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10 Cards in this Set

  • Front
  • Back
Goal of cardiac monitoring
Assess the quality of myocardial
performance (SV)
Preload
Afterload
Contractility
ECG monitoring does not guarantee what?
contraction or perfusion
ECG monitoring detects what?
Conduction abnormalities
Problems with perfusion
Pacemaker malfunctions
Electrolyte disturbances
ECG-Lead Selection
Get pre-induction strip****
Document ST – trending (note the leads)
Leads II and V5 – gold standard – 95% of ischemic changes on 12 lead EKG can be picked up with these leads.
Unipolar vs bipolar system
Lead II
P wave identification
Inferior wall ischemia..ST depression
Lead V5
Anterior and lateral wall ischemia
Place at 5th intercostal space..left anterior axillary
BP Methods
Take every 3-5 min**
Doppler
obese and FHT’s
Automated –Nerve palsies
often with obesity it is easier to put in an art line
BP Methods #2
Hand with highest cuff pressure
(if measuring both arms)
When do we use invasive BP/monitoring?
Patient : Hemodynamically unstable, CAD, pulmonary disease, frequent ABG needed, hypothermic or hyperthermic,
Surgery: Chest surgery, Brain, CABG (no pulsatile flow)
Anesthesia Technique: Low perfusion states
Central Venous Pressure Why place this?
Venous access
Large fluid shifts
Poor peripheral access
Access for transvenous pacing
Estimates preload - right side filling pressure (RVEDP) – or volume status
CVP monitor
Measure to check for volume status
Place it in R atrium if looking for waveform
Put in junction for monitoring
Put in Right atrium for aspirating back for air embolism
TEE
Based on principles of ultrasound
Can “see” heart volume and contractility status
i.e. wall motion irregularities