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I&M > I&M - Test 2 Brainscape > Flashcards

I&M - Test 2 Brainscape Flashcards

1
Q

measured value =

A

true value + (systmatic + random error)

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2
Q

example of a systematic error

A

transducer lower than patient producing higher reading

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3
Q

example of random errors

A

multiple BP measurements in atrial fibrillation

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4
Q

closeness of agreement between measured and true value

A

accuracy

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5
Q

the degree of consistency

A

precision

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6
Q

ability to maintain precision

A

reproducibility

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7
Q

likelihood an event will be detected

A

sensitivity

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8
Q

normal=no event indicated

A

specificity

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9
Q

accuracy formula

A

correct/total x 100

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10
Q

precision formula

A

measure-mean /mean

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11
Q

sensitivity

A

hits/ hits+misses

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12
Q

specificity

A

correct rejections / (correct rejections + false alarms)

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13
Q

characteristics of signal

A

each signal has inherent variability. The distinction between normal and abnormal

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14
Q

mechanics of the sensor

A

ability to detect the underlying state of the system

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15
Q

mechanics of the artifact rejection

A

ability to sense degredation in quality of signal and filter out noise

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16
Q

programming by the user

A

adjustable alarm limits can adjust hit to miss and false alarms and correct alarms

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17
Q

% saturation error in pulse ox

A

3%. Ex 97 can be 94 or 100 for adults. Neonate +/- 4%

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18
Q

% pulse rate variation

A

3% +/-

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19
Q

Bland-Altman plot

A

table for comparison of values in standard deviations from baseline

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20
Q

slow, low frequency component of a signal

A

drift

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21
Q

rise time

A

time it takes for instrument to get from 10 to 90% of complete response

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22
Q

frequency response

A

how well can instrument can reproduce the signal being measured

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23
Q

of harmonic waves needed to produce a box like waveform

A

5 to 6

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24
Q

the greater the rate of rise or the original waveform

A

the greater the number of harmonics needed

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25
Q

example of combining harmonics

A

arterial waveform

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26
Q

Dichrotic notch - what does it mean if it’s closer to the beginning of the waveform?

A

closer the reading is to the heart

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27
Q

transient increase in aortic pressure upon closure of aortic valve

A

dichrotic notch

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28
Q

What is the resulting aortic waveform?

A

the mean pressure

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29
Q

Symbol for freqeuncy

A

rounded “w”, Nu, Omega. f

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30
Q

Hz =

A

cycles per second (s^-1)

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31
Q

average amplitude of R wave

A

1 mV

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32
Q

digital horizontal and vertical resolution

A

sampling rate, diff btw 2 amplitudes

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33
Q

the higher the upstroke of a wave …

A

the higher the amplification needed to reproduce

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34
Q

fs > 2-fmax

A

space sampling frequency must be grater than twice the maximum frequency. Ex, we hear at 22000 hz, so it is reproduced at 44000

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35
Q

ACGME

A

accredation council for graduate medical education

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36
Q

APSF

A

anesthesia patient safety foundation

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37
Q

ACGME - 2 criteria

A

cognitive and psychomotor skills

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38
Q

cognitive ex

A

do i need an a line for this case

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39
Q

psychomotor skills

A

placing an oett tube

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40
Q

ASK goals

A

attitude, skills, knowledge

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41
Q

when you can be damaged from a complete or incomplete circuit

A

complete: standing in water helps complete the circuit, lower impedence, and causes further damage

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42
Q

Macroshock (milliA)

A

defined by 1-6000 mA. Intact skin

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43
Q

1 ma

A

threshold of perception, tingling

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44
Q

5 mA

A

accepted maximal harmless current

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45
Q

10-20 mA “let go” current

A

tetanic contraction of skeletal muscles.

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46
Q

50 mA

A

pain, fainting, mechanical injury

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47
Q

100-300mA

A

ventricular fibrillation

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48
Q

6000 mA

A

defibrillation. sustained ventricular contraction.

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49
Q

Microshock (microA)

A

defined by 10-100 micro Amps, vascular access (catheters), myocardial lead wires

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50
Q

10 uA

A

safe current limit for directly applied cardiac equipment

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51
Q

50 uA

A

max falt condition current for cardiac equipment

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52
Q

100 uA

A

ventricular fibrillation.

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53
Q

nadir point

A

50hz - low point of current in which most people can detect. threshold of sensation

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54
Q

point of “cannot let go” for general population

A

60hz, 8mA

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55
Q

watts =

A

volts x amps. (w~amp^2)

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56
Q

surface area regarding burns

A

large area of contact = no burns. small = burns

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57
Q

Current density =

A

amps / area

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58
Q

properly applied ESU

A

electrical surgical unit. current density at return plate is low

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59
Q

skin burn temperature

A

45 C

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60
Q

completed circuit

A

two contact points

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61
Q

ground prong

A

round, green, longest of the 3

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62
Q

hot

A

shorter thin, black

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63
Q

neutral

A

longer flat, white

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64
Q

which plug has 1 horizontal prong?

A

high current outlets.

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65
Q

hubbellock devices

A

lock into outlet. prevents tripping/disconnection

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66
Q

impedence can lower by a factor of 100 by..

A

operating in a wet environment in nonstandard footwear

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67
Q

Class I electrical outlet:

A

grounded. use of a fuse that melts disconnecting circuit

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68
Q

Class II outlet

A

double insulated

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69
Q

Class III outlet

A

internal power source

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70
Q

Which class at minimum do we use on patients?

A

Class II

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71
Q

three components of electrosurgical system

A

hand held probe, ESU, large dispersive electrode

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72
Q

the return pad of the ESU is not

A

a grounding pad

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73
Q

the right leg lead of an ECG is not

A

a ground

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74
Q

spark frequencies & effect

A

wide variety. might make muscle contract @ low spark freq.

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75
Q

What causes a microshock?

A

Pulmonary artery catheter (V-fib). Central line (A-fib).

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76
Q

Capacitive coupling

A

allows high frequency to be transmitted. conversion of DC (filtered out) to AC

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77
Q

equipment ground wire

A

protect patient.

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78
Q

earthing point

A

reference point in which voltages are measured

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79
Q

electrical interference

A

interference at a demand node pacemaker from an external electromagnetic field

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80
Q

inductors

A

transmits low frequencies

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81
Q

capacitors

A

transmit high frequencies, block low

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82
Q

isolation transformers

A

1-1 transformer, voltage on secondary side = first side. limits the connection. no direct connection to power source. 1 for each OR. reduces shock by 30%

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83
Q

line isolation monitor (LIM)

A

measures how much current is going through each line and ground. alarms if voltage goes to ground

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84
Q

LIM annunciator

A

electronic signaling device

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85
Q

GFCI

A

Ground fault circuit interrpters. If excessive current goes to ground, it triggers the fault switch.

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86
Q

3 things needed for a fire

A

oxygen, heat, fuel (oxidizer, ignition source, fuel)

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87
Q

4 combustible gasses

A

ethers, halo, enflurane, iso

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88
Q

3 combustion supporting gasses

A

O2 N2O Air

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89
Q

combustion squelching gases

A

N2 CO2 He

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90
Q

ignition sources

A

lasers, hot filaments, sparks and arcs, gas compression

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91
Q

difference of conditions needed for explosion vs fire

A

pressure, temperature. 1 bar (200-500 C) vs 25 bar (3000 C) (fire vs explosion)

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92
Q

clinical ignition sources

A

surgeons, esu’s lasers

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93
Q

increases molecular speed to allow a reaction to occur

A

activation energy

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94
Q

Rule of Arrhenius

A

rate is doubled when temp raised by 10 C

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95
Q

locations of surgical fires

A

head, neck upper chest (44%), airway (21%)

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96
Q

clinical oxidizers

A

anesthesia combustion supporting gases (O2, N2O, Air)

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97
Q

clinical fuel sources

A

drapes, prepping agents

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98
Q

Clinical recommendation for high risk fire prevention

A

keep O2 levels low as possible

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99
Q

APSF

A

Anesthesia Patient Safety Foundation

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100
Q

If at risk, is >30% required to maintain oxygen saturation?

A

Yes -> secure with ETT, No-> use delivery service such as blender or common gas outlet to maintain below 30

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101
Q

PASS

A

Pull aim squeeze sweep

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102
Q

first step if fire in airway

A

remove ETT, stop flow of all airway gases, remove sponges, pour saline into airway

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103
Q

type of fire extinguisher

A

CO2

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104
Q

oxidizer enriched atmosphere

A

any increase in O2 [ ] above room air level

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105
Q

airway fire

A

airway or breathing circuit

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106
Q

Types of fires: Class A

A

materials that leave residue in form of ash

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107
Q

Types of fires: Class B

A

flammable liquids and gases

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108
Q

Types of fires: Class C

A

electrical wiring or equipment (if electricity is cut, becomes one of other classes)

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109
Q

Types of fires: Class D

A

potassium, sodium fires. uncommon materials in specialized situation

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110
Q

open circuit

A

no path for current to return

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111
Q

complete circuit

A

:(

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112
Q

beta particle

A

electron

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113
Q

alpha particle

A

two neutrons and two protons

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114
Q

radiation absorbed by person

A

rad (conventional). Gray (SI)

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115
Q

inverse square law

A

E ~ 1/d2

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116
Q

GRadiation within the body of a patient

A

alpha and beta absorbed by surrounding tissue. gamma radiation: some escapes the body. Actively dividing cells (tumors cells), are very vulnerable

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117
Q

Tissue/organ sensitivity - what is most sensitive

A

gonads, bone marrow

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118
Q

ALARA

A

as low as reasonably achievable.

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119
Q

x-ray positioning do’s and donts

A

face the source. facing away permits double penetration (heh)

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120
Q

simulated absorption

A

photon transfers energy, pushes e- to higher energy orbit

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121
Q

spontaneous emission

A

electron spontaneously loses energy = emitted photon

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122
Q

stimulated emission

A

incoming photon + electron–>two photons leave the e-

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123
Q

lasers

A

deliver more photons to a given area

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124
Q

Gaseous lasing medium

A

CO2. HARKEN. He, Ne, Ar, Kr

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125
Q

Solid lasing medium

A

YAG

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126
Q

Liquid lasing medium

A

Excimer

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127
Q

Helium-neon

A

color: red: 632 wavelength, Aiming beam.

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128
Q

most medical lasers

A

CO2, Nd:YAG, argon, KTP

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129
Q

Excimer, CO2, YAG uses

A

Excimer for shallow, CO2 for medium, YAG for deep

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130
Q

laser hazards

A

plume, perforation, embolism, energy transfer

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131
Q

Most common laser injuries

A

perforation of organ/vessel (24%), gas embolism (24%), eye exposure (19%)

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132
Q

O2 index of flammability for tracheal tubes

A

polyvinylchloride>silicone>red rubber.

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133
Q

Mean time to ignition (tracheal tubes)

A

polyvinylchloride 3.06, silicone not tested, red rubber 33. (sec)

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134
Q

Eye protection - laser surgeries

A

patient eyes should be taped then covered with saline soaked knit or metal shield.

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135
Q

Lasers requiring color filtered eyewear & their colors

A

Nd:YAG (green). Ar&Kr (amber/orange). KTP:ND:YAG (red)

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136
Q

CO2 laser

A

any plastic or glass lens

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137
Q

2 ways to offset the baseline from a half-cell potential

A

1) differential input dc amp so that effects of two halfcell potentials are cancelled out.
2) use an ac coupled amplifier (capacitor makes it AC) so that the DC voltage is blocked out

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138
Q

Differential amplifier. how it works

A

inverts the input so that the voltage out is zero.

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139
Q

DC to AC coupled differential amplifier - key component

A

capacitor changes it from DC to AC

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140
Q

what is the most common source of ecg slippage

A

electrode slippage

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141
Q

needle electrodes for EEG

A

surface area of needle is the sensory input

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142
Q

Clustering of ECG leads in an MRI purpose

A

reduce burns - lowers surface area of open antenna of leads

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143
Q

Einthoven dog’s name

A

jimmy

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144
Q

monitors of both the patient and anesthesia system

A

Paw Qaq Vt Resp Gas Analyzer

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145
Q

Nae for the degree of consistency between repeated measurements

A

precision

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146
Q

ASA recommendations for the use of a circuit disconnect monitor

A

continuous

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147
Q

audible alarm definitions

A

advisory = 2 beeps “help me. caution = “help me please” 3 beeps. Warning = “oh my god help me” 5 beeps. 3db difference between each

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148
Q

Fourier components of a rapidly changing waveform

A

many high frequency components

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149
Q

Most sensitive lead for detection of myocardial left ventricular ischemia.

A

V5 @ 75%. V5+V4 = 90. V5+II = 80%. V5,V4,II = 96%

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150
Q

TOF and degree of blockade

A

100-95, 0/4. 90, 1/4. 85 2/4. 80 3/4. 70-80 4/4.

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151
Q

Amplitude of R wave changes with inspiration

A

increases with inspiration

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152
Q

Meaning of resultant vector in Einthoven’s triangle

A

vector component of the depolarizing dipole

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153
Q

Most common cause of peri-op arrhythmias

A

bovi?

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154
Q

The V4 ECG is located in what position

A

5th intercostal space mid-clavidular

155
Q

Normal surgical depth of field for a BIS

A

40-60

156
Q

TOF and PTC comparison

A

PTC of 10 = 1/4

157
Q

Common type of electrode used for ECG monitoring

A

Ag-AgCl or column tower.

158
Q

Average amplitude of EKG R wave

A

1 mV

159
Q

Sources of common mode interference

A

60 Hz. EKG cord wrapped around power cord, proximity of high current device, high electrode impedence from poor skin contact or faulty wire

160
Q

Position of V2 ECG electrode

A

L sternal border @ 4th intercostal space

161
Q

Most immediate indication of a circuit disconnect

A

bellows collapse

162
Q

Normal QRS complex as displayed in lead III

A

no Q wave.

163
Q

Primary method that skin electrodes make contact with the volume conductor

A

capacitive coupling through pores

164
Q

definition of waves present during v depolarization

A

QRS

165
Q

Cardiac vector axis determination

A

based on depolarizing vector being parallel or perpindicular to waveform and direction of vector

166
Q

American Heart Association recommendations for ECG diagnostic amps -

A

.05 - 100 hz

167
Q

Normal range of the cardiac vector in degrees

A

110-30. transverse 30- -30

168
Q

depolarization offset mV at action potential

A

90 mV

169
Q

functions of an ECG monitor that require the highest frequency range

A

pacemakers

170
Q

dipole theory explanation

A

propagation of depolarization is seen as moving dipole (separation of charges)

171
Q

ECG manifestations of ischemia

A

peaked T waves, ST elevation, Q waves, T wave inversion

172
Q

the augmentation provided by the augmented vector leads

A

0.5

173
Q

requirements of ASA standards of ECG monitoring

A

continuous

174
Q

duration of the ST interval

A

0.26 (seconds?)

175
Q

Einthoven’s Law

A

Lead II = Lead I + Lead III

176
Q

most common mechanism that creates artificial ECG monitoring

A

electrode slippage

177
Q

Effects of misplaced ECG leads?

A

??

178
Q

Effects of misplaced ECG leads?

A

??

179
Q

recognition of CS5 lead

A

R Arm at central subclavian, L Arm at V5, Lead I selected

180
Q

Cardiac vector axis determination

A

biphasic = perpendicular. Largest amplitude = parallel

181
Q

interpretation of upward sloping ST segments

A

infarction

182
Q

Definition of isoelectric line of the ECG

A

neutral baseline???

183
Q

dosing of a 20% medication

A

200 mg/ml

184
Q

calculating dose concentration and loading dose

A

??

185
Q

calculating dose concentration and loading dose

A

??

186
Q

display of stand alone oxygen analyzer

A

??

187
Q

point of ETCO2 on a capnogram

A

end of alveolar plateau (phase 3) (top right corner of the waveform)

188
Q

definition of specificity

A

correct rejection. how reliable the device is at detecting true abnormal readings

189
Q

definition of an ECG interval

A

from the beginning of one wave to another (vague)

190
Q

the meaning of “continual”

A

repeated

191
Q

the definition of precision

A

degree of consistency between repeated measurements

192
Q

determination of the first harmonic from heart rate

A

?? harmonics are multiples. Ex 5 = 1st = 10, 2nd = 15, 3rd= 20 etc.. via google: determined by the mean heart rate per second

193
Q

the definition of “drift” on a signal reproduction

A

slow, low frequency component of the signal. lower frequency than the signal

194
Q

major ion to cross the cell membrane during initial depolarization

A

Na

195
Q

the appearance of an “injury potential” on an ECG

A

depression under the baseline

196
Q

definition of an aVR lead

A

RA is +, LA, Legs are -

197
Q

the functions of an ECG monitor that require the highest frequency range

A

pacemaker

198
Q

the r-r interval differences in patients based on gender

A

men (can’t read this) larger weight = decreased HR, & Incr RR

199
Q

placement of anode during NMB

A

closest to heart

200
Q

cartoon forwny face and J point variation

A

normal healthy variation

201
Q

reason for specific placement of ECG electrodes in MRI

A

decrease burn risk and open atennae surface area of electrodes

202
Q

Einthoven’s Triangle

A

I: RA to LA II: RA to LL III: LA to LL

203
Q

Triaxial Reference system

A

Lead I: 0 deg; Lead II: 120 deg; Lead III: 60 deg

204
Q

Standard ECG limb lead positioning should be…

A

outside the cardiac borders.

205
Q

Information obtained from EKG: anatomy

A

infarction, ischemia, hypertrophy

206
Q

Information obtained from an EKG: physiology

A

automaticity, anthythmogenicity, conduction, ischemia, autonomic tone, electrolyte abnormalities, drug toxicity/effect, ejection fraction (?)

207
Q

Name of the vector angling system

A

triaxial reference system

208
Q

monitoring

A

repeated and continuous observations or measurements, assessement

209
Q

ASA standard monitors

A

oxygenation (FiO2) ventilation (ETCO2), circulation (ECG, arterial BP, HR: Q5min) + SPO2, temperature

210
Q

esophageal stethoscope

A

depth ~ 30 cm from lips

211
Q

a graph of gaseous CO2 [ ] as a fx of time

A

capnogram

212
Q

instrument for measuring CO2

A

capnometer

213
Q

practice of measuring

A

capnometry

214
Q

phases of capnogram

A

I: dead space, II: DS/alveolar mix. III: alveolar. IV: inhaled fresh gas

215
Q

ECG

A

Rate, Rhythm, ST segment

216
Q

NIBP

A

width 40% of limb circumference

217
Q

most common type NIBP

A

oscillometric

218
Q

direct arterial pressure requires a?

A

transducer

219
Q

SpO2

A

p is pulse

220
Q

which nerve wraps around humerus

A

radial nerve

221
Q

When is ischemia most easily detected. depol or repol

A

repolarization

222
Q

State angles of aVF:R:L

A

“+90, -150, -30”

223
Q

Area of typical depolarization (ventricular axis)

A

30 to 90

224
Q

What causes broadening of the ST segment?

A

delayed repolarization

225
Q

explain “left axis deviation” and who can get it

A

greater than minus 30 deviation. more upward from base of left ventricle .pregnancy, laprascopic, ascites. LEFT VENTRICULAR HYPERTROPHY

226
Q

What would cause right axis deviation

A

pulmonary hypertension. Right ventricular hypertrophy

227
Q

V1 location

A

At 4th intercostal space at rt margin of sternum

228
Q

V2 location

A

at 4th intercostal space, at left margin of sternum

229
Q

V3 location

A

midway between sites V2 and V4

230
Q

V4 Location

A

at 5th intercostal space at midclavicular line

231
Q

V5 Location

A

at same level as site of V4 at anterior axillary line

232
Q

V6 location

A

at same level as site of V4 at midaxillary line

233
Q

EASI electrode configuration

A

alternate lead system: upside down “T” configuration. Ground is reference and placed anywhere.

234
Q

Which 2 leads are in the sagittal plane?

A

V2 an aVF

235
Q

which 5 leads are in the frontal plane

A

aVR, aVL, II aVf, III

236
Q

Which leads are in the transverse plane?

A

V1 through V6, I?

237
Q

The cardiac vector is perpendicular to which lead?

A

III

238
Q

What is the cardiac vector (mean of QRS axis)

A

-45 degrees. (up to the right)

239
Q

What does a biphasic vector represent?

A

the vector is perpendicular to the reference lead

240
Q

Modified bipolar limb leads

A

Alternatives to V5 with the reference of lead I. The exploring lead is the LA (+), placed in the V5 position (except MCL1). the RA is then placed in various positions.

241
Q

CB5

A

central back

242
Q

CC5

A

central chest

243
Q

CM5

A

central manubrium

244
Q

CS5

A

central subclavian

245
Q

MCL1

A

Left arm is in its original location. Left Leg is to the right of the manubrium. Lead III used for reference

246
Q

Measurement of flammability of OETT

A

fractional oxygen concentration to sustain a candelight flame

247
Q

best type of fluid line to use to measure BP

A

short and stiffy

248
Q

effect of long sections of IV tubing on dampening of arterial waveforms

A

resonates at lower freq, increase ringing, decrease dampening

249
Q

effect of tiny amounts of air on damening of arterial waveforms

A

increases compliance

250
Q

interpretation of the critical daming diagram

A

coefficient =0.7

251
Q

zero a transducer

A

off to patient, open to atmosphere

252
Q

systolic and diastolic pressures in various regions of body

A

as you move more peripherally, systolic increases and diastolic decreases

253
Q

Doppler to determine BP?

A

flat probe over radial art, sound disappears when ceff exceeds intra arterial pressure

254
Q

phases of korotkoff sounds

A
  1. tapping 2. murmer 3. thumping 4. muffle 5. silence
255
Q

BP and left ventricular perfusion

A

happens during diastole

256
Q

effect of too small cuff on pressure readings

A

falsely elevated

257
Q

arterial pressure important in aneurysm mgmt

A

systolic

258
Q

uses of a pacemaker

A

rhythm

259
Q

ECMO

A

extra corporeal membrane oxygenation

260
Q

what designates a fixed rate sequential pacemaker

A

magnet

261
Q

piezoelectric crystal in TEEE

A

send and receive sound waves

262
Q

what distinguishes cardioversion from defibrillation

A

synchronization

263
Q

what interferes with functional CRMD

A

monopolar cautery

264
Q

results of doppler effect

A

sound wave moves toward you then: wavelength down, freq up, pitch up

265
Q

effects of improperly used IABP

A

incr O2 consumption, increase workload

266
Q

recognizing action of pacemakes on and ECG

A

pacing spike

267
Q

uses of a pulsed doppler

A

diameter, size, depth, low flow velocities in pulmonary veins and mitral valve

268
Q

CRMD

A

cardiac rhythm mgmt device

269
Q

effects of properly fuctioning IABP

A

decrease LVEDP

270
Q

BART

A

Blue away red toward

271
Q

uses of continuous wave doppler

A

measure high velocity but does not precisely ID their location

272
Q

osborn wave on ECG

A

post QRS, hypothermia

273
Q

reentry phenomenon

A

conduction complication

274
Q

meaning of the word stethoscope

A

chest examination, greek

275
Q

how a DINAMAP determines BP

A

oscillometric, measures amplitude and freq

276
Q

the physical basis of peripheral arterial tonometry

A

measures systolic, diastolic, and mean pressures; placed on skin over artery, artra-arterial pressure is transmitted from inside the vessel through skin and transducer

277
Q

effect of hydrostatic pressure on direct BP reading

A

1.87 per inch, 0.74 per cm (remember that 1 cmH2O = 1 mmHg)

278
Q

resonant frequency and tubing diameter

A

smaller diameter decreases resonance and larger diameter increases resonance

279
Q

suggested deflation rate for a manual BP cuff

A

3 mmHg

280
Q

width of BP cuff vs the extremitys circumference

A

40% width, 80%length

281
Q

the most common artifact and error for invasive pressure monitoring

A

ringing

282
Q

measurement points in an oscillmetric BP measurement

A

amplitude is map, systolic 0.5, diastolic, 0.625

283
Q

effects of the interaction bt the resonant frequency of the monitoring system and the freq components of the blood pressure waveform

A

overshoot, ringing, 0.7 optimal, no critical point

284
Q

arterial waveform appearance indicative of an overdamped arterial BP system

A

slurred upstroke, absent dicrotic notch, loss of fine detail

285
Q

importance of mean arterial pressure

A

tissue/organ perfusion, flow

286
Q

oscillometric BP and a variable HR

A

not useful, >15%

287
Q

wave form on elderly

A

increased PP, late sys peak, no diastolic wave

288
Q

4 subsystems of a clinical pressure msmt sys

A

mechanical coupling sys, transducer, transducer dislpay, electronic components

289
Q

best type of fluid line to monitor an arterial line

A

“short stiffy”

290
Q

effect of long sections of IV tubing on dampening of arterial waveforms

A

resonated at a lower frequency

291
Q

effect of tiny amounts of air on dampening of arterial lines

A

increase compliance

292
Q

appearance of arterial waveforms from various regions of the body

A

increase pulse pressure, steepen and increase systolic, decrease diastolic, dichrotic notch occurs later

293
Q

interpretation of the critical damping (damping coefficient) diagram

A

coeffiecient = 0.7

294
Q

position of stopcock to effectively “zero” a transducer

A

off to patient. open to atmosphere

295
Q

systolic and diastolic pressure in various regions of the body

A

systolic increases as you move towards periphery and diastolic decreases

296
Q

the use of ultrasonic Doppler systems to determine BP

A

flat probe over radial artery, sound disappears when cuff pressure exceeds intra-arterial pressure

297
Q

parameteres that monitor both the patient and the anesthesia delivery system

A

Paw, respiratory gas analysis, Qaw, tidal volume

298
Q

definition of precision

A

repeated measurements with consistent results, degree of consistency between repeated measurements

299
Q

phases of Korotkoff sounds

A
  1. tapping/snapping 2. murmur 3. thumping 4. muffle 5. silence
300
Q

BP and left ventricular perfusion

A

occurs during diastole (via coronary artery)

301
Q

troubleshooting failed ECG leads

A

replace electrode common to noisy leads (?)

302
Q

the effect of using too small a BP cuff on pressure readings

A

reading is falsely elevated

303
Q

how a DINAMAP determines BP

A

oscillimetry?

304
Q

the physical basis of peripheral arterial tonometry

A

senses intra-arterial pressure via transducer applied to skin surface

305
Q

effect of hydrostatic pressure on direct BP reading

A

1.87 per inch, 0.74 per cm (remember that 1 cmH2O = 1 mmHg)

306
Q

resonant frequency and tubing diameter

A

smaller diameter decreases resonance and larger diameter increases resonance

307
Q

suggested deflation rate for a manual BP cuff

A

3 mmHg per heartbeat

308
Q

width of a BP cuff vs. the extremity’s circumference

A

width of cuff == 40% of curcumference

309
Q

most sensitive leads for the detection of ventricular ischemia

A

V4/V5 and II

310
Q

which electrodes are used in which ECG leads

A

I - RA to LA; II - RA to LL; III - LA to LL; aVR - LL+LA to RA; aVL - LL+RA to LA; aVF - RA+LA to LL

311
Q

most common artifact and error for invasive pressure monitoring

A

ringing

312
Q

measurement points in an oscillometric BP measurement

A

highest amplitude = mean, 0.5 = systolic, 0.65 = diastolic

313
Q

effects of the interaction between the resonant frequency of the monitoring system and the frequency components of the BP waveform

A

Resonant frequency decreases causing increased interaction with frequency components of pressure wave =INVERSE ?

314
Q

arterial waveform appearance indicitave of an overdampened arterial BP system

A

lower sloped

315
Q

importance of MAP

A

tissue/organ perfusion

316
Q

BP relationships from core to periphery

A

Systolic, pulse pressure increased; diastolic, MAP decreased in the periphery

317
Q

arterial pressure important in aneurysm management

A

systolic

318
Q

oscillometric BP and a variable of HR

A

not useful > 15%

319
Q

conditions resulting in a direct BP system using “ringing”

A

overshoot/ringing

320
Q

accuracy of ischemia detection of combined ECG leads

A

1 lead: II=33% V4=61% V5=75%
2 leads: II/V5= 80% V4/V5=90%
3 Leads: V4/5/6=94% II/V4/5+96%
4 Leads: II + V3/4/5=100%

321
Q

ST segment detection and the “J” point

A

J point = end of R wave/ventricular depolarization, beginning of ST segment, no polarity
Typically measured 60-80msec after actual J-point to detect ST deviation

322
Q

interpretation of electrocautery effect on the ECG

A

Pulse ox should still be intact

323
Q

understanding alarm signals

A

1 or 2 beeps = low (advisory); awareness
3 beeps = medium (caution); prompt response
5 beeps x 2 = high (warning); immediate response

324
Q

standard range of accuracy for NIBP devices

A

5 mmHg

325
Q

non invasive BP monitor that produces a waveform

A

Peripheral Arterial Tonometer (Medwave)

326
Q

vascular elements most responsive to vasoactive drugs

A

brachial artery to radial (ulnar, medial) because they have a higher wall thickenss to diameter ratio (slide 41 of invasive 2)

327
Q

what determines the fundamental frequency of the arterial waveform

A

Origin of waveform (ventricular, central, peripheral), HR, and contractility

328
Q

acceptable palm blanch time in an Allen test

A

~7 seconds

329
Q

artery most likely to have plaque dislodgement during line placement

A

carotid??

330
Q

appearance of pulsus alterans

A

Alternating pulse pressure amplitude. Similar to Pulsus paradoxus, except the later is associated with inspiration.usually indicative of left ventricular systolic impairment

331
Q

description of compartment syndrome

A

inadequate blood flow to nerves and muscles due to increased pressure in a given compartment (arm, leg, etc)

332
Q

flow rate on transducer continuous flush device

A

3cc/hr

333
Q

appearance of an underdamped BP waveform

A

increased systolic pressure, artifacts in the waveform

334
Q

use of the right leg electrode

A

“reference” (not ground); removes/removes common mode signal

335
Q

interpretation of “delta down” in BP monitoring

A

Miller: total systolic pressure variation should not exceed 10mmHg. Delta up is usually 2-4mmHg and Delta down is usually 5-6 mmHg. Delta down >10-12mmHg can indicate hypovolemia

336
Q

name of the device that tracks heart rate

A

cardiotachometer

337
Q

elements that affect static calibration and zeroing of pressure transducer systems

A

height

338
Q

BP cuff size and return to flow pressure measurement

A

small cuff = slow return (increased BP) and large cuff = fast return (decreased BP)

339
Q

fluid filled blood pressure transduction systems and dampening

A

Fluid filled = less compliant = larger acceptable dampening range

340
Q

use of a pacemaker

A

rhythm

341
Q

meaning of acronym ECMO

A

extracorpreal membrane oxygenation

342
Q

what designates a fixed rate sequential pacemaker

A

magnet

343
Q

function of piezoelectric crystal in TEE

A

to send and receive sound waves

344
Q

what distinguishes cardioversion from defibrillation

A

synchronization

345
Q

essential functions of a CPB

A
  1. oxygenation of venous blood 2. elminitation CO2 3. maintenance of system perfusion
346
Q

what interferes with the functioning of a CRMD

A

monopolar cautery

347
Q

results of the Doppler effect

A

sound wave moves towards you, wavelength decreases, frequency increases, and pitch increases AND sound wave moves away from you, wavelength increases, frequency decreases, and pitch decreases

348
Q

effects of an improperly used IABP

A

increased oxygen consumption, increased workload

349
Q

recognizing the action of pacemakers on an ECG

A

arterial: pacing spike |, QRS is normal
ventricular: QRS is widened

350
Q

uses of a pulsed wave (gated) Doppler

A

diameter (area)/size/depth/low flow velocities in pulmonary veins and mitral valves

351
Q

position of the electrodes for precordial defibrillation

A

right of sternum, left of apex of heart

352
Q

elements of TEEs that corrects for signal loss from distant tissue beds

A

time gain compensation

353
Q

effects of properly functioning IABP

A

decreased LVEDP

354
Q

contents of cardioplegia infusions

A

potassium, bicarb, and mannitol

355
Q

meaning of the mnemonic BART

A

blue away, red towards

356
Q

technique of contracts echocardiology

A

injecting tiny gas bubbles into bloodstream in order to acquire better ultrasound imagery

357
Q

meaning of M in M-mode TEE

A

motion, assesses function of rapidly (moving?) parts of the heart

358
Q

uses of a continuous wave Dopler

A

measures high velocity but does not precisely ID their location

359
Q

the effects of increasing the frequency of the ultrasound signal on probe function

A

increased fequency = increased resolution, decreased penetration

360
Q

normal amount of left ventricular radial shortening

A

> 30%

361
Q

uses of transgastric angle of a TEE

A

LV function, RV function

362
Q

which signal property diminishes with the distance in an ultrasonic device

A

frequency?

363
Q

recognition of an ECMO system

A

VA or VV

364
Q

recognizing the Osborn wave on an ECG

A

hypothermia

365
Q

which thermal dilution curve would represent a low CO

A

largest area

366
Q

recognition of a TEE section

A

I: largest vessel, II: only long axis/diagonal III: transgastric

367
Q

sources of energy lost in ultrasound transmission

A

absorption

368
Q

uses of sequential excitation of the crystals of a TEE probe in a “phased array”

A

phased array = focal point

369
Q

the temp, in Celsius, that patients are cooled to during CPB surgery

A

30

370
Q

device that uses a cannula pump within the left ventricle to aid blood flow

A

hemopump

371
Q

CO determination devices that require calibration with/by another method

A

pulse contour

372
Q

CO technique that utilizes rebreathing

A

NICO

373
Q

red on color flow mapping TEE indicates

A

blood flowing towards the transducer

374
Q

defibrillators and monophasic waveforms

A

false: they biphasic waveforms

375
Q

perfusion pumps and trauma to blood cells

A

roller pump = more damage

376
Q

importance of systolic arterial pressure

A

anastemosis, anuerisms, suture

377
Q

most accurate pressure reading from a DINAMAP device

A

MAP?

378
Q

erros of the ausculatory method of BP determination

A

deflating the cuff too quickly

379
Q

algorithm used by the DINAMAP device to derive the BP

A

the lowest pressure at which maximal puslation amplitude and ___?___. 0.5 systolic/0.625 diastolic (integrated)

380
Q

definition of systolic, diastolic, and mean pressure

A

systolic: vascular wall tension, diastolic: driving pressure for blood flow to L ventricle, mean: tissue perfusion

381
Q

effects of small amounts of dampening on arterial waveforms

A

systolic overshoot

382
Q

parameteres that monitor both the patient and the anesthesia delivery system

A

Qaw, flow rate, tidal volume, respiratory gas analyzers

383
Q

conditions resulting in an oscillometric BP system providing incorrect results

A

anatomic, physiologic, cuff-related problems, pulse rate >15%

I&M (2 decks)

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