Exam 1: Hemodynamic Monitoring

Question 1

Four parameters that are continually evaluated during anesthesia:

Answer 1

Oxygenation
Ventilation
Circulation
Temperature

Question 2

Two exceptions to constant-presence requirement:

Answer 2

Laboring moms

Pain mgmt

Question 3

Minimal standard monitors (6):

Answer 3

BEPPOE:
BP
EKG
Precordial stethoscope 
Pulse ox
Oxygen analyzer
ETCO2

Question 4

Minimal information on monitor display:

Answer 4

BEVOH:
BP
EKG
Ventilation status (ETCO2)
O2 Saturation
HR

Question 5

Means of hemodynamic monitoring (6):

Answer 5

Stethoscope
EKG
BP (invasive and non)
CVP
PAP/PCWP
TEE

Question 6

Esophageal stethoscope distance of insertion:

Answer 6

28-30cm

Question 7

Advantage of esophageal/precordial stethoscope:

Answer 7

Very sensitive monitor for bronchospasm/changes in pediatric patients

Question 8

Purposes of EKG monitoring (5):

Answer 8

Detect arrythmias
Monitor HR
Detect ischemia
Detect electrolyte changes
Monitor pacemaker

Question 9

Best EKG lead for rhythm detection:

Answer 9

II

Question 10

Best EKG lead for ischemia detection:

Answer 10

V

Question 11

3-lead leads:

Answer 11

I, II, III

Question 12

5-lead leads:

Answer 12

I, II, III, aVR, aVL, aVF, V

Question 13

Significant coronary artery not viewed in a 3-lead:

Answer 13

LAD

Question 14

Reasons for EKG artifact:

Answer 14

Cautery/electrical equip
Movement
Hair
Sweat
Shivering

Question 15

Gain standard: ____ signal produces _____ calibration pulse so that a _____ ST segment change can be accurately assessed

Answer 15

1mV; 10mm; 1mm

Question 16

Two EKG filtering modes:

Answer 16

Monitor

Diagnostic

Question 17

Filtering should be set to this mode:

Answer 17

Diagnostic

Question 18

Five principle indicators of acute ischemia:

Answer 18

ST segment elevation or depression
T wave inversion or peaking
Q wave development

Question 19

Leads to detect posterior/inferior wall ischemia (RCA):

Answer 19

II
III
AVF

Question 20

Leads to detect lateral wall ischemia (circumflex):

Answer 20

I
AVL
V5-V6

Question 21

Leads to detect anterior wall ischemia (LCA):

Answer 21

I
AVL
V1-V4

Question 22

Leads to detect anterioseptal ischemia (LAD):

Answer 22

V1-V4

Question 23

Changes in SBP correlate with:

Answer 23

Changes in myocardial O2 requirements

Question 24

Changes in DBP correlate with:

Answer 24

Coronary perfusion pressure

Question 25

MAP calculation:

Answer 25

SBP+2(DBP)/3

Question 26

As pulse moves distally, it's distorted this way:

Answer 26

Exaggerated SBP/wider pulse pressure

Question 27

Rate of a-line upstroke correlates with:

Answer 27

Contractility

Question 28

Rate of a-line downstroke correlates with:

Answer 28

SVR

Question 29

Exaggerated change in a-line waveform with respiration indicates:

Answer 29

Hypovolemia

Question 30

Area under the a-line curve equals:

Answer 30

MAP

Question 31

Biggest a-line risk:

Answer 31

Hemorrhage/hematoma

Question 32

Best site for CVC and why:

Answer 32

RIJ - straight shot to heart, best success rate

Question 33

Better side for subclavian:

Answer 33

R

Question 34

Lowest infection rate CVC site:

Answer 34

Subclavian

Question 35

Highest infection rate CVC site:

Answer 35

Femoral

Question 36

CVC placement confirmation in OR setting:

Answer 36

Aspiration of blood from all 3 ports

Question 37

Contraindications to CVC:

Answer 37

R atrial tumor Infection at site Contralateral pneumothorax

Question 38

The one non-technique based CVC risk:

Answer 38

Dysrhythmias

Question 39

Normal mean RA/CVP pressure during spontaneous respiration:

Answer 39

1-7mmHg

Question 40

Normal mean RA/CVP pressure during mechanical ventilation:

Answer 40

4-12mmHg

Question 41

CVP "a" wave caused by:

Answer 41

Atrial contraction

Question 42

CVP "c" wave caused by:

Answer 42

R ventricular contraction and bulging of tricuspid back into R atrium

Question 43

CVP "x" descent caused by:

Answer 43

Ventricular contraction and relaxation of atrium

Question 44

CVP "v" wave caused by:

Answer 44

Filling of atrium with blood from vena cava

Question 45

CVP "y" descent caused by:

Answer 45

Tricuspid valve opening and ventricular filling

Question 46

Dimensions of PAP catheter:

Answer 46

7-9 Fr | 110 cm

Question 47

Dimensions of CVC catheter:

Answer 47

7 Fr | 20 cm

Question 48

Only patients with demonstrated benefits to PAP monitoring:

Answer 48

Shock/sepsis pts

Question 49

Biggest complications of PAP monitoring:

Answer 49

Arrythmias | PA rupture

Question 50

Pressures in RA:

Answer 50

1-7 mmHg

Question 51

Pressures in RV:

Answer 51

0-25mmHg

Question 52

Pressures in PA:

Answer 52

10-25mmHg

Question 53

Pressures in PAW:

Answer 53

8-12mmHg

Question 54

Distance from RIJ to RA:

Answer 54

15-25cm

Question 55

Distance from RIJ to RV:

Answer 55

25-35cm

Question 56

Distance from RIJ to PA:

Answer 56

35-45cm

Question 57

Distance from RIJ to PAW:

Answer 57

40-50cm

Question 58

PAWP "a" wave represents:

Answer 58

Contraction of LA | Tallest wave

Question 59

PAWP "c" wave represents:

Answer 59

Rapid rise in LV pressure during early systole that causes mitral valve to bulge backwards (Shortest wave)

Question 60

PAWP "v" wave represents:

Answer 60

Blood entering LA during late systole

Question 61

Prominent PAWP "v" wave reflects:

Answer 61

Mitral valve insufficiency

Question 62

Cardiac parameters observed via TEE (7):

Answer 62

``` Ventricular wall motion Valve structure/function EF estimation CO Flow characteristics Intracardiac air Intracardiac masses ```

Question 63

Indications for TEE:

Answer 63

Unusual and unknown causes of acute hypotension

Question 64

Major complication of TEE:

Answer 64

Esophageal trauma