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AP 1 > Test 1 part I (Clinical Monitoring) > Flashcards

Test 1 part I (Clinical Monitoring) Flashcards

1
Q

What are the AANA standards for monitoring and alarms?

A
  1. Monitor, evaluate, & document physiologic condition as appropriate for procedure & anesthetic technique
  2. Variable pitch & threshold alarms turned on & audible
  3. Document BP, HR, RR at least every 5 minutes for all anesthetics
  4. Oxygenation, Ventilation, Cardiovascular, Thermoregulation, Neuromuscular
  5. Inspection, Auscultation, Palpation
  6. Precordial Stethoscope (heart & breath sounds, all forms of anesthesia, Peds) or Esophageal Stethoscope (heart & breath sounds, temperature, only during GA)
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2
Q

What are the indications for ECG monitoring?

A

Measurement of HR, Diagnosis of arrhythmias, electrolytes imbalances, conduction defects, Diagnosis of ischemia, Pathologic Q waves

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3
Q

What is Heart Rate?

A

Electrical depolarization with systolic contraction

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4
Q

What is Pulse Rate?

A

Detectable peripheral arterial pulsation

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5
Q

Continuous ECG Monitoring =

A

Standard of care

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6
Q

Distorted ECG tracings

A

Artifact

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7
Q

What are the most common causes of Artifact?

A

ESU, IONM stimulation, shavers

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8
Q

Which part of the ECG waveform represents atrial depolarization?

A

P Wave

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9
Q

Which part of the ECG waveform represents the bridge between atrial and ventricular activation?

A

PR Interval

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10
Q

What is a normal PR Interval?

A

0.12-0.2 sec

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11
Q

Which part of the ECG waveform represents ventricular depolarization?

A

QRS Complex

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12
Q

What is the normal length of time for a QRS complex?

A

0.06-0.1 sec

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13
Q

Which part of the ECG waveform represents ventricular repolarization?

A

ST Segment

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14
Q

Which part of the ECG waveform represents ventricular repolarization?

A

T Wave

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15
Q

What are the standard limb leads and what direction is their waveforms?

A

I, II, and III; positive

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16
Q

What are Goldberger’s Augmented Leads?

A

aVR, aVL, and aVF

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17
Q

Which direction is the waveform for aVR?

A

Negative

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18
Q

Which direction is the waveform for aVL?

A

P&T Negative, QRS Biphasic

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19
Q

Which direction is the waveform for aVf?

A

Positive

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20
Q

What are the precordial chest leads?

A

V1-V6

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21
Q

What direction are the waveforms for the precordial leads?

A

P&T positive, QRS start negative and end positive

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22
Q

A common, simple, and inexpensive method of monitoring ECG.
-Inadequate for diagnosing complex arrhythmias & ST Segment analysis

A

3 Bipolar Leads

23
Q

A method of monitoring ECG that is the standard of care for at risk patients.

24
Q

Which lead is preferred for arrhythmia monitoring?

25
Which leads are preferred for ischemia monitoring?
V3-V5
26
Which part of the ECG waveform is the most sensitive to myocardial ischemia?
ST Segment
27
Indicates transmural ischemia (acute coronary occlusion or spasm)
ST segment elevation
28
Indicates subendocardial ischemia (stable angina, significant but stable CAD)
ST Segment Depression
29
What are ECG changes associated with Hypokalemia?
1. ST depression with flat T waves 2. Prolonged repolarization (long QT, Torsades de Pointes)
30
What are ECG changes associated with Hyperkalemia?
1. Narrow peaked T wave, short QT interval 2. QRS widening, flat P wave, PR prolonged, 2nd/3rd degree heart blocks 3. Ventricular flutter, asystole
31
What are ECG changes associated with Hypocalcemia?
Prolonged QT
32
What are ECG changes associated with Hypercalcemia?
Short QT, decreased T wave amplitude or inversion
33
Routine assessment of BP q ____ minutes is essential for safe anesthesia.
5 minutes
34
How to calculate MAP?
MAP = (SBP + DBPx2)/3
35
What are contraindications for NIBP Monitoring?
Iatrogenic injury from repeated cycling
36
What are limitations of NIBP monitoring?
Cuff about 40% circumference of extremity, detection of Korotkoff sounds, Requires pulsatile flow, Cuff movement, Shivering, Equipment failure
37
Cuff too small, too tight, or extremity below heart would cause a falsely ____ pressure.
Falsely high
38
Cuff too large, extremity above heart, or after quick deflation would cause a falsely ____ pressure.
Falsely low
39
What all is measured by the ClearSight Finger Cuff?
Non-invasive continuous BP, SV, SVV, CO, SVR
40
What is the gold standard for recording BP?
Invasive BP Monitoring
41
What is the gold standard for recording BP?
Invasive BP Monitoring
42
What is the most common location for invasive BP monitoring?
Radial artery (also ulnar, brachial, axillary, femoral, DP)
43
What are the risks associated with arterial line insertion?
Infection, thrombus, hematoma, vasospasm, ischemia, but vigilance is paramount!!
44
What are the indications for invasive BP monitoring?
Beat to beat continuous assessment of BP, Arterial blood sampling, Acute/gross changes in hemodynamics, Anticipated vasoactive meds, Significant comorbidities, Diagnostic waveform analysis, Failure of NIBP
45
What does the Modified Allen Test predict?
It predicts ischemia risk with arterial line by assessing collateral flow to the hand
46
How is the arterial waveform created?
Arterial waveform results from blood ejection from left ventricle into aorta during systole, followed by peripheral runoff during diastole
47
What does the area under the curve of an arterial waveform approximate?
The MAP
48
What does the Dicrotic Notch reflect?
Closure of the aortic valve
49
Tests the dampening in the system or how rapidly a system comes to rest after being set in motion.
Square Wave Test
50
What is a normal result on the Square Wave Test?
Distinct dicrotic notch, no more than 2 oscillations
51
A square wave test with a lost dicrotic notch, and no more than 1 oscillation
Over damped (Systolic BP is underestimated)
52
A square wave test with multiple artifacts, and many post flush oscillations
Under damped (Systolic BP is overestimated; MAP remains accurate)
53
As the arterial wave travels from central to peripheral, what happens to the Upstroke, Systolic Peak, Dicrotic Notch, Diastolic Wave, and End Diastolic Pressure
Upstroke becomes steeper, Systolic peak increases, Dicrotic notch is later, Diastolic wave more prominent & end diastolic pressure decreases

AP 1 (32 decks)

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