A&p Exam 2 Lecture 1: Patient Monitoring

Front 1

EXAM 2 LECTURE 1: PATIENT MONITORING

Back 1

EXAM 2 LECTURE 1: PATIENT MONITORING

Front 2

Motto of ASA?

Back 2

"Vigilance"- alert watchfulness

Front 3

Keep in mind that all monitor has?

Back 3

Risk to the patient.
Assess the benefits and the risk.

Front 4

ASA Monitoring Standard I

Back 4

Must be present in the room at all time.

Front 5

ASA Monitoring Standard II

Back 5

Patient's oxygenation, ventilation, circulation, and temperature shall be CONTINUALLY evaluated.

Front 6

How do you define continually?

Back 6

Repeated regularly and frequently in steady rapid succession.

Front 7

Continuously?

Back 7

Prolonged without any interruption at any time.

Front 8

ASA Standard: Oxygenation

Back 8

Methods:
1. inspired gas
2. blood oxygenation

Make sure there is adequate O2 conc in the inspired gas.

Front 9

How is the concentration of the oxygen in the breathing circuit measured?

Back 9

Oxygen analyzer

Front 10

When does hypoxia occur?

Back 10

PaO2 < 60 mmHg

Front 11

When does one become anemic?

Back 11

Hb < 12-13 g/dL

Front 12

Methemoglobin

Back 12

Oxidized form of Hb that has no affinity for oxygen.

NOTE: methemoglobinemia Fe state is Fe +3 (ferrous form)

Front 13

Shock

Back 13

Low BP resulting in inadequate carrying capacity.

Front 14

What is the normal total O2 is bound to Hb?

Back 14

97%

Note: 3% is dissolved in the plasma.

Front 15

CaO2

Back 15

Arterial O2 content
In ml/dl

Equation is:

Front 16

% Bound Hb is equal to:

Back 16

(1.39)(Hb)(SpO2) PLUS .003*PaO2

Front 17

What is the normal percentage of Hb saturated with O2?

Back 17

SpO2 ~ 95-98%

Front 18

What does the PaO2 indicate as measured in ABGs?

Back 18

Oxygen dissolved in plasma.

Front 19

OxyHb Dissociation curve values:

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P50= 27mmHg
P60= 30 mmHg
P75= 40mmHg
P90= 60 mmHg
P95= 75mmHg

Front 20

Pulse Oximeter

Back 20

Has light-emitting diodes (LEDs) that produce red and infrared light.

Front 21

Technology behind Pulse Ox

Back 21

Sensor placed so that light passes through capillary bed.

Hb and HbO2 have different light absorption.

HbO2 absorbs more infrared (940).

Hb absorbs more red (660 nm)

Front 22

What other info does a pulse ox. provide?

Back 22

Tissue perfusion (amplitude)

Heart Rate

Front 23

What are the drawbacks of oximetry?

Back 23

Delay b/w SaO2 and SpO2

Front 24

What are some Pulse Ox artifacts?

Back 24

1. dyes
2. ambient light
3. low perfusion
4. venous pulsation
5. nail polish

Front 25

Nail polish

Back 25

Usually not a problem.

Produces a SpO2 that is lower as a result of low signal strength.

Front 26

Pulse Ox. and carboxyHb

Back 26

Carboxy and HbO2 both absorb light identically at 940nm, oximeters will give false high reading in patients with CO poisoning.

Front 27

MetHb pulse oximetry

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1. Ferrous +2 to FERRIC +3 state.

2. SpO2 approximates 85% due to same absorption coefficient of 1:1.

Front 28

What are some hazards of Pulse Oximetry?

Back 28

Pressure necrosis

Thermal burns

Front 29

ASA Monitoring Standard II: Ventilation

Back 29

Methods:
1. CONTINUALLY evaluated
2. qualitative clinical signs are useful.
3. quantitative monitoring of expired gas is encouraged.
4. capnogram used
5. ETCO2 alarm shall be audible.

Front 30

Phases of the capnogram

Back 30

Draw it out here:

Front 31

Phase I?

Back 31

Mostly dead space, but it's the begining of exhalation.

Front 32

Phase II?

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Alveolar gas begins to mix with the dead space gas.

CO2 begins to rise rapidly.

Front 33

Phase III?

Back 33

Corresponds to elimination of CO2 from alveoli.

Front 34

Where is ETCO2 measured?

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At maximal point of phase III

Front 35

Phase IV?

Back 35

Inspiratory phase.

Front 36

Esophageal intubation capnogram appearance:

Back 36

Looks like descending steps.

Front 37

ASA Monitoring Standard III: Circulation

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Methods
1. EKG continuously displayed.
2. has arterial BP and HR determined and evaluated every FIVE MINUTES.
3. Circulatory functions be continually evaluated (heart sounds, palpation of pulse, etc...)

Front 38

PR interval

Back 38

0.12-0.2 msec

Front 39

Right leg electrode

Back 39

Act as an electrical reference for ECG amplifier.

Improve the common mode rejection.

Front 40

What are some EKG artifacts from?

Back 40

1. motion
2. cautery
3. 60 cycle interference

Front 41

What is the J point on the EKG?

Back 41

It's the point at end of QRS complex.

Front 42

ST segment

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If depressed: Ischemia
If elevated: MI

ST segment occurs at 60-80 msec after J point.

Front 43

V2 is used to measure what?

Back 43

Arrythmias, because it's closest to SA node.

Front 44

Specific areas of myocardium for: II, III, aVF

Back 44

Inferior wall

Front 45

Specific areas of myocardium for: I, aVL, V4-6

Back 45

Lateral wall

Front 46

Specific areas of myocardium for: V1-3

Back 46

Anteroseptal

Front 47

Specific areas of myocardium for: V1-6

Back 47

Anterolateral

Front 48

What is the appropriate use of systolic BP?

Back 48

To estimate vascular wall tension or stress in the case of new vascular anastomoses.

NOTE: systolic pressure is the maximal pressure during a heart beat.

Front 49

Diastolic pressure

Back 49

Pressure for blood flow through left ventricle.

Majority of blood flow to left ventricle during diastole.

The minimum pressure during a heart beat.

Front 50

MAP

Back 50

Describes tissue perfusion.

Used in calculating vascular resistance, perfusion pressure, and autoregulation.

Front 51

Pulse pressure

Back 51

S -- D

Used clinically as an indicator of stroke volume

Front 52

What is the phlebostatic axis?

Back 52

Zero reference point for blood pressure measurements.

Normal reference point: right ventricle.

Front 53

When do automated oscillometric methods fail under physiologic variation?

Back 53

Under physiologic variation:
1. shock
2. large variation in pressure

Front 54

Under anatomical variation?

Back 54

1. conically vs. cylindrical shaped arm.
2. calcified arteries
3. thoracic outlet syndrome/subclavian compression.

Thoracic outlet syndrome: symptoms in upper extremities due to pressure on nerves and vessels in the thoracic outlet area.

Front 55

Under cuff compression variation?

Back 55

Intrinsic factors:
1. shivering
2. seizures
3. arm movement

Extrinsis factors:
1. pt positioning
2. mechanical movement from surgeon.
3. vehicular vibration

Front 56

Cuff size

Back 56

Narrow worse than wide

Incorrect application:
1. not wrapping cuff snuggly enough.
2. not squeezing air out before applying.

Front 57

Where is an example of an alternate cuff placement?

Back 57

Right above foot around malleolus.

Front 58

What are the errors produced by BP waveforms interacting with resonant measurement systems?

Back 58

1. greatly increased systolic pressures
2. somewhat decreased diastolic pressures.
3. significantly increased dP/dt

Front 59

ASA Monitoring Standard: Body Temperature

Back 59

Normal: 37 +/- 0.5

Locations:
1. esophageal
2. axillary
3. skin
4. rectal
5. bladder
6. sublingual
7. nasopharygeal

Front 60

Hypothermia starts at:

Back 60

Temp < 36C