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Patient Monitoring/ Instrumentation Kristi > Miscellaneous Monitors > Flashcards

Miscellaneous Monitors Flashcards

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1
Q

febrile temperature

A

> 38 degrees

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2
Q

hypothermia temperature

A

<36 degrees

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3
Q

room temperature

A

23 degrees

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4
Q

the recommended operating room temperature

A

between 68-75 degrees (20-24 Celsius)

  • helps to inhibit bacterial growth
  • certain patients (infants, children, burn patients) require a warmer environment for the purpose of preventing hypothermia
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5
Q

what is the best estimate of core temperature

A

Blood (from the pulmonary artery catheter)

-not practical in most cases because most patients do not have a swan Ganz catheter

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6
Q

what is the most consistently reliable estimate of core body temperature during general anesthesia

A

esophageal (distal esophagus)

-less reliable in open chest cases and in cardiac bypass

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7
Q

when is rectal temperature not reliable?

A

when the rectum is not clear

-feces can blunt temperature measurement

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8
Q

temperature monitoring site that isn’t as accurate as esophageal temperature but a good choice for open heart surgery

A

nasal

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9
Q

reliable estimate of core temperature only when urine output is not low

A

bladder

- if urine output is low, becomes less reliable

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10
Q

not accurate reflections of core body temperature

A

skin and axillary

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11
Q

list 4 etiologies of intraoperative temperature loss

A
  1. IV fluids
  2. vasodilation
  3. blood products
  4. volatile agent
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12
Q

one unit of refrigerated blood or 1 L of crystalloid solution administered at room temperature each decreases mean body temperature by _____

A

0.25 degrees Celsius

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13
Q

intraoperative temperature loss from vasodilation can be caused by?

A

spinal/epidural anesthesia

  • similar degrees of hypothermia as general anesthesia
  • redistributes heat from warm central compartments (abdomen/thorax) to cooler peripheral tissues (arms/legs)
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14
Q

these blood products are stored in cooler temperatures to preserve shelf life and should be given through a blood warmer and used with IV tubing that has a filter

A

Packed red blood cells (PRBC)
cryoprecipitate
fresh frozen plasma

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15
Q

type of blood products that are stored at room temperature and should NOT be given through a fluid warmer

A

platelets

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16
Q

how does volatile agent cause intraoperative temperature loss

A

interferes with hypothalamic thermoregulation

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17
Q

4 adverse cardiovascular effects of hypothermia

A
  1. platelet dysfunction and bleeding
  2. decreased stroke volume
  3. bradycardia/ arrhythmias
  4. increased blood viscosity
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18
Q

hypothermia causes (increased/decreased) stroke volume

A

decreased

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19
Q

hypothermia causes (tachycardia/ bradycardia)

A

bradycardia

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20
Q

hypothermia causes (increased/ decreased) blood viscosity

A

increased

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21
Q

hypothermia causes a (increase/decrease) in cerebral vascular resistance and a (increase/decrease) in cerebral blood flow

A

increase

decrease

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22
Q

in hypothermia, for every 1 degree Celsius drop in temperature, cerebral blood flow decreases ____-____%

A

5-7%

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23
Q

hypothermia causes a (increased/decreased) GFR and (impaired/increased) renal tubular function

A

decreased

impaired

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24
Q

hypothermia causes a (increase/decrease) in respiration

A

decrease

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25
hypothermia causes a (left/right) shift of the HbO2 dissociation curve
left shift
26
hypothermia causes (increased/decreased) drug metabolism and (rapid/delayed) emergence from anesthesia
decreased | delayed
27
hypothermia causes (increased/decreased) wound healing
decreased
28
hypothermia causes (shivering/non-shivering) metabolic effect
shivering
29
shivering (increases/decreases) oxygen consumption by ____ fold
increases | 5
30
in which patients is shivering particularly concerning for?
patients with coronary artery disease
31
list 3 circumstances that shivering is more likely with
1. lower intraoperative temperature 2. longer surgeries 3. higher concentrations of volatile agent
32
2 treatments for shivering
1. warming the patient | 2. demerol 25 mg IV
33
list the 4 types of heat loss in the operating room in order from greatest to least
1. radiation 2. evaporation 3. convection 4. conduction
34
type of heat loss that is described as losing heat to the colder temperature of the atmosphere
radiation | -does not require contact
35
radiation accounts for _____% of heat loss in the operating room
60
36
type of heat loss where the body loses heat through the loss of water
evaporation | -sweating, and in surgery when the body is opened up
37
evaporation accounts for _____% of heat loss in the OR
20
38
type of heat loss when air flows over exposed surfaces
convection | -moving air currents with operating room circulation
39
convection accounts for _____% of heat loss in the OR
15
40
type of heat loss that involves the transfer of heat between adjacent surfaces
conduction | -laying on a cold metal table or immersing yourself in cold water
41
conduction accounts for _____% of heat loss in the OR
5
42
2 purposes to an esophageal stethescope
1. measure temperature | 2. listen to heart and lung sounds
43
2 reasons to use a precordial stethescope
1. constant heart/lung sounds | 2. popular in pediatrics
44
this monitor uses EEG to monitor awareness during anesthesia
BIS (bispectral index monitor)
45
on the BIS monitor a reading of ____ to _____ indicates sedation
65-85
46
on the BIS monitor, a reading of ____ to ____ indicates general anesthesia
40-65
47
on the BIS monitor, a reading of ____ indicates that the patient is too deeply anesthetized
<40
48
what drug can actually increase the BIS number
ketamine
49
list 3 common situations in which we would use the BIS monitor
1. paralyzed patients 2. patients undergoing TIVA who are paralyzed - anesthetists do not monitor "end tidal" propofol to gauge awareness like MAC values 3. sick patients that require less anesthesia - may not be able to mount a sufficient sympathetic response to alert the anesthetist of light anesthesia
50
the 2 exceptions when we cannot use vital signs to monitor awareness ( need to use BIS)
1. when beta blockers have been given | 2. when patients aren't healthy enough to mount a normal sympathetic response
51
it is (easier/harder) to prevent awareness than it is to prevent movement
easier | -if a patient is deep enough to not move, they should be deep enough to not have awareness
52
should an anesthetist need a BIS monitor if the patient is not paralyzed?
no
53
______ output is an indicator of adequate cardiac output and renal perfusion
urine
54
a common goal for urine output is > _____- ____mL/kg/hr
0.5-1
55
an ultrasound of cardiac structures with the probe resting in the esophagus posterior to the heart
TEE (Transesophageal Echocardiography)
56
4 things a TEE can estimate
1. ejection fraction 2. cardiac output 3. patency of heart valves (stenosis vs. regurge) 4. pulmonary artery pressure
57
the best monitor for diagnosing a venous air embolism
TEE
58
monitors nerves that are close to the surgical site and the technician monitors waves and can alert the surgeon when the nerve is ischemic or damaged
evoked potentials
59
what is the method of evoked potentials
1. the nerve is electrically stimulated, which produces a waveform 2. ischemic or damaged nerves produce abnormal waves
60
what are the two parts with evoked potential waves the technician looks at
1. amplitude - height of the wave 2. latency - time from the onset of the wave to the peak of the response
61
nerve damage and ischemia cause a (increased/decreased) amplitude and (increased/decreased) latency of the wave
decreased | increased
62
anesthetics display the (same/different) waveform of an ischemic nerve
same
63
3 things that can effect evoked potential readings
1. ischemia 2. lack of perfusion 3. hypotension
64
what can an anesthetist do to intervene when the wave amplitude decreases or latency increases in evoked potentials
increase the patient's blood pressure
65
which 2 anesthetics have the greatest effects on somatosensory evoked potentials (SSEP)
volatile agents and nitrous oxide
66
which anesthetics result in better signal quality of evoked potential waves
use of intravenous agents
67
which 2 anesthetics decrease amplitude and increase latency of evoked potential waves (mimic nerve damage)
propofol and volatile agents
68
what effect does versed have on evoked potential waves
1. decreases amplitude | 2. does NOT change latency
69
what effect does ketamine and etomidate have on evoked potential waves
1. increases latency | 2. INCREASE amplitude
70
what effects does nitrous oxide have on evoked potential waves
1. decreases amplitude | 2. does NOT change latency
71
what effect do opioids have on evoked potential waves
minimal effect
72
list the 4 types of evoked potentials
1. somatosensory evoked potentials (SSEP) 2. motor evoked potentials (MEP) 3. brainstem auditory evoked potentials (BAEPs) 4. visual evoked potentials (VEPs)
73
type of evoked potential that are used to monitor the integrity of sensory nerves
somatosensory evoked potentials | -peripheral nerve is stimulated which travels through the dorsal nerve roots of the spinal cord
74
class of drugs that do not affect somatosensory evoked potentials and can be dosed when SSEP are used
muscle relaxants
75
type of evoked potential that are used to monitor the integrity of a motor nerve
motor evoked potentials
76
somatosensory evoked potentials stimulate which nerves and where do they travel?
-peripheral nerve is stimulated which travels through the dorsal nerve roots of the spinal cord
77
motor evoked potentials stimulate which nerves and where do they travel?
motor nerves and they travel through the anterior and lateral pathways of the spinal cord
78
motor evoked potentials are (more/less) sensitive to volatile agents than SSEPs are
more
79
which drug class should not be administered when MEPs are used?
muscle relaxants
80
which evoked potentials measure the integrity of the vestibulocochlear nerve (VIII) and even the brainstem
brainstem auditory evoked potentials | -an audible click is delivered to the tympanic membrane through earphones
81
which evoked potentials are the LEAST affected by anesthetics
brainstem auditory evoked potentials
82
which evoked potentials measure the integrity of the optic nerve and can be used during pituitary tumor resection
visual evoked potentials
83
which evoked potentials are MOST affected by anesthetics?
visual evoked potentials
84
anesthetic management with evoked potentials: use _____ MAC volatile agent
<0.5
85
anesthetic management with evoked potentials: what are two agents we can supplement volatile agent with?
1. propofol drip - less effect on evoked potentials when infused, great effect on evoked potentials when bolused 2. narcotic drips - sufentanil, remifentanil
86
anesthetic management with evoked potentials: Keep anesthetic level as ______as possible
constant
87
anesthetic management with evoked potentials: avoid ______ ______ if MEPs are being used
muscle relaxants

Patient Monitoring/ Instrumentation Kristi (4 decks)

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