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51 Cards in this Set

  • Front
  • Back
What effects BP
Stress
Age
Positive Pressure Vent
Disease
Lead Pipe Syn (max dilation or constriction)
Flow =
Pressue/Resistance
R=
(R= Perph Resistance
P/Q
(P= Mean Art Press)
(Q= Cardiac Output)
P=
P = MAP
R x Q
= Perph Resist x C.O.
If pressure is high, if resist is also high then flow is
diminished
BP is an indicator of
organ perfusion not a measure of it.
Pulse Pressure =
Systolic - Diastolic
Narrow Pulse Pressure
Increased diastolic bp =
decreased compliance of vessels
Korotkoff Phases
1 =
Sharp, clear sound 120-110
Korotkoff Phases
2=
Blowing/swishing 109-100
Korotkoff Phases
3=
Sharp but softer than 1
99/88
Korotkoff Phases
4=
Muffled/Fading
82/87
Korotkoff Phases
5=
No Sound <81
Korotkoff Phases
Systole is between what phases
1-4
Korotkoff Phases
distole is between what phases
Starts between 4-5
Properly fitting BP cuff is
+20% of arm
BP cuff that is too smaller will
Make BP artifically high
BP cuff that is too big will
Make BP artifically low
What is a Bare Block
Inflating BP and using lidocaine and performing surg on the arm.
Automated BP techniques
Advantages
hand free to do other tasks
observer error avoided
alarms available
Intermit readings
Automated BP techniques
Disadvantages
Time dependent
<50 will recycle
Mechanical/arm position
BP readings: What is more important Absolute or trends of readings
Trends point in the direction that you are headed
How does auto BP cuff hear
Hear Oscillations, picks up highest amplitude= MAP. Alogirthim in the machine figures Sys/Diatolic based on MAP
BP cuff will automactically inflate to what pressure on the first attempted reading
160mmHg
after it will inflate 20mmHg higher than last Sys.
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)
Type of catheter for A-line
non tapered teflon (less thrombogenic)
Process of Placing A-line
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
Pressure Bag is inflated to what pressure
250-300mmHg
How much saline flows through
2-3ml/hr
What is a transducer
Transducer is a straingauge
displaces diaphram, changes mechanical into electrical energy
Wheatstone Bridge
Electronic based upon strain gauge, balanced electronic device
What is the diacrotic notch
closing of the aortic valve
A wide waveform
Root of the aorta
A narrow waveform
perph art (inc ht of wave)
very narrow in dorsalic pedis
Resonace Frequency
40Hz movement of the system without being hooked up
Inadequate Resonance
overshoot caused from the tubing
Calibration of the A line
Transducer to midaxillary = ht of R atria, 0 to air
Return to flow technique
Checking after a line is placed with return flow to determine if there is a difference
Advantanges of direct technique
Accuracy
shock induced hypotension
Continous record
Shape of wave
No observer bias
Intermittent sampline
Determine if ectopic beats are perfusing
DisAdvantanges of direct technique
Risk of art damage
technical expertise required
cost
infection
thrombosis (distal to aline = cold= clot/ischemia
MAP=
Diastolic Pressure + 1/3 (sys-dias press)

SBP + 2(DBP)/3
Autoregulation of Brain and kidneys like what pressure
50mmHg
Increase CO2 affects the brain by
inc CO2 = inc cerebral perfusion
MAP 60-100
Out of range <60
Becomes pressure dependent
>160
Brain sees the pressure
Causes of Inc ICP
CSF, Blood, hydrocephalus,tumor, trauma
Cushings Traid
Inc BP, brady, inc ICP (herniation)
Cushings Traid TX
Hyperventilation, mannitol draw off CSF (done in phase of 1& 2 not 3&4 d/t hernia
MAP = what % of Pt's range of pressures where BP's are normally
20%
Chronic HTN affects compliance curve
shifts curve to the right
Once the head is open the transducer can
measure CPP at the level of the head