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APA > SRNA Presentations: Part 2 > Flashcards

SRNA Presentations: Part 2 Flashcards

(50 cards)

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1
Q

What is piezoelectricity?

A

Ability of certain materials to generate AC voltage when subjected to stress or vibration-or vibrate when subjected to AC voltage
- most common piezoelectric material is quartz

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2
Q

Who is considered the “father of echocardiography”?

A

Dr Ingle Edler

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3
Q

How does ultra sound work?

A

An ultra sound beam is generated by oscillating crystals
- crystals are excited by electrical impulses (piezoelectric effect)
- U.S. waves sent from transducer, through tissues, return to transducer as reflected echos
- waves reflected at tissue surfaces of different density
* If no difference in tissue density—> no echos produced
(Homogenous fluids like blood, urine, ascites are seen as echo free structures)

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4
Q

What angle provides optimal ultrasound reflection?

A

90 degrees

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5
Q

What is M-mode echocardiography?

A
  • simplest type of echo
  • image is similar to a tracing
  • useful in measuring size of heart structures, thickness of heart walls and size of heart itself
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6
Q

What is doppler echo?

A

Assesses blood flow through chambers and valves

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7
Q

What is color Doppler?

A
  • enhanced form of Doppler echo

- different colors used to designate direction of blood flow

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8
Q

What is 2-d echo?

A

Used to view motion of heart structures in real time

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9
Q

What is 3-d echo?

A

View of heart structure in greater depth

Also in real-time

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10
Q

What do the different colors mean in color Doppler?

A 
Blue= away from probe
Red= toward probe
Green= turbulence
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11
Q

Advancing probe into esophagus allows for what types of views?

A

Upper, mid and transgastric

-probe can then be turned right and left

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12
Q

What can be viewed from an ME4 chamber view?

A 
Chamber size
Ventricle function
MVD
TVD 
Atrial-septal defect
Pericardial effusion
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13
Q

Unless contraindicated, TEE should be used:

A

In all open heart and thoracic aortic procedures

  • should be considered in CABGs
  • case by case basis for kids—> unique risks
  • use in non-cardiac surgery if suspected CV pathology ay result in severe hemodynamic, pulmonary, or neuro. Compromise
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14
Q

What is the primary use of TEE?

A

Diagnose hemodynamic instability caused by MI, heart failure, valve abnormalities, hypovolemia, tamponade

  • estimates SV, CO, intracavitary pressures
  • dx structural hart disease (PE)
  • guides surgical interventions/medications
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15
Q

What are absolute contraindications for TEE?

A
  • esophageal stenosis
  • large esoph. Diverticuli
  • recent esoph. Surgery/sutures
  • know esoph. Interruptions
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16
Q

Why is TEE especially risky for children?

A

Even a probe of appropriate size may cause airway obstruction, or compress descending aorta

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17
Q

What is blood pressure?

A

The driving force of blood against arterial walls

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18
Q

What are the ranges form hypertension and hypertensive crisis?

A

HTN= >_ 140/90

Hypertensive crisis= >_ 180/120

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19
Q

How do you calculate MAP?

A

SVR x CO

1/3 (SBP -DBP) + DBP

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20
Q

How does the size of BP cuff effect the BP measurement?

A

Cuff too large will not restrict flow properly (underestimates BP)
Cuff too small cuts off too much blood flow (overestimates BP)
** make sure 1 fingertip can fit beneath cuff **

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21
Q

What are indications for using an arterial line?

Study These Flashcards
A

When beat to beat monitoring is required for:

  • multiple comorbidities (anticipate instability)
  • certain surgeries: cardiothoracic, neuro, neurovascular—>prolonged surgery of any type
  • need for frequent arterial sampling
22
Q

When is an arterial line contraindicated?

Study These Flashcards
A

When arterial supply compromised

- Reynaud’s, thromboangitis obliterans (Buerger’s disease)

23
Q

What does the art line wave form tell you about MAP?

24
Q

How can you assess hypovolemia from an art line waveform?

Study These Flashcards
A

Will have shorter height during inhalation while on mechanical ventilation

25
What method of measurement does an automatic NIBP machine use?
Oscillometric
26
What part of waveform represents diastole?
After the dicrotic notch
27
What sounds are heard during auscultation of manual BP?
Kortokoff sounds (turbulence) are heard when an artery is partially constricted
28
What are some risks of cannulation of an artery?
Limb ischemia, hematoma, air emboli
29
What situation indicates the need for art line BP monitoring?
Pt with metabolic acidosis, scheduled for a lengthy procedure
30
What type of feedback system is thermoregulation?
Negative feedback system
31
How does thermoregulation work in the body?
Thermo-sensitive receptors send info to hypothalamus when excited - excited when temperature is sensed outside of threshold - brain sends messages to modify behavior in order to modify temp (shivering, removing clothing, etc)
32
What plays the most effective role in thermoregulation?
Behavior: clothing, changing environment, changing body position, voluntary movement * a pt under GA cannot “behave”
33
What are the types of heat loss and percentages they account for in the body?
Convection: 30% Conduction: 20% Radiation: 40% Evaporation: 10%
34
Hypothermia can cause:
- cardiac arrhythmias and ischemia—> j wave - increased peripheral vascular resistance - left shift - reversible coagulopathies - AMS - impaired renal function - increased post-op catabolism and stress response - delayed drug metabolism - impaired wound healing/increased risk of infection
35
What is a J wave (Osborne wave)?
Associated with hypothermia - slow upright deflection at the end of QRS and early part of ST segment - ST elevation often reported with ‘J’ waves
36
What are anesthetics that interfere with thermoregulation?
- inhaled gases: vasodilation - spinal/epidural: vasodilation, altered perception of temperature - GA: vasodilation, heat redistribution - opioids: depress sympathetic response and decrease threshold for cold response
37
What is phase 1 of hypothermia?
1st hour of GA Core temp drops 1-2 degrees C Vasodilation and heat redistribution
38
What is phase 2 of hypothermia?
3-4 hours of surgery Gradual decline (linear) in core temp From pt to environment
39
What is phase 3 in hypothermia?
Plateau | Core temp reaches a steady state
40
What is malignant hyperthermia?
Caused by anesthetic gases or succinylcholine - agents cause Ca release, but stop reabsorbing Ca back —> continuous reaction of muscle contraction—> hypermetabolic state
41
How do you recognize malignant hyperthermia?
Seen ~ 1 hour after receiving inhaled gas or succinylcholine * * WILL SEE A HUG (RAPID) SPIKE IN ETCO2 *** drastically elevated - tachycardia, fever, muscle rigidity - NMB reversal agents will do nothing to reverse MH - it’s a hypermetabolic state with increased sympathetic activity - metabolic acidosis, cyanosis, mottling
42
What is the only treatment for MH?
``` Dantrolene 2.5mg/kg - mix with 60mL sterile water Or Ryanadex 2.5mg/kg - mix with less volume * both require multiple doses * Treatment involves getting Ca reabsorbed ```
43
What is MH caused by?
A mutation of Ryanodine (Ryr 1) receptor on chromosome 19–> GENETICS
44
What is the most common condition confused for MH?
Elevated CO2 caused by insuflation * important to recognize early and rule out other cases—> start treating ASAP - dantrolene will not harm pt if given outside of MH (may cause muscle weakness afterwards)
45
What are other conditions that mimic MH?
- neuroleptic malignant syndrome (NMS): - pts receiving antidopaminergic agents - elevated temp, muscle rigidity, dyskinesia * reversing non-depolarizer will reverse rigidity in NMS - thyroid storm: - tachycardia/tachyarrythmias, elevated temp, hypotension, CHF * hypokalemia is common - drug induced hyperthermia - serotonin syndrome or from elicit drugs - environmental hyperthermia - not uncommon in peds from excessive warming devices - brainstem/hypothermic injury - sepsis - transfusion reaction
46
What does the pneumonic “Some hot dude better give iced fluids fast” mean?
``` Stop triggering agents Hyperventilate/Hunderd percent o2 Dantrolene (2.5mg/kg) up to 10 mg/kg Bicarbonate Glucose and Insulin IVF and cooling blanket Fluid output monitoring/furosemide Fast HR-tachycardia ```
47
What are some active warming devices?
- Kim Clark vest: with warm water running through it - bear hugger - IVF warmer * warm blankets are NOT active warmers—> they do not produce heat
48
What type of reaction is the CO2/soda lime reaction?
Exothermic
49
Where is the optimal location to place an esophageal temp probe?
Lower 1/4 of esoph. Is warmest and most stable site
50
What are common temp. Monitors in the OR?
- axilla, oral, rectal, or esophageal probes - skin- forehead sticker - swan-ganz thermistor

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