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Anesthesia Prinicples > Clinical Monitoring I > Flashcards

Clinical Monitoring I Flashcards

(50 cards)

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1
Q

AANA oxygenation required monitoring

A

Clinical observation
pulse ox
ABGs as indicated

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2
Q

Minimum required ventilation monitoring

A

Auscultation
Chest excursion
ETCO2

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3
Q

CV monitoing required

A

BP and HR q5 min (minimum required)
EKG
Auscultation as needed

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4
Q

List other AANA monitoring standards

A

Temperature when indicated
Neuromuscular when NMB are used
Positioning and protective monitors

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5
Q

Beer-Lambert Law

A

Law of Absorption
A beam of visible light passing through a chemical solution of fixed geometry experiences absoprtion proportional to the concentration of the solute

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6
Q

What are the 2 wavenlengths that a pulse ox typically works on?

A

660 and 940

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7
Q

Gold standard if oximetry is inaccurate

A

Co-oximetry…uses 4 wavelengths

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8
Q

What type of blood is a pulse ox reading?

A

arterial

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9
Q

True or false: a pulse ox waveform resembles an arterial waveform with a dichoratic notch

A

True

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10
Q

How does a pulse ox determine to read an arterial wavelength?

A

The pulsatile expansion of the artery increases the length of the light path and increases the absorbency

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11
Q

What is the math equation that a pulse ox computes?

A

Fluctuating (pulsatile) component/ nonfluctuating (nonpulsatile) component
660 wave/940 wave

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12
Q

Difference between SaO2 and SpO2

A

SaO2: arterial blood saturation
SpO2: pulse ox saturation
should be about the same…(within 2-3%)

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13
Q

List artifact problems and how to resolve them

A

Ambient: alternating red/infrared
Low perfusion: signal amplified
Venous blood pulsation: longer signal averaging time
Additional light absorbers: IV dyes

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14
Q

What is the result of low O2 saturation?

A

Very large changes/drops in O2 tension

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15
Q

What causes a right shift of oxyhemoglobin curve?

A

Increased temp
Increased 2-3 DPG
Increased H+ (acidosis)

**reduced affinity for O2

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16
Q

What causes a left shift of oxyhemoglobin curve?

A

Decreased temp
Decreased 2-3 DPG
Decreased H+ (acidosis)
CO

**increases affinity

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17
Q

What areas are less affected by vasoconstriction and reflex desaturation quicker with a pulse ox?

A

Tongue
Cheek
Forehead

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18
Q

What finger should a pulse ox not be placed on and why?

A

index finger, in case they go to itch their eye when they wake up

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19
Q

What area is more reliable with an epidural block?

A

Toes

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20
Q

Advantages of pulse oximeters?

A

Accurate when measured against ABGs (with Sats >70%)
not affected by anesthetic vapors
Noninvasive
Continuous
May indicate decreased CO
Convenient
Tone modulation
Probe variety
Battery operated
Economical

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21
Q

Which common dye causes the most artifact in a pulse ox?

Study These Flashcards
A

Methylene Blue

22
Q

True or False: Carboxyhemoglobin absorbs as much light in the 660nm range as oxyhemoglobin and therefore falsely elevates SpO2 by 1% for every 1% of COHb.

Study These Flashcards
A

True

*Many smookers have >6% COHb

23
Q

Who performed the 1st recorded blood pressure?

Study These Flashcards
A

Reverend Hales in 1733

24
Q

Kortotkoff Sounds

Study These Flashcards
A

Series of audible frequencies produced by turbulent flow beyond the partially occluding cuff

25
List the Korotkoff sound phases
Phase 1: the most loud/turbulent (SBP) Phasse II-III: sound character changes PHase IV-V: muffled/ absent (DBP)
26
Mean BP formula
(2xDP+ SP)/3
27
Limitations to auscultation of BP
- Decreased peripheral flow through shock or vasoconstriction - Changes in vessel compliance - Shivering
28
How does the wrong cuff size affect our BP reading?
Too large=falsely low Too small=falsely high
29
What are the standard cuff pressures for adults? neonates?
Adults: 300mmHg Neonates: 150mmHg
30
How big should a cuff bladder be?
40% of arm circumference 80% of length of upper arm
31
What does the arterial MAP need to be to correlate (within 5mmHg) with a NIBP?
75mmHg
32
How is a NIBP calculated by the machine?
Oscillometry Max amplitude is MAP SBP is 25-50% of MAP amplitude DBP is less and least accurate
33
True or False: ankle, thigh, calf cuffs are validated
False
34
What is the most common site for an arterial line?
Radial
35
Allen's test
Used to determine if there is enough collateral flow from the ulnar artery to prevent ischemia to the hand if the radial artery is occluded for an arterial line * Gold standard
36
Slogoff Study
found that 25% of sampled patients had radial artery occlusion after decannulation, but no evidence of ischemia
37
Steps to perform Allen's test
Compress both radial and ulnar arteries Patient makes tight fist to exsanguinate the palm Patient opens hand Release ulnar artery (outside artery) Color of palm should return w/in 10 seconds
38
Seldinger's Technique
1. Insert needle 2. Pass guidewire through needle 3. Remove needle 4. Insert catheter
39
Transfixion Technique
1. Insert needle and puncture front and back wall intentionally 2. Remove needle 3. Catheter withdrawn until pulsatile blood flow appears, then advance catheter
40
What does Dr. Kane say are complications she has noticed with using the transfixion technique?
More hematomas and they don't hold up as well
41
How should the patient's hand be placed for an art line insertion?
Rolled towel under and tape the fingers to the table
42
How can we maximize the waveform of the art line?
Limit stop cocks, tubing length, non-distensible tubing *have as close to the patient as possible
43
Why is heparin no longer used as an automatic flush for art lines and what is used instead?
Concerns of HIT 1-3ml/hr saline
44
How does the pressure wave change as it moves TO the periphery?
Arterial upstroke steeper Systolic peak higher Dicrotic notch later EDP lower MAP changes very little
45
Why do arterial pressures have different morphologies at different sites?
Impedence along the vascular tree
46
Fourier analysis
The analysis of the summation wave made up by the fundamental wave and harmonic wave of an arterial BP
47
Square Wave Test
Used to check for over or under dampening of arterial line
48
Underdampened
Systolic pressure looks elevated (elderly patients can have this)
49
Overdampened
Systolic pressure appears decreased Absent dicrotic notch Narrowed pulse pressure Loss of detail
50

Anesthesia Prinicples (5 decks)

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