Barry Monitoring
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| Map formula | (SBP + 2(DBP))/3
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| Pulse Pressure | the difference between systolic and diastolic
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| 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)
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| Indications for invasive blood pressure monitoring | hypotension, anticipated wide b/p swings, end-organ disease, need for multiple ABGs, Contraindications for invasive b/p
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| Complications associated with invasive b/p | Thrombosis, hematoma, bleeding, vasospasm, air embolism, necrosis/ischemia, nerve damage, infection, intra-arterial drug injection
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| Slope of a-line upstroke reflects | cardiac contractility
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| Slope of a-line down slope reflects | SVR
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| Over dampened a-line reading | underestimates systolic
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| Under dampened a-line reading | overestimates SBP
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| 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
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| 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
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| 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
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| 2 decents on CVP wave form | X and y
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| Complications of CVP | Arterial puncture with hematoma ,Pneumothorax/Hemothorax ,Nerve injury (Brachial plexus, Stellate ganglion (Horner’s syndrome) ,Air emboli , Catheter or wire shearing
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| Complications of any central catheter presence | Thrombosis, thromboembolism ,Infection, sepsis, endocarditis, Arrhythmias, hydrothorax
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| Peep does what to CVP | increases
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| CVP reflects | preload; RVEDV
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| CVP normal values | 1-15mm/hg
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| 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
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| Swan Ganz contraindications | LBBB,Tricuspid or pulmonary valvular stenosis,Right atrial or right ventricular masses (tumor or thrombus),Tetralogy of fallot
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| Swan Ganz complications | same as with CVP in addition to: Emboli (air, catheter insertion),Cardiac perforation,Cardiac dysrhythmia/heart block,Knotting
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| 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
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| TEE complications | Pharyngeal and/or laryngeal trauma, dental injuries, esophageal trauma or bleeding, arrhythmias, respiratory distress, and hemodynamic effects
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| EEG used for | Carotid and Neurosurgery,Measures electrical activity of the neurons in the cerebral cortex,Detects risk of ischemia due to hypoperfusion
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| EEG Waves | Alpha (Eyes closed but awake),Beta(Normal, awake waveform),Delta(Sleep state-deep sleep),Theta(Sleep state )
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| Concerning EEG Activity (Decreased blood flow to the brain) | Loss of amplitude, Increase in slow wave activity,Loss of fast activity
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| Anesthetics can cause ___ on the EEG | decreased frequencies, slowing
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| BIS monitoring values and meaning | 100-85 (Awake; memory intact),85-65 (Sedation),65-40 (General anesthesia; deep hypnosis),<40 (Cortical suppression)
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| BIS useful because it may | Decrease incidence of awareness,Reduce costs(Less drug),Faster awakening,Less total hospital time
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| 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
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| 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)
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| SSEP’s: somatosensory evoked potentials | (dorsal) Stimulate peripheral nerve, Record evoked potential over spinal cord or brain
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| 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
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| MEP’s: motor evoked potentials | (ventral) Detect motor function of spinal cord, MOST SENSITIVE to effects of anesthesia, TAA; spinal surgeries
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| 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
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| Pulse oximetry measures what | % of hgb saturated with oxygen
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| 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.
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| Beer-Lamberts Law | used to related concentration of a solute to the intensity of light transmitted through a solution
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| CarboxyHgb affects pulse ox how ? | results in falsely high readings because carboxy hgb absorbs red light identically like oxyhgb
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| 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
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| 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;
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| Elevated Carboxyhgb is seen in what type of pts | smoke inhalation, copd, smokers (cherry red lips is a late sign)
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| Methemoglobin | occurs in <1% of humans, congenital or acquired, impairs unloading of oxy onto tissues,
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| Causes of aquired methemoglobin | Causes of acquired methemoglobinemia include: nitrobenzene, benzocaine(hurricane spray), prilocaine, and dapsone
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| Methemoglobin s/s | brownish-gray cyanosis, tachypnea, metabolic acidosis, healthy pt will tolerate but anemic or severe heart failure will not
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| Methemoglobin reversal | will occurs spontaneously 2-3hrs following last LA dose, or methylene blue 1mg/kg for immediate reversal
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| The further peripheral you get with a non-invasive b/p the | higher the systolic and lower the diastolic
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| Korotkoff sounds | volatile blood flow, which causes vibrations against the artery walls
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| b/p cuff deflation rate | 2-3 mmHg per heart beat, or 3-5mmHg /sec
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| Allen Test |
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| 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)
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| ECG can detect | Arrythmias, MI, conduction abnormalities, pacemaker malfunction and electrolyte disturbances
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| Lead II benefits | Largest p wave voltage, Better diagnosis of arrhythmias, Detection of inferior wall ischemia
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| Lead V | 5th intercostal space ant. axillary line, Most sensitive for anterior and lateral wall ischemia, True lead V possible only with 5 leads
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| 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
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| Leads II, III, AVF reveal | disease in the right coronary artery (inferior wall)
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| Lead V1-V6 reflects | LAD and circumflex artery
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| Lead V1 and aVL reflect | posterior wall MI
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| V1, V2 & V3 reflect | anteroseptal wall
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| V3, V4 & V5 reflect | anteroapical wall
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| V4, V5 & V6 reflect | anterolateral wall
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| Stethoscopes detect | Detect changes in HR, onset of dysrhythmias, airway/ventilation problems, VAE (venous air embolism)
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| Esophageal stethoscope | Soft, thinned walled tube placed in the lower 1/3 of the esophagus, most accurate measure of temp
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| Esophageal stethoscope contraindications | eso varices
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| Anesthetics affect temp through the | hypothalamus
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| Body heat is lost through | radiation, convection, evaporation and conduction
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| Volatile anesthetics effect all EP’s by | decreasing amplitude and prolonging latency
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| IV agents have ____ effect on EP’s | Less; Often do TIVA technique when doing EP monitoring
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| alveolar deadspace | alveoli that are ventilated but not perfused
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| If no co2 detected on capnography assume | failure to ventilate first (Equipment failure, apnea, disconnect, accidental extubation, esophageal intubation, no perfusion state, obstruction etc)
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| If not returning to baseline 0 then | Recalibrate, rebreathing CO2, retaining CO2, Change soda lime(co2 absorber), check expiratory valve
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| If capnography wave is lean to on side | Having trouble blowing out CO2, COPD; kink, foreign body obstruction, emphysema
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| Stairsteping form | cardiogenic oscillations at end expiratory phase, matches up with HR
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| What else could cause a decrease in the EtCO2 reading from normal to a sudden low value | PE
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