I&M: Introduction to Noninvasive Perioperative Monitoring Flashcards Preview

MSA S2015 > I&M: Introduction to Noninvasive Perioperative Monitoring > Flashcards

Flashcards in I&M: Introduction to Noninvasive Perioperative Monitoring Deck (13):
1

Noninvasive, invasive?

Puncturing skin? Inserting instrument or foreign material into body?

Noninvasive - BP, EKG
Invasive - arterial line

2

Continuous, continual?

Repeated regularly and frequently in steady rapid succession (continual)?
Prolonged without interruption (continuous)?

Continual - BP, twitch (every 15min)
Continuous - pulse ox, capnogram, EKG, arterial line

3

Iatrogenic

Harm to the patient caused by provider

4

Artifact

Interference, altered data

5

ASA Standards

1. Qualified anesthesia person in room at all times
2. Patient's oxygen, ventilation, circulation and temp shall be monitored

6

Pulse oximeter

Non-invasive measurement of arterial blood using two wavelengths of light: 660nm (red) - deoxyhemoglobin, 940nm (infrared) - oxyhemoglobin. The difference in light absorption during systolic pulsation determines reading.

Waveform gives idea of tissue perfusion--small waves may indicate weak blood flow.

Normal saturation: 97-100%

7

Oxy-hemoglobin dissociation curve

Slippery slope when pulse-ox reading reaches ~90%. PaO2 is ready to drop exponentially.

ALSO, there is a slight delay between what's happening with patient and what's on the monitor.

Right shift - decreased Hb-O2 affinity ↑H+, ↑PCO2 ↑Temp
Left shift - increased Hb-O2 affinity ↓H+, ↓PCO2 ↓Temp

8

Ventilation

Can be monitored with ETCO2, chest excursion, auscultation of breath sounds, movement in reservoir bag. ETCO2 can be measured with capnography, capnometer, mass spec.

Capnography also experiences slight delay between what's happening with the patient and what's on the monitor.

9

Circulation

EKG, BP and HR (at least every 3-5min)
At least one of the following: pulse palpation, auscultation of heart sounds, arterial line, pulse oximetry

10

Blood pressure cuff

MAP = DBP + 1/3PP
PP = SBP-DBP

Can be placed on upper arm, forearm, calves

Don't place cuff on arm with AV graft or fistula, surgical field, or where lymph node dissection has occurred (mastectomy)

11

EKG

Usually monitor leads II and V in adults and lead II in children. Lead II is the vecter between the W lead and the R lead.

White - right
Black over Red - smoke over fire
Green = grounding - can really go anywhere
Brown - axillary 5th intercostal space

12

Temperature

Normal body temperature regulation is inhibited by anesthesia --> patients get cold. Patient can be kept warm with a bair hugger kept at ~40C

Thermistors can be placed in nose, esophagus, rectum, on skin, oropharynx, armpit.

13

Other common monitors

Foley bags - determine urine output
Acceptable = 0.5-2.0ml/kg/hr

Nerve stimulator - commonly placed on ulnar or facial nerve to monitor paralysis

Esophageal stethoscope - positioned right behind the heart, so can listen to heard and lungs during anesthesia; can also be used as temperature probe