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Principles of Anesthesia 1 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

CVP measures what

A

RAP
RVEDP
preload
fluid volume status

In healthy individuals, RV = LV

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2
Q

CVP measurement

A

1-8

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3
Q

atrial contraction produces an initial spike then descent as blood leaves atrium and fills the ventricle

A

A wave

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4
Q

closed tricuspid elevates during isovolumic ventricular contraction

A

C wave

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5
Q

downward movement of tricuspid valve during systole and atrial relaxation when the base of the heart descends

A

X descent

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6
Q

venous return against a closed tricuspid valve during systole

A

V wave

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7
Q

opening of tricuspid valve during diastole as atrial pressure is higher than ventricular pressure

A

Y descent

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8
Q

what valve is on right side of heart: between atrium and ventricle

A

tricuspid

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9
Q

what valve is on left side of heart: between atrium and ventricle

A

mitral

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10
Q

no A wave, prominent C-V waves

A

a fib

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11
Q

large A wave due to atrium contracting against a closed tricuspid during ventricular systole

A

AV asynchrony/dissociation
(AV dissociation, V pacing, AV nodal rhythms)

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12
Q

large A wave (3 answers)

A

pulmonary hypertension
decreased RV compliance
tricuspid stenosis

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13
Q

broad, tall systolic C-V wave; “regurgitant V wave” (shaped like an M)

A

tricuspid regurgitation: CVP
mitral regurgitation: PA catheter

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14
Q

tall end diastolic A wave with an early diastolic Y descent

A

tricuspid stenosis

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15
Q

CVP high

A

LV failure
RV failure
pulm HTN
cardiac tamponade
constrictive pericarditis
pulm embolism
tricuspid stenosis or regurgitation

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16
Q

CVP low

A

hypovolemic

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17
Q

PAP high

A

LV failure
mitral stenosis or regurgitation
L to R shunt
ASD or VSD
volume overload
pulm HTN
catheter whip

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18
Q

PAOP high

A

LV failure
mitral stenosis or regurgitation
cardiac tamponade
constrictive pericarditis
volume overload
ischemia

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19
Q

subclavian distance

A

10

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20
Q

R IJ distance

A

15

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21
Q

L IJ distance

A

20

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22
Q

femoral vein and right median basilic vein

A

40

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23
Q

left median basilic vein

A

50

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24
Q

where is R IJ in relation to carotid

A

lateral and anterior

30 degree angle, toward ipsilateral nipple

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25
Q

Seldinger’s Technique

A

catheter over guidewire

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26
Q

transverse plane

A

short axis

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27
Q

longitudinal plane

A

long axis

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28
Q

linear/high frequency transducer

A

7-15 mHz (milli)
used for CVLs
shallow

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29
Q

low frequency transducer/curvilinear/phase array

A

2-5 mHz (milli)
used for deep structures

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30
Q

waves bounce and return to probe for processing

A

reflection

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31
Q

waves bounce away from probe

A

refraction

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32
Q

move marker towards the LEFT

A

short axis

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33
Q

move marker towards the HEAD

A

long axis

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34
Q

true or false
orientate caudad (towards the FEET)!

A

true

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35
Q

2 most important measures of PA monitoring

A

CO and PAOP

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36
Q

contraindications for PA catheter

A

Coagulopathy
Thrombolytic treatment
Prosthetic heart valve
Endocardial pacemaker

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37
Q

what does the PAOP look at

A

non-active occluded segment
looking forward
LEFT side of heart (LA and LVEDP)
pulmonary VENOUS system

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38
Q

what is a normal LVEDP

A

8-12 mmHg

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39
Q

what causes the PA catheter to NOT reside in zone 3

A

hypovolemia
positive pressure ventilation (PEEP)
various types of positioning (prone, standing)

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40
Q

P(Alveoli) > P(arterial) > P(venous)

A

zone 1

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41
Q

fully compressed capillaries

A

zone 1

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42
Q

records true PA systolic pressure, but PA diastolic pressure and PWP (PAOP) are meaningless

A

zone 2

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43
Q

capillaries are open in systole and compressed/closed by alveoli during diastole

A

zone 2

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44
Q

P(arterial) > P(Alveoli) > P(venous)

A

zone 2

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45
Q

capillaries are consistently patent

A

zone 3

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46
Q

P(arterial) > P(venous) > P(Alveoli)

A

zone 3

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47
Q

PAOP > LVEDP

A
  • Tachycardia >130
  • 5 cmH20 of PEEP increases PAOP by 1 mmHg; leading to increased pulm venous congestion
  • Catheter tip in zone 1 or 2; increased pulm venous congestion
  • COPD; increased pulm venous congestion
  • Pulmonary venoocclusive disease
  • Mitral regurgitation
  • Mitral stenosis
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48
Q

If PA diastolic climbs _______ mmHg higher than PAOP it indicates an increase in pulmonary artery vascular resistance (PVR)

A

4-5 mmHg
>4 is an issue!!!

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49
Q

normal PAOP (3 things)

A

pulm embolism
pulm HTN
RV failure

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50
Q

elevated PAOP (4 things)

A

LV failure
restrictive cardiomyopathy
cardiac tamponade
overwedging

“CORL”

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51
Q

No “A” waves or “V” waves

A

Overwedging

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52
Q

Build-up of intracatheter pressure from the high-pressure flush system*

A

overwedging

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53
Q

most important determinant of LV afterload

A

blood pressure monitoring

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54
Q

palpation and visualization

A

Rapid systolic estimation/Return of flow technique

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55
Q

auscultatory (korotkoff), no mean available

A

systolic and diastolic

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56
Q

Low compliance (distendability)
(e.g., shivering and arteriosclerosis)

causes what with cuff measurement

A

false HIGH

57
Q

Shock or pressors obliterate sound generation
Too rapid cuff deflation rate

causes what with cuff measurement

A

false LOW

58
Q

Amplitude of pulsations are increasing and are at 25%-50% of maximum

A

systolic pressure

59
Q

Amplitude of pulsations has declined from the peak value approximately 80%

A

diastolic pressure

least accurate

60
Q

what makes cuff measurement unreliable

A

Poor circulation/perfusion: low BP
Erratic pulse: afib, PVCs (bigeminy, trigeminy), tachycardia
Burns, AV shunts

61
Q

Back and forth repeated motion; quantity that regularly fluctuates above and below some mean value, as the pressure of a sound wave

NORMAL

A

oscillation

62
Q

Stretch and recoil of spring (bouncing vibrations/oscillations)
a series of oscillations in which each oscillation has a frequency that is an integral multiple of the same basic frequency
ABNORMAL

A

harmonics

63
Q

exaggerated wave amplitudes occurring when the monitored frequency matches the systems natural frequency resulting in overshoot or overestimated wave reading
ABNORMAL

A

resonance

64
Q

Diaphragm moves too easily= too long oscillation

A

underdamped

65
Q

Diaphragm is too stiff=fails to oscillate

A

overdamped

66
Q

widened pulse pressure

A

underdamped

67
Q

narrowed pulse pressure

A

overdamped

68
Q

Physical behavior of the system

A

dynamic response

69
Q

what is dynamic response BASED on

A

elasticity
mass
friction

70
Q

what is dynamic response ASSESSED by

A

natural frequency
damping coefficient

71
Q

How easily or rapidly the system oscillates

A

natural frequency

72
Q

NF should be at least ___x the frequency of the waveforms to be monitored

A

5x

73
Q

an objects tendency to cease vibrating/oscillating (how rapidly an object will return to resting baseline)

A

damping coefficient

74
Q

Completely undamped

A

Object will continue to oscillate indefinitely
0.0

75
Q

completely damped

A

Object will instantly return to resting state as soon as the stimulus is withdrawn
1.0

76
Q

when one displacement causes one vibration

A

critical damping

77
Q

damping coefficient

A

.4

78
Q

1.5-2 oscillations

A

optimally damped

79
Q

> 2 oscillations

A

underdamped

80
Q

<1 oscillation

A

overdamped

81
Q

Increasing damping will ___________ natural frequency because damping causes slower vibration

A

decrease

inversely related

82
Q

optimal tubing length

A

4 ft

83
Q

optimal damping

A

.6-.7

84
Q

Air causes _______ NF and _________ damping

A

Air causes decreased NF and increased damping

85
Q

__cm below _______ border and __th ICS corresponds to _______ root

A

5cm below sternal border and 4th ICS corresponds to aortic root

86
Q

1 cm of height = _____ mmHg

A

.75 mmHg

87
Q

Delayed upstroke, narrowed pulse pressure (overdamped)

aline

A

aortic stenosis

88
Q

Sharp rise, double peak

aline

A

aortic regurgitation

89
Q

Spike and dome due to midsystolic obstruction

aline

A

hypertrophic cardiomyopathy

90
Q

what is a positive allens test

A

normal artery!

91
Q

aline
Enter at ____-degree angle, bevel up, until flash of blood
Dip to _____-degree angle

A

Enter at 45-degree angle, bevel up, until flash of blood
Dip to 30-degree angle

92
Q

Ether or chloroform dripped onto gauze over a mask

A

open-drop

93
Q

Blowing gas across the face

A

insufflation

94
Q

open circuits

A

insufflation
open-drop

95
Q

semi-open circuits

A

draw-over
maplesons

96
Q

Ambient air is inhaled over liquid agent

A

draw-over

used on battlefield

(oxygen canNOT go very high)

97
Q

Simple, portable, can deliver almost 100% O2
resuscitation

A

AMBU Artificial Manual Breathing Unit

98
Q

NON-rebreathing system

Breathing tube, fresh gas inlet, adjustable pressure-limiting valve (APL), reservoir bag

A

maplesons

99
Q

“Tube in a tube”

A

bain circuit (mapleson D)

100
Q

bain circuit, peds

A

mapleson D

101
Q

good for transport, peds

A

mapleson F

102
Q

As volume increases, compliance __________ (this is a good thing, protective; think of it like a balloon)

A

As volume increases, compliance increases

103
Q

If your baseline is going up (>____ mmHg), inspired and ETCO2 is also going to increase

A

> 3 (not good)

104
Q

With low flows, gradient (the difference between what is being delivered and what is inspired) __________ between delivered and inspired

A

increases

105
Q

tidal volume that does not move into alveoli

A

dead space

tube length does NOT affect dead space

106
Q

Increased fresh gas flow (increasing the flowmeters) leads to __________ equilibration time between “dialed-in concentration” and inspired concentration

A

Increased fresh gas flow (increasing the flowmeters) leads to decreased equilibration time

107
Q

CO2 + H2O =

A

carbonic acid

108
Q

soda lime

A

Ca (OH)2 (calcium hydroxide)
NaOH (sodium hydroxide)
H2O
KOH (potassium hydroxide)
silica

109
Q

true or false

4 mesh is bigger than 8 mesh

A

true

110
Q

Dryness (occurs when flows are not turned off or machine is not turned off)

A

desiccation

111
Q

Breakdown of a volatile agent (bad)

A

degradation

112
Q

Carbon monoxide (CO)

A

desflurane

113
Q

Compound A

A

sevoflurane

114
Q

Compound A is nephrotoxic: you must run flows at __L/min, unless using Amsorb

A

2L min

115
Q

alveolar concentration that prevents movement in 50% of patients in response to surgical stimuli (incision)

A

MAC

116
Q

when should you change out CO2

A

50-70% color change
or rebreathing CO2 noted >3 mmHg

117
Q

What are 2 common reasons to see increased inspired CO2 (>3 mmHg)

A
  1. Valves not working
  2. CO2 absorbent exhausted/not working
118
Q

jackson rees

A

mapleson F

119
Q

spontaneous, general anesthesia <25 kg

A

mapleson F

120
Q

what is the fresh gas flow for jackson rees (mapleson F)

A

2.5-3x MV (minimum 4 L per minute)

121
Q

spontaneous, intermittent, positive-pressure ventilation (IPPV); general anesthesia

A

mapleson D

122
Q

FGF SV for mapleson D (bain)

A

150-200 ml/kg/min

123
Q

FGF IPPV for mapleson D (bain)

A

70-100 ml/kg/min

124
Q

1 MAC Hour = ___ hour at MAC
or ___ hours at 0.5 MAC, etc.

A

1 MAC Hour = 1 hour at MAC
or 2 hours at 0.5 MAC, etc.

125
Q

Mirrors partial pressure in the brain
Used to compare agent potencies
Used for experimental standard
Median value only (limited usefulness due to patient individuality)

A

MAC minimum alveolar concentration

126
Q

0.5 MAC N2O (53%) + 0.5 MAC Sevoflurane (1%) = __ MAC total

A

1 MAC total; it is additive! just add like normal

127
Q

what is the US-NIOSH max for compound A

A

2 ppm

128
Q

when is compound A nephrotoxic

A

25-50 ppm (easily created in extremely low flows)

129
Q

Increased risk of Compound A formation (3 things)

A

High concentration
Long anesthesia time (>2 MAC hours)
Low-flow technique (< 2 L/min)

130
Q

mesh: number of holes per _______ inch of screen

A

number of holes per linear inch of screen

131
Q

what does a reservoir bag do

A

Anesthetic gas reservoir

+ positive pressure ventilation

132
Q

Location of _____ determines Mapleson class

A

fresh gas inlet

133
Q

Long tubes and/or high compliance = _______ gradient* between gas delivery to circuit and gas delivery to patient

A

LARGER gradient

134
Q

resistance is decreased by (5 things)

A

Decreased circuit length
Avoiding sharp bends
Maintaining laminar flow
Increased circuit diameter
Eliminating valves

(DAMIE)

135
Q

true or false
STENOSIS causes large (cannon) A waves

A

true!

136
Q

true or false
REGURGITATION causes large V waves

A

true!

137
Q

PA Diastolic Pressure > PAOP (4 things)

A

Hypoxemia
Pulmonary embolism
Acidosis
Pulmonary vascular disease

138
Q
  • Large v waves
  • PA waveform is notched
A

Massive Mitral Regurgitation

(notching goes away when wedged, becomes single V wave)

Principles of Anesthesia 1 (8 decks)

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