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Anaesthesia & Analgesia > Monitoring Equipment > Flashcards

Monitoring Equipment Flashcards

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1
Q

What parameters does Blood Pressure monitoring equipment measure?

A
  1. Systolic pressure (SAP)
  2. Diastolic pressure (DAP)

SAP = Systolic Arterial Pressure

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2
Q

Syst = quick

Define Systolic pressure

A
  1. Pressure inside arteries
  2. When heart beats + pushes blood out + around the body
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3
Q

Diah = tired

Define Diastolic pressure

A
  1. Pressure inside ateries
  2. When the heart relaxes
  3. Between beats
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4
Q

What does Direct arterial blood pressure monitoring allow?

A

Monitoring of:
1. SAP
2. DAP
3. MAP (Mean Arterial Pressure)

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5
Q

What does In-Direct arterial blood pressure monitoring allow?

A

Intermittent arterial blood pressure

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6
Q

Why is In-direct + Direct blood pressure monitoring useful during anaesthesia?

A
  1. Indicates anaesthetic depth
    * Can show:
    * Hypotension
    * Reduced arterial BP
    * Due to less cardiac contractility + vasodilation
  2. Identifies plane of anaesthesia
    * Hypertension
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7
Q

What are the 2 In-Direct methods of monitoring BP?

A
  1. Doppler
  2. Oscillometric
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7
Q

How is Direct BP measuring equipment prepared?

A
  1. Ensure its charged
  2. Check over equipment + plugs before use for any damage
  3. Clean unit, cuff + cables by wiping disinfectant wipes
  4. Flush DAPB monitoring system w/heparinised saline, before connecting to patient’s arterial catheter
  5. Attach fluid admin set to heparinised bag of NaCl
  6. Pressurize fluid bag above patient’s Systolic pressure to prevent backflow of arterial blood into the system
  7. Attach fluid bag tubing, attached to pressure transducer, by a cable to the monitor
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8
Q

5 ..

How is In-Direct BP measuring equipment prepared?

A

Doppler
1. Clip hair over suitable artery site
2. Swab w/alcohol
3. Apply ultrasound coupling gel to doppler probe
4. Choose appropriate cuff size
5. Connect to sphygomonometer

Oscillometric
1. Attach cuff to oscillometric monitor!

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9
Q

Which is considered gold standard Direct or In-Direct BP monitoring?

A

Direct

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10
Q

2 ..

How is In-Direct, Oscillometric method attached to the patient?
&
How does it work?

A
  1. Attach inflatable cuff > monitor
  2. Place around tail base or limb
    * This picks up on Oscillations from the artery wall, as the cuff deflates
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11
Q

2 ..

How is In-Direct, Doppler method attached to the patient?
&
How does it work?

A
  1. The cuff is inflated until there is no sound of flow
  2. Then it deflates slowly, until the sound of the blood flow returns
    * Doppler ultrasonography uses an ultrasound probe
    * To mimic the sound of blood flow
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12
Q

3 ..

How is Direct method attached to the patient?
&
How does it work?

A
  1. Catheter placed into peripheral artery (Femoral artery or Metatarsal)
  2. Catheter connects to pressure transducer
  3. Allowing BP to be seen on monitoring device
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13
Q

2 ..

List the limitations of In-direct Doppler Ultrasonography

A
  1. Only detects Systolic pressure
  2. Low charge
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14
Q

3 ..

List the limitations of In-direct Oscillometrics

A
  1. Monitors fail to produce results more regularly than Dopplers
  2. BP is only to be used to observe trends
  3. The preciceness may be lessened in animals < 5kg
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15
Q

2 ..

List the limitations of Direct BP monitoring

A
  1. Catherisation is less tolerated, unless anaesthetised in a critically ill condition
  2. Air bubbles in the line - affecting accuracy of readings
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16
Q

Answer the following Qs.

  1. What is Systemic Hypertension?
  2. What is considered an abnormal SAP reading?
  3. What is considered an abnormal DAP reading?
A
  1. High BP throughout whole body
  2. SAP = > 140 mmHg or >
  3. DAP = > 90 mmHg
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17
Q

What is Primary Hypertension?

A

Hypertension with no underlying disease

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18
Q

What is Secondary Hypertension?

A
  • Hypertension, due to underlying disease
  • Often seen in Cats + Dogs
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19
Q

List 8 potential causes of Primary Hypertension

A
  1. Sudden blindness
  2. Bleeding from eye
  3. Detached retinas
  4. Epistaxis
  5. Heart murmurs
  6. Abnormal heart rhythm/Arrythmias
  7. Ataxia
  8. Haematuria
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20
Q

What readings are considered Hypotension in Cats + Dogs?
(SAP + MAP)

A
  1. SAP = < 90 mmHg
  2. MAP = < 60 mmHg
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21
Q

What are the 4 common causes of Hypotension in Cats?

A
  1. Large amount of blood loss
  2. Shock
  3. Bradycardia
  4. Hypothermia
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22
Q

What are the 5 common causes of Hypotension in Dogs?

A
  1. Kidney disease
  2. Liver disease
  3. Heart problems
  4. Dehydration
  5. Severe anaemia
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23
Q

3 ..

How does Hypotension manifest itself in Cats?

A
  1. Weakness
  2. Non-responsive
  3. Disorientation
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24
What are the common causes of **Hypo**tension in **Dogs**?
1. **Ataxia** 2. **Extreme fatigue** 3. Pale MMs 4. **PUPD** 5. Confusion
25
What can cause an **abnormal BP** reading?
1. **Incorrect** cuff **size** (big cuff = low reading, small cuff = high) 2. **Loud, bright environmen**t 3. Harsh restraint/rough handling 4. **Stress** (Will inc high BP) 5. **Incorrect patient position** (Should be **lateral** recumbency) 6. **Insufficent consecutive readings** (Req several to compare + ensure they coincide w/each other) 7. **Cuff isn't placed a**t the **Right Atrium Level**
26
What is Capnography?
The **measurement** + **graphical recording** of Carbon dioxide (CO2) concentration in exhaled gases (**ETCO2**)
27
How does a Capnograph measure ETCO2?
1. Uses **infrared light** 1. **Wavelengths** are **absorbed by CO2** 2. Which passes through an **expired gas sample** 3. The concentration is then determined according to the Beer-Lambert Law
28
How do you read a Capnograph?
1. It creates a graphical recording/measurement of the concentrated or partial pressure (ETCo2) of CO2 2. That is present in exhaled gases from the patient
29
What are the units used to measure ETCO2 on a Capnograph?
Measured in **mm Hg** = Millimeters of Mercury
30
Name the 2 types of Capnography
1. Sidestream (In-direct, Continual divertion) 2. Mainstream (Direct, Sensor)
31
What is occuring in these capnographs? A) Left B) Right
A) = Hypoventilation B) = Re-breathing
32
Is this an normal or abnormal capnogram?
Normal/ideal
33
What shape is ideal on a Capnograph?
Tilted top-hat
34
What are the limitations of Capnography
1. **Difficult** to use in **spontaneously** breathing patients 2. **Condensation**, as a result of false elevations of CO2 readings 3. **Kinked lines** - causing waveform issues 4. Water or **secretion blockages** - "
35
Explain what is happening in each phase: A) Phase 1 B) Phase 2 C) Phase 3 D) Phase 4
A) Phase 1 = **Inspiration** occurs B) Phase 2 = ***Part* of exhalation, where CO2 containing alveolar gas**, ***starts*** to be **exhaled** C) Phase 3 = **Alveolar gas** is **exhaled** D) Phase 4 = Inspiration (Return)
36
How does Sidestream attach to the patient + ana circuit?
1. Samples of patient's ETCO2 obtained from ana circuit 2. Using **adaptor** 3. This **attaches** to **end** of **ET** tube 4. Adapter **attached** to point of **patient's nose** 5. To ***avoid excessive dead space + prevent re-breathing***
37
How is Capnography equipment prepared for use?
1. Ensure that the breathing circuit is **disconnected** 1. Ensure there is **no leak** in the **sampling tube** 1. **Inspect** before use for: * Any **damage** to the equipment * It is **operating correctly** * All **accessories** needed have been **added** 1. The capnograph should be **calibrated every 6 months** 1. The device should be properly **cleaned before use,** as **secretions** will **contaminate** the unit
38
What 7 parameters to an **Electrocardiogram** (ECG) measure?
1. HR 2. Heart rhythm 3. **RR intervals** 4. **P + T waves** 5. **PR + QT** intervals 6. **QRS complex** 7. **ST** segment
39
What equipment do you require for ECG monitoring?
1. ECG recording machine 1. **Alcohol** and/or **ultrasound gel** 1. **Alligator clips** **or ECG patches** 1. Blanket
40
Why should a patient always be in R-lateral recumbency for ECG monitoring?
Because this position is the **standard** for correct measurements to be obtained
41
Wheen using an ECG, why should you not: A) Touch the electrodes B) Let the electrodes touch each-other C) Metal tablet contact with the electrodes (All 1 answer)
Creates an **artifact** on the ECG
42
How do you set up an ECG?
1. Place px in **R-lateral recumbency** 2. **Attach limb electrodes** to px's **elbows + stifles** 3. ***Red*** = ***R-ForeLimb*** 4. ***Yellow*** = ***L***-FL 5. ***Black*** = ***R-HindLimb*** 6. ***Green*** = **L**-HL 3. *If using **alligator clips**, consider **blunting** or glattening the clips, to make px more **comfortable*** 4. If leads are ***snapped on w/adhesive patches*** - ***clip + clean area before*** applied 5. **Record ECG** at **50 mm/sec** (25 mm/sec is also acceptablle in some px) + **10 mm/l mv** - for **standard amplitude calibration** 6. ECG **anaylsis** should be made in **lead 2**, which should always be **labelled** 7. Clearly **record** on px's form + note if other lead used
43
At what **mm/sec** should ECGs use for standard amplitude calibration?
1. At **50 mm/sec** 2. 25 mm/sec is also acceptablle in some patients 3. **10 mm/l mv** - for **standard amplitude calibration**
44
What **part** of the ECG machine should you not immerse in any liquid when cleaning or avoid dropping?
The sensors
45
If the ECG is damaged, what you shoudl do?
Remove + get it serviced immediately, by authorized personnel
46
What order should you place the following leads? A) Yellow, red, black, green B) Red, green, yellow, black C) Green, black, red, yellow D) Black, yellow, green, red Based on: 1. Left forelimb 2. Right forelimb 3. Left hindlimb 4. Right hindlimb
B) Red, green, yellow, black
47
What are 5 limitations of ECGs?
1. **Only** display cardiac **rhythm + electrical output** 2. **Cannot** provide **info** on **circulation or tissue perfusion** 3. Acts of **shivering + respiratory movement** can cause **poor quality** readings + a **change in base lines** 4. **Electrical interference** commonly occurs 5. **Human erro**r with wrong lead placement = inaccurate readings
48
How would you treat the following abnormal readings on an ECG? *(under VS direction)* A) Abnormal waveform B) Sinus bradycardia C) Sinus tachycardia
A) Abnormal waveform = Establish cause, admin **meds** + **diuretics** to **aid contraction** of heart muscle, **decrease fluid retention** + **restore rhythm** B) Sinus Bradycardia = Only **treat if severe**, such as signs of exercise intolerance or **collapse** - in this case admin **Atropine** C) Sinus Tachycardia = **Treat** underlying **cause** + **admin Beta-blockers**, such as **Atenolol** All under VS direction
49
What is an ECG chamber enlargement?
* Abnormal waveform in Dogs + Cats * **Length or height of waves can show enlarged or norma**l **chambers** within the heart
50
What is Sinus bradycardia in ECGs?
* A **regular** sinus rhythm, that is slower than normal * Usually seen in **anaesthetic overdoses or hypothermia**
51
What is Sinus tachycardia in ECGs?
* Regular sinus rhythm that is faster than normal * Often triggered by: 1. Stress 2. Exercise 3. **Hyperthyroidism** 4. **Heart failure**
52
What is Sinus arrhythmia in ECGs?
* Occurs from **irregular discharge** of **sinus node** * When **HR inc** w/***inspiration*** + HR **decrease** w/***expiration*** * Causes **apnoea**
53
What is Sinus Arrest in ECGs?
1. **Absence** of **P waves** for short period 2. Due to **excessive Vagal Tone** or i***nherent Sinus Node Disease*** (SND)
54
What is an ECG?
1. Graphical recording of electrical impulses produced by cardiac muscle 2. During different phases of the cardiac cycle
55
What 3 things do ECGs measure?
1. HR 2. Rhythm 3. Timing of electrical impulses (SA, SV nodes etc)
56
Explain what is meant by **De**polarisation + **Re**polarisation in ECGS
1. **DE**polarisation = **Travel** of eletrical impulses **from Bundle of HIS > Ventricles** - causing ***ventricular depolarisation*** 2. **RE**polarisation = **Return** of e**lectrical charges** to **resting** state
57
How should you prepare an ECG machine before use?
1. Ensure the machine is **clean** 2. **Check cables + leads** are not damaged 3. **Battery operated** ECG machine: check that the battery is **fully charged** 4. **Check electrode gel** is not **dried out**, replace if needed
58
Why are ECGs important?
1. Help monitor **pain**, stress + **depth of ana** 2. **Detect drug-induced + electrolyte arrhythmias** 3. Help detect general changes in ana 4. **Identify** presence of arrhythmias dor diagnosis 5. Useful **pre-anaesthetic profile** for **dogs + cats** ***> 7 y/o*** 6. Greatly **influences** **chosen drugs, dosages + agents** used
59
List the 3 simple steps taken to set up the ECG machine
1. Set **display** to **lead 2** 2. Set **sensitivity to 10 mV** + adjust if necessary 3. Ensure **paper speed is set** at **25 mm/sec**
60
Name 3 types of electrodes used for ECGs
1. **Crocodile clips** 2. Adhesive pads 3. **Limb plates**
60
Identify the abnormal ECG reading
Ventricular tachycardia
61
Identify the abnormal ECG reading
2nd + 3rd degree Atrioventricular block
62
True or False. **Supraventricular tachycardia** can occur during surgery, but may not always be clear to see, due to the fast HR.
True!
63
What drug can commonly cause **Ventricular Premature Complexes** (VPC) on ECGs?
Alpha-2-Agonists
64
What abnormal ECG waveform can Alpha-2-Agonists cause?
**Ventricular Premature Complexes** (VPC)
65
What does an **Oesophageal** stethoscope monitor?
Measure HR in anaesthetised patients
66
Where should an Oesophageal stethoscope lie directly over ?
Directly over the **heart**
67
Why should an Oesophageal stethoscope lie directly **over** the **heart**, inside the Oesophagus?
To monitor both the **HR + Lung sounds**, synergistically
68
True or False. Oesophageal stethoscopes are a simple + effective method of monitoring HR, Rhythm + RR.
False. Oesophageal stethoscope's measure: 1. HR 2. Rhythm 3. Lung sounds
69
Name this piece of monitoring equipment. & Where should it be placed?
1. Oesophageal stethoscope 2. In the Oesophagus
70
# 5 .. How do you clean an Oesophageal stethoscope?
1. Place into **warm, soapy water** 2. Use **brush** to clean off any **organic materials** (if blood, use water obv - but hopefully none there!) 3. **Soak** in **0.5% Chlorohexidine** for **15 mins** 4. **Rinse** thoroughly w/water 5. Leave to dry
71
How do you apply a Oesophageal stethoscope to a patient, safely?
1. Place the thin, flexible tube + **attach stethoscope** (that has diaphragm removed) 2. ***Only commence placement, once patient has been intubated - to prevent advancecment into Trachea !!!*** 2. **Insert** tube into px's mouth > **Oesophagus + advance gently** 3. **Until audible heart beat** is detected through ear pieces
72
What are the limitations of Oesophageal stethoscopes?
1. Unless worn throughout the whole sx, the device cannot provide continuous information 2. Can be advanced to far, if px isn't intubated 1st (**Into Lungs**) 3. **Only** provides **HR + Rhythm** 4. ***Noise from coat, aginst stethoscope, can impact results*** 5. **Obesity** 6. **Masses** **in** the **Hemithorax** 7. Interference from URT noises - especially **bracycephalics** 8. Intensity of sounds are not reliable, can be ***associated w/changes in BP or CO***
73
What can be attached to Oesophageal stethoscopes, to amplify cardiac sound?
Electrical monitors
74
What is this?
Oesophageal Temperature probe
75
# 6 .. How is an Oesophageal Temperature probe prepared for use?
1. Ensure cleaned between patients 2. **Connect** to **multi-parameter machine** 3. **Lightly lubriate** 4. Once patient is under GA, **Advance into** the **Oesophagus** 5. To the **same level as** the **heart** 6. Into the **lower 1/3** of the Oesophageal **tract**
76
What are the limitations of using an Oesophageal Temperature probe?
1. Can only be **placed under GA** 2. **Incorrect positioning of probe** leads to **inaccurate results**
77
What type of thermometer is this? Humour me!
A Digital **PERIPHERAL** thermometer
78
True or False. Digital Peripheral thermometers have changeable batteries.
True
79
What are the limitations of Digital peripheral rectal thermometers?
1. Can't obtain a **true core** body temp 2. Disease transmission 3. Not accesible if wounds are present
80
What is an advantage of Digital peripheral thermometer?
* **Decreased hair density inside** the **rectum** * Allows for **direct contact with** the **skin** * To allow for a s**urface reading of peripheries**
81
Oseophageal stethoscopes + Stethoscopes can monitor HR + RRs. State the normal HR + RR of Dogs + Cats
Dogs 1. HR = 70 - 140 bpm 2. RR = 10 - 30 bpm Cats 1. HR = 100 - 200 bpm 2. RR = 20 - 30 bpm
82
What position can prove handy when advancing an Oesophageal stethoscope, under GA? (If temporary)
Sphinx position!
83
Explain what these abnormal respiratory sounds you may hear whilst using an **Oesophageal Stethoscope**, may indicate? A) Crackles B) Wheezes C) Stridor D) Stertor E) Friction rub
A) **Crackles** = **Obstructed** airway B) **Wheezes** = **Narrowed** airway C) **Stridor** = Abnormal **narrowing** of Layrnx D) **Stertor** = **Partial** obstruction E) ***Friction rub = Inflamed Pleura***
84
Give the normal body temperature for a Dog + Cat.
1. Dog = 3**8.3** - 3**9.2** degrees Celsius 2. Cat = 38.2 - 38.6 degrees Celsius
85
What should you always do when taking a rectal temperature?
1. Apply lube 2. **ALWAYS prioritize animal's comfort + safety**
86
How should you prepare an Aural thermometer for a peripheral body temp?
1. **Clean** probe with **alcohol wipe** or disinfectant * If digital - **ensure fully charged or** has **fresh batterie**s 3. Attach a **disposable probe cover** 4. **Test** to ensure it powers on + displays an accurate reading 5. **Gently position** the thermometer in the animal's **ear canal**, ***ensuring a proper fit***, while ***avoiding excessive force*** 6. This process ensures accurate readings and **minimizes discomfort** for the patient * Whilst **promoting** a **smooth** temperature monitoring procedure
87
Whats another word for an ear thermometer?
Tympanic thermometer
88
What does Pulse Oximetry used to measure?
Assess **tissue perfusion**! 1. HR 2. SpO2
89
How is a Pulse Oximeter attached to a patient?
1. **Attach** probe to areas of **thin + non-pigmented skin**, like ***under the tongue***, ***ears*** or ***between toes*** 4. **Move** the probe **around** the area to **prevent** any **trauma** from occurring 5. **Choose correct size** probe for patient 6. ALWAYS **place** ***photosensor*** of probe **upwards** + ***LED*** facing **downwards** 7. **If signal is poor** a **wet swab** can be positioned **between** **probe + tongue** to **improve** tissue perfusion
90
List the 6 limitations of Pulse Oximetry
1. **Skin pigment + thickness** *(Dark skin = doesn't absorb as well)* 2. **No info** on **O2 delivery** to tissues *(Determined by CO + haematocrit)* 3. Doesn't detect **Hypoventilation** ***(Takes minutes to detect hypoxaemia + hypoventilating px may breath 100% O2 w/normal SpO2 - but still have dangerously high levels of CO2)*** 4. **Patient movement** *(Prevents probe from sensing Arterial blood flow)* 5. **Ambient/fluorescent lighting** interfers w/probes ***(Prevents ability to differentiate between Oxyhaemaglobin + Deoxyhaemaglobin)*** 6. Probe clips can **compress skin, veins** + cause **trauma** *(+ Capillary beds, interfering w/SpO2 readings)*
91

Anaesthesia & Analgesia (30 decks)

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