NIBP Flashcards
(144 cards)
1
Q
Perfusion =
A
Pressure and flow
2
Q
When you give phenylephrine to treat low BP then what are you effecting?
A
TPR (total peripheral resistance)
3
Q
When you give ephedrine to treat low BP then what are you effecting?
A
TPR , HR, CO
4
Q
All drugs for induction effect what two parameters?
A
Coronary blood flow
Cardiac sympathetic discharge
5
Q
What induction agents effect venous capacity?
A
Propofol, fent, inhaled gases
6
Q
What induction agents are vasodilator substances?
A
Propofol, inhaled gases
7
Q
What is the normal CO?
A
5 L / min
8
Q
What is the normal blood volume ?
A
5 L / min
9
Q
When a pt is in sepsis, what physiological status must you account for?
A
Increased norepi usage
Low BP
CO 2-3x normal
Decreased perfusion to peripheries
10
Q
What is the mean circulating filling pressure?
A
Pressure anywhere where flow is stopped
11
Q
What do baroreceptors do?
A
Provide the driving pressure that permits local autoregulation of all vascular beds
12
Q
What are the 2 main baroreceptors used to regulate central blood pressure?
A
Carotid sinus
Aortic arch baroreceptors
13
Q
When using auscultation as the means for measuring BP manually, what sounds do you hear?
A
Korotkoff Sounds
14
Q
What does NIBP mean?
A
Non invasive blood pressure
15
Q
What artery is most used for listening for Korotkoff sounds?
A
Brachial
16
Q
What is the most common technique used for measuring NIBP?
A
Oscillometric
17
Q
When using oscillometric technique for NIBP, which pressure is most accurate?
A
Mean
18
Q
Remember in Biggs class, we measure VARIABLES and not PARAMETERS
A
DUH
19
Q
What law do you use when talking about wall pressure and and blood vessels?
A
Laplace’s law
20
Q
NIBP overestimates at what state? (HTN, or hypotension?)
A
Hypotensive
21
Q
NIBP underestimates at what state?
A
Hypertensive
22
Q
Which parameter describes tissue perfusion?
A
Mean pressure
23
Q
What is the calculation used to determine perfusion pressure?
A
PP = arterial P - venous P
24
Q
Mean pressure is also known as what?
A
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
