Mm Chapter 6. Patient Monitors

Front 1

During catheterization of the internal jugular vein the possibility of placement of a vein dilator or central venous catheter into the carotid artery can be decreased by 2x

Back 1

transducing the intravascular pressure waveform or by comparing the blood's color or PaO2 with an arterial sample.

Front 2

The central venous pressure (CVP) catheter's tip should not be allowed to migrate into

Back 2

into the heart chambers.

Front 3

Relative contraindications to pulmonary artery catheterization include

Back 3

complete left bundle branch block (because of the risk of complete heart block), Wolff–Parkinson–White syndrome, and Ebstein's malformation (because of possible tachyarrhythmias

Front 4

Pulmonary artery pressure should be continuously monitored to detect

Back 4

overwedged position indicative of catheter migration

Front 5

initial decrease in temperature, with actual heat loss being a minor contributor results from

Back 5

Redistribution of heat from warm central compartments (eg, abdomen, thorax) to cooler peripheral tissues (eg, arms, legs) from anesthetic-induced vasodilation explains most of the initial decrease in temperature, with actual heat loss being a minor contributor.

Front 6

During general anesthesia, however, the body cannot compensate for hypothermia because anesthetics inhibit central thermoregulation by interfering with ...

Back 6

hypothalamic function.

Front 7

Standards for Basic Anesthetic Monitoring1

Standard I

Back 7

Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics, and monitored anesthesia care.

Front 8

Standards for Basic Anesthetic Monitoring1

Standard II

Back 8

During all anesthetics, the patient's oxygenation, ventilation, circulation, and temperature shall be continually evaluated

Front 9

Standards for Basic Anesthetic Monitoring1

Every patient receiving anesthesia shall have arterial blood pressure and heart rate determined and evaluated at least

Back 9

every 5 min.*

Front 10

Pulse pressure is

Back 10

the difference between the systolic and diastolic pressures.

Front 11

The mechanical energy of a pressure wave is converted into an electric signal. Most transducers are resistance types that are based on the ____________ stretching a wire or silicone crystal changes its electrical resistance.

Back 11

strain gauge principle:

Front 12

the largest P wave voltages of any surface lead

Back 12

he electrical axis of lead II is approximately 60° from the right arm to the left leg, which is parallel to the electrical axis of the atria, resulting in the largest P wave voltages of any surface lead.

Front 13

lead II enhances the diagnosis of arrhythmias and the detection of

Back 13

inferior wall ischemia.

Front 14

Lead V5 lies over the fifth intercostal space at the anterior axillary line; this position is a good compromise for detecting

Back 14

anterior and lateral wall ischemia

Front 15

The ECG is a recording of

Back 15

electrical potentials generated by myocardial cells

Front 16

Commonly accepted criteria for diagnosing myocardial ischemia include

Back 16

flat or downsloping ST-segment depression exceeding 1 mm, 60 or 80 ms after the J point (the end of the QRS complex),

Front 17

central venous waveform
a waves

Back 17

atrial contraction

Front 18

central venous waveform
c waves

Back 18

due to tricuspid valve elevation during early ventricular contraction

Front 19

central venous waveform
v waves

Back 19

venous return against a closed tricuspid valve

Front 20

central venous waveform
x waveform

Back 20

downward displacement of the tricuspid valve during systole

Front 21

central venous waveform
y descents

Back 21

tricuspid valve opening during diastole.

Front 22

3 Relative contraindications to pulmonary artery catheterization include

Back 22

complete left bundle branch block (because of the risk of complete heart block),
Wolff–Parkinson–White syndrome,
and Ebstein's malformation (because of possible tachyarrhythmias

Front 23

pulmonary artery rupture

Back 23

carries a 50–70% mortality rate and can occur because of balloon overinflation, the frequency of wedge readings should be minimized

Front 24

CI =
NORMAL

Back 24

CO/BSA

2.2-4.2

Front 25

total peripheral resistance =
SVR

NORM =

Back 25

((MAP-CVP)X80)
/ CO

1200 - 1500

Front 26

PVR =

Back 26

PA-Paop x 80
/
CO

Front 27

norm PVR =

Back 27

100 - 300

Front 28

Fick Principle =

Back 28

The amount of oxygen consumed by an individual ( O2) equals the difference between arterial and venous (a–v) oxygen content (C) (CaO2 and CvO2) multiplied by cardiac output (CO).

Front 29

Thus, methemoglobinemia causes a falsely

Back 29

falsely low saturation reading when SaO2 is actually greater than 85% and a falsely high reading if SaO2 is actually less than 85%.

Front 30

Hypothermia, usually defined as

Back 30

a body temperature less than 36°C

Front 31

Postoperative shivering increases oxygen consumption as

Back 31

5-fold, decreases arterial oxygen saturation, and has been shown to correlate with an increased risk of myocardial ischemia and angina

Front 32

postoperative shivering can be effectively treated with

Back 32

intravenous meperidine (25 mg),

Front 33

explains most of the initial decrease in temperature, with actual heat loss being a minor contributor.

Back 33

Redistribution of heat from warm central compartments (eg, abdomen, thorax) to cooler peripheral tissues (eg, arms, legs) from anesthetic-induced vasodilation

Front 34

Normally the ____________ maintains core body temperature within a very narrow range

Back 34

hypothalamus

Front 35

only reliable method of monitoring urinary output.

Back 35

Urinary bladder catheterization

Front 36

Rapid decompression of a distended bladder can cause

Back 36

hypotension

Front 37

Inadequate urinary output (oliguria) is often arbitrarily defined as

Back 37

less than 0.5 mL/kg/h

but actually is a function of the patient's concentrating ability and osmotic load

Front 38

Train-of-four stimulation denotes

Back 38

four successive 200- s stimuli in 2 s

Front 39

Disappearance of the fourth twitch represents a____ block

Back 39

75%

Front 40

the third twitch an___ block

Back 40

80%

Front 41

and the second twitch a ____block

Back 41

90%

Front 42

Clinical relaxation usually requires ____% neuromuscular blockade.

Back 42

75–95

Front 43

______ at 50 or 100 Hz is a sensitive test of neuromuscular function

Back 43

Tetany

Front 44

Sustained contraction for ____ indicates adequate—but not necessarily complete—reversal from neuromuscular blockade.

Back 44

5 s

Front 45

The diaphragm, rectus abdominis, laryngeal adductors, and orbicularis oculi muscles recover from neuromuscular blockade sooner than the_____________

Back 45

adductor pollicis.

Front 46

3 Other indicators of adequate recovery include

Back 46

include sustained ( 5 s) head lift, the ability to generate an inspiratory pressure of at least –25 cm H2O, and a forceful hand grip.

Front 47

ASA standards
Standard I:

Back 47

personnel present in room t/o GA, regional or MAC

Front 48

ASA Standard II:

Back 48

Continuous evaluation of oxygenation, ventilation, circulation and temperature
1. Continuous evaluation of oxygenation AEB O2 measured by an O2 analyzer with a low O2 concentration limit alarm and blood oxygenation measured by pulse ox
2. Continuous evaluation of ventilation AEB chest rise, BS, bag movement, ETCO2, capnography, and mechanical ventilator with audible alarms

Front 49

Exaggeration of SBP and PP occurs as

Back 49

pulse moves peripherally d/t distortion of pressure waveform

Front 50

Radial pressure normally > aortic systolic pressure d/t

Back 50

radial distal location, but after hypothermic CABG radial pressure < aortic pressure d/t decreased vascular resistance in hand. Vasodilating Iso and NTG accentuate this.

Front 51

ABP is assumed to reflect

Back 51

organ BF (flow also depends on vascular resistance, F=P/R)

Front 52

NIBP: Accuracy

Back 52

depends on BP cuff placement (bladder should go > ½ way around the arm and width should be 20-50% > diameter)

Front 53

aTaking pressure too frequently causes
2x

Back 53

nerve palsies and IV extravasation

Front 54

ECG monitoring of leads _________ are necessary to detect anterior and lateral ischemia as well as arrhythmias

Back 54

II and V

Front 55

ischemia may be noted by

Back 55

iii. Flattened ST > 1 mm after QRS J point and T wave inversion = ischemia
Elevated ST > 1 mm wit peaked T’s also = ischemia

Front 56

4 Contraindications for CVP monitoring include

Back 56

renal cell carcinoma extending into the right atrium,
TV vegetation,
ipsilateral CEA,
and pt on anticoagulation

Front 57

The C-line tip should lie at

Back 57

junction of the SVC and the right atrium, exposing the tip to intrathoracic pressures (inspiration will increase or decrease CVP depending on whether ventilation is controlled or spontaneous)

Front 58

safest entry point for cline

Back 58

The right IJ is the safest entry point

Front 59

concerns of C line with

SC
and
left IJ

Back 59

the SC has a HRF pneumothorax and infection, the left IJ has a HRF pleural effusion and vascular erosion

Front 60

Waveform and cardiac contraction:
a =

Back 60

atrial contraction

Front 61

Waveform and cardiac contraction: c =

Back 61

TV closing during ventricular contraction

Front 62

Waveform and cardiac contraction: v =

Back 62

venous return against closed TV

Front 63

Waveform and cardiac contraction: x & y =

Back 63

descents (TV closure during systole & TV opening during diastole)

Front 64

Waveform and cardiac contraction: Not predictive of pulmonary capillary pressure in pt with EF <

Back 64

< 50%

Front 65

PAC is contraindicated with 4X

Back 65

complete left BBB (causes HRF CHB),
WPW and Epstein’s (causes HRF tachyarrhythmias),
bacteremia or
pt with hypercoagulation

Front 66

PAOP is an indirect measure of

Back 66

function (Starling’s law: LVEDV = muscle fiber length if compliance is not abnormally decreased by ischemia, overload, hypertrophy or tamponade

Front 67

Starling’s law:

Back 67

LVEDV = muscle fiber length if compliance is not abnormally decreased by ischemia, overload, hypertrophy or tamponade)

vi. LVEDV (actual preload) and PAOP (estimated preload) relationship is unpredictable in patients with changing LA/LV compliance, MV function, or pulmonary vein compliance as occurs after cardiac/vascular surgery or in critically ill pt on inotropics or in septic shock.

Front 68

CI =

Back 68

CO/BSA(m2) (norm = 2.2-4.2)

Front 69

g. Precordial and esophageal stethoscopes assess breath and heart sounds (muffled heart tones =

Back 69

↓ CO

Front 70

Precordial and esophageal stethoscopes
Contraindicated in 2x

Back 70

with esophageal varices and strictures

Front 71

Oxyhgb absorbs

Back 71

more infrared light (960)

Front 72

Deoxyhgb absorbs

Back 72

more red light (660)

Front 73

The ratio of absorptions at red and infrared wavelengths =

Back 73

O2 sat of arterial blood

Front 74

carboxyhgb and oxyhgb absorb light

Back 74

iv. Both carboxyhgb and oxyhgb absorb light identically, so pulse ox that only reads 2 wavelengths will give a false high reading

Front 75

Methgb absorbs red and infrared

Back 75

1:1 with the resulting sat of 85% (cause a false low when sat is actually > 85% and a false high when sat is actually < 85%)

Front 76

Brain oximetry measures

norm?

Back 76

, arterial and capillary blood saturation to provide an average of all (normally 70%)

Front 77

Capnography
Rapid ↑

Back 77

= MH

Front 78

Capnography
Rapid ↓

Back 78

= air embolism

Front 79

Capnography
Non-diverting/mainstream located

Back 79

inside circuit and problematic

Front 80

Capnography
Diverting/sidestream

Back 80

continuously suck gas from circuit into sample cell and compare the infrared light absorption of CO2 to a chamber free of CO2
1. Diverting units prone to precipitation and obstruction causing inaccuracies

Front 81

↑ CO2 in inspiratory gas =

Back 81

expiratory valve malfunction

Front 82

PaCO2 : ETCO2 gradient

Back 82

2-5 and reflects alveolar dead space

1. ↓ lung perfusion d/t air embolism, ↓CO, or HOTN → ↑ alveoli that are ventilated but not perfused and decreases ETCO2 d/t dilution of CO2

Front 83

Inhalation agents are measured by 3x

Back 83

mass spectrometry, Raman, Infrared or Piezoelectric analysis

i. Most measured by infrared d/t Beer Lambert law
1. Absorption of infrared light passing through solvent = amt of unknown gas
2. O2 and N do not absorb infrared light

Front 84

Piezoelectric analysis uses

Back 84

uses an oscillating quartz crystal covered in lipid
Compares the frequency of oscillation of the uncovered quartz to frequency of IA saturated lipid covered quartz to calculate concentration of IA

Front 85

Paramagnetic uses

Back 85

a magnetic field to expand O2 when on and contract when off

Comparisons of resulting change in volume, pressure or flow to known standard = O2 concentration

Front 86

SSEP assess

Back 86

nerve path patency
(delivers current that transmits to contralateral sensory cortex if pathway is intact → EP)

Front 87

SSEP and MEP are altered by 3x

Back 87

IA,
high dose Benzos
and temp < 32

MEP are also altered by NMB

Front 88

Temperature

Core temp ↓s

Back 88

1-2 C in 1st hour of GA with a gradual ↓ over next 3-4 hours to a point of equilibrium

Front 89

normally maintains temp but cannot during GA

Back 89

Hypothalamus

Front 90

Urinary output

Rapid decompression can cause

Back 90

HOTN

Front 91

UO is a reflection of

2x

Back 91

kidney perfusion and function as well as an indicator of CV, renal and fluid volume status

Front 92

Oliguria is defined as

Back 92

UO < 0.5 ml/kg/hr and reflects concentrating ability and osmotic load

Front 93

Peripheral nerve stimulation

2 Most commonly monitored

Back 93

ulnar adductor pollicis and facial orbicularis occuli

Front 94

To deliver stimulation PNS must generate at

Back 94

a 50 mA current

Front 95

TO4: four successive

Back 95

stimuli in 2 s (2Hz)
Response fades as relaxation increases
Ratio of responses to 1st and 4th twitch is sensitive indicator of NDM paralysis
3 twitches = 75% blockade
2 twitches = 80% blockade
1 twitch = 90% blockade

Front 96

Clinical relaxation requires __________ blockade

Back 96

75% - 95%

Front 97

Tetany delivered at ______ Hz with sustained contraction for____ indicates adequate but not necessarily complete reversal from NM blockade

Back 97

50 – 100

5 s

Front 98

3 test indicate adequate recovery

Back 98

Sustained head lift,
forceful hand grip,
and ability to generate > -25 insp pressure