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Flashcards in NIBP Deck (144):
1

Perfusion =

Pressure and flow

2

When you give phenylephrine to treat low BP then what are you effecting?

TPR (total peripheral resistance)

3

When you give ephedrine to treat low BP then what are you effecting?

TPR , HR, CO

4

All drugs for induction effect what two parameters?

Coronary blood flow
Cardiac sympathetic discharge

5

What induction agents effect venous capacity?

Propofol, fent, inhaled gases

6

What induction agents are vasodilator substances?

Propofol, inhaled gases

7

What is the normal CO?

5 L / min

8

What is the normal blood volume ?

5 L / min

9

When a pt is in sepsis, what physiological status must you account for?

Increased norepi usage
Low BP
CO 2-3x normal
Decreased perfusion to peripheries

10

What is the mean circulating filling pressure?

Pressure anywhere where flow is stopped

11

What do baroreceptors do?

Provide the driving pressure that permits local autoregulation of all vascular beds

12

What are the 2 main baroreceptors used to regulate central blood pressure?

Carotid sinus
Aortic arch baroreceptors

13

When using auscultation as the means for measuring BP manually, what sounds do you hear?

Korotkoff Sounds

14

What does NIBP mean?

Non invasive blood pressure

15

What artery is most used for listening for Korotkoff sounds?

Brachial

16

What is the most common technique used for measuring NIBP?

Oscillometric

17

When using oscillometric technique for NIBP, which pressure is most accurate?

Mean

18

Remember in Biggs class, we measure VARIABLES and not PARAMETERS

DUH

19

What law do you use when talking about wall pressure and and blood vessels?

Laplace's law

20

NIBP overestimates at what state? (HTN, or hypotension?)

Hypotensive

21

NIBP underestimates at what state?

Hypertensive

22

Which parameter describes tissue perfusion?

Mean pressure

23

What is the calculation used to determine perfusion pressure?

PP = arterial P - venous P

24

Mean pressure is also known as what?

Pressure of perfusion

25

The majority of blood flow to the LV occurs during what?

Diastole

26

What is the term that describes the formula we use to calculate Mean Pressure? (formula is M = {(S - D) / 3} + D

Wiggers Estimate

27

When using wiggers estimate, where must the pressures be derived from?

Cuff must be on Upper arm

28

What is the k value for the brachial artery?

0.33

29

When using k values what is the formula you must use to determine mean pressure?

MP = D + k (pulse pressure)

30

What is the k value for the aorta?

0.41

31

What is the k value for the femoral artery?

0.30

32

Define pulse pressure

Difference between systolic and diastolic pressures

33

What is pulse pressure used for in the clinical setting?

Indicator of stroke volume

34

When under anesthesia, does your O2 requirement increase or decrease?

Decrease

35

What is the minimum required blood pressure for a patient?

20% of the systolic pressure

36

What is the minimum required BP for the brain?

60 mm Hg

37

CPP stands for what

Cerebral perfusion pressure

38

What is formula for CPP?

CPP = MAP - ICP
(You can assume ICP is close to CVP so can assume 8 - 12 mmHg)

39

Who's cuff system used an occlusive counter-pressure system to measure BP in 1896?

Scipione Riva-Rocci's

40

What size of the limb's circumference should the cuff width be?

40%

41

The length is nearly how many times larger than the width of the cuff?

2 times

42

Which is more critical to the accuracy of the measurement, length or width?

Width

43

When your cuff size is too small, what will happen to the NIBP reading?

Will be falsely high

44

What is wrong with the cuff when you are getting falsely low blood pressure readings?

Cuff is too large

45

What other problem with the cuff can be associated with falsely high BP readings?

Cuff being applied too loosely

46

When using the return to flow method of determining a BP, what is the only pressure that can be obtained?

Systolic

47

What is the kind of doppler used when determining pressure by the return to flow method?

Parks doppler

48

What artery is most used when using the return to flow method for BP?

Radial

49

What is the return to flow method of determining BP?

Where you apply pressure to a blood vessel above systolic, then decrease the pressure until the first pulse is detected distally from the occluded vessel
(ie pressure applied to upper arm, doppler device placed over radial artery at hand to detect pulse)

50

What technique is similar to oscillometric but is a continuous recording of the pulse waveform while applying only mean pressure to the vessel?

Vascular unloading

51

When using the auscultation method, how much pressure do you let off and how often?

3 mmHg for every heart beat

52

How many phases are there in the ausultatory method of determining BP?

5 phases

53

What is phase 1 of auscultatory method?

Snapping tones heard

54

Murmurs are heard during what phase of the auscultatory method?

Phase 2

55

The auscultatory gap is found in which phase of the auscultatory method?

Phase 2

56

What is phase 3 of auscultatory method?

Thumping

57

What is phase 4 of auscultatory method?

Muffling

58

Phase 5 of the auscultatory method consist of what?

SILENCE
(it really is golden)

59

What phase does the ASA recommend for determining diastolic pressure when using the auscultatory method?

Phase 5

60

The auscultatory gap phenomenon comes about by what cause?

Inflation of the cuff too slowly. This causes venous engorgement which does not allow for artery to be heard due to the inadequate runoff capacity

61

Are systolic pressures higher or lower as you move farther away from the heart?

Higher, this drops mean pressure

62

What is the term for laying down?

Recumbent

63

What does DINAMAP stand for?

Device for Indirect Noninvasive automatic mean arterial pressure

64

Which pressure is most accurate on a DINAMAP?

Diastolic

65

What are the 2 main errors attributed to the observer?

Causing systematic errors
-----Having prejudice for normal readings
Causing random errors
-----Mental concentration / hearing acuity

66

What are the true variations in blood pressure?

1) unknown factors
2) Recent physical activity
emotional state
position of subject

67

What method of NIBP do you not want to use when the patient is in Atrial fib?

Oscillometric methods

68

What order of anatomical locations if the preferred order of placing the cuff?

Biceps
Forearm
Calf
Thigh

69

What is petechiae?

Pinpoint blood spot

70

What is ecchymoses?

Bruising

71

What is PAT? And what does it do?

Peripheral arterial tonometry
Uses an indirect continuous non-invasive blood pressure by using a transducer to detect intra-arterial pressure changes

72

Name one well known version of a PAT?

Medwave

73

Direct arterial cannulation will give you which BP measurements?

S, D, M

74

Oscillometric will give you which BP measurements?

Calculated S, calculated D, M

75

Return to flow will give you which BP measurements?

S

76

Vascular unloading and PAT will give you which BP measurements?

S, D , M

77

What do baroreceptors do?

Provide the driving pressure that permits local autoregulation of all vascular beds

78

What are the 2 main baroreceptors used to regulate central blood pressure?

Carotid sinus
Aortic arch baroreceptors

79

When using auscultation as the means for measuring BP manually, what sounds do you hear?

Korotkoff Sounds

80

What does NIBP mean?

Non invasive blood pressure

81

What artery is most used for listening for Korotkoff sounds?

Brachial

82

What is the most common technique used for measuring NIBP?

Oscillometric

83

When using oscillometric technique for NIBP, which pressure is most accurate?

Mean

84

Remember in Biggs class, we measure VARIABLES and not PARAMETERS

DUH

85

What law do you use when talking about wall pressure and and blood vessels?

Laplace's law

86

NIBP overestimates at what state? (HTN, or hypotension?)

Hypotensive

87

NIBP underestimates at what state?

Hypertensive

88

Which parameter describes tissue perfusion?

Mean pressure

89

What is the calculation used to determine perfusion pressure?

PP = arterial P - venous P

90

Mean pressure is also known as what?

Pressure of perfusion

91

The majority of blood flow to the LV occurs during what?

Diastole

92

What is the term that describes the formula we use to calculate Mean Pressure? (formula is M = {(S - D) / 3} + D

Wiggers Estimate

93

When using wiggers estimate, where must the pressures be derived from?

Cuff must be on Upper arm

94

What is the k value for the brachial artery?

0.33

95

When using k values what is the formula you must use to determine mean pressure?

MP = D + k (pulse pressure)

96

What is the k value for the aorta?

0.41

97

What is the k value for the femoral artery?

0.30

98

Define pulse pressure

Difference between systolic and diastolic pressures

99

What is pulse pressure used for in the clinical setting?

Indicator of stroke volume

100

When under anesthesia, does your O2 requirement increase or decrease?

Decrease

101

What is the minimum required blood pressure for a patient?

20% of the systolic pressure

102

What is the minimum required BP for the brain?

60 mm Hg

103

CPP stands for what

Cerebral perfusion pressure

104

What is formula for CPP?

CPP = MAP - ICP
(You can assume ICP is close to CVP so can assume 8 - 12 mmHg)

105

Who's cuff system used an occlusive counter-pressure system to measure BP in 1896?

Scipione Riva-Rocci's

106

What size of the limb's circumference should the cuff width be?

40%

107

The length is nearly how many times larger than the width of the cuff?

2 times

108

Which is more critical to the accuracy of the measurement, length or width?

Width

109

When your cuff size is too small, what will happen to the NIBP reading?

Will be falsely high

110

What is wrong with the cuff when you are getting falsely low blood pressure readings?

Cuff is too large

111

What other problem with the cuff can be associated with falsely high BP readings?

Cuff being applied too loosely

112

When using the return to flow method of determining a BP, what is the only pressure that can be obtained?

Systolic

113

What is the kind of doppler used when determining pressure by the return to flow method?

Parks doppler

114

What artery is most used when using the return to flow method for BP?

Radial

115

What is the return to flow method of determining BP?

Where you apply pressure to a blood vessel above systolic, then decrease the pressure until the first pulse is detected distally from the occluded vessel
(ie pressure applied to upper arm, doppler device placed over radial artery at hand to detect pulse)

116

What technique is similar to oscillometric but is a continuous recording of the pulse waveform while applying only mean pressure to the vessel?

Vascular unloading

117

When using the auscultation method, how much pressure do you let off and how often?

3 mmHg for every heart beat

118

How many phases are there in the ausultatory method of determining BP?

5 phases

119

What is phase 1 of auscultatory method?

Snapping tones heard

120

Murmurs are heard during what phase of the auscultatory method?

Phase 2

121

The auscultatory gap is found in which phase of the auscultatory method?

Phase 2

122

What is phase 3 of auscultatory method?

Thumping

123

What is phase 4 of auscultatory method?

Muffling

124

Phase 5 of the auscultatory method consist of what?

SILENCE
(it really is golden)

125

What phase does the ASA recommend for determining diastolic pressure when using the auscultatory method?

Phase 5

126

The auscultatory gap phenomenon comes about by what cause?

Inflation of the cuff too slowly. This causes venous engorgement which does not allow for artery to be heard due to the inadequate runoff capacity

127

Are systolic pressures higher or lower as you move farther away from the heart?

Higher, this drops mean pressure

128

What is the term for laying down?

Recumbent

129

What does DINAMAP stand for?

Device for Indirect Noninvasive automatic mean arterial pressure

130

Which pressure is most accurate on a DINAMAP?

Diastolic

131

What are the 2 main errors attributed to the observer?

Causing systematic errors
-----Having prejudice for normal readings
Causing random errors
-----Mental concentration / hearing acuity

132

What are the true variations in blood pressure?

1) unknown factors
2) Recent physical activity
emotional state
position of subject

133

What method of NIBP do you not want to use when the patient is in Atrial fib?

Oscillometric methods

134

What order of anatomical locations if the preferred order of placing the cuff?

Biceps
Forearm
Calf
Thigh

135

What is petechiae?

Pinpoint blood spot

136

What is ecchymoses?

Bruising

137

What is PAT? And what does it do?

Peripheral arterial tonometry
Uses an indirect continuous non-invasive blood pressure by using a transducer to detect intra-arterial pressure changes

138

Name one well known version of a PAT?

Medwave

139

Direct arterial cannulation will give you which BP measurements?

S, D, M

140

Oscillometric will give you which BP measurements?

Given M, calculated S , D

(Systolic is 0.5 amplitude of MAP)
(Diastolic is 0.625 amplitude of MAP)

141

Return to flow will give you which BP measurements?

S

142

Vascular unloading and PAT will give you which BP measurements?

S, D , M

143

In the hypertensive range of BP, indirect methods of BP do what to actual readings?

Underestimate direct measurements

144

In the hypotensive range of BP, indirect NIBP methods of BP do what to actual readings?

Overestimate direct measurements