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monitorthermalgas
nu568 monitor thermal gas
| Question | Answer |
|---|---|
| Who issues regulation for handling transportation and storage and disposal of cylinders | USDOT, CGA, and NFPA |
| oxygen is in what state at room temp | gas |
| oxygen is refrigerated to maintain what state | liquid |
| manifolds redude pressure of cylinder from what to what? | 2000 psi to 50psi |
| service pressure of oxygen is what | 2000psi |
| critical temp of oxygen | -119C |
| capacity of Ecylinder | 660liters |
| is even of loss of pipelie pressure | 1. fully open E cylinder, and use low FGF. 2. if not fully open, flow ends before its empty. 3. hoses to pipeline are disconnected |
| at 1000psi of O2 how many liters are left? | 330L |
| adiabatic means what | no heat loss to atmosphere |
| Nitrous oxide PSIG, LIters, and temp | 1600Liters, 745 psig, stored as liquid critical temp 36.5C |
| N2O is easily compressible without a large incrase in tank pressure T or F | True |
| what is a rupture disk | is emergecny relief valve to prevent explosion, will rupture at 3300 PSI. E cylinder them self can withstand 5000psi |
| woods metal | metls at 158F , ventilates gas into air |
| volume of N2O is what to cylinder pressure | not proportional |
| what what liter of N2O will nitrous be expended | 400L |
| what is tare weigt | empty wieght |
| energy to convert liquid to gas | endothermic |
| how do you crack a cylinder | slowly |
| how to determind residula volume of N2O | weigh the cylinder. |
| medical air | made from compressors |
| crtical temp of medical air | -146.6C, pressure falls proportional to tank content |
| medical air cylinder | 660L and 1900psi yellow |
| pipeline constructions | seamless copper tubing, 1993 NFPA made stricter standards against contaminants. |
| DISS connectore help prevent connection errors | TRUE |
| how far apart are the O2 lines are labled | every 20 feet, every story of a building, and entering each OR |
| installation of anesthesia gas system | copper only, certified installer, 48 hour pressure test, |
| Yellow PSI L PIN | 1900psi 660L 1,5 |
| Green PSI L PIN | 1900psi 660L 2,5 |
| Blue PSI L PIN | 745psi 1600L 3,5 |
| H cylinders hold about 6900 liters so at 3/l min you can run it for how long | 38hours |
| central vacums contain what to prevent system contamincation | Traps. |
| what happens if you bypass a trap | may shut down system for terminal cleaning, upto 24 hours. |
| O2 shut off valves AKA | zone valves |
| gas tubing in OR present three diff ways | gas colums, hose drops, articulated arm BOOM |
| compressed nitrogen | not for patients, BLACK in color, commonly in H cylinder, 660L at 200psi |
| what seamlessly selects the supply tank with apreoate pressure and swtitches from central supply to tanks | manifold system |
| carbon dioxide | insulfation gas, Grey tanks, CGA says color code, but not all do. not mandated by FDA. |
| testing anesthesia gas circuits | 1. pressure test, 2. test for cross connections. 3. pipeline purge using cheese cloth. 4. standing pressure test after walls are closed. in accordance with ASSE 6000 |
| what type of burn is prevalent among small children | scald injuries |
| chemical burn degree depends on what | type of chemical, concentration and duration of exposure |
| what causes death in burn pts | not the thermal toxic damage, but the shock state following by potential sepsis. |
| what systems can be affected by burns | all can be affected |
| Burn degree | 1st, sunburn 2nd. partial thickness 3rd. all epidermus white sluffing off. 4.muscle fascia bone burn. |
| estimation of body percent burned | the rule of nine |
| rule of nine breakdown adult | head and each arm 9. front 18 back 18, circumfrance of each leg 18 |
| rule of nine with babies | head 18, arms 9 each, front 18 back 18 and legs are 14 each |
| is the rule of nine definitive | no, just a good estimate |
| lund and browder chart | more accurate burn injury quantification, esp for pediatric. |
| burn formula and if greater than what is predictive with high mortality rate | age + %TBSA of burn >115 then the mortality is great than 80% |
| how can mortality of burn victim be doubled | if there is an inhalation injury with thermal burn |
| 4 types of burns | chemical, electrical, thermal, and inhalational |
| treatment of chemical burn | large amount of water flush, noxious fumes can also cause serious injury. |
| electrical burns | depends on voltage, duration. point of entry is not the point of exit and not always appartent. |
| electrical burn damages what | bones, blood vessel, muscle, nerve |
| muscle damage from electrical burn | can cause myoglobinemia which leads to renal failure. |
| thermal burns from ages of what to what is normal | 1-4 |
| what is the second leading cause of accidental death | fire |
| scald burns in children are one of the most common injuries that result in what | abuse |
| with thermal injury what should always be suspected untill ruled out | inhalational burn both upper and lower |
| dry air at what temp and steam at what temp can cause damage | dry at 300C and steam at 100C |
| lower airway injury from | soot and particles, airway mucosa makes acidic and alkali substances, which results in INCREASED capillary permeability. |
| signs of inhalational injury | hoarseness, sore throat, dysphagia, hemoptysis, tachypnea, accessory muscles, wheezing, carbon in sputum, and or elevated carbon monox |
| three phases of treatment | 1. resuscitative, 2. debridment and graft 3. reconstructive |
| Resuscitative | ABC, and coexisting trauma, all at risk for pulmornay injury, |
| how to diagnose airway injury | history physical, direct visualization, CXR normal in early phase unless aspirations, intubation even if not showing signs of decompensation. |
| why intubate early | because once edea sets in, very hard to intubate, especially after fluid resusication has occured. children no cuff, and one size smaller than norm, naso for kids is better tolerated. |
| if burn injury great thatn 24 hours what can NOT be used | succinocholine |
| upregulations of acetylcholine can cause what if succs is given | increase of K from muscle, resulting in hyper K and possibly cardiac arrest |
| what determines the K release in a burn patient if succs is given | the size of the burn |
| burn patient have a what sensitivity to NDMB | decreased, due to increased nicotinic acetylcholine receptors and change in volume of distribution. may need two or three times the dose |
| best intubation if when a patient is | awake |
| carbon monoxide poisoning | any burn patient in enclosed space, is at risk for CO. 50-60 % die from CO poisening. |
| symptoms of CO poisoning depends on what | carboxyhemoglobin level |
| CO affinity to heme is | 200 times that of Oxygen, tissue beceomes acidotic ABG normal arterial oxygen tension but decreased total oxygen content. |
| carboxyhemoglobin level of what kills | greater than 60 |
| a shift to the what is seen with CO toxicity | shift to the left |
| pulse ox is a good measure of CO poisoning? | NO, pulse ox can not tell difference |
| Treatment of CO includes | oxygen at 100% face mask. Shortens half life of CO from 4 hours, to 40 min. |
| upon securing airway, and other life threatening injury | pt given fluid, include blood. need to maintain renal function. |
| Fluid losses are great in the first | 12 hours and stabilized after 24 hours |
| edema and or third spacing causes what | depletion of plasma volume, increase in extracellular fluid and shows up as HYPOVOLEMIA and BURN INDUCED EDEMA |
| inflamation and edema can occur localy or systemically why | depends on the size of burn. |
| fluid resuscitation formular | 2-4ml/kg x BSA for adults. 3-4 for children. NSS for adults, LR for children under 3yrs. |
| what type of fluid should be given according to american college of surgens commitee on trauma | cystalloid. |
| why are colloids not given within the first 24 hours | they wont stay in vascular. |
| after the first 48 hours patient goes into what state of metabolism | hypermetabolic hyperhemodynamic phase |
| hypermetabolic state is manifested by | hyperthermia, tachypnea, tachycardia, increased catecholamine, increased Oxygen, increased basal metabolic rate. stays for weeks, till wound healing starts. |
| cardiovascular system after burns | edema, third spacing due to disrupted endothelium, shock 24-36 initial hours, HALL MARK IS DECREASED Cardiac Output. initially compensated. |
| inflamatroy syndrome in burn patiens | increased CO, tachycardia, and reduction in SVR, 24-35 hours post burn. Initial burn hours, decreased CO and increased SVR. |
| in hypermetabolic state patient shows increased consumption of what | oxygen and production of CO2 |
| children weeks after burn injury become | hypertensive, increased catecholamine production, activation of renin-angiotensiin |
| Pulmonary system and burns | may decrease, FRC reduced, chest wall compliances decreased. edema, eschar formation, |
| If no inhalational are lungs still compromised | yes, plasma oncotic pressure decreases, results in pulmonary edema. |
| Immune system and burn | susceptible to infection, altered immune system starts hours after burn, Leukocyte activity is depresses as well as humoral and cellular response. |
| prime medium for bacterial growth | is the burn eschar |
| which bacteria increases mortality | gram negative bacteria, septic, pneumonia, require prolonged mechanical vent |
| death after burns, most deaths is attributed to | 100% infection in children, and 75% in adults. |
| Renal and burns | ARF is a serious injury, increases mortality. glomerular filtration alteration, due to intravascular depletion, decreased CO, and increased catecholamine |
| renin-angiotensin release what and it does what | ADH and conserve sodium and water. |
| electrical burns and renal | myoglobinemia, can damage the renal tubules and impair function |
| what do we give to protect the renal system | bicarb |
| bicarb in renal system in burn patients prevents what | myoglobin casts formation |
| how soon after burn can ARF occur | 2-3 weeks |
| damage to renal arencyma occurs from | myoglobinuria, rhabdomyonecrosis and or hemoglobinuria due to hemolysis. |
| what blood product can be given to protect renal in burns | FFP, contains haptoglobin, binds free hemoglobin. |
| GI and burns | with a 40% burn pt has a 132% higher basal energy espendature. for sepsis is 79% increase and major surgery is 25% |
| burn patients and prevention of catabolism what is more nurtietionaly available | carbs are better than fats. Insulin not functioning, need blood sugars. |
| what is better for protein fats or carbs in burn patients | carbs |
| enteral feeding before surgery | stop the night before |
| intubated patients and enteral feeding | may continue feeding. Un-intubated stop 4 hours before. |
| NG tube should be what once in OR | suctioned and RSI should be in order. |
| if patient is on parenteral hyperalimentation | continue through out surgeory and line should not be used for anesthetic |
| 20% TBSA burn or more can cause what in GI | illeus, gastric and duodenal ulcers can occur called Curlings ulcer. |
| what is curlings ulcer | gastric and duodenal ulcers cause by burn. ie stress ulcer from burn |
| treatment of curlings ulcer | H2 blockers and antacids. these patients have increased infection of pseudomonas of lung. H2 blockers end in -tidine |
| burn patients and changes in plasma protein | decreased albumin and increased alpha-1 gylcoprotein |
| decreased albumin affects what drugs how | albumin/plasma binding of drugs like benzo, phenytoin, salicylic acid is decreased. ie need LESS drugs. larger volume of volume distribution. |
| drugs bound to alpha1-glycoprotein | need more drugs, eg lidocaine, Demerol, propofol |
| volume distribution of drugs in burns is affected by | extracellular fluid volume and Protein binding. these effect how drugs work in body and how much you need to give. |
| In hypermetabolic state CO increases to kidney and liver causing | increased drug clearance. |
| Surgical debridment and skin grafting | restore skin integrity, ealier eschar is removed and less chance of infection. other advocate waiting 1-3 weeks after injury. |
| before surgery pt must be what | stable and fluid resuscitated. |
| surgical limited to how much of body | 20% at a time. otherwise hemodynamics and coagulation status must be considred. |
| what preop test are important before surgery | acid-base, electrolyte, ABG, CXR, chem panel, CBC, EKG, airway eval, coags |
| what electrolyte imbalance might be seen with burn | HyperKalemina, hypercholeremic , Na, Cl |
| tpoical antibiotics like Mafenide acetate inhibits carbonic anhydrase which causes | hyperchloremic acidosis |
| silver nitrate aka silvadine decreases what | Na, Cl, and K levels. |
| electrolyte imbalances with burns can be seen with what “procedures” | surgical time of 2-3 hours and core temp 35C or blood loss of 10 units PRBC |
| Grafts in burn patients | can use own skin or other type of grafts if own skin is not available |
| pre-op eval of burn pts | medical hx, lab, physical, lungs, airway, resp compliance. know type of burn, and TBSA% and location of burns. surigcal intentions. alot to consider when giving anesthesia to them. |
| other pre-op considerations for burns | monitors, core temp, airway, invasive lines, sedation, analgesia all must be considered. |
| pre-op oral assessment | if not intubated, awake fiberoptic should be considered. no tape, consider cloth to hold ETT. |
| hypothermia and burn | great risk for hypothermia, warm fluids, bair hugger, warm OR, humidifiers if possible. |
| detriment bloody considerations | gauze may be soaked in epi and neo to vasoconstrict. this can cause tachycardia. elevation in BP. Instead use THrombin soaked sponges instead. |
| Thrombin soaked sponges | an alternative to epi and neo soaked for detriment. |
| all blood products should be immediately be available to you T or F | True |
| in burn patients what is of utmost importance | VIGILANCE and careful planning. survery the surgical field, do not rely on surgeon for blood loss. |
| Burn patients and anesthetics | go slow, titrate, regional is debatlable during reconstructive phae. (infections, hypovolemia, vasodilation) |
| Inductions drugs and burns | standard induction is ok to use. Succs becareful, sodium thiopental, propofol and etomidate all can be used but know downfall to fix it. |
| what has a greater negative ionotropic effect than sodium thiopental and etomidate | propofol |
| ketamine is a good hemo-stable drug, some analgesia for burns | True |
| if no IV in ped, then what VAA can be used | Sevo, keep in mind cardio vascular depressant effect of VAA and if pt is NOT fluid resuscitated. |
| non-depolarizors can be used in burns but | need redosing, increase in postjunctional acetylcholin receptores becareful about succs |
| in burn pts need more opiods due to | activation of endogenous opoid pathways., PCA over IM. Morphine, fentynl and sufent are all ok intraop |
| what opioid is good for dressing change | remifyntanel |
| why NSAIDS not a good idea for burn pt when changing dressing | prevention of thromboxin A, faiiure of platelet aggregation. |
| if to be extubated in OR | need full spontatnous breaths, niff of -30, follows all directions, all properly reversed. adequate tidal volume, good RR |
| what is monitored by anesthesia | BP(invasive and non) EKG |
| respiratory system monitors | precodal and esophageal stetchescopes. Pulse oximetry, end tidal CO2, and anesthetic analysis. |
| Neurological systems | EVP by neurophysiologist, BIS and perfipheral nerve stimulators. |
| We keep an an eye out for renal | urin ouput, temp. |
| vital signs are | HR, BP, EKG, Pulse Ox, End tidal CO2, Temp (for GA and peds mac) |
| Rhythmic contraction of left vent | ejects blook in vascular system results in pulsitile arterial pressure. |
| Peak pressure generated during | systolic contraction |
| trough pressure during | diastolic relaxation |
| MAP, Mean arterial pressure, average pulse cycle | SBP +2(DBP)/ 3 |
| PULSE PRESSURE | is the difference between the systolic and diastolic pressures |
| radial artery systolic pressure is usually higher | than aortic systolic pressure |
| aortic root has the lowest SBP and narrowest pulse pressure. | TRUE |
| the dorsalis pedis has the highest | SBP and widest pulse pressure |
| Pulse pressure = | SBP-DBP |
| Non invasive blood pressure | inflation of BP cuff, artery partially collapsed, as released Korotkoff sounds, audible distal third of BP cuff |
| BP cuff size | too small high BP, too big low BP. too narrow most significant error. |
| width of the cuff should be how much greater than diameter of extremity | 20-50 |
| automatic bp cuff based on | oslometric q3 to q5 min |
| BP should be viewed as an indicator not a | measure of end organ perfusion |
| Gold standard of blood pressure | Invasive arterial blood pressure |
| reasons for Aline | cardiovascular instability, fuild shift, intracranial surgery, CV disease, LVH, valvular disease, diabetes, cardiac arrest |
| reasons for Aline | direct maipulation of cardiovasular, surgery, vascular surgery, deliberate, hypoten, deliberate hypothermia, obesity, frequest Arterial samples |
| technique of invasive arterial line insertion | percutatneous arterial cannulation of radial, dorsiflexion, secure wrist, palpate, mark, sterile technique |
| sterile A line technique | gloves, prep, skin wheal 1% insert 30-45deg upon flash drop angle to 10 to 30deg |
| Trans-arterial or through arterial | through artery, pull back flash remove stylet and advance, use guide wire or 3cc syringe to advance catch. |
| Seldinger technique | over wire technique |
| Pressure transducer | IBP tubing non compliant, fluid filled, transducer used, |
| Transducer are based on | strain gauge principle. crystal stretched and electrical resistance is changed. |
| mechanical characterstics of transducer system is based on two parameter | natrual frequency and damping coefficient |
| Natural frequency | the frequency at which the system will resonate or ring |
| Damping coefficient | which describes the tendency of the apparatus to extinguish oscillations through viscous and frictional forces. |
| Natural Frequency of Arterial Pulse= | 16 -24 Hz |
| Natural Frequency of Transducer = | 1 to >200 Hz |
| addition of arterial extension tubing, extra stopcocks, air bubbles all can lead to | damping effect |
| Overdamping____estimastes systolic pressure | under estimates |
| underdamping leads to ____ and reads a falsly____ | overshoot and reads falsely systolic pressure |
| Underdamping will over shoot or ringing the image lookslike | one or more “step offs” |
| damping | underestimating the systolic pressure, slurred stroke absent dichroitic notch |
| damping coefficient of ___is optimal, and can be determined by examining tracing oscillations after a high-pressure flush | 0.6 to 0.7 on a scale of 1 |
| Air bubbles in the tubing runs the risk of flushing the air bubbles ___ into the arterial tree, possibly causing a cerebral air embolus | RETROGRADE |
| baseline drifts, requires periodic | re-zeroing |
| Usually at the level of the RIGHT ATRIUM Known as | Phlebostatic axis |
| The zero reference point of the transducer is the | TIP of the stopcock. |
| ischemia may be reduced by presence of | collateral blood supply |
| ___is meant to identify a patient’s risk for ischemic complications during or after radial artery catheterization | allen’s test. |
| 5% of patient have incompetent palmer arches and lack | collateral blood flow |
| allen’s test determins adequecy of | ulnar collateral circulation in case of radial thrombosis |
| Technique for Allen’s Test | 1. make a fist to exanguinate hand 2. occlude radial and ulnar artery with fingertip pressure 3. relax blanched hand. release ulnar. 4. collateral is good if pink 5 seconds thumb |
| allen’s test | if thumb does not occur within 10 seconds not good collateral. |
| Alternative site for arterial bp monitoring | ulnar, brachial, axillary, fermoral (next most common) dorsalis pedis, posterior tibials, head superficial temp artery |
| complications of arterial catheterization | hematoma, loss of digit, bleeding, thrombosis, infection, vasospasm, skin necrosis, nerve damage |
| Dicrotic notch | seen at apex of waveform of A line and represents closure of aortic valve. |
| square wave test | flush no more than 2- 3 seconds. should return to normal after 2 seconds. |
| Anacrotic limb “The rise” | first phase of arterial pulse cycle, ventricles eject blood into arterial tree. arterial pressure rises to end systole. |
| steepness of ascending phase affected by | HR, increases SVR, vasopressor, norepi, vasodialator less steep. |
| systolic notch | not normal, aortic insufficiency, stenosis, hypertrophic obstructive cardiomyopathy. OVERESTIMATE systolic BP |
| Descending limb of Aline | pressure falls to that of end diastolic pressure. Has dicrotic notch. |
| Dicrotic notch | occurs at any point of fluctuation in pressure during descending arterial limb. aortic and pulmonary valves snap shut causing pressure reverberations. |
| Dicrotic notch ie | aortic valve closure |
| Incisura | deep notch at surface ie when it comes to Aline dicrotic notch |
| flat or non existing dicrotic notch | dyhydrated, |
| low dictorotic notch | high pulse pressure, spetic shock ie low diastole |
| flat notch | present in cardio pulmonary valve insufficiency |
| the rate of fall off or fall of end systole to early diastole changes in relation to | SVR |
| what does the upstroke of arterial waveform represent | ventricular contraction |
| what does the down stroke of arterial wave form represent | SVR |
| what does the area under the curve represent | MAP |
| what does respiratory variation represent | pt is dry |
| lead what has the greatest Pwave voltage tracing | lead II, it parallels the atria. |
| lead V lies where | 5th intercostal space mid axillary, |
| lead V use for | detecting anterior lateral wall ischemia. a true lead V needs 5 leads |
| electrocautery, lead, cable and patient movent can@ simulate dysrhythmias | |
| how many patient scheduled for cardiac surgery have risk factor for CAD | 1/3 |
| No universal criteria for ischemia | TRUE |
| ST segment analysis is more sensative than | holter in detecting ischemia |
| ST analysis | STdepressression greater than 1mm, greater than 1mm sloping or down sloping from J point, 1mm or greater ST elevation, are all worthy for ischemia |
| transmural ischemia | ST elevation greater than 1mm |
| subendocardial ischemia | down ST depression |
| who cant get PA RIJ | hypovol, hypoten |
| why RIJ over Left | Left has thoracic duct |
| what is thoracic duct | lymph empties into it |
| technique for PA RIJ | seldinger, over wire, trendelinburgh, sternocleidomastoid and clavicle, facing opposite nipple |
| characteristic pressure waveforms of monitor | A C X V Y |
| positive deflection of PA | A C V |
| negative deflection of PA | X Y |
| CVP monitoring helpful in dx and treating | cardiac tamponade |
| cardiac tamponade and CVP | diastolic pressure equalize and CVP become monophasic |
| characteristic of significant cardiac constriction and tamponade | CVP=RVDP=PDP=PAOP(wedge) |
| The postive deflections A | atrial contraction, correlates with PR interval |
| the positive deflections C | represent ventricular contraction, bulging of tricuspid valve into atria, follows onset of QRS on EKG |
| the positive deflections V | represents pressure buildup from venous return until AV valve opens. follows T wave on EKG |
| negative deflictions X | atrial relaxation |
| negative defrlection Y | early ventricular filling, opening of tricuspid valve. |
| CVP is proportional to preload of the right heart, PCWP is proportional to | preload of left side of heart. |
| canon a waves on CVP | result from atrium contracting against closed tricuspid valve. for example in junctional retrograde atrial antegrade vent depol |
| RA reading | 2-6 |
| RV reading | 25/2-6 |
| LA reading | 2-12 |
| LV reading | 100-140/2-12 |
| A-LA pressure during | atrial contraction, PR interval |
| C-LA | ventricular constant follow onset QRS, or bulging of tricuspid valve into RA |
| V-LA | represents buidling up from venous sys untill AV valve opens, follows T waves |
| X wave | atria relax |
| Y wave | early vent filling |
| cardiac index= | cardiac output/BSAm2 |
| normal CO= | 5-6L/min |
| Normal CI= | 2.8-3.8 |
| swan ganz aka pulmonary artery catheter | first described by letegalo and rhan in 1953. Used by Swan and Ganz in 1970. |
| the PAC is balloon tipped, flow directed, multilumen can measure | CVP, PAP, PCWP, |
| PAC’s also measure cardiac output by | thermo dilution technique. |
| PAC capabalities | fiberoptic measurement of mixed venous and oxygen sat, cadiac pacing, Volume/venous infusion port, |
| PA catheters are indicated | cardiac surgery, heart and lung and liver Tx, guide resuscitation in trauma, major blood loss, multiple organ system injury. |
| PAC indication cont | poor LV, EF less than 40%, CI less than 2L/Min/m2, recent MI, ischemic disease, Pulm HTN, shock, sepsis, large volume shift, cross clamping of abd or thoracic aorta. |
| PAC outside of OR | diagnosis and treatment of intra-cardiac shunt, sepsis, Pulm HTN, ARDS, cardiac tamponade, volume delivery, high risk surgical patients, and shock |
| equipment for PA catheter insertion | percutaneous introducer ie Cordis, pressure transducer, mornitor capable of displaying waves, |
| Fluoroscopy, may be needed with anomolies of | greater veins, RA or RV, or PA |
| any contraindications for PAC insertion | NO ABSOLUTE CONTRAINDICATIONS |
| relative contraindications | severe coagulopathies, thrombocytopenia, prosthetic right heart valve, endocardial pacemaker, infection or tissue breakdown at insertion site. |
| PAC and LBBB | may be contraindicated becaue it may cause a RBBB and then a Complete hear block. Have PA pacer and good to go. |
| complications with PAC | during venous access, while in place air embolism, arrythmia. carotid artery cannulation aka BIG RED, pneumothorax |
| when inserting a PA catheter and you have arrythmia | you should push past it. |
| complications with PA catheters | dysrhythmia 70% pt, may need lidocaine 13%, INTRAPULMONARY HEMORRHAGE SECDONDARY TO PULMONARY ARTERY RUPTURE, pulm infarc, embolis, sepsis |
| most serious complication of PA catherterization | pulmonary artery rupture |
| pulmonary artery rupture | rapid hypotension, hemoptysis, reveral of anticoag, leave PA in place CALL THORACIC surgreon, place DL tube |
| a double lumen tube is | needed to isolate injured lung. possible emergent lobeectomy or pneumonectomy |
| common site for insertion of PAC | RIJ, align with superior vena cava and right atrium. Second best site, left subclavian. |
| LEFT IJ and right Subclavian for PAC | not good, due to thoracic duct and serious turns required to gain access to PA |
| wedge pressure when and what | evaluate LV preloading, and LVEDP, left vent end dias pressure, after the A wave but before the C wave. taken at end expiration |
| we want a wedge pressure of greater than | 60mmHg |
| PAC is calibrated to | atmospheric pressure |
| Zones of west | 1. PA>Pa>Pv 2. Pa>PA>Pv 3. Pa>Pv>PA |
| zones of west are anatomical or physiological | physiological, move with position of lung. |
| PAOP should be less than PAD | “drop Off”, if higher then not in zone 3. Pa>Pv>PA |
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Created by:
Rooz
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