Mod1: Monitoring for Cardiac Surgery - EKG Flashcards by Olivier Mba

_{Monitoring for Cardiac Surgery}

Why should invasive monitoring be consistently utilized in pts with significant CV dz?

Hemodynamic changes can occur rapidly

Corrective measures need to be instituted promptly.

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_{Monitoring for Cardiac Surgery}

True or False: ANESTHETIC MANAGEMENT should be tailored to allow for the measurement of physiologic parameters in order to maintain hemodynamic stability to reduce perioperative complications

True

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_{Monitoring for Cardiac Surgery - ANESTHETIC MANAGEMENT}

What are ASA minimal monitoring standards?

Oxygenation

Ventilation

Circulation

**Temperature

These standards could be exceeded

(You could use more than what’s required)

However the basic monitoring must always be continiously maintained

(with the exception of Temperature)

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_{Monitoring for Cardiac Surgery - ANESTHETIC MANAGEMENT}

Temperature does not necessarily need to be monitored continiously; except in which case?

When the anesthesia provider anticipates clinically significant changes in body temperature

Otherwise, it could just be measured regularly

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_{Monitoring for Cardiac Surgery - ANESTHETIC MANAGEMENT}

True or False: The most invasive form of monitoring is the preferred choice for the anesthesia plan of care

False

The least invasive forms of monitoring that will provide and idea of the total picture of the pt is considered safe for the anesthetic plan

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_{Monitoring for Cardiac Surgery}

Which factors make monitoring for Cardiac Surgery CHALLENGING?

Risk of placing monitors

^{(Pneumothorax, ischemic arm, bleeding etc.)}

Acting on erroneous/incorrect results

Over treatment

Distraction d/t too many monitored variables

Cost

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_{Monitoring for Cardiac Surgery}

ULTIMATE GOALS:

Improve patient outcome

Minimize Risk

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

What are the two meanings of “positive” and “negative” with regard to THREE-LEAD SYSTEM?

Deflection of the EKG tracing
Direction of depolarization

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_{Electrocardiography- THREE-LEAD SYSTEM (Bipolar lead)}

Upward deflection on isoelectric line means:

Positive deflection of the EKG tracing

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

Downward deflection on EKG isoelectric line means:

Negative Deflection of the EKG tracing

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

What does a Positive Direction (or deflection) of the electrical activity means?

Depolarization is going towards that electrode

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

What does a negative Direction (or deflection) of the electrical activity means?

Depolarization is moving away from that electrode

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

How does electricity moves in Lead I between RA and LA?

Lead I (-) RA => (+) LA

We know this because the atria depolarizes first, followed by the ventricles

The LA can be either (+) in lead I or (-) in lead III depending on which lead is used to measure

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

How does electricity moves in Lead II between RA and LL?

Lead II (-) RA => (+) LL

The LL is always (+) because depolarization is always going towards it

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

How does electricity moves in Lead III between LA and LL?

Lead III (-) LA => (+) LL

The LL is always (+) because depolarization is always going towards it

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

How is the heart observed in Lead I?

The heart in observed from the LA, looking at the RA

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

How is the heart observed in Lead II?

The heart in observed from the LL, looking at the RA

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

How is the heart observed in Lead III?

The heart in observed from the LL, looking at the LA

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

What’s the Standard of Care Monitor (AANA/ASA Monitoring Guidelines) with regards to Electrocardiography?

Every pt receiving anesthesia must have Electrocardiography continiuously monitored from the begining of care till the time they are prepared to leave the anesthetizing location

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

Why is the use of THREE-LEAD SYSTEM (Bipolar lead) limited in myocardial ischemia

It provides a narrow picture of myocardial electrical activity

It uses a single positive electrode and a single negative electrode between which electrical potential is measured

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

How many limb electrodes?

3 limb electrodes

RA (White)

LA (Black)

LL (Red)

Use of a single positive electrode and a single negative electrode between which electrical potential is measured.

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

How many views (leads)

3 views (leads)

Lead I : RA -; LA +

Lead II: RA -; LL +

Lead III: LA -; LL +

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

True or False: THREE-LEAD SYSTEM (Bipolar lead) monitors Inferior & lateral myocardial walls for ischemia

True

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_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)}

True or False: THREE-LEAD SYSTEM (Bipolar lead) can also monitor ANTERIOR OR POSTERIOR walls

Study These Flashcards

False

THREE-LEAD SYSTEM (Bipolar lead) cannot monitor ANTERIOR OR POSTERIOR walls

_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)} In the THREE-LEAD SYSTEM, what's the more disirable lead and why?

**Lead II** is the more desirable lead, because it is _in line with the vector forces of the heart_, resulting in **large p-waves** and **large QRS complexes**, and making it easier to _dignose dysrhythmias_

_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)} What's the positive electrode in an Augmented Unipolar lead

Each of the limb lead (RA, LA, LL) _{•Augmented leads (aVR, aVL, aVF)} _{•Termed “unipolar” because the one positive pole is at each limb and the negative pole is the center of the heart} _{•“Augmented” because they have a low electrical potential and must be augmented 1.5 times}

_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)} What's the negative electrode in Augmanted Unipolar lead?

The center of the heart (which is theoretically electrically neutral)

_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)} Which leads monitor inferior wall?

II, III, AVF

_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)} Which leads monitor the lateral wall?

I & AVL

_{Electrocardiography - THREE-LEAD SYSTEM (Bipolar lead)} Which lead in the THREE-LEAD SYSTEM (I, II, II, avL, avF, avR) monitors the anterior or posterior walls?

None

_{Electrocardiography - MODIFIED THREE-LEAD SYSTEM} What's the other name for the MODIFIED THREE-LEAD SYSTEM, and why is it called that?

Lewis Lead (S5-Lead) Because it was created by Thomas Lewis

_{Electrocardiography - MODIFIED THREE-LEAD SYSTEM} Thomas Lewis created the MODIFIED THREE-LEAD SYSTEM for what purpose?

In response to **decrease in p-wave amplitude** with traditional EKG placement The thinking was that by _repositioning the lead_, the _p-wave height will be maximized_, so that _Atrial arrhythmias could be quickly identified_

_{Electrocardiography - MODIFIED THREE-LEAD SYSTEM} How is the MODIFIED THREE-LEAD SYSTEM used in practice?

It's a _modification of standard bipolar limb lead system_ Place **LA** electrode in the **V1** position, then select the **lead I** _on the monitor_ _{Rarely used in practice because more advanced technology has been discovered}

_{Electrocardiography - V1 FIVE-LEAD SYSTEM} Researchers began challenging the effectiveness of 3-lead EKG and their ability to diagnose and distinguish which two arrhythmias?

SVT and VT SVT and VT were correctly identified only about a third of the time

_{Electrocardiography - V1 FIVE-LEAD SYSTEM} Why was the 3-lead EKG not effectiveness in diagnosing or distinguish SVT vs VT?

The traditional EKG positions don't offer enough amplitude on the p-wave to be able to distinguish SVT from VT

_{Electrocardiography - V1 FIVE-LEAD SYSTEM} How frequently did the Use of a 12 lead EKG resulted in correct identification of SVT vs VT?

90% of the time

_{Electrocardiography - V1 FIVE-LEAD SYSTEM} Which lead in the V1 FIVE-LEAD SYSTEM was found to be the single best lead in determining SVT from VT

Lead **V1** Could be paired with the modified-lead placement Came out superior in its ability to distinguish SVT from VT The 5-lead with V1 position is most effective in viewing ventricular activity When compared to modified lead placement, V1 more superior

_{Electrocardiography - V1 FIVE-LEAD SYSTEM} Which lead position is most effective in viewing ventricular activity? A. The 5-lead with V1 position B. The modified lead placement

**A. The 5-lead with V1 position** B. The modified lead placement * Because V1 is the best lead to view ventricular activity* * This is the reason why the modified lead placement isn't used* * P-wave are also bigger and ....(inaudible!!!!)*

_{Electrocardiography - V1 FIVE-LEAD SYSTEM} In the V1 FIVE-LEAD SYSTEM, where is the V1 lead placed?

4th ICS, RSB

_{Electrocardiography - FIVE-LEAD SYSTEM} Which 7 leads can be viewed and recorded simultaneously with the FIVE-LEAD SYSTEM?

6 standard limb leads (I,II,III, aVR, aVF, aVL) 1 precordial/unipolar lead (brown lead - Could) Brown lead could be placed in any precordial position, V1 through V5

_{Electrocardiography - FIVE-LEAD SYSTEM} What does precordial lead placement depends on?

Depends on "What needs to me monitored in the pt"

_{Electrocardiography - FIVE-LEAD SYSTEM} What's the standard precordial lead for cardiovascular surgery? why?

**V5** Best to assess ST segment depression

_{Electrocardiography - FIVE-LEAD SYSTEM} Where is V5 placed?

5 ICS anterior axillary line

_{Electrocardiography - FIVE-LEAD SYSTEM} What is a major monitoring benefits of the FIVE-LEAD SYSTEM over the Three-lead system?

With the addition of only two electrodes in the ECG system, as opposed to the 3 electrodes in the Three-lead system, _up to 7 different leads can be monitores simultatneously_ This allows one to monitor several areas of the heart for ischemia Monitors Lateral, inferior & ANTERIOR myocardial walls monitored for ischemia or to establish a diagnosis between atrial and ventricular arrythmias Diagnosis atrial or ventricular arrhythmias

_{Electrocardiography - FIVE-LEAD SYSTEM} True or False: The FIVE-LEAD SYSTEM allows to monitor Posterior wall?

False NOT POSTERIOR

_{Electrocardiography - FIVE-LEAD SYSTEM} Which leads have the Greatest sensitivity in the detection of ischemia?

Lead V5 (75%) Followed by Lead V4 (61%)

_{Electrocardiography - FIVE-LEAD SYSTEM} Which is a benefit of Monitoring leads V4 & V5 simultaneously in the detection of ischemia

Increases sensitivity to ischemia to 80%

_{Electrocardiography - FIVE-LEAD SYSTEM} Which is a benefit of Monitoring V5 & Lead II simultaneously in the detection of intraoperative ischemic events?

Enhances detection of intraoperative ischemic events (90%)

_{Electrocardiography - FIVE-LEAD SYSTEM} Which is a benefit of Monitoring 3 leads (II, V4 & V5) simultaneously in the detection of intraoperative ischemic events?

Increases sensitivity (98%)

_{Electrocardiography - FIVE-LEAD SYSTEM} True or False: Modern ECG monitors incapable of simultaneous display of more than one precordial lead

**True** This is significant because lead II monitoring only recognizes ischemia in 35% of the cases

_{Electrocardiography - FIVE-LEAD SYSTEM} True or False: This is significant because lead II monitoring only recognizes ischemia in 35% of the cases

True

_{Electrocardiography - FIVE-LEAD SYSTEM} Which leads look at the inferior wall ischemia (RCA distribution), and at the superior wall for atrial arrhythmias

Lead II, III, & aVF

_{Electrocardiography - FIVE-LEAD SYSTEM} Which leads look at the Lateral wall left ventricle (Circumflex)

Lead I & aVL

_{Electrocardiography - FIVE-LEAD SYSTEM} Which leads look at the Anterior wall ischemia (LAD artery distribution)?

Lead V5

_{Electrocardiography - 12 LEAD SYSTEM} Which leads constitute the 12 LEAD SYSTEM?

Precordial leads (V1 through V6), and Unipolar leads that take a perpendicular look at the heart muscle directly underneath the leads

_{Electrocardiography - 12 LEAD SYSTEM} Which leads look at the septum?

V1 & V2

_{Electrocardiography - 12 LEAD SYSTEM} Which leads look at the Anterior wall?

V3 & V4

_{Electrocardiography - 12 LEAD SYSTEM} Which leads look at the Lateral wall?

V5 & V6

_{Electrocardiography - 12 LEAD SYSTEM} Since none of the leads in the 12 LEAD SYSTEM will monitor the posterior heart, how can we assess changes in the posterior heart?

Must look at reciprocal changes in V1 & V2

Mod1: Monitoring for Cardiac Surgery - EKG Flashcards

(59 cards)