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