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25 Cards in this Set
- Front
- Back
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On the EKG, where does electrical systole begin? |
peak of the R wave
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On the CVP tracing, where does electrical systole begin?
What does this coincide with on the EKG? |
At the notch consisting of x prime (downsweep)and the c wave (upsweep).
This coincides with the peak of the R wave on the EKG. |
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True or false: The R wave is at the beginning of ventricular ejection
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FALSE, the R wave is at the beginning of ventricular systole which is isovolumetric.
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How does hyperkalemia causes cardioplegia?
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K+ moves out of cell and does not allow repolarization.
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The ventricle arrests in what cardiac phase? Why?
YOU WILL SEE THIS ON AN EXAM!! |
Diastole
The K+ overwhelms the NA/K+ ATPase dependent pump, preventing repolarization. |
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What does cooling the heart in bypass do?
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Decreases the metabolic demands.
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What are the best leads for monitoring the heart intraop? What walls are you seeing?
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II-inferior
v3,v4-anterior wall |
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What are the best leads for atrial monitoring?
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lead I II III
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Manual BP listens for what sounds-what phase represents sytole? diastole?
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Korotkoff sounds
phases I&II systole phase V-diastole |
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how does the dynamap work?
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Oscillometric BP-measures the mean by recording the peak plateau of flow and resistance and using an algorithm to calculate SBP and DBP.
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What is a critical component to correct measurement with oscillometric BP?
What else is crucial to correct reading? |
cuff SIZE
applied properly (tight) don't touch during reading |
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Where is the oscillometric SBP most accurate?
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When mean is between 50-80.
When mean is >90, there is a statistically signifcant underestimation of SBP Therefore if arterial waveform morphology is normal, trust it! {Given transducer is at correct height:)} |
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What is the driving force of the arterial pulse?
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Change in pressure/change in time or intrinsic contractility of LV
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What is the opposing force of the arterial pulse?
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1. resistance-viscosity/geometry(dilation vs, constriction)
2. inertia-mass vs. accelaeration 3. compliance-vascular distensibility |
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What hct is needed to maintain SVR? why?
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15%
the main component of SVR is viscosity high output failure occurs with low viscosity |
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What happens to the SBP as you get farther from the heart? DBP?
MAP? |
SBP_higher
DBP-lower MAP consistent |
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In the arterial waveform, the dicrotic notch signals.....?
This is the beginning of the _________phase. |
Aortic vavle closure
diastolic phase |
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timing the IABP, you inflate on_______ and deflate on________.
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inflate on dicrotic notch
deflate on anacrotic rise (R wave on EKG) |
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As SVR icreases the dicrotic notch_______.
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gets higher.
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Name some factors that prevent an accurate arterial waveform
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apropriate catheter size
low compliance tubing no more than 3-4 feet of tubing free of bubbles minimal stopcocks/devices one inch height diff=2mmHg pressure sensitivity of system-change at least q 72 hrs |
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How do you test an a line for over/underdamping?
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square wave configuration test
pull pigtail- normal damping =normal waveform after 2-3 bounces overdamped = long, low bounces-probably due to air bubbles, several stopcocks or VAMP underdamped= several high sharp bounces -catheter whip, additive harmonic resonance |
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Arterial waveform pathology: describe aortic stenosis
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delayed upstroke, poorly formed dicrotic notch, narrowed pulse pressure
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Arterial waveform pathology:
describe Pulsus Paradoxus |
Systolic pressure varies more than 10 mmHg, preload phenomenon(SBP dec with inspiration, inc HR), pericardial pressure creates a venous pressure obstruction.
Reverse physiology in positive pressure ventialtion(preload decreases with pos pressure breath, SBP goes up, exhale, SBP goes down) |
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Arterial waveform morphology:
describe afib |
rhythm phenomenon
varying preload no atrial kick, ( no atrial contibution to CO, as rate inc, CO falls) |
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Arterial waveform morphology:
describe pulsus alternans |
volume phenomenon
related to intrathoracic pressure changes and respiratory cycle reflecting failing ventricular performance (seen in very poor EF-Coreg is a clue!) |
