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Hemodynamic Monitoring Flashcards

1
Q

Purpose of hemodynamic monitoring (5 items)

A
  1. Assess homeostasis, trends
  2. Observe for adverse reactions
  3. Assess therapeutic interventions
  4. Manage anesthetic depth
  5. Evaluate equipment function
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2
Q

How we monitor oxygenation (4 items)

A
  1. Pulse ox
  2. Skin color
  3. ABGs
  4. 02 analyzer on machine
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3
Q

How we monitor ventilation (5 items)

A
  1. End tidal CO2
  2. breath sounds,
  3. flow volume loop,
  4. chest rise,
  5. movement of respiratory bag
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4
Q

How we monitor circulation (7 items)

A
  1. Pulse ox,
  2. capillary refill,
  3. pulses,
  4. a line,
  5. skin color,
  6. BP,
  7. HR, heart sounds
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5
Q

Minimal standard for monitoring (5 items)

A
  1. ECG,
  2. bp,
  3. pulse ox,
  4. 02 analyzer,
  5. end tidal co2
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6
Q

Minimal standard on graphic display (5 items)

A
  1. ECG
  2. BP
  3. HR
  4. Ventilation Status
  5. O2 Sat
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7
Q

Considerations when choosing monitoring (7 items)

A
  1. Indications
  2. Contraindications
  3. Risks/benefits
  4. Techniques
  5. Alternatives
  6. Complications
  7. Cost
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8
Q

Hemodynamic monitoring tools (6 items)

A
  1. Stethoscope
  2. EKG
  3. BP
  4. CVP
  5. PAP
  6. TEE
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9
Q

What is precordial stethoscope

A

Continuous heart and breath sounds, goes into esophagus of intubated pts 28 cm, monitors bronchospasm and peds changes

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10
Q

Purpose of EKG (5 items)

A
  1. Monitor HR
  2. Arrythmia detection
  3. detect ischemia
  4. detect lyte changes
  5. monitor pacemaker function
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11
Q

3 lead EKG:

  1. Electrodes
  2. Leads
  3. Views
A

RA, LA, LL.
Leads I, II, III.
3 views, no anterior. No LAD view

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12
Q

5 lead EKG

  1. Electrodes,
  2. Leads
  3. Views
A

RA, LA, LL, RL, chest lead (ususally V1 or V5).
I, II, III aVR, aVL, aVF, V.
7 views

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13
Q

Best lead for

  1. Arrythmia,
  2. Ischemia
A

II.

V5.

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14
Q

What gain and filtering capacity should be set at

A

Standardization. Diagnostic mode

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15
Q

What filtering capacity is

A

Filters out unwanted noise/artifact

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16
Q

Indicators of acute ischemia on ECG (5 items)

A
  1. ST elevation >1 mm,
  2. T wave inversion,
  3. Q waves,
  4. ST depression, flat or downslope >1 mm.
  5. Peaked T waves
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17
Q

Where inferior wall ischemia shows, artery

A

II, III, AVF

Supplied by RCA

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18
Q

Where lateral wall ischemia shows, artery

A

I, AVL, V5-V6

Circumflex of LCA.

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19
Q

Where anterior wall ischemia shows, artery

A

V3-4

Left Coronary Artery

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20
Q

Where anteroseptal ischemia shows, artery

A

V1-V2

LDA

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21
Q

What SBP and DBP correlate with

A

Myocardial o2 requirement changes. Coronary perfusion pressure

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22
Q

MAP calculation

A

SBP + 2DBP/3

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23
Q

Proper NIBP cuff width

A

40% of circumference of extremity

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24
Q

Proper NIBP cuff length

A

Must encircle at least 80% of extremity

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25
What creates a falsely high BP (3 items)
1. Cuff too small or loose, 2. extremity below heart, 3. arterial stiffness in htn or PVD.
26
What creates a falsely low bp (4 items)
1. Cuff too big, 2. above heart, 3. poor tissue perfusion, 4. too quick of deflation
27
Complication of NIBP (6 items)
1. Edema of arm, 2. bruising, 3. ulnar neuropathy, 4. interferes IV flow, 5. pain, 6. compartment syndrome
28
Indications for arterial line bp (7 items)
1. Elective hypotension, 2. wide swings or rapid bp changes intra op 3. fluid shifts, 4. titrate vasoactives, 5. end organ disease, 6. blood sampling 7. NIBP failure
29
How to improve A-line accuracy (6 items)
1. Remove air bubbles, 2. limit tube length, 3. limit stop cocks, 4. small mass of fluid, 5. stiff tubing, 6. calibrate at heart
30
Where to zero a line when monitoring: 1. BP 2. CPP
1. Supine- mid axillary line (RA). | 2. Meatus of ear (circle of Willis)
31
A line wave forms: what rate of upstroke and downstroke show. Variations in size. Area under curve. Dicrotic north
Contractility. SVR. Hypovolemia. MAP. Aortic valve closure
32
Points on a line waveform 1-6
Systolic upstroke, systolic peak pressure, systolic decline, dicrotic notch, diastolic runoff, end diastolic pressure
33
Distal pulse amplification does what
For a line. SBP peak increases, DBP wave decreases, MAP same. Dicrotic notch becomes less and appears later
34
Arterial Line Complications (6 items)
1. Hematoma 2. Nerve Damage 3. Infection 4. Thrombosis/embolus 5. Vasospasm 6. Retained Guide Wire
35
Indications for CVL (6 items)
1. Measure R heart filling 2. assess fluid status, 3. rapid admin fluids, 4. give vasoactives, 5. remove air emboli, 6. insert transcutaneous pacing leads
36
CVL: size, length, where tip should be
7 French, 20 cm length skin to RA junction. 15 if left side. 10 if subclavian. Within SVC above vena cava and RA. Below inferior border of blavice, above 3rd rib, T4/5 interspace,
37
Contraindications to CVL (3 items)
1. Contralateral pneumo 2. RA tumor 3. Infection at site
38
Risks of CVL (8 items)
1. Air or thromboembolism 2. Dysrhythmias, 3. Hematoma, 4. Carotid puncture, vascular damage 5. Pneumo/hemothorax, 6. Tamponade, 7. Infection, 8. Guidewire embolism
39
Normal RAP/Vented RAP
1-7. | 3-5 rise w vent
40
CVP Waveform: A wave (High/Low causes)
``` Atrial contraction (follows EKG P); atrial kick; End of diastole High: tricuspid regurg, fluid overload Low: a-fib, fluid deficit ```
41
CVP Waveform: C wave
Tricuspid valve bluges into atrium during ventricle contraction; occurs early in systole (after QRS on EKG)
42
CVP Waveform: X descent
Systolic collapse in atrial pressure; mid-systolic even
43
CVP Waveform: V wave
Filling of the atrium from the VC; occurs late systole while tricuspid closed (after T wave on EKG)
44
CVP Waveform: Y descent
Diastolic collapse in atrial pressure; drop in atrial pressure as tricuspid opens
45
CVP Wave to Cardiac Cycle: 1. A Wave 2. C Wave 3. X Descent 4. V Wave 5. Y Descent
1. End diastole 2. Early Systole 3. Mid Systole 4. Late Systole 5. Early Diastole
46
Pulmonary Artery Assessments (6 items)
1. Intracardiac pressures (PAP, PCWP) 2. Estimate LV pressures 3. Assess LV function 4. CO 5. Mixed venous saturation 6. PVR/SVR
47
PA Catheter: 1. French 2. Length 3. Lumens (4)
1. 7 French (introducer 8.5) 2. 110 cm 3. Distal, Proximal, Balloon, Thermistor
48
Indications for PA monitoring (5 items)
1. LV dysfunction, 2. valvular disease, 3. pulm htn, 4. CAD, ARDS, Resp fail, shock, sepsis, ARF, 5. cardiac/aortic/OB procedures
49
Complications of PA Catheter (6 items)
1. Arrhythmias (V fib, RBBB, heart block), 2. catheter knotting, 3. balloon rupture, 4. thrombo/air embolism, 5. ptx, pulm infarct, PA rupture, 6. endocarditis, damage to valves
50
Contraindications to PA insertion (2 items)
Wpw syndrome, complete LBBB
51
What happens to wave form as PA inserted
CVP wave in RA, more turbulent and higher P in RV, SBP same and DBP rises in PA, more compact pressure when wedged
52
Distance from right IJ to : 1. RA junction, 2. RA, 3. RV, 4. PA, 5. PA wedge
1. 15, 2. 15-25, 3. 25-35, 4. 35-45, 5. 40-50
53
PCWP a wave
contraction of the left atrium. small deflection unless there is resistance in moving blood into the left ventricle as mitral stenosis.
54
What c wave is PCWP
rapid rise in the left ventricular pressure in early systole, causing the mitral valve to bulge backward into the left atrium, so that the atrialpressure increases momentarily.
55
What v wave is PCWP. Prominent wave means what
Blood enters LA in late systole. Prominent reflects mitral insufficiency causing large amts of blood to reflux into LA in systole
56
How to monitor CO
Thermodiluton, continuous thermodilution, mixed venous oximetry, ultrasound, pulse contour
57
What can cause loss of a waves in CVP/PAOP.
A fib, ventricular pacing
58
What can cause large v waves cvp and paop
Mitral regurg and acute inc in IV volume
59
What can cause giant a waves cvp and paop
Junctional rhythm, complete HB, mitral stenosis, diastolic dysfunction, myo ischemia, ventricular hypertrophy
60
What TEE observes
Ventricular wall traits/motion, valve structure/function, EF, CO, blood flow, intracardiac air or masses
61
Uses of TEE
Unusual causes of acute hypotension, tamponade, PE, aortic dissections, myo ischemia, valvular dysfunction
62
TEE complicaitons
Mostly in awake pts. Esophageal trauma, dysrhythmias, hoarseness, dysphagia
63
Types of NIBP (4 items)
1. Palpation 2. Doppler 3. Auscultation 4. Oscillometry
64
NIBP Palpation: 1. Technique 2. Considerations
1. Palpating a pulse while deflating cuff | 2. Only measures SBP but usually underestimates; is cheap, simple
65
NIBP Doppler: 1. Technique 2. Considerations
1. Use doper on artery w/ cuff | 2. Measures only SBP reliably
66
NIBP Auscultation: 1. Technique 2. Considerations
1. Listen for Korotkoff sounds | 2. Can estimate SBP and DBP; usually underestimates in HTN patients
67
NIBP Oscillometry: 1. Technique 2. Considerations
``` 1. Senses oscillations: 1st is SBP Max is MAP Cease at DBP 2. Can have false highs/lows ```

Positioning (6 decks)

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