulse oximeters utilizing reflectance technology

These advancements improve accuracy during patient movement and low-perfusion states.

53
Q

True or False: There are contraindications to pulse oximetry.

A

False

Pulse oximetry is considered safe for all patients.

54
Q

What are the implications of false readings from pulse oximeters?

A

False readings can negatively impact patient outcomes and should be documented.

Documentation is crucial in anesthesia records.

55
Q

What is the normal core body temperature in humans?

A

37 degrees Celsius

This temperature can vary between patients.

56
Q

Define hypothermia in terms of core body temperature.

A

Core body temperature of less than 36 degrees Celsius.

It is commonly caused by anesthesia which inhibits thermoregulation and causes vasodilation.

57
Q

What is malignant hyperthermia?

A

A genetic hypermetabolic muscle disease triggered by certain anesthetics.

It leads to an uncontrolled release of intracellular calcium, resulting in sustained muscle contraction and hypermetabolism.

58
Q

What is the normal operating room temperature range?

A

20 to 24 degrees Celsius (68 to 75 degrees Fahrenheit).

This range helps maintain patient safety during surgery.

59
Q

What are common noninvasive temperature monitoring methods?

A

• Temporal
• Axillary
• Oral
• Tympanic
• Nasopharynx
• Esophageal
• Bladder
• Rectal
• Pulmonary artery

Each method has its advantages and disadvantages concerning accuracy and invasiveness.

60
Q

Fill in the blank: The most significant mechanism of heat loss in humans is _______.

A

Radiation

Humans lose heat through radiation, convection, conduction, and evaporation.

61
Q

What is the treatment for shivering in the postoperative period?

A

• IV dose of meperidine 12.5-25 mg
• Warming blankets
• Forced-air warming device (bear hugger)

Shivering can occur due to hypothermia or effects of anesthetic agents.

62
Q

What are the common causes of hypothermia during surgery?

A

• General and regional anesthesia
• Radiant heat loss
• Cool ambient temperature in the operating room

Prolonged exposure of large wounds and high flow of unhumidified gases can also contribute.

63
Q

What is the role of preoperative warming?

A

To reduce the phase one decline in core temperature by minimizing heat loss to the environment.

It is especially important for patients with specific comorbidities.

64
Q

What is a disadvantage of tympanic temperature monitoring?

A

Possible trauma to the ear drum if the provider pushes in too far.

Infrared devices may also be less accurate.

65
Q

What are the advantages of using a pulmonary artery catheter for temperature monitoring?

A

It provides a definite reflection of core temperature.

However, it is invasive and carries risks of infection.

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