Patient Monitoring During Anesthesia Flashcards
(114 cards)
1
Q
What are the 4 things we monitor
A
Circulation Oxygenation Ventilation Temperature
2
Q
Systolic - diastolic pressures = ____
A
Pulse pressure **Not a surrogate for blood pressure
3
Q
Pulse at different sites may feel different therefore you should examine the ____ at the same site
A
Examine the trend at the same site
4
Q
Use a _____ artery such as the ____ metatarsal
A
Use a distal artery such as the dorsal metatarsal
5
Q
Common pulse palpation sites in small animal
A
Labial, digital, femoral, dorsal pedal, metatarsal
6
Q
Pulse palpation sites in large animals
A
Auricular, transverse facial, facial
7
Q
Where is the esophageal stethoscope inserted
A
Exactly midline, dorsal to the ET tube, right along palatine raphe
8
Q
The ECG does NOT indicate that ______
A
ECG does not indicate that the heart is contracting
9
Q
What can the ECG tell you
A
HR and rhythm Electrolyte imbalances Chamber enlargement May provide clues about myocardial oxygenation and perfusion
10
Q
P Wave is
A
Atrial depolarization
11
Q
QRS Complex is
A
Ventricular depolarization
12
Q
T wave is
A
Ventricular repolarization
13
Q
Mammalian A Type: Purkinje fibers ____ the _____ only and excitation spreads via muscle fibers
A
Purkinje fibers excite the endocardium only
14
Q
Mammalian A Type: Generates ____ to ____ current flow
A
Base to apex flow (Positive R Wave)
15
Q
Who have mammalian A type
A
Humans, small animals
16
Q
Mammalian B Type: Purkinje fibers _____ the ____ and most of it is excited simultaneously
A
Purkinje fibers penetrate the myocardium and most of the myocardium is excited simultaneously
17
Q
Mammalian B Type: Generates ____ to ____ current flow
A
Apex to base flow (Negative R Wave)
18
Q
Who have mammalian B type
A
Horses, ruminants, pigs
19
Q
White lead goes on the
A
Right arm
20
Q
Black lead goes on the
A
Left arm
21
Q
Red lead goes on the
A
Left leg
22
Q
In healthy small animals lead ___ is yielding the tallest R wave and therefore preferred
A
Lead 2 (white to red)
23
Q
Lead 1 goes from ___ to ____
A
Lead 1 from white (right arm) to black (left arm)
24
Q
Lead 2 goes from ____ to _____
A
Lead 2 goes from White (right arm) to Red (left leg)
25
Lead 3 goes from ____ to \_\_\_\_\_
Lead 3 goes from Black (left arm) to Red (left leg)
26
Where is the white lead place on the horse
Right jugular furrow or withers
27
Where is the black lead placed on a horse
Cardiac apex region
28
Where is the red lead place on a horse
Anywhere else
29
Which lead is preferred for horses
Lead 1 - White to Black (whithers/jugular to cardiac apex)
30
On the horse lead 1 has a ___ R wave
Negative
31
What two substances can you use for electrode contact
ECG gel or saline
\*\*\*NOT ALCOHOL
32
What are the two common arrhythmias seen under anesthesia
Sinus bradycardia/tachycardia
AV blocks (1st and 2nd)
33
What is this, what caused it and how can it be prevented
V Tach in a dog with pheochromocytoma
Prevented with phenoxybenzamine pretreatment
34
What does V Tach do to blood pressure
Blood pressure plummets when HR is high
35
What is the goal when treating ventricular arrhythmias
Improve hemodynamics and prevent sudden death
36
What is the first line of treatment for ventricular arrythmias
Lidocaine IV
37
Treatment of arrythmias should be done when there is
underlying heart disease -- there is risk of sudden death
38
You should consider treating Ventricular arrythmias when
There is severe systemic disease
39
With moderate systemic disease or trauma, ventricular arrythmias should only be treated when
hemodynamics are affected
40
BP going from Central to Peripheral the systolic becomes
Higher
41
BP going from Central to Peripheral the diastolic becomes
Lower
42
BP going from Central to Peripheral the Mean
Remains similar
43
Highes point on the BP curve, represents afterload for the left ventricle
Systolic Pressure
44
Average BP over a full cycle, determinant of tissure perfusion
Mean pressure
45
Lowest point of the BP curve, determinant of myocardial perfusion
Diastolic pressure
46
Values of hypotension in small animals (mean and systolic)
Mean \< 60
Systolic \< 80
47
Values of hypotension for large animals (Mean and Systolic)
Mean \< 70
Systolic \< 90
48
During hypotension which organs may become under perfused
Brain, kidney, muscles
49
What are the three steps to treating hypotension
Decrease anesthetic
Give fluid bolus
Give drugs (inotropes or vasoconstrictors)
50
Inotropes used to treat hypotension
Dobutamine, dopamine, ephedrine
51
Vasocontrictors used to treat hypotension
Phenylephrine, norepinephrine, vasopressin
52
BP changes with respiration indicates \_\_\_\_\_
Hypovolemia
53
What does the pressure waveform provide information on
Inotropy, CO and the effect of arrythmias
54
BP measurement also yields HR which is a determinant of ____ and ______ which provides information about the function of the vegetative nervous system and pain
Determinant of CO and myocardial work load, indicating function of vegetative nervous system and pain
55
What is the mathematical model for BP
BP = (HR x SV) x SVR
SV: Stroke Volume
SVR: Systemic Vascular Resistance (vasoconstriction)
CO: Cardiac Output
56
Stroke Volume (SV): depends on preload and \_\_\_\_\_
Contractility
57
Preload depends on \_\_\_\_\_\_
Circulating volume
58
What are the two ways of measuring blood pressure, which one is more accurate and considered the "gold standard"
Invasive (direct) - via arterial catheter -- Gold Standard
Non-invasive (indirect) - via pressure cuff
59
Which form of BP measurement should be used on horses if anesthetized longer than 45 min
Invasive (direct)
60
What arteries in the dog can be used to measure BP
Dorsal pedal, metatarsal
61
What arteries in the cat can be used to measure BP
Dorsal pedal, coccygeal
62
What arteries in the horse can be used to measure BP
Facial, Transverse Facial
63
What arteries in cattle can be used to measure BP
Auricular
64
What arteries in sheep/goat can be used to measure BP
Median
65
Where should the BP transducer be placed?
At the level of \_\_\_\_\_\_\_
\_\_\_\_\_\_\_ in dorsal recumbency
\_\_\_\_\_\_\_ in lateral recumbency
Transducer should be positioned at the base of the heart
Point of shoulder in dorsal recumbency
Point of sternum in lateral recumbency
66
What is an Oscillometer
Arterial blood flowing under an inflated cuff generates pressure fluctuations in cuff that is detected by the monitor
67
What is Doppler
Inflated cuff is placed over an artery, blood flow is detected distally from the cuff using a doppler flow probe. After complete occlusion of flow cuff pressure is gradually decreased, pressure where blood flow appears is systolic BP
68
The cuffs width should be about ____ of the circumference of the limb and be placed at \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
40%, placed at the level of the base of the heart
69
Where can the cuff be placed on small animals
Distal radius, distal tibia, metatarsus
70
Where can the cuff be placed on large animals
metacarpus, tail
71
What readings does oscillometry provide
Systolic, Mean, Diastolic
72
What are disadvantages of oscillometry
May be inaccurate
If patient arrested between readings you may not know
73
How does the doppler flow probe work
Probe transmits U/S signal that is refelcted back from moving red cells
Transmitted and refelcted wavelength shifts depending on blood flow
74
Changes in the strength of the doppler signal indicates changes in _____ and \_\_\_\_\_
Changes in blood flow velocity and volume
75
Where should the doppler sensor be placed on a small ruminant
Median artery
76
Where should the doppler sensor be placed on small animals
Digital artery
77
What are the advantages of doppler
Can measure on small animals
Less sensitive to artifacts from movement/arrhythmias/vasoconstriction
Excellent pulse monitor
78
Disadvantages of doppler
Doesn't matter MAP
Noisy
Can be difficult to place
Labor intensive
79
Hypoxemia is defined as PaO2 _____ or SaO2 \_\_\_\_\_
PaO2 \< 60 mmHg
SaO2 \< 90%
80
Healthy breathing animals should have SaO2 of \_\_\_\_\_
If breathing pure O2 \_\_\_\_\_\_
Adequate value for healthy animals \_\_\_\_
Normal \> 95 %
Pure O2 \> 98%
Adequate \> 90%
81
Pulse oximetry results are affected by
Hypoperfusion (vasoconstriction)
Pigmentation
Movement (shaking)
Abnormal Hb species -- CO poisoning (reads higher) Methemoglobinemia (reads around 85%)
82
When is using a pulse oximeter important
Patient is breathing room air
There is V/Q mismatch (horses)
There is respiratory disease
83
Ventilation is defined as _____ and the normal value should be \_\_\_\_\_
Defined as PaCO2 with a normal value of 35-45 mmHg
84
Regarding ventilation along with a normal PaCO2 they should also have normal
Tidal volume, RR, rhythm and effort
85
What are the PaCO2 values for:
hypercapnia/hypoventilation
Normocapnia/normoventilation
Hypocapnia/hyperventilation
hypercapnia/hypoventilation \> 45
Normocapnia/normoventilation 35-45
Hypocapnia/hyperventilation \< 35
86
T/F: Tachypnea = hyperventilation
FALSE --- Tachypnea DOESN'T equal hyperventilation
\*\*There is no reliable correlation between respiratory pattern and PaCO2
87
What is capnometry
Measurement of CO2 partial pressure in the airways -- resipiratory monitor
88
What does a capnometer measure
Only measures the ET CO2
89
What does the capnograph do
Continuously displays ET CO2 vs. time on a graph
90
What does a capnogram indirectly assess
Indirect assessment of cardiac output especially during CPR
91
What factors influence ET CO2 values
CO2 production
Circulation
Alveolar ventilation
Measurement error
92
What does each phase on the graph represent and what is the arrow pointing to
Phase I - Baseline (respiration)
Phase II - Expiratory upstroke
Phase III - Alveolar plateau
Phase IV - Inspiration begins
Arrow - ET CO2
93
What is does this graph represent
Hyperventilation
94
What does this graph represent
Hypoventilation
95
What does this graph represent
CO2 Re-breathing
96
What does this graph represent
Spontaneous breathing during mechanical ventilation
97
What does this graph represent
Progressive airway obstruction
98
What does this graph represent
Cardiogenic Oscillations
99
What does this graph represent
Cardiac arrest
100
At what temperature is it considered hypothermia
\< 96 F
101
What are the complications associated with hypothermia
Decreases the MAC of anesthetics
CV system may be depressed (bradycardia)
102
At what temperature is it considered hyperthermia
\> 102 F
103
What are the consequenses associated with hyperthermia
Increases MAC
May damage CNS
104
What should you not do to treat hyperthermia
Increase vaporizer dial setting
105
What should be determined without regard to body temperature during hyperthermia
Anesthetic depth
106
What is the normal limit for temp under anesthesia
98 - 102.5 F
107
What is the normal HR range of dogs under anesthesia
50 - 160 bpm
108
What is the normal HR range of cats under anesthesia
100 - 200 bpm
109
What is the normal HR range of horses under anesthesia
28 - 50 bpm
\*\* Foal up to 80 bpm
110
What is the normal HR range of ruminants under anesthesia
48 - 90 bpm - cow
60 - 150 bpm - sheep/goat
111
What are the values of MAP and SAP with hypotension for dogs under anesthesia
MAP \< 60
SAP \< 80
112
What are the values of MAP with hypotension for horses under anesthesia
MAP \> 70
113
What is the normal value for SpO2 under anesthesia
95 - 100%
114
What is the normal value for ETCO2 under anesthesia
35 - 45 mmHg
