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Principles of Anesthesia 1 (Summer 25') > 5 June 25 Clinical Monitoring Standards and Techniques > Flashcards

5 June 25 Clinical Monitoring Standards and Techniques Flashcards

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1
Q

What is clinical monitoring?

A

A standard required by the American Society of Anesthesiologists (ASA) that involves various types of monitors for patient safety.

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2
Q

What parameters must be monitored for oxygenation?

A
  • Clinical observation
  • Pulse oximetry
  • Arterial blood gases (ABGs) when indicated
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3
Q

Does every patient require pulse oximetry?

A

Yes, every patient must have a pulse oximeter.

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4
Q

When are arterial blood gases (ABGs) required?

A

Only if there are concerns about acid-base balance or oxygenation issues.

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5
Q

What is the minimum monitoring standard for blood pressure and heart rate?

A

Every five minutes.

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6
Q

What is thermoregulation monitoring?

A

Monitoring body temperature when clinically significant, such as in cases of high or low temperature.

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7
Q

When is neuromuscular status monitoring necessary?

A

When neuromuscular blocking agents are used.

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8
Q

What is the purpose of the Allen test?

A

To assess the blood supply of the hand before arterial line placement.

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9
Q

What does pulse oximetry measure?

A

The saturation of arterial blood.

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10
Q

What is the Beer-Lambert law related to?

A

The absorption of light through a medium, which is the basis for how pulse oximeters function.

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11
Q

What types of hemoglobin are typically found in adult blood?

A
  • Oxyhemoglobin
  • Deoxyhemoglobin
  • Methemoglobin
  • Carboxyhemoglobin
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12
Q

What wavelengths do traditional pulse oximeters use?

A

660 nm and 940 nm.

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13
Q

What distinguishes the newer pulse oximeters?

A

They use four wavelengths for more accurate measurements.

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14
Q

What is the difference between SAO2 and SPO2?

A

SAO2 is the arterial saturation, while SPO2 is the saturation detected by the pulse oximeter.

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15
Q

What is a normal arterial blood saturation level?

A

Above 90%.

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16
Q

What can cause inaccuracies in pulse oximeter readings?

A
  • Ambient light
  • Low perfusion
  • Intravenous dyes
  • Certain types of hemoglobin
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17
Q

What effect does a right shift of the oxygen-hemoglobin dissociation curve have?

A

It promotes oxygen unloading to tissues.

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18
Q

What effect does a left shift of the oxygen-hemoglobin dissociation curve have?

A

It decreases oxygen unloading to tissues.

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19
Q

Fill in the blank: The minimum monitoring standard for blood pressure is every _______.

A

five minutes.

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20
Q

True or False: Pulse oximetry provides readings for venous blood saturation.

A

False, Arterial is monitored.

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21
Q

What can cause a pulse oximeter to read inaccurately low?

A

Intravenous dyes or low perfusion.

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22
Q

What is the significance of monitoring positioning during clinical monitoring?

A

To prevent nerve damage and ensure patient safety.

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23
Q

What does the term ‘pulsatile expansion’ refer to?

A

The variation in light absorption due to arterial pulsation.

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24
Q

What is the role of the EKG in clinical monitoring?

A

To monitor the cardiovascular system.

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25
What is the acceptable difference between SAO2 and SPO2 readings?
2 to 3%.
26
What factors can cause a left shift of the oxygen dissociation curve?
Acidosis, alkalosis, carbon monoxide ## Footnote Changes to the curve affect how oxygen is unloaded to tissues.
27
Which body parts are most sensitive to vasoconstriction when using a pulse oximeter?
Distal digits (fingers and toes) ## Footnote These areas can yield inaccurate readings if pulsatile flow is insufficient.
28
What can inhibit the transmission of pulse oximeter readings?
Dark polish, synthetic nails ## Footnote These can affect the accuracy of the readings.
29
What areas are recommended for pulse oximeter placement for unstable patients?
Nose, earlobe ## Footnote These areas are closer to the trunk and less affected by peripheral conditions.
30
Why should a pulse oximeter not be placed on an index finger, specifically on the patient's dominant hand?
Risk of corneal abrasion ## Footnote Patients may rub their face after waking up, potentially injuring their eyes.
31
What are reliable sites for pulse oximetry in patients with an epidural block?
Toes, tongues, cheeks, foreheads ## Footnote These areas are less affected by vasoconstriction and provide quicker readings.
32
What is the expected accuracy range for SAO2 and SPO2 **when saturations are above 70%**?
Within 2 to 3% ## Footnote This is essential for ensuring adequate oxygenation.
33
What can a pulse oximeter indicate regarding cardiac output?
Decreased cardiac output ## Footnote Changes in pulse flux may suggest a reduction in blood flow to the monitoring site.
34
What are some features of pulse oximeter probes?
Clamps, stickers, wraps ## Footnote Different designs cater to various patient needs, including neonates.
35
What are some limitations of pulse oximeters?
Poor perfusion, high partial pressures, inaccurate with different hemoglobins ## Footnote These factors can lead to unreliable readings.
36
How does carboxyhemoglobin affect SPO2 readings in smokers?
Elevates SPO2 by 1% for each 1% of carboxyhemoglobin ## Footnote This means SPO2 readings may be falsely elevated in chronic smokers.
37
What historical figure is known for the first understanding of the circulatory system?
Dr. William Harvey ## Footnote His work in the 1600s laid the foundation for our understanding of blood circulation.
38
What significant development in blood pressure measurement occurred in 1905?
Understanding of Korotkoff sounds ## Footnote These sounds are related to systolic and diastolic blood pressure.
39
What is the mathematical formula for calculating mean blood pressure?
((2 x diastolic) + systolic) / 3 ## Footnote This calculation is often required in clinical settings.
40
What can lead to inaccurate blood pressure readings using non-invasive methods?
Decreased peripheral flow, incorrect cuff size, shivering ## Footnote These factors can significantly affect the accuracy of readings.
41
What is the recommended cuff bladder size for accurate blood pressure measurements?
40% of arm circumference, 80% of upper arm length ## Footnote Proper cuff size is crucial for accurate blood pressure readings.
42
What are the limitations of using non-invasive blood pressure monitors?
Noise interference, cuff size issues, decreased accuracy in certain conditions ## Footnote These factors can lead to discrepancies in readings.
43
What is the expected difference between non-invasive blood pressure and arterial line measurements?
Within ±5 mmHg ## Footnote Accurate correlation is essential for effective patient monitoring.
44
What is the significance of monitoring trends in blood pressure readings?
Trends provide insight rather than isolated readings ## Footnote Monitoring trends helps in understanding patient condition over time.
45
What is the preferred location for placing a blood pressure cuff when a dialysis fistula is present in the upper arm?
Forearm or ankle
46
What is more diagnostic: a single blood pressure reading or trends observed over time?
Trends observed over time
47
Advantages of non-invasive blood pressure monitors include:
* Automatic readings * Simplicity * Non-invasive nature * Reliable monitoring
48
What can occur if a non-invasive blood pressure cuff is used too frequently or for too long?
Patient discomfort, tissue damage, compartment syndrome
49
Indications for invasive blood pressure monitoring include:
* Large surgeries with blood loss * Patients needing continuous blood pressure monitoring * Frequent blood samples required
50
What is the most common site for arterial line placement?
Radial artery
51
What does the Allen test assess?
Collateral circulation in the hand before radial artery cannulation
52
True or False: The Allen test is still considered the gold standard for assessing radial artery occlusion.
True
53
What is the Seldinger's technique used for arterial line placement?
Gradually increasing catheter size from small to larger
54
What is the transfixion technique in arterial line placement?
Going through the front and back wall of the artery while inserting the catheter
55
What is a common complication of the transfixion technique?
Hematoma due to puncturing the back wall
56
What flush solution is generally used in arterial line setups to prevent thrombus formation?
Normal saline
57
What should be done to maximize the waveform in an arterial line?
Minimize tubing length and avoid unnecessary stopcocks
58
What does the systolic upstroke in an arterial waveform indicate?
Peak systolic pressure
59
How do arterial pressures vary at different sites in the body?
They change due to impedance along the circulation
60
What is the significance of the dichotic notch in an arterial waveform?
Marks the end of systole and the beginning of diastole
61
What does the end diastolic pressure represent in an arterial waveform?
Lowest arterial pressure during diastole
62
What type of waves are seen in an arterial line waveform?
Combination of fundamental and harmonic waves
63
What is hidden during the QRS complex?
Repolarization of the atria ## Footnote The QRS complex represents ventricular depolarization, overshadowing atrial repolarization.
64
What two types of waves are summed in a pressure wave analysis?
Fundamental wave and harmonic wave ## Footnote These waves combine to create the typical pressure wave observed in physiological measurements.
65
What analysis is used to sum waves in pressure waveforms?
Fourier analysis ## Footnote Fourier analysis breaks down complex waveforms into simpler components.
66
What does the square wave test ensure about an arterial line?
It is correctly calculated and not over damped or under damped ## Footnote The test involves observing the waveform produced when flushing an arterial line.
67
What should be observed in a properly functioning arterial line after a flush?
Square wave followed by normal arterial waveform ## Footnote A rapid return to the normal pattern indicates proper damping.
68
What indicates that an arterial line is under damped?
Systolic pressure appears much higher than it is ## Footnote Under damping can exaggerate systolic readings.
69
What happens to the systolic pressure reading if the arterial line is over damped?
Systolic pressure is much lower than it should be ## Footnote Over damping compresses the waveform, leading to inaccurate readings.
70
What is a characteristic of the waveform in an over damped arterial line?
Very narrow pulse pressure ## Footnote A narrow pulse pressure indicates diminished systolic and diastolic pressure distinction.
71
What can cause waveform changes in arterial lines aside from damping issues?
Co-morbid conditions ## Footnote Conditions like atherosclerosis can alter arterial pressure readings.
72
Which condition leads to a higher systolic peak in arterial waveforms?
Atherosclerosis ## Footnote Atherosclerosis affects arterial distensibility, resulting in elevated systolic readings.
73
What are some complications associated with arterial lines?
* Ischemia * Pseudoaneurysm * Hemorrhage * Arterial utilization * Local infection * Peripheral neuropathy ## Footnote These complications can arise from improper placement or maintenance of arterial lines.
74
What test is mentioned in relation to assessing arterial line patency?
Allen's test ## Footnote Allen's test evaluates the patency of the radial and ulnar arteries.
75
What can happen if a needle is reinserted after removal from an arterial line?
Part of the wire or catheter can be shaved off ## Footnote This can lead to complications and is a practice to avoid.
76
What can cause peripheral neuropathy near an arterial line?
Injury to nearby nerves ## Footnote The proximity of nerves to the artery makes them susceptible to damage during procedures.
77
What does a 'saggy' waveform in an arterial line indicate?
Over damping ## Footnote A non-distinct waveform suggests that the pressure readings are not accurately represented.

Principles of Anesthesia 1 (Summer 25') (10 decks)

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