Bb Monitors 1

Front 1

What does a sudden drop of the capnography waveform but not to zero indicate?

Back 1

leakage or partial obstruction of the airway

Front 2

What does an exponential decrease of the capnography waveform indicate?

Back 2

increase alveolar dead space such as a PE or cardiac arrest

Front 3

When during the cardiac cycle is the pulse ox saturation measured?

Back 3

it measures the difference between the background absorption during diastole and the peak absorption during systole
-means that a pulse must be present

Front 4

When do you get a very low or absent pulse with pulseox?

Back 4

1. hypotension,
2. hypothermia
3. hypovolemia
(due to the vasoconstriction that occurs during the above conditions - there must be a pulse to distinguish between light absorbed by arterial blood and background associated with venous blood)

Front 5

What conditions lead to a pulse ox reading of 85%?

Back 5

1. met-hgb,
2. indocyanine green
-lower the saturation reading for about 10 min

Front 6

what are the typical pulse ox readings for carboxyhemoblobin?

Back 6

normal bc pulse oximeter views carboxyhemoglobin as oxygenated Hb
-co-oximeter must be used to distinguish the two

Front 7

How can anemia affect the pulse ox values?

Back 7

pulse ox doesn't work well with hgb of 3-5

Front 8

How does RV failure or tricuspid regurgitation affect pulse ox readings?

Back 8

can produce false values

Front 9

What are the magnetic properties of oxygen and the anesthetic gases?

Back 9

-oxygen is paramagnetic (attracted to magnetic field),
-volatiles are diamagnetic(repealed by magnetic field)

Front 10

What situation leads to a underdampened/hyperresonant arterial waveform?

Back 10

1. small tubing (internal diameter<1.5 mm),
2. long tubing (>1.5m long),
3. stiff tubing,
4. big catheter(ie 18g in radial artery)

Front 11

What situations lead to an overdampened/hyporesonant arterial waveform?

Back 11

1. high viscosity,
2. soft, high compliance tubing,
3. bubbles in the system

Front 12

How do you convert cm variations in arterial transducer height into mmHg pressure variations?

Back 12

1.36 cm H20 = 1mmHg

Front 13

How does systolic and diastolic pressure change based on distance from the heart?

Back 13

The further from the heart the higher the systolic and the lower the diastolic
-ie increase in pulse pressure

Front 14

What happens if the blood pressure cuff is too small or loosely wrapped? What if cuff is too large?

Back 14

1) Blood pressure readings are too high
2) BP readings are falsely low

Front 15

What risk is associated with brachial artery cannulation for arterial pressure monitoring?

Back 15

thrombosis (10-17%)

Front 16

How does size of the cannula and duration of cannulation affect incidence of hand ischemia with radial artery cannulation?

Back 16

it may not influence hand ischemia

Front 17

What is a complication of superficial temporal artery cannulation in children?

Back 17

cerebral emboli via the carotid artery system

Front 18

What are contraindications to radial artery cannulation?

Back 18

1. local infection,
2. pre-existing ischemia to the hand,
3. raynauds phenomena

Front 19

How can you remember the CVP wave components?

Back 19

think of the following sequence:
1. atrial contraction, atrial relaxation, atrial filling, atrial emptying;
or
2. All College Exams Vary Yearly (a,c,x,v,y)

Front 20

What is the a wave? When do you lose the Awave?

Back 20

atrial contraction
-afib

Front 21

when do you see giant A waves?

Back 21

1. heart block,
2. nodal rhythms,
3. tricuspid stenosis
4. RVH
5. pulmonary stenosis
6. pulmonary htn
7. junctional rhythms

Front 22

What does the C wave result from?

Back 22

corresponds to ventricular systole and results from tricuspid valve closure

Front 23

What does the V wave represent and when do you see an increased size of the wave?

Back 23

the tricuspid valve is closed and the right atrium begins to fill
- tricuspid regurg

Front 24

What are the most frequent causes of elevated CVP?

Back 24

1. fluid overload,
2. right heart failure,
3. light anesthesia

Front 25

When is there good correlation between CVP and PCWP?

Back 25

1. when there is good LV function,
2. no wall motion abnormalities,
3. resting PCWP<18

Front 26

What are causes of increased pulmonary vascular resistance? ie What are the situations in which right and left sided filling pressures do not correlate?

Back 26

1. pain,
2. hypoxia,
3. hypercarbia,
4. drugs,
5. acidosis,
6. pulmonary emboli,
7. pulmonary edema,
8. COPD,
9. mitral valve disease

Front 27

When are PA catheters useful?

Back 27

major surgery with major fluid shifts in the presence of:
1. severe LV dysfunction,
2. cardiac failure,
3. pulmonary htn
4. cor pulmonale

Front 28

What surgical circumstance would a PA catheter be useful?

Back 28

If the aorta is to be crossclamped it helps detect LV failure in response to cross clamping which is difficult to predict in the presence of mild to mod LV dysfxn

Front 29

What are normal intracardiac presssures obtained with a PA catheter?

Back 29

1. RA 1-5mm Hg;
2. RV 15-30/1-5mmHg;
3. PA 15-30/5-15mmHg with mean of 10-20;
4. PCWP 5-12mmHg

Front 30

How does PCWP relate to PADP?

Back 30

PADP should be 1-3mmHg higher than PCWP (to maintain forward flow)
-PCWP should never be higher than PADP
-when it does occur the balloon is overinflated and needs to be deflated immediately to prevent rupture of the artery

Front 31

If a and v waves are present on the pulmonary catheter tracing what should you worry about?

Back 31

spontaneous wedging of the PA catheter and increased risk of PA rupture or infarction (small a and v waves are common when the balloon is inflated)

Front 32

What can cause large a waves on the PAOP waveform?

Back 32

1. mitral stenosis,
2. complete heart block,
3. atrial myxoma,
4. early acute heart failure

Front 33

What can cause large v waves on the PAOP waveform?

Back 33

1. mitral regurg,
2. mitral stenosis,
3. CHF,
4. VSD
-will result in a falsely high estimate of LV filling pressure
-in this setting the best measure of the LV filling is the lowest part of the pressure trace (diastolic PAOP)

Front 34

How can PA catheter affect the hearts conducting system?

Back 34

-can cause RBBB;
-may want to place temporary pacer in a patient with preexisting LBBB

Front 35

What are the absolute and relative contraindications of a PA catheter?

Back 35

-absolute - mechanical heart valves;
-relative:
1. recently inserted transvenous pacer;
2. bifascicular heart block,
3. coagulopathy,
4. frequent dysrhythmias,
5. hx of pulm stenosis

Front 36

How should cardiac output be measured?

Back 36

end expiration with 10cc of room temp injectate;

Front 37

How is thermodilation CO obtained?

Back 37

use "cold" as an indicator and measure the "concentration" of cold as the indicator in the PA after mixing has occured in the RV

Front 38

When is thermodilution CO inaccurate?

Back 38

1. AF,
2. TR,
3. intracardiac shunts,

Front 39

How does a decreased amount of cold indicator affect CO measure by thermodiluation technique?

Back 39

artifically high value of CO
-computer will assume that more indicator was injected than actually was
-since it measures a low concentration of indicator, it assumes that the indicator was mixed in a large volume

Front 40

In a healthy patient how does PCWP, LAP, LVEDP, LVEDV relate

Back 40

PCWP=LAP=LVEDP=LVEDV
-ie PCWP serves as an indirect measure of LVEDP

Front 41

When is PCWP>LVEDP?

Back 41

1. PEEP,
2. mitral stenosis,
3. mleft atrial myxoma where there can be a ball valve effect preventing proper emptying of atrium

Front 42

how do you treat low CO?

Back 42

1. optimize preload,
2. optimize afterload,
3. start inotrope

Front 43

When is PCWP<LVEDP?

Back 43

1. LV is noncompliant,
2. LVEDP>25mmHg,
3. when AI leads to premature closure of mitral valve

Front 44

What are causes of increased capillary leak that can lead to pulmonary edema?

Back 44

1. aspiration,
2. ARDS (sepsis, DIC, massive blood transfusion),
3. burn,
4. neurogenic

Front 45

What are signs associated with cardiogenic pulmonary edema? How do you treat?

Back 45

1. elevated PCWP,
2. bibasillar rales,
3. patchy infiltrates
4. pink frothy sputum
-fluid restriction, diuretics, inotropes

Front 46

What are signs associated with noncardiogenic pulmonary edema?

Back 46

1. PCWP generally not elevated,
2. bibasillar rales
-fluid restriction or cautious administration

Front 47

How can you do a modified V5 lead when you only have 3 leads?

Back 47

-place right arm electrode just to the right of ther sternum
-place left arm electrode in V5 position (5th intercostal space ant axillary line)
-place L leg electrode in normal position
-monitor lead I

Front 48

What leads can evaluate the RCA?

Back 48

II, III, aVF (RA, RV)

Front 49

What leads can evaluate the LAD?

Back 49

V3-5 (ant lat LV)

Front 50

What leads evaluate the circumflex?

Back 50

I, aVL (lateral LV

Front 51

How do you determine if there is LVH on EKG?

Back 51

add up S in V1 and R in V5
- if they add up to >35mm (each box is 1mm) there is probably LVH