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6900 > Clinical Monitoring > Flashcards

Clinical Monitoring Flashcards

1
Q

EEG recording produced by

A

Synchronous depolarization of cell bodies and dendrites as chemical activity is converted to electrical activity

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2
Q

EEG pattern for anesthesia (general and deep)

A

General: Theta, slower, higher amplitude
Deep: Delta, wider, loopy sleep waves

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3
Q

General anesthesia produces _____ changes on EEG

A

Dose-dependent

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4
Q

Most common patient perceptions of awareness under anesthesia (5)

A
  • Sounds and conversation (89-100%)
  • Sensation of paralysis (85%)
  • Anxiety and panic
  • Helplessness and powerlessness
  • Pain (39%)
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5
Q

Least common patient perceptions of awareness under anesthesia (3)

A
  • Visual perceptions
  • Intubation
  • Feeling operation without pain
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6
Q

BIS number ranges (normal, general anesthesia, values more likely to have recall)

A
  • Range from 0-100
  • General anesthesia: 40-60
  • More likely to have recall: >70
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7
Q

Anesthetic technique effect on SSEPs, how to change your anesthetic when they’re used

A
  • IV agents have less effect than inhaled agents
  • Propofol/narcotic gtt, no paralysis
  • 0.5-1 MAC inhaled agent if cannot do TIVA
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8
Q

Normal ICP in adults

A

5-15 mmHg, lower in infants/children

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9
Q

MAP calculation

A

SBP + 2xDBP / 3

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10
Q

Upper arm BP vs down arm

A

Upper arm=10mmHg lower than down arm

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11
Q

Calf/ankle BP vs arm

A

Calf/ankle approximately 5mmHg lower than arm

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12
Q

Normal PA pressure

A

15-30/4-12

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13
Q

Normal PA Wedge pressure

A

4-12

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14
Q

PA catheter should reside where?

A

West Zone III of lung

  • Bulk of pulmonary blood flow
  • Direct communication between right heart and pulmonary pressures and left intraventricular pressures
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15
Q

Mixed venous O2 saturation (SvO2) measures (and normal value)

A
  • Percentage of SaO2 after tissue extraction
  • Reflects overall tissue utilization of O2, tissue perfusion, CO
  • Alteration in SaO2 will cause alteration in SvO2
  • Normal value 5-77%
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16
Q

Oxyhemoglobin dissociation curve

A

Relationship between plasma O2 and Hgb saturation

-Reflects changing affinity of O2 to Hgb

17
Q

Right shift of oxyhgb dissociation curve

A

Decreased affinity so O2 is released to the tissues

-Caused by hypercapnia, fever, acidosis, elevated 2,3DPG

18
Q

Left shift of oxyhgb dissociation curve

A

Increased affinity of O2 to Hgb = higher saturation for given PaO2
-Caused by hypocapnia, hypothermia, alkalosis, decreased 2,3DPG

19
Q

SpO2 50%=PaO2 ____
SpO2 60%
SpO2 90%

A 
50% = PaO2 27 mmHg
60% = PaO2 30 mmHg
90% = PaO2 60 mmHg
20
Q

End Tidal CO2 Monitoring

A

Estimates PaCO2 and evaluates ventilation and dead space

21
Q

Possible causes for increasing baseline on ETCO2

A
  • Defective exhalation valve
  • Rebreathing of previously exhaled CO2
  • Exhausted CO2 absorber
22
Q

Possible causes for gradual increase in ETCO2

A
  • Hypoventilation
  • Increased metabolism (fever, pain, shivering)
  • Partial airway obstruction
  • Absorption of CO2 from exogenous source (Lap surg)
23
Q

Possible causes of suddenly elevated ETCO2

A
  • Tourniquet release
  • Bicarb administration
  • Reperfusion during vascular grafting
  • Malignant hyperthermia
24
Q

Possible causes for decreasing ETCO2

A
  • Cardiopulmonary arrest
  • Pulmonary embolism
  • Sudden hypotension, massive blood loss
  • Cardiopulmonary bypass
25
Q

Possible cause of Low ETCO2 with good plateau

A
  • Hyperventilation
  • Hypothermia
  • Dead space ventilation
26
Q

Possible causes of low ETCO2 without plateau

A
  • Partially kinked ETT
  • Bronchospasm
  • Mucous plugging
  • Poor sampling techniques
27
Q

Possible causes of sudden ETCO2 decrease to near 0

A
  • Leak in system
  • ETT in hypopharynx or cuff leak
  • Poorly fitting anesthetic mask
  • Partial disconnect from ventilator circuit
28
Q

Possible causes of loss of ETCO2

A
  • Airway disconnection
  • Dislodged ETT, esophageal intubation
  • Totally obstructed/kinked ETT
  • Complete ventilator malfunction
  • Air embolism
29
Q
  • Best place to hear breath and heart tones with precordial

- Best place to listen at induction/emergence

A

Apex of heart

  • 5th left intercostal space at midclavicular line just below left nipple
  • Induction/emergence: suprasternal notch, best for airway monitoring

6900 (12 decks)

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