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Principles of Anesthesia I > Exam 1 - Clinical Monitoring > Flashcards

Exam 1 - Clinical Monitoring Flashcards

(51 cards)

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1
Q

What are the minimum monitoring requirements per the AANA?

A

Oxygentation: Pulse ox and observation
Ventilation: Auscultation, chest excursion, EtCO2
CV: ECG, BP/HR q5mins
Plus: any additional monitors required per procedure (BIS, temperature, etc)

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2
Q

What must you document if you are not utilizing the minimum required monitors?

A

Must document the omission with reason

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3
Q

What are the 3 ways light can be affected by matter?

A
  • Transmitted
  • Absorbed
  • Reflected
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4
Q

What does the Beer-Lambert Law state?

A

A beam of light passing through a solution with a fixed geometry will be absorbed proportional to the concentration of the solute

↑ solute concentration; ↑ light absorption

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5
Q

What are the 4 Hb found in adult blood?

A
  • HbO2
  • DeoxyHb
  • metHb
  • COHb
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6
Q

Why is the tradional 2 wavelength pulse ox prone to inaccuracies?

A

Because at the 660 nm wavelength, metHb/oxyHb and deoxyHb/COHb have very similar absorptions - making it unable to distinguish between them

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7
Q

What is the gold standard for monitoring SpO2 if the 2 wavelength oximeter is inaccurate?

A

Co-oximetry, using 4 wavelenghts

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8
Q

What blood does a pulse oximeter monitor?
Why?

A
  • Pulsatile arterial blood
  • Because absorption of light increases with pulsations d/t artery expansion
  • Whereas venous, blood, bone, and continuous arterial blood have constant absorptions
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9
Q

What is the formula to determine SpO2?

A
  • Pulsatile divided by nonpulsatile
  • R = (AC 660/DC660) ÷ (AC 940/DC 940)

DC is the basline absorption and AC is the pulstaile change

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10
Q

What happens to the SpO2 signal if the patient has low perfusion?

A

Signal and artifact are amplified

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11
Q

Difference between SaO2 ane SpO2?

A

SaO2: direct measurement of arterial saturation (ABG)
SpO2: indirect measurement of arterial saturation (Pulse Ox)

Normally different by 2-3%

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12
Q

What happens to the SpO2 if you inadvertantly measure venous pulsations?

A

Signal averaging times lengthen
Slower to report changes

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13
Q

How do IV dyes affect SpO2?

A

They increase light abosrption and lead to a falsely low SpO2

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14
Q

What are the characteristics of the higher end of the oxy-Hb dissociation curve?
Compare this to the lower end?

A
  • Hb saturation is maintained above 90% down to a partial pressure of 60 mmHg
  • Below a pO2 of 60 mmHg, the saturation begins to decrease dramatically
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15
Q

What causes a shift left on the OHDC?

A

Decreased temperature, 2-3 DPG, [H+]
Increased CO

Increases affinity for O2

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16
Q

What causes a shift right on the OHDC?

A

Increased temperature, 2-3 DPG, [H+]

Reduces affinity for O2

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17
Q

Why might you consider placing the pulse oximeter centrally and not peripherally?

A
  • If peripheral flow is decreased, the periphery is first to vasoconstrict
  • Detection of desaturation/resaturation is slower peripherally
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18
Q

Where should avoid placing a pulse oximeter?

A

Index finger - patients will rub eyes and could cause corneal abrasion

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19
Q

What location may be more reliable for a SpO2 reading in a patient with an epidural?
Why?

A
  • Toe
  • Epidural causes vasodilation below the level of blockade - increasing flow
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20
Q

Below what Hb saturation is the SpO2 inaccurate at reflecting SaO2?

A

SpO2 < 70%

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21
Q

How do anesthetic vapors affect the SpO2?

22
Q

How can the SpO2 indicated decreased CO?

Study These Flashcards
A

Typically, peripheral vasoconstriction occurs under low CO states. Vasoconstriction would lead to a decreased SpO2 waveform

23
Q

What dyes affect the SpO2?
Which one affects it the most?

Study These Flashcards
A
  • Methylene Blue - most absorption, but very transient
  • Indocyanine green
  • Indigo carmine
24
Q

Effect of increased COHb on SpO2?
Why?

Study These Flashcards
A
  • Falsely elevates SpO2 by 1% for every 1% increase in COHb
  • COhb absorbs the same amount of light in the 660 nm range as oxyHb
25
What do you need to remeber when observing smokers SpO2?
- Many smokers have an COHb > 6% - Remeber their true SpO2 is lower than what is being reported
26
Which doctor helped develop understanding of the circulatory system in the 1600's?
William Harvey
27
When and who recorded the first blood pressure?
Reverend Hales in 1733 on a horse
28
Who and when was the sphygmomanometer created?
Samuel von Basch in 1881
29
When was the modern blood pressure cuff measurement described? What are sound auscultated called?
1905; Kortokoff sounds
30
Desribe the phases Kortokoff sounds:
Phase I: most turbulent/audible = SBP Phase II-III: change in sound character Phase IV-V: muffled/absent = DBP
31
What is the formula for MAP?
2(DPB+SBP) ÷ 3
32
What can limit the ability to auscultate a blood pressure?
- Decreased peripheral flow - Change in vessel compliance (severe edema, arteriosclerosis) - Shivering
33
How does too large and too small of a BP cuff effect the reading?
Too large - falsely low Too small - falsely high
34
What is the maximum cuff pressures for adults and neonates?
Adults: 300 mmHg Neonates: 150 mmHg
35
What should the cuff size be in relation to arm size?
40% of upper arm circumference 80% of upper arm length
36
Describe how the automatic NIBP works?
- Based upon oscillometry, where the maximum aplitude is the MAP - SBP and DBP are calculated - SBP is typically 25-50% of MAP amplitude - The DBP is least accurate
37
At what MAP is the NIBP correlating to direct arterial MAP?
When MAP is 75 mmHg or greater
38
How do hypertension and hypotension affect NIBP? What must we do to maintain reliable measurements?
Hypertension - underestimates MAP Hypotension - overestimates MAP Need to trend measurements to ensure reliablity
39
What traumas can be caused by frequent NIBP cycling?
- Coagulopathies - Peripheral neuropathy - A/V insufficency - Compartment syndrome
40
Indications for an arterial line?
- Need for real time BP monitoring - Planned pharmacoligic manipulation - Repeated blood draws - Determination of volume responsiveness - Timing of IABP conterpulsation
41
How do you ensure that placing a radial arterial line will not cause a problem with hand perfusion?
Perform and Allen's test to make sure the ulnar artery can procide sufficent flow when the radial artery is occluded
42
What would be a postive Allen's test?
Color change does not return within 10 seconds
43
What is the name of the technique used to insert an arterial line?
Seldinger's
44
What is the transfixion technique? Problems?
- Intentionally puncture both walls of the artery - Remove the needle - Withdraw the catheter until blood flow then advance - Per Dr. Kane's experience - increased hematomas and decreased lifespan of catheter
45
How can you maximize the arterial line waveform?
Limit stopcocks, tubing length (ensure it is non-distensible)
46
Label the portions of the waveforms:
1: systolic upstroke 2: systolic peak pressure 3: systolic decline 4: dicrotic notch 5: diastolic runoff 6: end-diastolic pressure
47
How does the pressure waveform change as the measurement moves to the periphery?
- Arterial upstroke is steeper - Systolic peak is higher - Diacrotic notch is later - EDP lower - MAP unchanged
48
How is the arterial line waveform made?
Summation of sine waves - "Fourier analysis" Fundamental + harmonic = pressure wave
49
How can you ensure correct damping of an arterial line waveform?
Square wave test Should have less than 2 oscillations after a fast fluid flush
50
What are the differences between an underdamped and overdamped arterial waveform?
Underdamped: SBP is elevated Overdamped: SBP is decreased, absent dicrotic notch, narrowed pulse pressure, loss of detail
51
How does age and atherosclerosis affect the arterial waveform?
Decreases distensibility creating a larger and more narrowed waveform

Principles of Anesthesia I (3 decks)

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