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Barry Monitoring

Map formula (SBP + 2(DBP))/3
Pulse Pressure the difference between systolic and diastolic
As a pulse moves peripherally through the arteriole tree what happens to the wave form systolic and pulse pressures are exaggerated. (ie radial systolic will be higher than the aortic)
Indications for invasive blood pressure monitoring hypotension, anticipated wide b/p swings, end-organ disease, need for multiple ABGs, Contraindications for invasive b/p
Complications associated with invasive b/p Thrombosis, hematoma, bleeding, vasospasm, air embolism, necrosis/ischemia, nerve damage, infection, intra-arterial drug injection
Slope of a-line upstroke reflects cardiac contractility
Slope of a-line down slope reflects SVR
Over dampened a-line reading underestimates systolic
Under dampened a-line reading overestimates SBP
CVP insertion indications fluid admin. in shock, caustic drug admin., TPN, aspiration of air emboli, insertion of transq pacer leads, gaining venous access in pt with poor peripheral veins, major trauma, frequent blood sampling
Contraindications for CVP renal cell tumor extension into RA, tricuspid vegetation, not if on anticoags, insertion site infection, new pacer wires, carotid disease (plaque thrombus), contra-lateral diaphragm dysfunction, prior neck sx
3 Peaks on CVP wave form A wave: R atrial contraction; C wave: occurs due ventricular contraction forcing the tricuspid valve to bulge upward into the right atrium.; V wave: reflects venous return against closed tricuspid valve: large v waves with tricuspid regurg
2 decents on CVP wave form X and y
Complications of CVP Arterial puncture with hematoma ,Pneumothorax/Hemothorax ,Nerve injury (Brachial plexus, Stellate ganglion (Horner’s syndrome) ,Air emboli , Catheter or wire shearing
Complications of any central catheter presence Thrombosis, thromboembolism ,Infection, sepsis, endocarditis, Arrhythmias, hydrothorax
Peep does what to CVP increases
CVP reflects preload; RVEDV
CVP normal values 1-15mm/hg
Swan Ganz indications Poor LV function,Detect MI or complications of MI (IABP),Complicated valve lesions,Shock of any cause,Severe pulmonary disease,Bleomycin toxicity,Complicated surgical procedure,Massive trauma, Hepatic transplantation
Swan Ganz contraindications LBBB,Tricuspid or pulmonary valvular stenosis,Right atrial or right ventricular masses (tumor or thrombus),Tetralogy of fallot
Swan Ganz complications same as with CVP in addition to: Emboli (air, catheter insertion),Cardiac perforation,Cardiac dysrhythmia/heart block,Knotting
TEE used for Diagnose myocardial ischemia, valve problems, wall motion abnormality, air emboli, confirm the adequacy of valve reconstruction and other surgical repairs, determine the cause of hemodynamic disorders and other intraoperative complications
TEE complications Pharyngeal and/or laryngeal trauma, dental injuries, esophageal trauma or bleeding, arrhythmias, respiratory distress, and hemodynamic effects
EEG used for Carotid and Neurosurgery,Measures electrical activity of the neurons in the cerebral cortex,Detects risk of ischemia due to hypoperfusion
EEG Waves Alpha (Eyes closed but awake),Beta(Normal, awake waveform),Delta(Sleep state-deep sleep),Theta(Sleep state )
Concerning EEG Activity (Decreased blood flow to the brain) Loss of amplitude, Increase in slow wave activity,Loss of fast activity
Anesthetics can cause ___ on the EEG decreased frequencies, slowing
BIS monitoring values and meaning 100-85 (Awake; memory intact),85-65 (Sedation),65-40 (General anesthesia; deep hypnosis),<40 (Cortical suppression)
BIS useful because it may Decrease incidence of awareness,Reduce costs(Less drug),Faster awakening,Less total hospital time
Evoked potentials Evaluate integrity of neural pathways by monitoring response to stimulus,Electrical potentials are generated in response to stimulation of a peripheral or cranial nerve, Potentials are recorded as they travel from periphery to the brain
A Damaged pathway on an evoked potential will Will show decrease in amplitude(intensity of response) of waveform and prolonged latency (length of time from stimulation time until it reaches the brain)
SSEP’s: somatosensory evoked potentials (dorsal) Stimulate peripheral nerve, Record evoked potential over spinal cord or brain
BAEP’s: Brainstem auditory EP’s Reflect impulses along auditory pathway, MOST RESISTANT to effects of anesthesia, Posterior fossa crani’s; acoustic neuromas; CN VIII
MEP’s: motor evoked potentials (ventral) Detect motor function of spinal cord, MOST SENSITIVE to effects of anesthesia, TAA; spinal surgeries
What is an oxygen analyzer measures the o2 being delivered to pt; never set the alarm to lower than 28-29%; mandatory for general anesthesia
Pulse oximetry measures what % of hgb saturated with oxygen
How does a pulse ox work uses light emitting diodes with 2 wavelengths of light transmitted through tissues. Oxy hgb absorbs more Infrared and Deoxy absorbs more Red light.
Beer-Lamberts Law used to related concentration of a solute to the intensity of light transmitted through a solution
CarboxyHgb affects pulse ox how ? results in falsely high readings because carboxy hgb absorbs red light identically like oxyhgb
Methemoglobin affects pulse ox how will always give an 85% (because it absorbs red and infrared in equal ratio 1:1) pulse ox reading, therefore it may be falsely high or falsely low depending pt’s true ox saturation
Factors that alter pulse ox readings Decr. Pulsatile blood flow (hypothermia; hypotension; hypovolemia; PVD); bright lighting; shivering; venous congestion; nail polish; methylene blue(can drop for a couple minutes); MethHgb; carboxyHgb(falsely high, ie.copd); motion/electrical interference;
Elevated Carboxyhgb is seen in what type of pts smoke inhalation, copd, smokers (cherry red lips is a late sign)
Methemoglobin occurs in <1% of humans, congenital or acquired, impairs unloading of oxy onto tissues,
Causes of aquired methemoglobin Causes of acquired methemoglobinemia include: nitrobenzene, benzocaine(hurricane spray), prilocaine, and dapsone
Methemoglobin s/s brownish-gray cyanosis, tachypnea, metabolic acidosis, healthy pt will tolerate but anemic or severe heart failure will not
Methemoglobin reversal will occurs spontaneously 2-3hrs following last LA dose, or methylene blue 1mg/kg for immediate reversal
The further peripheral you get with a non-invasive b/p the higher the systolic and lower the diastolic
Korotkoff sounds volatile blood flow, which causes vibrations against the artery walls
b/p cuff deflation rate 2-3 mmHg per heart beat, or 3-5mmHg /sec
Allen Test
Zero points for a-line R atrium (phlebostatic axis), at the tragus if in the seated position(this measures perfusion at the circle of willis)
ECG can detect Arrythmias, MI, conduction abnormalities, pacemaker malfunction and electrolyte disturbances
Lead II benefits Largest p wave voltage, Better diagnosis of arrhythmias, Detection of inferior wall ischemia
Lead V 5th intercostal space ant. axillary line, Most sensitive for anterior and lateral wall ischemia, True lead V possible only with 5 leads
Modified lead V on 3 lead system take LA lead and place at 5th intercostals space ant. Axillary line, then select lead 1 on the monitor
Leads II, III, AVF reveal disease in the right coronary artery (inferior wall)
Lead V1-V6 reflects LAD and circumflex artery
Lead V1 and aVL reflect posterior wall MI
V1, V2 & V3 reflect anteroseptal wall
V3, V4 & V5 reflect anteroapical wall
V4, V5 & V6 reflect anterolateral wall
Stethoscopes detect Detect changes in HR, onset of dysrhythmias, airway/ventilation problems, VAE (venous air embolism)
Esophageal stethoscope Soft, thinned walled tube placed in the lower 1/3 of the esophagus, most accurate measure of temp
Esophageal stethoscope contraindications eso varices
Anesthetics affect temp through the hypothalamus
Body heat is lost through radiation, convection, evaporation and conduction
Volatile anesthetics effect all EP’s by decreasing amplitude and prolonging latency
IV agents have ____ effect on EP’s Less; Often do TIVA technique when doing EP monitoring
alveolar deadspace alveoli that are ventilated but not perfused
If no co2 detected on capnography assume failure to ventilate first (Equipment failure, apnea, disconnect, accidental extubation, esophageal intubation, no perfusion state, obstruction etc)
If not returning to baseline 0 then Recalibrate, rebreathing CO2, retaining CO2, Change soda lime(co2 absorber), check expiratory valve
If capnography wave is lean to on side Having trouble blowing out CO2, COPD; kink, foreign body obstruction, emphysema
Stairsteping form cardiogenic oscillations at end expiratory phase, matches up with HR
What else could cause a decrease in the EtCO2 reading from normal to a sudden low value PE
Created by: dupy6