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13 Cards in this Set

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General anesthesia monitoring includes?
ECG- 5 lead
Blood pressure q 5 at a min./ q 2.5 at induction
O2 sat
ETCO2
Inspired O2 SM 6-10 lpm
Temperature- must in Peds
PNS- if you are paralyzing
Gas anaylzer- end tital measurements usually
Pre-case machine and monitor check
set alarm parameters
alarms volumes > radio
Pre-op preparation
H&P
Meds
Labs – i.e. glucose monitoring
Observations of patient
Technique
Precordial stethoscope placement
Adults – supraclavicular notch or apex of the lung
Children – left side of chest
ventilation considerations
Ventilatory volumes and flows
Patient’s ventilatory drive
Apnea
Resp muscle strength
Compliance and Resistance
Vent Pressures
WHAT FACTORS AFFECT RELIABILITY OF PULSE OXIMETRY CAUSING A FALSE LOW?
methylene blue
Clinical Conditions Causing Decreased EtCO2?
Hyperventilation
Hypothermia
Impaired Pulm circulation (ie air embolism)
Shock
Air Embolism
Contamination…by room air
Clinical Conditions Causing Increased EtCO2?
Hypoventilation
Hyperthermia
Increased Metabolic Rate (malignant hyperthermia)
IV Sodium Bicarb
Rebreathing
Exhausted CO2 absorbent(will change color; dry and hard)
Faulty breathing circuit valves
Tourniquet Release (release of CO2 from extremity)
When do we monitor temperature?
General – Intermittently or continuously monitored and recorded
Always on children!
What factors affect temp?
Room temp (cold)
Length of surgery
Surgical Prep
Fluid Replacement
Irrigation
Fact: Lose 1–5 C in core temp in 1st hour
Urine output monitoring?
Direct Monitoring - Not every case
Usually if case > 4 hrs (healthy)
Cases with large fluid shifts, patient hemodynamically unstable..
0.5ml/kg/hr – 1ml/kg/hr
Giving a Break/ Leaving
Report
Review the monitors together
Document the exchange
When giving break or leaving..what to do in report?
Patient status (ASA, pathophysiology)
Procedure and course of surgery
Anesthesia plan, course and problems ( eg. Hypotension, bronchospasm)
Meds and last time of dose
Fluid, blood, urine status
Airway (difficult intubation, tube size)
Any other important or unusual aspects