Shared Flashcard Set

Details

Monitors
NA
43
Chemistry
Graduate
04/29/2011

Additional Chemistry Flashcards

 


 

Cards

Term
Normal values for cardiac output, cardiac index, and pulmonary artery pressures.
Definition
CO:4-7L/min
CI: 2.5-4L/min/m2 of BSA
PAP: 30s/10d with mean <20
Term
What is normal CVP,right ventricle pressure,PAW?
Definition
CVP: 0-5
RVP: 30/5
PAW/PAOP: <20
Term
Name normal left atrial, left ventricle, and aortic pressures?
Definition
LAP: <12m
LVP: 140/12
Aorta: S<140, D<90, M: 70-90
Term
Name equation for MAP
Definition
(systolic-diastolic)/3 + diastolic
Term
Normal ICP values
Definition
Normally 7-18 cm water, measured in lumbar area
In lateral recumbent 13 cm water
If sitting 37-55 cm water
Term
Law of La Place
Definition
sphere: P=2t/r
cylinder:P(2RL) = T(2L) or T = PR
• Where
o P = pressure at outlet
o T = tension of wall
o R = radius of wall
• Note
o If the wall is stationary, the outward and inward forces
across it are equal.
o Cross-sectional area: A = 2RL
o Distending force (outward pressure times area):
PA = P(2RL)
o Restraining pressure acting inward (tension times
length): T(2L)
Term
Describe BP variance with respiration
Definition
Inhalation causes a decrease intrathoracic pressure that aids venour return. Exhalation does the opposite.
Term
Describe BP variance under mechanical ventilation.
Definition
PPV= increased intrathoracic pressure, decreased venous return, especiallly during inspiration. Decreased art. line amplitude under PPV= pt is dry.
Term
SVR equation
Definition
SVR=[(MAP-CVP)x80]/CO
nomal is 1500-1900 dynes/sec/cm-5
As resistance increases, flow (perfusion) decreases
Term
Increased SVR
Definition
Adaptive in low volume states
Maladaptive post MI where it decreases tissue perfusion and increases cardiac afterload
Also seen during SNS response, increased catecholamine release
Term
Decreased CO
Definition
Caused primarily by decreased venous return in a variety of conditions
Term
Causes of increased CO
Definition
Septic shock (early), nipride, increased metabolism, etc. Will have a higher mv02
Term
Hemodynamic trends in septic shock
Definition
decreased PCW, MAP, SVR. Increased CI.
Term
Hemodynamic trends in cardiogenic shock.
Definition
Decreased MAP, CI. Increased PCW and SVR
Term
Hemodynamic trends in hemhorragic shock
Definition
Decreased MAP, CI, PCW. Increased SVR.
Term
Modified Allen's Test
Definition
Shows Ulnar nerve patency. To be done before art line insertion
Term
List circumstances in which PWP may not equal LVEDP
Definition
Stiff and noncompliant LV, mitral valve disease, LA hypertrophy or pulmonary disease (normal PWP with elevated LAP)
Term
List circumstances in which CVP will not reflect accurate LVEDP
Definition
pulmonic and tricuspid valve problems. RAP is influenced by volume, venous tone, increased PVR
Term
CVP reflects...
Definition
RAP, RVEDV, preload,
Term
RAP reflects...
Definition
cardiac function, venous return to the heart.
Term
4 determinants of cardiac function
Definition
preload, afterload, HR, contractility
Term
Name components of CVP waveform
Definition
a wave:right atrial contraction, p wave
c wave: tricuspid valve bulge during early RV contraction. QRS
x descent: downward movement of RV during contraction. Before T wave
v wave:RA full and tricuspid is bulging. As T wave is ending
y descent: Tricuspid open, RV diastole, before p wave.
Term
Pathologic CVP waveforms
Definition
Afib: no A waves
AV dissociation: Cannon A waves. Increased in size
Tricuspid regurg: looks like artline waveform. c wave and x descent replaced by regurg wave. False high mean, look at pressures between regurg waves
Tamponade: all pressures elevated, y descent small or gone
Term
Contraindications to SWAN
Definition
relative: WPW, Ebstein's malformations, L BBB, left fascicular block
Term
Instances where PCWP overestimates LVEDP
Definition
chronic mitral stenosis, PEEP, LA myxoma, pulmonary HTN
Term
Instances where PAWP underestimates LVEDP
Definition
Things that increase LV pressure: stiff LV, LVED>25 mm Hg, Aortic Insufficiency
Term
Relationship between PCWP and PAEDV
Definition
In absence of PVR, difference is 1-4 mm Hg
Term
Determinents of preload
Definition
1. atrial pressure (venous pressure and return)
2. HR
3. ventricular distensibility (compliance)
Term
Depolarizing neuromuscular blockers
Definition
Succ. Ach receptor agonist. Metabolized by pseudocholinesterase
Term
Nondepolarizing neuromuscular blockers
Definition
Ach competative antagonists. No depolarization.Reversal of their blockade depends on redistribution, gradual metabolism, excretion, or administration
of specific reversal agents (cholinesterase inhibitors) that inhibit acetylcholinesterase enzyme activity.
Term
TOF
Definition
Train of four is four supramaximal stimuli every 0.5 sec (2 Hz).
T4 is lost at 80% receptor occupancy, T3 at 85%, T2 at 90%, T1 at 95%
Term
Phase I Block
Definition
A phase I block (depolarizing blockade-Succinylcholine) does NOT exhibit fade during train of four. If enough Succinylcholine is
given, however, you can witness a phase 2 blockade. This usually occurs with repeated dosing and succinylcholine infusions.
Term
Phase II BLock
Definition
The occurrence of fade, a gradual lessening of evoked response, is
characteristic of nondepolarizing blockade. This is a phase II block.
Term
Tetanic Stimulation
Definition
Characterized by:
o Fade and post-tetanic facilitation (NDMR and phase II depolarizing block) or
o Diminished height from control without fade or PTF (depolarizing block).
• Disadvantages: It is painful and may produce lasting antagonism of block during recovery. It may also hasten onset by
increasing blood flow to the limb.
Term
Post-Tetanic Count
Definition
Post-tetanic count (PTC) - Apply tetanus at 50 Hz x 5 sec, wait 3 sec, then begin single twitch at 1 Hz.
• Number of PTCs correlates inversely with time to recovery of a deep block.
Term
Double Burst Stimulation
Definition
This is a mode consisting of two short bursts of 50 Hz tetanic stimulation separated by 750 msec.
• The aim is to allow tactile detection of small amounts of residual blockade under clinical conditions (more sensitive than TOF in
detecting residual paralysis).
Term
Extubation parameter and associated NIFs
Definition
Parameter Negative Inspiratory Pressure (cm H2O)
Control -90
Head lift 5 sec -53
Effective swallow -43
Patent airway with jaw lift -39
Term
Evoked Potentials
Definition
Can be sensory, motor, visual or auditory
Signals are produced as a nervous system response to stimuli, and altered signals can indicate dysfunction
Latency – time between the stimulus and potential
Amplitude – intensity or height of stimulus
Term
Somatosensory Evoked Potentials (SSEP)
Definition
Monitor the integrity of the sensory spinal cord (dorsal columns)
Can warn against spinal cord ischemia (posterior spinal arteries)
Technology is square-wave signals with sensory input, transfer to sensory (posterior) cord, then to the
thalamus and eventually the sensorimotor cortex
Volatile anesthetics decrease amplitude and increase latency of SSEPs. Use about 0.5 MAC of a volatile
agent and no greater than 50-60% N20
Term
BIS monitor
Definition
(Bispectral) monitor is used to measure depth of anesthesia.
• Data measured by EEG (electroencephalography) are taken through a number of steps to calculate a single number that
correlates with depth of anesthesia and hypnosis.
• BIS monitoring may reduce patient awareness and resource utilization in terms of drugs. It may also help facilitate a faster wakeup
time. Many of the initial studies were observational in nature and not randomized, prospective trials.
Term
BIS Scale
Definition
100 – awake
90-70 light/moderate sedation
70-60 deep sedation (low probability of recall)
60-40 general anesthesia
40-10 deep hypnotic state
10-0 flat EEG
Term
Sudden increase in BIS
Definition
Increased stimulation
Decreased anesthetic level
Vaporizer malfunction
Movement
Bair Hugger interference
Term
Sudden decrease in BIS
Definition
Decrease in surgical stimulation
Hypothermia
Lead placement
Supporting users have an ad free experience!