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Board Exam COPY > Monitoring > Flashcards

Monitoring Flashcards

1
Q

What is dynamic compliance?

A

Compliance of the lung and chest wall DURING MOVEMENT

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2
Q

What is static compliance?

A

Lung compliance while there is no airflow. It’s a function of the natural tendency of the lung/chest wall to collapse

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3
Q

What is plateau pressure?

A

Pressure in the small airways and alveoli after the target TV has been delivered.

There is NO airflow at this time, so it’s value is NOT a function of airway resistance. It instead reflects the elastic recoil of lungs and thorax during the inspiratory pause –> at this point the pressures of the lung and chest wall wanting to collapse and the pressure within the lung are equal.

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4
Q

Risk of barotrauma exists when plateau pressures are > ____

A

35cmH2O

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5
Q

O2 blood absorbs this wavelength

Deoxygenated blood absorbs this wavelength

A 
O2 = 990nm (near-infrared)
Deox = 660 (red)

Higher O2 content = higher wavelength

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6
Q

Pulse oximetry is based on this Law

A

Beer-Lambert:

- related to the intensity of light trimmed through a solution and the concentration of the solute within the solution.

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7
Q

Can pulse ox be used to look at pulse pressure variation (PPV%)?

A

Yes

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8
Q

Does pulse ox account for O2 dissolved in blood?

A

No

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9
Q

Does jaundice affect pulse ox readings?

A

No

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10
Q

Methemoglobin

A

Fe3+
Absorbs 990 and 660 equally
Thus, it falsely underestimates SpO2 when sat is >85%
Falsely overestimates SpO2 when

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11
Q

Carboxyhemoglobin

A

CO-Hbg (carbon monoxide)

Pulse Ox reads CO-Hgb and O2-Hgb the same. Thus, it overestimates saturation.

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12
Q

This is the most common method of analyzing exhaled gas in the OR

A

Infrared absorption

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13
Q

How is O2 analyzed?

A

O2 does not absorb infrared light, so it must be measured by electrochemical means (Galvanic Cell or Clark Electrodes) or paramagnetic analysis

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14
Q

The ideal BP bladder WIDTH is ___% the circumference of the pt’s arm

A

40%

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15
Q

The ideal BP blade LENGTH is ___% the circumference of the pt’s arm

A

80%

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16
Q

Do a-lines measure pressure at the site of insertion or level of transducer?

A

Level of transducer

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17
Q

Most common complication while obtaining CV access

A

Dysrhythmias

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18
Q

This is the classic presentation of PA rupture

A

Hemopytsis

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19
Q

This is the point of phlebostatic access

A

Mid anteroposterior level at 4th intercostal space

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20
Q

Where in the respiratory cycle should CVP be measured?

A

End expiration

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21
Q

Meanings of high and low CVP

A

Low CVP is easy: either transducer is too high or the pt is hypovolemic.

If CVP is too high, could be a million things related to

1) Hypervolemia
2) Decreased ventricular compliance
3) Increased intrathoracic pressure

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22
Q

How to manage Mobitz II heart block

A

Often unresponsive to atropine.
High risk of progression to Third Degree heart block.

Manage with pacemaker (transcutaneous, transvenous, or implantable)

23
Q

Treatment of third degree heart block

A

Isoproterenol

Pacing

24
Q

What is the most common pre-excitation syndrome?

A

WPW

25
Q

Two types of WPW

A

1) Orthodromic
- Most common (90% of cases)
- Narrow complex (Goes thru AV node and his-purkinje system, then tract goes back up through atrium to stimulate AV node again)
- Treatment: Increase the refractory period of the AV node so it won’t be stimulated so frequently by the aberrant pathway.
- -> Vagal maneuvers, amiodarone, adenosine, BBs, verapamil, or cardioversion.

2) Antidromic
- Less common (10%)
- Wide Complex (Abberent pathway goes from SA, accessory pathway, ventricle, AV node, atrium). The his-purkinje system is bypassed, so it’s wide complex)
- Treatment: Increase the refractory period of the aberrant pathway
- -> Procainamide, amiodarone, cardioversion. In this case, DO NO give anything that will prolong AV refractory period –> this will cause the aberrant pathway to be favored and result in Vfib!)

26
Q

Medications to avoid in Antidromic WPW (AVNRT)

A

AVOID ALL DRUGS THAT BLOCK CONDUCTION THROUGH THE AV NODE

  • Adenosine
  • Digoxin
  • BBs
  • Verapamil
  • Lidocaine
  • Diltiazem
27
Q

What are the two safe options for BOTH orthodromic AND antidromic WPW?

A

Amiodarone and cardioversion

28
Q

Effect of K+ on the QT interval

A

Hypokalemia can cause QT prolongation

29
Q

Only narcotic that prolongs QT

A

Methadone

30
Q

What things cause Torsades des Pointes?

A

POINTES

Phenothiazines (Thorazine)
Other meds (meds that are known to lengthen QT –> methadone, droperidol, halloo, zofran, VAs, amiodarone, and quinidine)
Intracranial bleed (SAH)
No known cause
Type 1 antiarrhythmics
Electrolyte Disturbances (low K+, Mg+, and Ca+2)
Syndromes

31
Q

Those with chronically prolonged QTc will likely be placed on

A

BBs like metoprolol

SNS stimulation and precipitate torsades, and BBs are good at blocking the sympathetic response on the heart

32
Q

Pacemaker designation positions

A

Position 1 = Chamber paced
Position 2 = Chamber sensed
Position 3 = Response to sense native cardiac activity
Position 4 = Programmability of the pacemaker
Position 5 = Indicates that the pacer can pace multiple sites

33
Q

Codes for position III in pacemaker designation

A

Position III = pacer response to sensed native cardiac activity

0 = None
T = Triggered (triggers the pacer to fire)
I = Inhibited (tells the pacer NOT to fire)
D = Dual (If native activity is sensed, the pacer does NOT fire. If no native activity is sensed, then the pacer WILL fire)
34
Q

Codes for position IV in pacers

A

Position 4 = Programmability

0 = None
R = Rate modulation

This describes the ability to adjust HR in response to physiologic need

35
Q

Effect of magnet on Pacemaker

A

Changes it to asynchronous mode

36
Q

Effect of magnet on ICD

A

Prevents shock delivery

37
Q

Effect of magnet on Pacer/ICD combo

A

Suspends ICD shock

NO EFFECT on pacemaker

38
Q

Elecromagnetic interference (EMI) can interfere with pacer function. EMI can often come from

A

Electrocautery

  • Worse with coagulation setting than with cutting setting
  • Worse with monopolar than bipolar
  • If surgeon insists on monopolar, tell them to use it in short bursts (
39
Q

Conditions that make the myocardium more resistant to depolarization with pacers

A
  • High and low K+
  • Hypocarbia (will cause inward K+ shift)
  • Hypothermia
  • MI
  • Fibrotic tisue buildup around the leads
  • Antiarrhythmic meds
40
Q

Is lithotripsy contraindicated in those with pacer?

A

No, but the beam should be directed away from the pulse generator

41
Q

What to do if pacer fails

A

Have method of backup pacing immediately available

Chemical pacing with isoproterenol, epi, and atropine

42
Q

A greater than ___% reduction in cerebral oximeter readings suggests a reduction in cerebral oxygenation

A

25%

43
Q

Can scalp hypoxia interfere with cerebral oximeter readings?

A

Yes

44
Q

Do cerebral oximeters detect pulsatile flow?

A

No

45
Q

Order of EEG waveforms with most awake to deepest

A

BAT-D

Beta
Alpha
Theta
Delta
Burst suppression
Isoelectric
46
Q

Amount of lag in BIS

A

About 20-30 seconds

47
Q

BIS is less accurate in this population

A

Children

48
Q

General anesthesia range for PSI

A

Similar to BIS, but uses different number

GA is 25-50

49
Q

Macroshocks and their effects

A 
1mA = threshold for touch
5 = max harmless
10-20 = Let go current
50 = LOC
100 = Vfib!
50
Q

Microshock

A 
10uA = max allowable leak in OR
100uA = Vfib!
51
Q

For an electrical shock to occur in the OR, two faults must occur

A

1) After the first fault, the system becomes grounded

2) After the second fault, the circuit is complete and shock occurs

52
Q

What is the function of the line isolation monitor (LIM)?

A

To alert OR staff of the first fault

When the alarm sounds, the last piece of equipment to be plugged in should be unplugged

53
Q

LIM will alarm when ____mA leak current is detected

A

2-5mA

Board Exam COPY (21 decks)

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