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PMI > 18. Misc Monitors > Flashcards

18. Misc Monitors Flashcards

1
Q

febrile

A

> 38C

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2
Q

hypothermia

A

<36C

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3
Q

room temp

A

23C

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4
Q

OR recommended temp

A

20-24C

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5
Q

temp monitoring sites

A

blood from PAC
esophageal
rectal
nasal
bladder
skin/axillary

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6
Q

most accurate estimate of core temp

A

blood from PAC

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7
Q

most consistently reliable estimate of core temp

A

esophageal

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8
Q

nasal temp is ______ than esophageal

A

less accurate

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9
Q

when is bladder temp reliable

A

with adequate urine output

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10
Q

not accurate reflections of core temp

A

skin
axillary

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11
Q

reasons for temp loss

A

redistribution (vasodilation)
IV fluids
blood products
VA
radiation/evap/convection/conduction

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12
Q

1 reason a pt gets cold in GA/Spinal/Epidural

A

vasodilation causes temp redistribution

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13
Q

how much heat do you lose in the first 60 mins of anesthesia?

A

1.6C

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14
Q

radiation heat loss

A

60%

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15
Q

evaporation heat loss

A

20%

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16
Q

convection heat loss

A

15%

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17
Q

conduction heat loss

A

5%

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18
Q

hypothermia CV effects

A

bleeding
decr SV
bradycardia
arrythmia
incr blood viscosity

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19
Q

hypothermia metabolic effects

A

decr drug metabolism
delayed emergence
decr wound healing
shivering

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20
Q

hypothermia resp effects

A

respiratory depression
left shift

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21
Q

hypothermia neurologic effects

A

decr CBF
incr cerebral vascular resistance

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22
Q

hypthothermia renal effect

A

decr GFR
impaired renal function

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23
Q

for every _____ drop in temp, CBF decreases _____

A

for ever 1 C drop in temp, CBF decreases 5-7%

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24
Q

how much does shivering incr O2 consumption

A

5X

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25
Q

when is shivering more likely

A

lower intraop temp
longer sx
higher [VA]

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26
Q

shivering treatment

A

warm pt
demerol (25mg)

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27
Q

esophageal stethoscope purposes

A

measure temp
listen to heart/lung sounds

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28
Q

precordial stethoscope

A

popular in peds
constant lung sounds

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29
Q

goal for urine output

A

0.5-1 mL/kg/hr

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30
Q

TEE estimates

A

EF
CO
heart valve patency
pulmonary artery pressure

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31
Q

which monitor is the best for diagnosisng venous air embolism

A

TEE

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32
Q

BIS sedation

A

65-85

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33
Q

BIS GA

A

40-65

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34
Q

BIS oversedation

A

<40

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35
Q

clinical uses for BIS

A

TIVA
“sick” pts who do not tolerate normal dosing
prevent anesthetic overdose

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36
Q

is BIS useful to prevent awareness?

A

no

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37
Q

high BIS during emergence

A

faster emergence

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38
Q

lower BIS during emergence

A

slower emergence

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39
Q

BIS monitoring is shown to

A

decr time to extubation
decr PACU/hospital stay length
decr PONV
decr porpofol use

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40
Q

does nitrous affect the BIS

A

no

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41
Q

does ketamine affect the BIS

A

can increase

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42
Q

rainbow SpHb probe pulse wavefortm

A

SVV

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43
Q

SVV represented by

A

PVi

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44
Q

PVi value that indicates hypovolemia

A

> 14

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45
Q

rainbow SpHb measures

A

SVV
[hb]
SpO2 / pulse rate
SpOC (CaO2)
Pi (perfusion index)

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46
Q

weak perfusion index (weak pulse)

A

Pi = 0.02%

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47
Q

strong pulse perfusion index

A

Pi = 20%

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48
Q

Pi can be affected by

A

temp
tighness of sensor

49
Q

when is SpO2 unreliable

A

Pi < 0.4%

50
Q

sedline give us

A

brain wave spectrogram (DSA)
spectral edge frequency (SEFL and SEFR)
patient state index (PSI)

51
Q

brain wave spectrgram frequency bands

A

alpha
beta
delta
theta

52
Q

alpha

A

8-12 hz
green

53
Q

beta

A

13-30hz
blue

54
Q

delta

A

0.5-4hz

55
Q

theta

A

4-8hz

56
Q

beta waves are produced

A

middle of deep thinking

57
Q

alpha waves relate to

A

creativity
daydreaming

58
Q

when are delta/theta waves found

A

deep sleep

59
Q

specral edge frequency monitor indication

A

white line in spectrogram

60
Q

what does the SEF tell us

A

95% of pts brain wave activity is BELOW that frequency

61
Q

goal SEF for GA

A

mid-teens and LOWER

62
Q

which monitor is the PSI similar to?

A

the BIS

63
Q

recommended range for PSI for GA

A

25-50

64
Q

PSI > 50

A

pt is too light

65
Q

what falsely elevates PSI number

A

EMG (muscle movement)
artifact (Cautery)

66
Q

PSI high
no artifact
no EMG

A

pt is light

67
Q

PSI high
artifact or emg present

A

pt may or may not be light

68
Q

what doe vertical white lines indicate

A

artifact

69
Q

what do vertical black lines indicate

A

periods of burst suppression
(pt is very deep)

70
Q

what might you see in a pt with several periods of burst suppression:

A

several vertical black lines on DSA
suppression ration increase
PSI decrease

71
Q

how much is the PSI delayed

A

20-40s

72
Q

how much is SEF delayed

A

it is not delayed

73
Q

is SEF affected by articat/muscle activity?

A

no

74
Q

cerebral oximeter

A

give O2 saturation number in cerebral vessels

rSO2

75
Q

cerebral oximeter uses what technology

A

near-IR spectroscopy (NIRS)

76
Q

cerebral oximetry is an indicator of

A

cerebral perfusion

77
Q

what indicates low cerebral perfusion

A

low rSO2 value

78
Q

clinical use for cerebral oximetry

A

beach chair/sitting
heart surgery

79
Q

when should you be concerned with rSO2 levels?

A

rSO2 < 50%
20%+ drop from baseline rSO2
>30% difference between L and R hemispheres

80
Q

which rSO2 values are associated with poor neurologic outcomes

A

<45% absolute
>25% declines

81
Q

what decreases rSO2

A

decr CBF
hypotension
hyperventilation (low CO2)
hypoxemia (decr SaO2)
anemai
mechanical distrubances

82
Q

michancial distubracnes that decr rSO2

A

vascular occlution/compression
embolic events
clamping
dissection

83
Q

how to incr cerebral SpO2

A

incr FiO2
incr cerebral perfusion pressure (incr MAP / decr ICP)
incr EtCO2
incr hematocrit
hypothermia (dec metabolism)
check head/neck positioning
NTG (decr MAP)

84
Q

how to decr ICP

A

mannitor
lumbar drain

85
Q

masimo cerebral oximeter measures

A

current rSO2 (blue)
baseline rSO2 (green)
change in rSO2 (red)

86
Q

left oximeter probee slot

A

1

87
Q

right oximeter probe slot

A

2

88
Q

when do you set baseline for cerebral oximeter

A

before preoxygenation

89
Q

evoked potentials alert sx to

A

nerve ischemia or damage

90
Q

amplitude

A

wave height

91
Q

latency

A

time form onset to peak

92
Q

nerve damage/ischemis

A

decr amplitude
incr latency

93
Q

anesthetics

A

decr amplitude
incr latency

94
Q

what can the AA do if the evoke potential change intraooperatively not related to nerve damage?

A

incr BP

95
Q

Evoked potentials: VA

A

decr amplitdue
incr latency

96
Q

evoke potentials: N2O

A

decr amplitude
no change latency

97
Q

EP: Propofol

A

decr amplitude
incr latency

98
Q

EP: versed

A

decr amplitude
no change latency

99
Q

EP: ketamine

A

incr amplitude
incr latency

100
Q

EP: etomidate

A

incr amplitude
incr latency

101
Q

which drugs incr amplitude of EP

A

ketamine
etomidate

102
Q

whcih drugs incr latency of EP

A

VA
propofol
ketamine
etomidate

103
Q

which durgs have not change to latency

A

nitrous
versed

104
Q

types of EP

A

SSEP
MEP
BAEP
VEP

105
Q

SSEP monitor

A

sensory nerves

106
Q

SSEPs travel through

A

dorsal/posterior pathways

107
Q

what can be dosed during SSEPs

A

muscle relaxants
(no impact to sensory)

108
Q

MEPs stimulate

A

motor nerve

109
Q

MEPs travel through

A

anterior/lateral pathways

110
Q

MEPs are ________ sensitive to VA than SSEPs

A

more sensitve

111
Q

can you use MR with MEPs

A

no

112
Q

BAEPs measure

A

vestibulocholear nerve (VIII)

113
Q

which evoked potential are least effected by anesthetics

A

BAEPs

114
Q

VEPs measure

A

optic nerve integrity

115
Q

which evoke potential are most affected by anesthetics

A

VEP

116
Q

EP anesthetic management

A

<0.5 MAC
constant anesthetic level
avoid MR for MEPs

117
Q

supplement VA w/

A

propofol
narcotic drips

118
Q

propofol has a _______ effect on EP if it is infused
propofol has a _______ effect of EP if it is bolused

A

lower effect for infusion
higher effect for bolus

PMI (18 decks)

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