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43
Chemistry
04/29/2011

Term
 Normal values for cardiac output, cardiac index, and pulmonary artery pressures.
Definition
 CO:4-7L/minCI: 2.5-4L/min/m2 of BSAPAP: 30s/10d with mean <20
Term
 What is normal CVP,right ventricle pressure,PAW?
Definition
 CVP: 0-5RVP: 30/5PAW/PAOP: <20
Term
 Name normal left atrial, left ventricle, and aortic pressures?
Definition
 LAP: <12mLVP: 140/12Aorta: 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 areaIn lateral recumbent 13 cm waterIf sitting 37-55 cm water
Term
 Law of La Place
Definition
 sphere: P=2t/rcylinder:P(2RL) = T(2L) or T = PR• Whereo P = pressure at outleto T = tension of wallo R = radius of wall• Noteo If the wall is stationary, the outward and inward forcesacross it are equal.o Cross-sectional area: A = 2RLo Distending force (outward pressure times area):PA = P(2RL)o Restraining pressure acting inward (tension timeslength): 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]/COnomal is 1500-1900 dynes/sec/cm-5As resistance increases, flow (perfusion) decreases
Term
 Increased SVR
Definition
 Adaptive in low volume statesMaladaptive post MI where it decreases tissue perfusion and increases cardiac afterloadAlso 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
Term
 RAP reflects...
Definition
Term
 4 determinants of cardiac function
Definition
Term
 Name components of CVP waveform
Definition
 a wave:right atrial contraction, p wavec wave: tricuspid valve bulge during early RV contraction. QRSx descent: downward movement of RV during contraction. Before T wavev wave:RA full and tricuspid is bulging. As T wave is endingy descent: Tricuspid open, RV diastole, before p wave.
Term
 Pathologic CVP waveforms
Definition
 Afib: no A wavesAV dissociation: Cannon A waves. Increased in sizeTricuspid regurg: looks like artline waveform. c wave and x descent replaced by regurg wave. False high mean, look at pressures between regurg wavesTamponade: 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
Definition
 1. atrial pressure (venous pressure and return)2. HR3. 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 administrationof 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 isgiven, 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, ischaracteristic 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) oro 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 byincreasing 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 indetecting residual paralysis).
Term
 Extubation parameter and associated NIFs
Definition
 Parameter Negative Inspiratory Pressure (cm H2O)Control -90Head lift 5 sec -53Effective swallow -43Patent airway with jaw lift -39
Term
 Evoked Potentials
Definition
 Can be sensory, motor, visual or auditorySignals are produced as a nervous system response to stimuli, and altered signals can indicate dysfunctionLatency – time between the stimulus and potentialAmplitude – 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 thethalamus and eventually the sensorimotor cortexVolatile anesthetics decrease amplitude and increase latency of SSEPs. Use about 0.5 MAC of a volatileagent 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 thatcorrelates 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 wakeuptime. Many of the initial studies were observational in nature and not randomized, prospective trials.
Term
 BIS Scale
Definition
 100 – awake90-70 light/moderate sedation70-60 deep sedation (low probability of recall)60-40 general anesthesia40-10 deep hypnotic state10-0 flat EEG
Term
 Sudden increase in BIS
Definition
 Increased stimulationDecreased anesthetic levelVaporizer malfunctionMovementBair Hugger interference
Term
 Sudden decrease in BIS
Definition