Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Intro to Anesthesia > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

What is your first duty as an anesthesia care provider

A

-vigilance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Electrocardiogram

A
  • monitors HR and rhythm
  • detects arrhythmias, electrolyte disturbances, myocardial ischemia
  • be mindful of many sources of interference in the OR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 lead ECG

A
  • lead I, II, and III (RA, LA, LL) (black, white, red)
  • lateral and inferior views
  • detects HR and Vfib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What leads are most sensitive to ischemia?

A

-precoridal leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

5 lead ECG

A
  • I, II, III, aVR, aVL, aVF, V (7 views)

- RA, LA, LL, RL, V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What lead monitors for special arrhythmias

A

V1: distinguishes between RBBB and LBBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What leads are preferred for monitoring for ischemia

A

-V3 through V5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the standard for monitoring patients who are at higher risk for perioperative ischemia detection?

A

-Lead II and V5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where does V5 lead get placed

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should your gain and filtering capacity be set to?

A

Gain = 1mV

Filtering Capacity = diagnostic mode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some indicators of ischemia

A
  • ST segment elevation >1.0 mm
  • T wave flattening or inversion
  • presence of Q waves
  • ST segment flattening or downslope of >1.0mm
  • peak t-waves
  • arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ST elevation vs ST depression

A
  • ST elevation usually signals a poor supply (thrombus, block etc.)
  • ST depression usually means ischemic demand.
  • ST elevation specific to occluded artery;
  • ST depression not specific to artery, just indicates demand ischemia
  • ST elevation = transmural ischemia; coronary artery occlusion or arterial vasospasm; reciprocal ST depression contralateral leads = coronary thrombosis; subendocardial ST depression ischemia = stable angina occurs in tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does the ST segment mean?

A

-ventricular repolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Baseline ST depression

A
  • find baseline
  • set alarms between 1/2mm elevation and depression

-antidysrythmics, prior ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Changes in II, III, AVF insinuate

A
  • inferior wall ischemia

- Right Coronary Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Changes in I, aVL, V5-V-6 insinuate:

A
  • Lateral wall ischemia

- Left circumflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Changes in V3-V4

A
  • Anterior Wall ischemia

- Left Coronary Artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Changes in Lead V1-V2

A
  • Septal Ischemia

- Left Anterior Descending

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What leads are most sensitive for exercise induced ischemia?

A

-leads V4-V5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do you do in the OR if you suspect your patient is having a ischemic event

A

1) regulate supply/demand: lower HR, increase BP, lower catecholamine response
2) order TEE to check for RWMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Left axis deviation

A

,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Right axis deviation

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Changes in SBP correlate with

A

-myocardial oxygen requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Changes in DBP

A

-changes in coronary perfusion pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

MAP

A

-time weighted average of blood pressure during cardiac cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Auscultation of blood pressure relies on

A

-Korotkoff sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Oscillatory method measures

A
  • oscillations or pressure fluctuations that occur in response to arterial pulsation
  • DBP mathematically calculated
  • requires pulsatile flow; cannot be done with VAD or ECMO
  • usually underestimates SBP and overestimates DBP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What issues will give you a falsely high BP

A
  • too small cuff
  • extremity below heart
  • stiff blood vessels (atherosclerotic dx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What issues will give you a false low BP

A
  • cuff too big
  • too quick deflation
  • extremity level above heart
  • poor tissue perfusion
  • dysrythmias, tremors, shaking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Indications for arterial line

A
  • continuous real time blood pressure monitoring
  • planned pharmacological CV manipulation
  • repeated blood sampling
  • failure of indirect arterial blood pressure monitoring
  • severe end organ disease
  • anticipated or induced hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When do you place an arterial line in relation to induction?

A

-can do pre or post induction; if you anticipate patient will have HD changes upon induction or high risk; place pre-induction

32
Q

Where is the A-line transduced from?

A
  • phlebostatis axis (RA)

- Circle of Willis (tragus of ear)

33
Q

What are the components of an arterial waveform? How does the morphology change as you change location?

A
  • systolic uptake
  • peak systolic pressure
  • systolic decline
  • dichroic notch
  • diastolic runoff

-as you get more peripherally, the waveform becomes more exaggerated: higher peak, sleaper slope, wider pulse pressure, more prominent dichrotic notch

34
Q

What is the interval between the R wave and systolic upstroke?

A
  • 180 msec
  • represents the delay between ventricular depolarization, isovolumetric ventricular contraction, aortic valve opening, blood pressure wave, and blood pressure that signals to the transducer
35
Q

Dichroic notch

A

-closure of aortic valve

36
Q

Overdamped

A
  • when the a-line waveform is too severe a slope and difficult to discern dichroic notch
  • kinks
  • air bubbles
  • vasospasm
  • blood clot
37
Q

Underdampened

A
  • when the pulse pressure is narrowed and flattened, however the MAP will stay the same; no pulsatility
  • hypothermia
  • tachycardia/arrhythmia
  • not enough fluid in the bag
38
Q

Ways to troubleshoot different dampening

A
  • ensure adequate pressure in pressure bag 300mmHg
  • power flush
  • reposition patient
  • verify appropriate scale
39
Q

Arterial waveform in Aortic Stenosis

A
  • Pulses parvus (narrow pulse pressure)

- Pulses tardus (delayed upstroke)

40
Q

Arterial waveform in Aortic Regurgitation

A
  • Bisferiens Pulse (two peaks)

- wide pulse pressure

41
Q

Arterial waveform in Hypertrophic Cardiomyopathy

A

-Spike and Dome

42
Q

Arterial waveform in Systolic LV Failure

A

-Pulses Alternans

43
Q

Arterial waveform in Cardiac Tamponade

A

Pulses Paradoxus

44
Q

Beers Law

A

Absorption of a wavelength of light depends on the absorptivity of the material, the concentration, and the thickness of the material
-oxygenated hemoglobin and deoxygenated hemoglobin have different absorption spectra

45
Q

What wavelengths do pulse oximeters measure at

A

-660 and 940 nm

46
Q

How do pulse oximeters work?

A
  • pulse oximeters measure the % of O2 bound to Hgb (HgbO2)
  • they do this by measuring concentrations of HgbO2 in systole and diastole and find the difference to find concentration in arterial blood
47
Q

Types of Hbg in blood

A
  • oxygenated hgb
  • deoxygenated hgb
  • carboxy hgb
  • met hbg
48
Q

CarboxyHbg

A
  • does not absorb any light

- patient with carbon monoxide poisoning will have falsely elevated Spo2

49
Q

Met Hbg

A
  • absorbs light at 660

- O2 sat well be 85% regardless of what the SaO2

50
Q

Indications for CVC

A
  • CVP/PAP monitoring
  • administration of medications (vasoactive, chemo etc)
  • intermittent dialysis
  • temporary pacing of heart
51
Q

Complications of CVC insertion

A
  • cardiac tamponade
  • pneumothorax
  • hemothorax
  • nerve injury
  • infection
  • arrhythmia
  • thromboembolic event
52
Q

CVP

A
  • central venous pressure (2-8)

- waveform: 3 peaks (a, c, v) 2 descents (x,y)

53
Q

“A” wave

A
  • atrial contraction
  • follows p wave
  • corresponds with atrial kick which actively fills RV
  • occurs end diastole
54
Q

“C” wave

A
  • represents isovolumetric contraction of RV
  • during this time TV is closed, so RV bulges into RA
  • occurs at early systole
55
Q

“X” descent

A
  • corresponds with atrial relaxation

- occurs mid systole

56
Q

“V” wave

A
  • refilling of atrium from ventricular ejection
  • TV still closed
  • occurs: late systole
  • occurs: just after t-wave EKG
57
Q

“Y” descent

A
  • TV opens
  • atrial empties
  • occurs early diastole
58
Q

CVP waveform in a fib

A
  • loss of a-wave

- prominent c-wave

59
Q

CVP waveform in AV disassociation

A

-cannon a waves

60
Q

CVP waveform in Tricuspid stenosis

A

-tall a and v waves

61
Q

CVP waveform in TR

A

-Tall c-v waves

62
Q

Indications for PAC

A
  • cardiac surgery
  • assess LV function, LV filling,
  • cardiac ischemia
  • valvular disease
  • shock (septic, cardiogenic, distributive, hypovolemic)
  • ARF
  • pulm HTN, ARDS, severe pulm dysfunction
63
Q

Complications of PAC

A
  • arrhythmias (afib, VF, CHB)
  • catheter knotting
  • balloon rupture
  • thromboembolic event
  • pneumothorax
  • PA rupture
  • valvular damage
  • contraindications: WPW, complete LBBB
64
Q

Distance of PAC in skin

A
  • RA = 25cm
  • PA = 35-45
  • wedge = 40-50
65
Q

PCWP “a” wave

A
  • left atrial contraction

- pronounced in mitral stenosis

66
Q

PCWP “c” wave

A

-bulging on mitral valve back into left atrium as left ventricle contracts

67
Q

PCWP “v” wave

A
  • Passive filling of left atrium

- prominent v wave indicative of mitral vale insuffienciency

68
Q

Normal cardiac output

A

-5L/min

69
Q

Normal stroke volume

A

-75mL

70
Q

Normal SVR

A
  • 800-1600

- normal ~1200

71
Q

Normal PVR

A
  • 40-180

- Normal ~80

72
Q

Mixed Venous O2Sat

A

-70-80

73
Q

TEE measures:

A

1) ventricular wall (regional wall motion abnormalities)
2) valve structure/function
3) EF
4) CO
5) blood flow
6) intracardiac air
7) intracardiac masses

74
Q

Reasons for TEE in OR

A
  • tamponade
  • PE
  • MI
  • dissection
  • hypotension
  • valvular disease
  • valvular function
  • wall motion
75
Q

Complications

A
  • hoarseness
  • sore throat
  • arrhythmias
  • esophageal trauma

Intro to Anesthesia (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions