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Comprehensive Exam > Monitoring > Flashcards

Monitoring Flashcards

1
Q

relative contraindications to each A-line location

A
  • radial artery
    • inadequate collateral blood flow
  • femoral artery
    • prior vascular surgery
    • skin infection
  • dosalis pedis
    • diabetes
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2
Q

A-line and EKG comparison

A
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3
Q

(4) events determinig arterial waveform

A
  • ejection of blood
  • runoff of blood into peripheral vessels
  • reflectance from peripheral circulation
  • interaction with transducer system
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4
Q

Central locations for A-line

A

aortic arch

descending thoracic aorta

abdominal aorta

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5
Q

peripheral locations for A-line

A
  • axillary artery
  • brachial artery
  • radial artery
  • femoral artery
  • dosalis pedis artery
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6
Q

Central vs Peripheral arterial waveforms

A

Central:

  • narrower pulse pressure
  • eariler upstroke
  • earlier dicrotic notch
  • muted diastolic wave
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7
Q

the dicrotic notch recorded directly from the central aorta is termed the _____

A

incisura

  • related to aortic valve closure
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8
Q

periperal pressures have a ____ systolic and a ____ diastolic compared to central pressures

A

higher systolic

lower diastolic

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9
Q

study comparing central and peripheral pulse pressures

A

22.6 mmHg pressure difference

  • most extreme in aortic insufficiency
  • smallest difference in AS
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10
Q

A-line catheter size for infants

A

24g

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11
Q

A-line catheter size for adults

A

20g

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12
Q

radial artery lies between which two tendons?

A

branchioradialis

flexor carpi radiallis

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13
Q

murmur heard in aortic stenosis

A

systolic ejection murmur

crescendo-decrescendo

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14
Q

pulsus tardus

A

slurred upstroke with delayed systolic peak

  • seen in aortic stenosis
  • caused by increased compliance fo the post-stenotic vessel wall
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15
Q

Anesthetic management in Aortic Stenosis

A

avoid tachycardia and bradycardia

  • maintain an increased afterload
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16
Q

Aortic Regurgeitation

A

flow of blood from aorta into left ventricle during diastole

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17
Q

aortic insufficiency is normally caused by _____

A

aortic root abnormalities

  • connective tissues diseases
    • Marfan’s
    • Ellers-Danlos syndrome
  • Aortic dissection
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18
Q

anesthetic management in Aortic Insufficiency

A

elevated to normal HR with slight afterload reduction

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19
Q

what hemodynamics should be avoided in aortic insufficiency?

A

bradycardia and increased afterload

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20
Q

Pulsus Bisferiens

A

wide pulse pressures with double systolic peak

  • occurs in aortic regurge
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21
Q

FloTrac measurements

A

CO, SV, SVV, and SVR

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22
Q

normal stroke volume variation

A

< 15%

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23
Q

normal Cardiac Output

A

4.0 - 8.0 L/min

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24
Q

normal Cardiac Index

A

2.8 - 4.2 L/min/m2

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25
normal Stroke Volume
60 - 90 mL/beat
26
normal Systemic Vascular Resistance
900 - 1400 dynes*sec/cm5
27
normal Systemic Vascular Resistance Index
1900 - 2400 dynes*sec/cm5
28
normal ScvO2
\> 70%
29
Dampening in A-lines
lower systolic and higher diastolic ## Footnote **falsely low CO**
30
SVV is a reliable indicator of \_\_\_\_\_\_
preload responsiveness
31
required conditions for SVV
* mechanical ventilation with VT \> 8 mL/kg * no SIMV or PSV * Normal sinus rhythm * closed chest
32
SVV greater than _____ will respond to fluid bolus
13
33
Indications for Central Venous Access
* monitoring * central venous pressure * pulmonary artery catheterization * Therapeutic * hemodialysis * aspiration of air emboli * repeated blood sampling
34
phlebitis
vein inflammation
35
drugs likely to induce phlebitis
* calcium chloride * potassium * NE * vasopressin * Epi * Dopamine
36
absolute contraindications to Central line
* inexperienced operator * overlying skin infection * thrombophlebitis
37
(4) Types of central venous access devices
* non-tunneled * tunneled * PICC * implanted ports
38
Types of Tunneled central lines
hickman, broviac, leonard, and groshong
39
PICC
peripherally inserted central catheter
40
PICC is usually placed in the \_\_\_\_\_
brachial vein
41
3.0 Fr = \_\_\_\_\_
20g
42
5.0 Fr = \_\_\_\_\_
16 g
43
7.0 Fr = \_\_\_\_
12g
44
sizes of double lumen
5 and 6 Fr
45
Sizes of triple lumen central line
5.5 and 7 Fr
46
colors for distal, medial, and proximal central line
distal - red or brown medial - blue proximal - white
47
preferred site for central line during emergencies
femoral
48
Advantage vs Disadvantage of IJ central line
* advantage * easy to recognize bleeding * less risk of pneumo * disadvantage * risk of carotid puncture
49
Advantage vs Disadvantage of subclavian central line
* advantage * most comfortable * disadvantage * highest risk of bleeding * highest risk of pneumo
50
Advantage vs Disadvantage of femoral central line
* advantage * easy to find * preferred for emergencies * disadvantage * infection risk * DVTs * not good for ambulatory patients
51
preferred side for IJ insertion
right lower pleural dome and no thoracic duct
52
CVP waveform
53
mechanical event during a-wave of CVP waveform
atrial contraction
54
mechanical event during c-wave of CVP waveform
isovolumic ventricular contraction
55
mechanical event during x-descent of CVP waveform
atrial relaxation
56
mechanical event during v-wave of CVP waveform
systolic filling of the atrium
57
mechanical event during y-descent of CVP waveform
opening of atrioventricular valve
58
Cannon A waves
represents right atrium contracting against closed tricuspid valve * juntional rhythm * complete heart block * ventricular arrhythmias or increases resistance to right atrium to right ventricle flow
59
loss of the A-wave in CVP waveform
loss of coordination of right atrium contraction * a-fib * a-flutter
60
Cannon V-waves
severe tricuspid regurge
61
slow Y-descent in CVP waveform
tricuspid stenosis * impaired right ventricle filling during diastole
62
what does CVP measure?
pressure of blood in the thoracic vena cava near the right atrium * reflects the balance of intravascular volume, venous tone, and RV function
63
normal CVP in spontaneously breathing patients
1 - 7 mmHg
64
CVP is ____ proportional to compliance in thoracic veins
inversely
65
CVP significance
approximation of right atrium pressure, which determines right ventricle filling, and therefore right ventricular preload
66
what can increase CVP?
* pulmonary hypertension * protamine * acidosis * PEEP * RV failure
67
indications for PAC
* ASA IV and V * high risk procedures * assess volume status * assess right or left ventricular failure * assess pulmonary hypertension
68
absolute contraindications to PAC
* tricuspid stenosis * pulmonic valve stenosis * RA or RV mass * tetralogy of fallot * h/o LBBB
69
standard PAC
110 cm 7 - 8 Fr 3-5 lumens
70
distal lumen of CVP
measures PA pressures
71
proximal lumen of PAC
measures right atrium pressures )CVP) injection for thermodilution
72
waveform for PAC
73
distance to right atrium using PAC
25 cm
74
distance to pulmonary artery using PAC
45 cm
75
Insertion complications using PAC
* transient arrhythmia * complete heart block * catheter knotting * valvular damage * ventricular perforation * incorrect placement
76
most common arrhythmia with PAC
PVC
77
Indwelling complications of PAC
* endobronchial hemorrhage * pulmonary infarction * thrombus * balloon rupture
78
normal pulmonary artery pressure
15-30 over 6-15 mmHg
79
normal pulmonary artery occlusion pressure
5 - 12 mmHg
80
normal right ventriuclar ejection fraction
40-60%
81
normal left atrial pressure
4 - 12 mmHg
82
what causes Giant V-waves
mitral regurgitation or MI leading to decreased LV compliance
83
cause of large A-waves
severe aortic stenosis or mitral stenosis
84
(4) mechanisms that result in decreased SvO2
* decrease CO, Hgb, SaO2 * increased O2 extraction
85
functions of TEE
* regional wall motion * ventricular volume and function * valve gradients and regurgitation * air embolism
86
(5) Modes of TEE
* M-mode echocardiography * 2D echocardiography * pulsed-wave doppler * continuous-wave * color-flow
87
Contraindications of TEE
* perforated viscous * esophageal pathology * trauma, tumor, scleroderma * active upper GI bleeding * recent upper GI surgery * esophagectomy
88
—Ultrasound waves transmitted from the transducer interacts with the patient’s tissues in four ways:
1. Reflection 2. Refraction 3. Scattering 4. Attenuation
89
velocity of transmitted US through soft tissue
1,540 m/s
90
depth to visualize great vessels
upper esophagous 20 - 25cm
91
depth to visualize valvular and systolic function
mid-esophageal 30-40 cm
92
depth to visualize EF, volume status, and wall motion
transgastric 40-45 cm
93
depth to visualize AV valve
deep transgastric 45-50cm
94
ME 4 chamber view
probe at 30 - 40cm * can view * chamber enlargement, LV function, MV/TV pathology, ASD, and pericardial effusion
95
LAD supplies:
* anterior right ventricle * anterior left ventricle * LV apex * anterior 2/3 of interventricular septum
96
Coumadin Ridge
tissue that separates left atrial appendage and left pulmonary vein * important in A-fib * blood will fillup in this area and eventually form clots
97
Anatomical Structures in ME 2 view
* left atrium and left atrial appendage * mitral valve * left ventricle * coumadin ridge * coronary sinus * circumflex coronary artery
98
how to convert ME4 view to ME2
increase omniplane angle to 80-100 degrees * mitral valve should be center of screen
99
ME2 assessment
left ventricle size and function MV pathology and annulus
100
ME LAX anatomical structures
* left atrium and ventricle * mitral valve * right ventricle * aortic valve * proximal ascending aorta
101
ME LAX view mitral and aortic valve in the same view
102
how to convert ME4 to ME LAX
increase omniplane angle to 120-140o rotate probe slightly to the right
103
TG mid SAX anatomical structures
LV cavity and it's segments papillary muscles right ventricle
104
how to convery ME4 view to TG mid SAX
set omniplane angle to 0 advanve probe into stomach (40-45cm)
105
which view has the best assessment of volume status?
TG mid SAX

Comprehensive Exam (6 decks)

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