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Barry- Monitoring

What is the most important monitor? The anesthetist.
4 essential features of monitoring? Observation and vigilance, Instrumentation, Interpretation of data, Initiation of corrective therapy if indicated
Who sets the standards of care of monitoring? The ASA
What is the first standard of care set by the ASA? Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics and MAC.
What is standard II set by the ASA? The patients oxygenation, ventilation, circulation and temp. shall be continually evaluated during all anesthetics.
In what ways can you ensure that your patient is adequately oxygenated? Measuring inspired gas thru teh oxygen anzalyzer, on the inspired limb of circuit and pulse and visual inspection of the patient
How do you ensure adequate ventilation of your patient? Auscultation, chest excursion, ETCO2, disconnect alarms (vent), volume monitoring/ alamrs (vent)
What is the minimum frequency that you must monitor blood pressure? Every 5 mins.
What monitors do you use to ensure adequate circulation? EKG, BP, palpation of pulse, Aline, visualization of the patient, pulse ox, auscultation of heart sounds
What is the 2nd most important monitor? Pulse ox
Pulse oximetry is based on what law? Beer-Lamberts law
Carboxyhemoglobin exists in smokers and other patient populations. What will you see in regards to your SpO2? Falsely high reading. Carboxyhemoglobin absorbes at the same wavelength of light as oxyhemoglobin
What can cause methemoglobinemia? Benzocaine, prilocaine, dapsone, or nitrobenzene. Can also be acquired
SpO2 will be ____ with methemoglobin? fasely low SpO2
What is the treatment for methemoglobinemia? Methylene blue 1mg/kg and 100% O2.
Blood pressure is a measurement of end organ perfusion. T/F False... Not a measurement but an indicator
Proper BP cuff size should be? 20% greater than diameter of limb and cover 2/3 of upper arm or thigh
The more peripheral the blood pressure sight the lower the systolic and higher the diastolic. T/F False. Higher the systolic, lower diastolic
What test do you use to determine adequate collateral circulation before placing an arterial line? Allen's test
If your patient is in the sitting position, where should you zero your transducer for an aline? The circle of Willis
What are some complications of arterial line insertion? Thrombosis, hematoma, bleeding, vasospasm, air embolism, necrosis/ischemia, nerve damage, infection, intra-arterial drug injection
Respiratory variations seen in an arterial pressure tracing indicate what? Hypovolemia
What the slope of upstroke on the arterial waveform represent? Myocardial contractility
What does the slope of the downstroke on the arterial waveform represent? SVR- systemic vascular resistance. A slurred/delayed stroke is indicative of increased afterload
The dicrotic notch of the arterial waveform represents what? AV closure
EKG are used to detect what? Arrythmias, MI, conduction abnormalities, pacemaker malfunction, and electrolyte disturbances
What can be seen best in Lead II? Inferior wall MI and better to diagnosis arrthymias.
Lead V is most sensitive for? Ischemia is best seen in lead V.
If the patient has a venous embolism, what will you hear with your precordial stethoscope? Mill-Wheal murmur
Esophageal temp. are most accurate when placed how far down into the esophagus? Lower 1/3
What does CVP measure? Estimates preload and the ability of the Right ventricle to pump blood to the pulmonary circulation
What is the normal value for CVP 1-15mmHg
A-wave of CVP represents what? Right atrial contraction (occurs just after the p wave on the EKG)
C-wave of CVP represents what? isovolumic R ventricular contraction. Forces the tricuspid valve to bulge upward into the R atrium
V-wave of CVP represens what? Venous return against closed tricuspid valve
Large V-wave are seen in when? Tricuspid regurg
Complications of CVP insertion Arterial puncture with hematoma, Pneumothorax/hemothorax, nerve injury, air emboli, catheter or wire shearing
Volatile anesthesics effect all EP's by ________ amplitude and ____________ latency. Decreasing; prolonging
Which EEG waveform indicates eyes closed but awake? Alpha waves
Beta waves on the EEG indicate what? Normal awake state
Delta waves on EEG? Deep sleep state
Theta waves on EEG? Sleep state
EEG waveforms can be affected by? Temp, BP, pH, Anesthetics
BIS is used for? to decrease incidence of awareness
What BIS numbers corralate with stage 3? 40-65- General anesthesia, deep hypnosis
What are evoked potentials used for? To evaluate integrity of neural pathways
Amplitude of EP intensity of response
Latency of EP Length of time from stimulation to time it reaches the brain
What do SSEP's monitor? (somatosensory evoked potentials) Dorsal or posterior spinal cord
What do BAEP's monitor? (Brainstem auditory EP) Monitor auditory pathways.
What do MEP's monitor? (Motor EP) Detect motor function. Ventral/Anterior spinal cord.
What do VEP's monitor? (Visual EP) Measure cerebral response to flashing light
Which EP is the most sensitive to anesthesia? MEP's
Which EP is the most resistance to anesthesia? BAEP's
What is the gold standard to confirm endotracheal tube placement? ETCO2
If no CO2 detected, what should you assume? FAILURE TO VENTILATE.
How many phases are there in anazyling a CO2 waveform? 4. I- Inspiration, II- expiratory upstroke, III- expiratory plateau (no air movement) IV- Inspiratory downstroke
A low EtCO2 waveform indicates what? Hyperventilation
An elevated EtCO2 waveform indicates what? Hypoventilation or MH
If you see a Curare cleft, what does this indicate? Rebreathing
Cardiogenic oscillations are life threatening. T/F False
What could cause a sudden decrease in the EtCO2 to a low value? Pulmonary Embolus
What is a possible cause of a decreased EtCO2 to zero? Esophageal intubation, vent disconnect or defect, defect in CO2 analyzer, kinked ETT
What is a possible cause of decreased EtCO2? (not to zero) Leak in vent system, obstruction, Partial disconnect from vent, partial airway obstruction (secretions)
What is a possible cause of an exponential decrease in EtCO2? Pulmonary Embolus, Cardiac Arrest, Sudden hypotension, severe hyperventilation
What is a possible cause of a change in the CO2 baseline? Calibration error, CO2 absorber saturation, water droplet in analyzer, mechanical failure of vent
What can cause a gradual increase in ETCO2? Increasing body temp, Hypoventilation, CO2 absorption, Partial airway obstruction, reactive airway disease
What can cause a gradual lowering in ETCO2? Hypovolemia, decreased CO, Hypothermia
What can cause a sudden increase in ETCO2? Sudden increase in BP, accessing an area of lung previously obstructed, release of tourniquet
Created by: shelbys
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