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Principles of Anesthesia I (Summer 2025) > Clinical Monitoring I Exam I > Flashcards

Clinical Monitoring I Exam I Flashcards

(85 cards)

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1
Q

AANA Monitoring Standards for Oxygenation

A
  • Clinical Observation (watch your patient)
  • Continuous Pulse Oximetry
  • ABG’s as indicated
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2
Q

AANA Monitoring Standards for Ventilation

A
  • Auscultation
  • Chest excursion (rise/fall of chest)
  • ETCO2 documentation
  • Pressure monitors as indicated
  • Monitor RR q 5 mins
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3
Q

AANA Monitoring Standards for Cardiovascular System

A
  • Electrocardiogram
  • Auscultation as needed
  • BP and HR documentation q 5 mins
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4
Q

AANA Monitoring Standards for Thermoregulation

A
  • When clinically significant changes in body temp are anticipated or suspected
  • Continuous monitor of temperature in cases longer than 20 minutes, pediatric cases, or elderly patients.
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5
Q

AANA Monitoring Standards for Neuromuscular System

A
  • When neuromuscular blocking agents are administered.
  • TOF are charted q 15 mins
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6
Q

Name factors that will cause the Hb dissociation curve to shift right.

Name factors that will cause the Hb dissociation curve to shift left

A

Remember:
Right shift = ↓ Hb affinity to O2.
Left shift = ↑ Hb affinity to O2

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7
Q

How low can a healthy normal adult patient’s PaO2 decrease before their O2 saturation drops below 90%?

A

PaO2 can decrease to 60 mmHg before O2 saturation drops below 90%.

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8
Q

Upon what law of physics is pulse oximetry based?

A
  • Beer-Lambert Law
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9
Q

Explain how concentration of a solute affects light absorption in pulse oximetry.

A
  • Amount of light absorbed is proportional to the concentration of the light absorbing substance (Beer’s Law)
  • Higher Hb concentration, more light absorption
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10
Q

Explain how distance affect light absorption in pulse oximetry.

A
  • Amount of light absorbed is proportional to the length of the path that the light has to travel in the absorbing substance (Lambert’s Law)
  • Wider arteries, more light absorption
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11
Q

What were the four species of Hb in adult blood discussed in lecture?

A
  • Oxyhemoglobin (O2Hb)
  • Deoxyhemoglobin (deO2Hb)
  • Methemoglobin (metHb)
  • Carboxyhemoglobin (COHb)
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12
Q

What is considered the gold standard for SaO2 measurements and is relied on when pulse oximetry readings are inaccurate or unobtainable?

A
  • CO-oximetry

4 wave lengths

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13
Q

The wavelength of red light

A
  • 660 nm
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14
Q

The wavelength of infrared light

A
  • 940 nm
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15
Q

__________ absorbs more infrared light.

___________ absorbs more red light.

Choose between oxyhemoglobin and deoxyhemoglobin

A

SeXy DARLing:
SiX hundred wavelength, DeoxyHb Absorbs Red Light.

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16
Q

How does the amount of oxyhemoglobin and deoxyhemoglobin in the blood affect SPO2?

A
  • As the amount of oxy Hb and deoxy Hb changes, the light ratio comparing red and infrared light also changes.
  • The pulse oximeter uses the ratio to work out the oxygen saturation.
  • More DeoxyHb present, ↑ Red Light: Infrared Light Absorption Ratio, ↓ O2 sat
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17
Q

Which Hb species absorbs as much light in the 660 nm range as OxyHb?

A
  • Carboxyhemoglobin

The absorption of light at 660 nm by COHb is similar to that of O2Hb. At 940 nm, COHb absorbs virtually no light. Thus, in a patient with carbon monoxide poisoning, the SpO2 will be falsely elevated.

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18
Q

Each 1% increase in COHb will increase SpO2 by _____%.

A
  • 1%
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19
Q

Many smokers have > ______% of COHb.

A
  • 6%
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20
Q

What is the Pulse Principle in regards to pulse oximetry?

A
  • The pulse principle in pulse oximetry refers to the fact that the device can distinguish between arterial blood and other tissues by detecting the pulsatile nature of arterial blood flow.
  • Your arteries “pulse” with each heartbeat — the volume of blood increases and decreases rhythmically.
  • Your veins, skin, and bone do not pulse — their light absorption stays constant.
  • The pulse oximeter tracks changes in light absorption that occur with each pulse.
  • It uses these changes (the pulsatile signal) to isolate arterial oxygen saturation (SpO₂) and ignore non-pulsatile components like skin and tissue.
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21
Q

What factors cause signal artifacts in pulse oximetry? (6)

A
  • Ambient light
  • Low perfusion
  • Venous blood pulsations
  • Additional light absorbers (methylene blue)
  • Additional forms of Hb
  • Nail polish
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22
Q

How accurate is pulse oximetry when measured against ABGs as long as the patient’s O2 saturation is >70%?

A
  • Pulse oximetry’s accuracy is within 2% of an ABG.
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23
Q

List advantages of pulse oximetry. (Long list, common sense)

A
  • Accurate/ Convenient
  • Not affected by anesthetic vapors
  • Noninvasive
  • Continuous
  • May indicate decreased cardiac output
  • Tone modulation
  • Probe variety (Ear probe)
  • Battery-operated/ Cheap
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24
Q

List disadvantages of pulse oximetry. (Long list, common sense)

A
  • Poor function with poor perfusion
  • Delayed hypoxic event detection
  • Erratic performance with dysrhythmias
  • Inaccuracy with different hemoglobin (COHb)
  • Inaccuracy with dyes
  • Optical interference
  • Nail polish and coverings
  • Motion artifact
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25
Fingers are relatively sensitive to ________
* vasoconstriction
26
What kind of nails inhibit pulse oximeter transmission?
* Dark polish or synthetic nails
27
True/False: Pulse Oximetry detection of desaturation and resaturation from the periphery is slow.
* True
28
Why shouldn't the pulse oximeter be placed on the index finger?
* ↑ risk of corneal abrasion
29
Where will you place a pulse oximeter for the most accurate reading during an epidural block?
* Toes *Toes will be more dilated than fingers with an epidural block.*
30
What three parts of the body are least affected by vasoconstriction and will reflect desaturation quickly?
* Tongue * Cheek * Forehead
31
Most indirect methods of blood pressure measurement utilize a sphygmomanometer. What is the series of audible frequencies produced by turbulent flow beyond the partially occluded cuff called?
* Korotkoff sounds
32
Describe the phases of the Korotkoff sounds. During what phase will you hear SBP and DBP?
* **Phase I: the most turbulent/audible (SBP)** * Phase II: softer and longer sounds * Phase III: crisper and louder sounds * Phase IV: softer and muffled sounds * **Phase V: sounds disappear (DBP)**
33
Give the formula to calculate MAP
* MAP = DBP + 1/3 (SBP - DBP)
34
What factors will limit BP auscultation?
* Decrease peripheral flow (shock/vasoconstriction) * Changes in vessel compliance (atherosclerosis) * Incorrect cuff size * Obesity
35
What is the best way to measure BP in pediatric patients?
* Use the automatic NIBP
36
Blood pressure cuff bladder should should be ____% of arm circumference and _____ % of length of upper arm.
* Blood pressure cuff bladder should should be **40%** of arm circumference and **80%** of length of upper arm.
37
What method is used by many automatic NIBP devices to measure blood pressure non-invasively.
* Oscillometry *Automatic NIBP correlates well with invasive BP in healthy pts.*
38
What factors will cause errors in automatic NIBP resulting in low SBP and high DBP?
* Atherosclerosis * Edema * Obesity * Chronic HTN
39
What will be the result of a BP reading if the patient's BP cuff is too large?
* falsely low BP
40
What will be the result of a BP reading if the patient's BP cuff is too small?
* falsely high BP
41
For standards of automatic NIBP they must be within how many mmHg?
* +/- 5 mmHg *Deviations up to 20 mmHg are acceptable*
42
What part of the arm is preferable in obese patient when measuring their BP?
* Forearm
43
What are advantages of automatic NIBP?
* Eliminate clinician subjectivity * Improved quality and accuracy * Automaticity * Noninvasive
44
What are disadvantages of automatic NIBP?
* Unsuitable in rapidly changing situations * Patient discomfort * Complications (Compartment syndrome, Pain, Limb edema, etc)
45
Caution use of automatic NIBP in:
* Severe coagulopathies * Peripheral neuropathies * Arterial/venous insufficiency * Recent thrombolytic therapy
46
# Determination of..? Timing of..? List indication for an arterial line. (5)
* Continuous, real-time * Planned pharmacologic manipulation * Repeated blood sampling * Determination of volume responsiveness * Timing of balloon pump counterpulsation
47
Common Monitoring sites for a-line placement: (7)
* Radial (most common, easy to access) * Ulnar * Brachial * Axillary * Femoral * Posterior tibial * Dorsalis pedis
48
What test is used to assess collateral blood flow to the hands before radial arterial line placement.
* Allen's Test * Good circulation: Color returns <5 seconds * > 10 seconds indicate severely reduced collateral flow *Predictive value of this test is poor*
49
Describe the Seldinger technique for arterial placement.
50
Describe the Transfixion technique for arterial placement.
* Front and back walls are punctured intentionally * Needle removed * Catheter withdrawn until pulsatile blood flow appears and then advanced
51
When placing an arterial line, the needle should enter at a _______ degree angle (range) to the skin directly over the point at which the pulse is palpated.
* 30 to 45 degrees
52
What is used to prevent thrombus formation in an arterial line?
* 1-3 ml/hr automatic NS flush (pressure bag)
53
What does zeroing an arterial line do?
* The measuring system must also be zeroed to obtain accurate data. * Zeroing the system provides a reference point of pressure. * Most commonly, this is atmospheric pressure.
54
Where is the arterial line leveled?
* Aortic root (mid axillary chest)
55
How can the waveform of an arterial line be maximized?
* Limit stopcocks * Limit tube length * Use non-distensible tubing (hard tubing)
56
Label parts 1-6 of the arterial waveform.
* 1: systolic upstroke * 2: systolic peak pressure * 3: systolic decline * 4: dicrotic notch (closing of the aortic valve) * 5: diastolic runoff * 6: end-diastolic pressure *SBP is measured at 2 and the DBP is measured at 6.*
57
As the pressure wave moves to the periphery, what happens to the: Arterial upstroke Systolic Peak Dicrotic notch End Diastolic pressure
* Arterial upstroke will be steeper * Systolic Peak will be higher * Dicrotic notch will appear later * End Diastolic pressure will be lower
58
What causes distal pulse amplification?
- Arterial pressures measured at different sites will have different waveform morphologies - Caused by impedence changes along the vascular tree
59
What two waves make up a typical pressure wave (summation wave)?
* Fundamental wave * Harmonic wave
60
What is the square wave test?
* The arterial line can measure BP inaccurately unless properly calibrated. * Rapidly flushing the line generates a square wave. * Counting oscillations after the square wave indicates that the arterial line works properly. * There should be no more than two oscillations after the fast flush
61
Describe an under-damped arterial waveform.
* Systolic pressure is falsely high * >2 oscillations * Multiple dicrotic notches
62
Describe an over-damped arterial waveform
* Systolic pressure is falsely low * No oscillations * Absence of dicrotic notch * Loss of detail * Falsely narrowed pulse pressure, but accurate MAP
63
# Seven Pathologies that cause waveform changes in an a-line:
* Age: lack of distensibility * Atherosclerosis * Embolism * Arterial dissection * Septic shock * Hypothermia * Vasopressors
64
Compare the arterial waveforms between a normal young person and an elderly person.
* The elderly patient will have an ↑ SBP * The elderly patient will be a widened Pulse Pressure * This is due to the decrease in distensibility in the elderly patient
65
# Five List arterial line complications.
* Distal ischemia or pseudoaneurysm * Hemorrhage, hematoma (hold pressure longer) * Arterial embolization (Art line staying in too long) * Local infection * Peripheral neuropathy
66
Cyclic arterial BP variations due to changes in intrathoracic pressure are related to what two factors?
* Positive pressure ventilation * Lung volume changes
67
What happens initially when the ventilator delivers a breath?
Initially, in early inspiration: - PPV ↑ lung volume → compressing lung tissue - This displaces pulmonary venous blood into the left heart → **↑ LV preload** - ↑ in intrathoracic pressure causes a relative↓ in afterload → leading to an ↑ LV SV
68
During the EARLY inspiratory phase of PPV, the increase in LV preload and decrease in afterload produce an increase in what three variables?
* ↑ LV SV * ↑ CO * ↑ Systemic arterial pressure *Miller pg. 1167*
69
What happens as intrathoracic pressure continues to increase during PPV?
As intrathoracic pressure continues to rise: - ↓ Venous return and R. heart preload - ↑ in pulmonary vascular resistance causes an ↑ R. heart afterload - R. Heart SV drops → L. Heart preload decreases → Systemic arterial BP declines
70
What is the overall effect of increasing intrathoracic pressure on cardiac output?
* ↑ Intrathoracic Pressure = ↓ CO *Memorize the flowchart*
71
The cycle of increasing and decreasing stroke volume and systemic arterial blood pressure in response to end expiration is:
* Systolic pressure variation (SPV).
72
In mechanically ventilated patients, normal SPV is __________ mmHg (range).
* 7-10 mmHg
73
What is a normal Δ up SPV?
* 2-4 mmHg
74
What is a normal Δ down SPV?
* 5-6 mmHg
75
What does an increased SPV indicate?
* Patient may be volume responsive * Patient may have residual preload reserve * Possible early indicator of hypovolemia * Critically ill patients will have an increased SPV with a drastic Δ down component.
76
This variable is used as a dynamic indicator of preload reserve by utilizing the max and min pulse pressure over the entire respiratory cycle.
* Pulse Pressure Variation
77
What is considered a normal pulse pressure variation?
* < 13-17% *PPV >13-17% will indicate a positive response to volume expansion*
78
PPV formula
[Maximum difference in arterial pulse pressure] / [ Average of Max and Min pulse pressure]
79
The changes in stroke volume between the inspiratory and expiratory phases of positive pressure ventilation.
* Stroke Volume Variation
80
How do you calculate SVV?
(SV max - SV min) / SV mean
81
What is normal SVV?
* Less than 10-13% *SVV >10-13% indicates a positive response to volume expansion.*
82
SVV uses computer analysis of arterial pulse pressure waveforms and correlates resistance and compliance based on what two factors?
* age * gender
83
For an accurate SVV reading, mechanical ventilation should have a tidal volume of ______ (range).
* 8-10 mL/kg
84
To predict accurate results of residual preload reserve through SPV, PPV, and SVV, what factors need to be met in mechanically vented patients?
* Tidal volume of 8 to 10 mL/kg * Positive end-expiratory pressure ≥ 5 mm Hg * Regular cardiac rhythm * Normal intra-abdominal pressure * A closed chest *Miller pg. 1168*
85
What is the importance of the Frank-Starling Law?
* Left ventricular filling determines the left ventricular end-diastolic volume (LVEDV), which is generally directly proportional to left ventricular preload and CO. * The Frank–Starling Law describes the relationship between LVEDV and CO. * According to the Starling Law, CO increases with increasing left ventricular preload.

Principles of Anesthesia I (Summer 2025) (23 decks)

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