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2-General Anesthesia Exam 2 > Cardiac Monitoring > Flashcards

Cardiac Monitoring Flashcards

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1
Q

What should be done if you are unable to place the ECG lead properly? What needs to be documented?

A

When unable to place chest or limb lead optimally due to surgical constraints, document appropriately:

  • Rationale for lead modification
  • Location of adjusted lead
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2
Q

What is a J point?

A

Repolarization

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3
Q

What is sensitivity?

A

The ability of a test to correctly identify those with the disease

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4
Q

What is specificity?

A

The ability of the test to correctly identify those without the disease

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5
Q

What is true about analyzing the ST segment?

A

Elevation or depression assessed relative to the PR interval (isoelectric line).

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6
Q

Where is the ST junction measured?

A
  • ST junction measured from where the QRS complex ends and the ST segment begin
  • Synonymous with the J point
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7
Q

What is the sensitivity and specificity of ST segment analysis?

A
  • Average sensitivity of 74%
  • 73% specificity in detecting myocardial ischemia
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8
Q

Which chest lead have the best ST junction?

A

V2 and V3 chest leads have greatest shift of the ST junction

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9
Q

What are the preferred leads for ST analysis?

A

V3, V4, V5, limb lead III and aVF (in this order)

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10
Q

What is the default for most ECG leads?

A
  • Research from 1988 suggested leads II and V5 were optimal and many still default to this option
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11
Q

More recent literature suggests _______ detects ischemia the earliest and most frequently

A

V3

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12
Q

What is the threshold value for abnormal J-point elevation, for men 40 years or older?

A

should be 0.2 mV (2 mm) in leads V2 and V3 and 0.1 mV (1 mm) in all other leads.

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13
Q

What is the threshold value for abnormal J-point elevation, for men 40 years or younger?

A

the threshold values for abnormal J-point elevation in leads V2 and V3 should be 0.25 mV (2.5 mm).

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14
Q

What is the threshold value for abnormal J-point elevation, for women?

A

the threshold value for abnormal J-point elevation should be 0.15 mV (1.5 mm) in leads V2 and V3 and greater than 0.1 mV (1 mm) in all other leads.

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15
Q

What is the threshold value for abnormal J-point elevation, for men and women in V3R and V4R?

A

the threshold for abnormal J-point elevation in V3R and V4R should be 0.05 mV (0.5 mm), except for males less than 30 years of age, for whom 0.1 mV (1 mm) is more appropriate

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16
Q

What is the threshold value for abnormal J-point elevation, for men and women for V7-V9?

A

the threshold value for abnormal J- point elevation in V7 through V9 should be 0.05 mV (0.5 mm).

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17
Q

What is the threshold value for abnormal J-point depression, for men and women of all ages in V2 and V3?

A

For men and women of all ages, the threshold value for abnormal J-point depression should be −0.05 mV (−0.5 mm) in leads V2 and V3 and −0.1 mV (−1 mm) in all other leads.

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18
Q

What is ocurring with ST segment depression?

A

Imbalance between oxygen supply and demand

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19
Q

What leads are most important in st segment depression analysis?

A
  • Leads V2 and V3 (males and females)
  • -0.5mm (-0.05mV)
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20
Q

What is the measurement for ST segment depression?

A
  • All ECG leads except V2 and V3
  • -1.0mm (-0.1mV)
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21
Q

What is EASI?

A
  • Utilizes a 5 cable ECG lead system to derive a 12 lead ECG
  • Comparable but not equivalent
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22
Q

EASI: Where is the LA lead placed?

A

placed over the manubrium

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23
Q

EASI: Where is the V lead placed?

A

(chest lead) placed over the lower body of the sternum

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24
Q

EASI: Where is the LL lead placed?

A

left midaxillary, horizontal to the chest electrode

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25
EASI: Where is the RA lead placed?
right midaxillary, horizontal to the chest electrode
26
EASI: Where is the RL lead placed?
in any convenient location
27
What is the characteristics of the radial aline cannulation?
Preferred site; Allen’s test necessary
28
What is the characteristics of the ulnar aline cannulation?
Allen’s test necessary as this is primary source of hand blood flow
29
What is the characteristics of the brachial aline cannulation?
Insert medial to biceps tendon; median nerve damage possible
30
What is the characteristics of the axillary aline cannulation?
•Insert at junction of pectoralis and deltoid muscles
31
What is the characteristics of the dorsalis pedis aline cannulation?
Collateral circulation is posterior tibial artery; shows systolic pressure readings higher than radial (means likely comparable)
32
What is the characteristics of the umbilical aline cannulation?
Used in critically ill newborns; may require a cutdown; risk of aortic thrombosis
33
Identify the aortic, brachial artery, radial artery, femoral artery and dorsalis artery waveform.
34
Arterial waveform: what is the anacrotic limb?
The anacrotic limb marks the waveform's inital upstroke, which occurs as blood is rapidly ejected from the ventricle through the open aortic valve into the aorta
35
Arterial waveform: what is the systolic peak?
Arterial pressure then rises sharply, resulting in the systolic peak-the waveform's highest point.
36
Arterial waveform: what is the dicrotic limb?
as blood continues into the peripheral vessels, arterial pressure falls and the waveform begins a downward trend called the dicrotic limb. Arterial pressure usually keeps falling until pressure in the ventricle is less than pressure in the aortic root
37
Arterial waveform: what is the dicrotic notch?
when ventricular pressure is lower than aortic root pressure, the aortic valve closes. This event appears as a small notch on the waveform's downside.
38
Arterial waveform: what is the end diastole?
when the aortic valve closes, diastole begins, progressing until aortic root pressure gradually falls to its lowest point. On the waveform, this is known as end diastole
39
What are the results of a normal allen's test?
Return of color within 6 seconds
40
What are the results of a slow arch filling allen's test?
Return of color delayed 7 to 15 seconds
41
What are the results of a incomplete arch allen's test?
Return of color greater than 15 seconds
42
What are the different techniques of arterial line cannulation?
* Direct arterial puncture * Guidewire assisted cannulation (Seldinger technique) * Transfixion withdrawl
43
What is the appropriate sizing for an adult NIBP monitoring?
width of the bladder should be roughly 40% the circumference of the arm and length of the bladder should cover about 80% of the circumference of the arm
44
What is the appropriate sizing for an child NIBP monitoring?
cuff should cover approximately 2/3 upper arm or thigh
45
What is a source of most error for NIBP monitoring?
Inappropriate cuff size or too rapid deflation
46
What can cause a false high on bp cuff?
Too narrow
47
What can cause a false low on bp cuff?
Too wide
48
What is true about central lines and PA catheters in general surgery?
Rarely use, Less invasive means now available
49
What is needed when placing lines?
* Basic anatomy must be understood when placing lines, e.g. distance from entry to point of measure
50
Wbat should be done if the PA catheter is advanced beyond 10 cm of expected distance?
provider should withdraw catheter (with balloon deflated in the case of PA catheter) and reinsert)
51
What occurs in the a part of the RA waveform (CVP)?
Contraction of the RA
52
What occurs in the C part of the RA waveform (CVP)?
Closure of the tricuspid valve
53
What occurs in the V part of the RA waveform (CVP)?
Passive filling of the RA
54
What occurs in the X part of the RA waveform (CVP)?
Start of atrial diastole
55
What occurs in the y part of the RA waveform (CVP)?
Opening of tricuspid valve
56
Id the components of the RA waveform.
57
What are causes of loss of a waves or only v waves? (2)
* Atrial fibrillation * Ventricular pacing in the setting of asystole
58
What are causes of cannon A waves? (8)
* Junctional rhythms * Complete AV block * PVCs * Ventricular pacing (asynchronous) * Tricuspid or mitral stenosis * Diastolic dysfunction * Myocardial ischemia * Ventricular hypertrophy
59
What are causes of large V waves? (2)
* Tricuspid or mitral regurgitation * Acute increase in intravascular volume
60
How many types of pulmonary artery catheters are there?
Two: * one measures Continuous Cardiac Output & Mixed Venous Oxygenation * standard PA catheter
61
What can be used to help determine PA catheter placement?
West zones
62
What is West zone 1?
PA\>Pa\>Pv * Zone 1 * No blood flow
63
What is West zone 2?
Pa\>PA\>Pv * Zone 2 * moderate blood flow
64
What is West zone 3?
Pa\>PV\>PA * Zone 3 * Greatest blood flow
65
Which zone is where the PA catheter should be?
Zone 3
66
Identify the PA catheter waveform.
Slide 76
67
What is mixed venous oxygen saturation (SVO2)?
the percentage of oxygen bound to hemoglobin in blood returning to the right side of the heart.
68
What does the mixed venous oxygen saturation (SVO2) reflect?
Reflects the amount of oxygen "left over" after the tissues remove what they need
69
Wbat are the three cardiac output analysis devices? (3)
* FloTrac * PiCCO * LiDCOrapid
70
What do cardiac output anaylsis devices measure?
* Directly measure fluctuations in arterial pressure and the heart rate * From this they estimate the beat-to-beat stroke volume
71
What is cardiac output?
HR x SV
72
What is flotrac?
* Less invasive than PA catheter – requires arterial line but not central line * Insufficient evidence showing decreased mortality with more invasive measures
73
What is clearsight?
* Uses a noninvasive finger blood pressure cuff rather than an arterial line * Cuff dynamically inflated/deflated to track brachial artery BP while also assessing the absorption of infrared light
74
What is function of the TEE based on?
Uses piezoelectric elements to absorb, reflect or scatter light
75
TEE: How is abnormal wall motion described?
Hypokinesia, Akinesia, Dyskinesia
76
Define hypokinesia.
Contraction that is less vigorous than normal
77
Define akinesia.
Absences of wall motion; May be associated with MI
78
Define dyskinesia.
* Correlates with paradoxical movement (outward motion during systole) * Hallmark of MI and ventricular aneurysm
79
RA ECG placement
Over the outer right clavicle
80
LA EKG placement
Over the outer left clavicle
81
LL EKG placement
Near the left ilia crest or midway between the costal margin and left illiac crest, anterior axillary line
82
RL EKG placement
any convient location on the body
83
V1 EKG placement
4th intercostal space right of the sternal border
84
V2 EKG placement
4th intercostal space left of the sternal border
85
V3 EKG placement
Equal distance between V2 and V4
86
V4 EKG placement
Midclavicular line at 5th intercostal space
87
V5 EKG placement
Horizontal to V4 on the anterior axillary line
88
V6 EKG placement
Horizontal to V5 on the midaxillary line
89
V7 EKG placement
Horizontal to V6 on the posterior axillary line
90
V8 EKG placement
Horizontal to V7 below the left scapula
91
V9 EKG placement
Horizontal to V8 at the left paravertebral border
92
V3R EKG placement
right side of chest wall in mirror image to chest lead V3
93
V4R
right side of chest wall in mirror image to chest V4
94
What is the distance from the insertion site of the subclavian to the right atrium?
10 cm
95
What is the distance from the insertion site of the right internal jugular vein to the right atrium?
15 cm
96
What is the distance from the insertion site of the left internal jugular vein to the right atrium?
20 cm
97
What is the distance from the insertion site of the femoral vein to the right atrium?
40 cm
98
What is the distance from the insertion site of the right median basilic vein to the right atrium?
40 cm
99
What is the distance from the insertion site of the left median basilic vein to the right atrium?
50 cm
100
What is the distance of the right internal jugular to the junction venae cave and right atrium?
15 cm
101
What is the distance of the right internal jugular to the right atrium?
15-25 cm
102
What is the distance of the right internal jugular to the right ventricle?
25-35 cm
103
What is the distance of the right internal jugular to the pulmonary artery?
35-45 cm
104
What is the distance of the right internal jugular to the pulmonary artery wedge position?
40-50 cm
105
What is the absolute value and range of normal MRAP?
Absolute: 5 mmHg Range: 1-10 mmHg
106
What is the absolute value and range of normal RV?
Absolute: 25/5 Range: 15-30/0-8
107
What is the absolute value and range of normal PA S/D?
A: 25/10 mmHg Range: 15-30/5-15 mmHg
108
What is the absolute value and range of normal MPAP?
A: 15 mmHg R: 10-20 mmHg
109
What is the absolute value and range of normal PAOP?
A: 10 mmHg R: 5-15 mmHg
110
What is the absolute value and range of normal MLAP?
A: 8 mmHg R: 4-12 mmHg
111
What is the absolute value and range of normal LVEDP?
A: 8 mmHg R: 4-12 mmHg
112
What are causes of High CO and High SvO2?
Sepsis, Eccessive blood flow (hypervolemia, excessive vasoactive therapy)
113
What are causes of High CO and Low SvO2?
Anemia, hypoxia, high VO2 = inadequate cardiac output???
114
What are causes of low CO and high SvO2?
Low VO2 (anesthesia, hypothermia) = adequate cardiac output
115
What are causes of low CO and low SvO2?
low output syndrome (hypervolemia, heart failure and pulmonary embolism)
116
What is femoral aline cannulation?
•Ideal in low flow states; long catheter optimal; potential for local and retroperitoneal hemorrhage

2-General Anesthesia Exam 2 (11 decks)

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