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51 Cards in this Set
- Front
- Back
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What effects BP
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Stress
Age Positive Pressure Vent Disease Lead Pipe Syn (max dilation or constriction) |
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Flow =
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Pressue/Resistance
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R=
(R= Perph Resistance |
P/Q
(P= Mean Art Press) (Q= Cardiac Output) |
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P=
P = MAP |
R x Q
= Perph Resist x C.O. |
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If pressure is high, if resist is also high then flow is
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diminished
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BP is an indicator of
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organ perfusion not a measure of it.
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Pulse Pressure =
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Systolic - Diastolic
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Narrow Pulse Pressure
Increased diastolic bp = |
decreased compliance of vessels
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Korotkoff Phases
1 = |
Sharp, clear sound 120-110
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Korotkoff Phases
2= |
Blowing/swishing 109-100
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Korotkoff Phases
3= |
Sharp but softer than 1
99/88 |
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Korotkoff Phases
4= |
Muffled/Fading
82/87 |
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Korotkoff Phases
5= |
No Sound <81
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Korotkoff Phases
Systole is between what phases |
1-4
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Korotkoff Phases
distole is between what phases |
Starts between 4-5
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Properly fitting BP cuff is
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+20% of arm
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BP cuff that is too smaller will
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Make BP artifically high
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BP cuff that is too big will
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Make BP artifically low
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What is a Bare Block
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Inflating BP and using lidocaine and performing surg on the arm.
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Automated BP techniques
Advantages |
hand free to do other tasks
observer error avoided alarms available Intermit readings |
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Automated BP techniques
Disadvantages |
Time dependent
<50 will recycle Mechanical/arm position |
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BP readings: What is more important Absolute or trends of readings
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Trends point in the direction that you are headed
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How does auto BP cuff hear
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Hear Oscillations, picks up highest amplitude= MAP. Alogirthim in the machine figures Sys/Diatolic based on MAP
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BP cuff will automactically inflate to what pressure on the first attempted reading
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160mmHg
after it will inflate 20mmHg higher than last Sys. |
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Indications for Invasive BP monitoring
Absolute= always Relative = judgement |
Major cardiac surg- requires bypass
Major vasc surg (poss hemo instability, large bld loss) Surg procedures needing strict monitoring (CAD, Neurosurg, deliberate hypotension) Multi ABG or bld draws (>3) |
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Type of catheter for A-line
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non tapered teflon (less thrombogenic)
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Process of Placing A-line
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1) Assess Pulses
2) Hyperflex wrist 3) Lidocaine 4) Insert cath 45 deg 5) Flash -> flatten 30 deg 6) Advance cath, 7) apply press, connect tubing |
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Pressure Bag is inflated to what pressure
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250-300mmHg
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How much saline flows through
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2-3ml/hr
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What is a transducer
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Transducer is a straingauge
displaces diaphram, changes mechanical into electrical energy |
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Wheatstone Bridge
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Electronic based upon strain gauge, balanced electronic device
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What is the diacrotic notch
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closing of the aortic valve
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A wide waveform
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Root of the aorta
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A narrow waveform
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perph art (inc ht of wave)
very narrow in dorsalic pedis |
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Resonace Frequency
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40Hz movement of the system without being hooked up
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Inadequate Resonance
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overshoot caused from the tubing
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Calibration of the A line
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Transducer to midaxillary = ht of R atria, 0 to air
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Return to flow technique
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Checking after a line is placed with return flow to determine if there is a difference
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Advantanges of direct technique
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Accuracy
shock induced hypotension Continous record Shape of wave No observer bias Intermittent sampline Determine if ectopic beats are perfusing |
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DisAdvantanges of direct technique
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Risk of art damage
technical expertise required cost infection thrombosis (distal to aline = cold= clot/ischemia |
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MAP=
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Diastolic Pressure + 1/3 (sys-dias press)
SBP + 2(DBP)/3 |
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Autoregulation of Brain and kidneys like what pressure
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50mmHg
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Increase CO2 affects the brain by
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inc CO2 = inc cerebral perfusion
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MAP 60-100
Out of range <60 |
Becomes pressure dependent
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>160
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Brain sees the pressure
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Causes of Inc ICP
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CSF, Blood, hydrocephalus,tumor, trauma
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Cushings Traid
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Inc BP, brady, inc ICP (herniation)
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Cushings Traid TX
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Hyperventilation, mannitol draw off CSF (done in phase of 1& 2 not 3&4 d/t hernia
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MAP = what % of Pt's range of pressures where BP's are normally
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20%
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Chronic HTN affects compliance curve
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shifts curve to the right
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Once the head is open the transducer can
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measure CPP at the level of the head
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