The quiz for our LAST technology test! Sweet. . . . . .
Auscultation
Arterial Tonometry
Arterial Line
Oscillometry
Mean Arterial pressure
Systolic BP
Diastolic BP
Ventricular Contractility
Equal to diameter of arm
70-80% of arm diameter
20-50% greater than the diameter of arm
Twice arm diameter
Compartment Syndrome
Sciatic Nerve Parasthesia
Thrombophlebitis
Limb edema & pain
Immediately start CPR, the patient must be in PEA.
Send someone to go get another BP cuff for you.
Check for radial pulse, since Systolic must be at least 80 if you can palpate radial pulse.
Insert a central line.
Lower, lower
Higher, higher
Lower, higher
Higher, lower
Laminar, Poiseiulles
Turbulent, Renolds
Mixed, Poiseiulles
Determined by gradients, Ficks
Aorta
Femoral
Subclavian
Radial
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End organ disease which necessitates precise beat-to-beat blood pressure measurement.
Need for multiple ABG’s and labs during case.
Severe hypertension
Anticipation of wide blood pressure swings
True
False
Femoral
Ulnar
Brachial
Radial
Brachial
Femoral
Subclavian
Jugular
Brachial
Femoral
Radial
Ulnar
True
False
The line is inserted improperly and needs to be adjusted
The patient may be hypertensive.
The patient may have a very low SVR.
Nothing, so long as the notch is there it is good.
Strain Gauge Technique
High Anterior technique
Wheatstone technique
Seldinger Technique
Your MAP will still be relatively accurate
You diastolic BP will be underestimated
Your systolic BP will be overestimated
You will have unusually high pressure readings.
Acute burn patient with need for aggressive fluid management
A patient with severe atherosclerosis who recently had a carotid endarterectomy and is on an anticoagulant drip.
Septic patient who will need several caustic drugs as well as hyperalimentation infused.
A patient in 3rd degree heart block who requires emergent insertion of transvenous pacing wires.
Left Internal Jugular
Right Femoral
Right Internal Jugular
Left Subclavian
First, obtain a blow gun. Then standing far enough away where the patient can’t see or attempt to hit you, insert a dart into the gun…. Aim at his neck…. And BLOW.
Find the point that sternal and clavicular heads join the sternocleidomastoid, insert needle 30 degrees at ipsilateral nipple
Posterior border of sternocleidomastoid and external jugular vein, ispsilateral corner of the sternal notch
At cricoid level, lateral to carotid, insert needle 30 degrees ipsilateral nipple. Start with 22g finder needle.
Give the needle to your preceptor and say "pretty please? Can you insert this for me?"
Find the point that sternal and clavicular heads join the sternocleidomastoid, insert needle 30 degrees at ipsilateral nipple
Posterior border of sternocleidomastoid and external jugular vein, ispsilateral corner of the sternal notch
At cricoid level, lateral to carotid, insert needle 30 degrees ipsilateral nipple. Start with 22g finder needle.
Atrial pressure during contraction
Bulging tricuspid, early ventricular contraction
Tricuspid valve opening during diastole
Venous return(atrium filling) against a closed tricuspid valve
Atrial pressure during contraction
Bulging tricuspid, early ventricular contraction
Tricuspid valve opening during diastole
Venous return(atrium filling) against a closed tricuspid valve
Downward movement of the ventrical during systole
Bulging tricuspid, early ventricular contraction
Tricuspid valve opening during diastole
Venous return(atrium filling) against a closed tricuspid valve
Atrial pressure during contraction
Bulging tricuspid, early ventricular contraction
Tricuspid valve opening during diastole
Venous return(atrium filling) against a closed tricuspid valve
Downward movement of the ventrical during systole
Bulging tricuspid, early ventricular contraction
Tricuspid valve opening during diastole
Venous return(atrium filling) against a closed tricuspid valve
In the Right Atrium
At junction of superior vena cava
In the pulmonary artery
In the radial artery
Right Atrium
Left Atrium
Right Ventricle
Left Ventricle
Pneumothorax
Complete heart block in pts with Left BBB.
Cardiac Perforation
Air Embolism
60%
90%
75%
100%
Open up your bag of IV fluids to infuse quicker and add volume.
Start a dopamine drip
Start a nitro drip
Give some lasix
RV failure, give vasodilators
LV failure, give inotropes.
Pulmonary edema, give diuretics
Hypervolemia, give diuretics
0-3 mm HG
5-10 mm HG
12-18 mm HG
15-30 mm HG
Nothing, these values are fine.
Pt has LV failure, give inotropes.
Pt is hypovolemic, give volume
Pt is in RV failure, give vasodilators.
30 cm
50 cm
10 cm
20 cm
Hypovolemia
Cardiac Tamponade
Pulmonary HTN
Chronic LV failure
Loss of A waves
Giant Cannon A waves
Larger V waves
Loss of C waves
Loss of A waves
Giant Cannon A waves
Larger V waves
Loss of C waves
Loss of A waves
Giant Cannon A waves
Larger V waves
Loss of C waves
Pulm Venous Pressure > alveolar pressure > PAP
PAP > Pulm venous pressure > Alveolar pressure
Physiologically, not anatomically, defined so it can change.
Located in Pulmonary Vein
Alveolar pressure > PAP > pulm venous pressure
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Left Ventricular failure
Mitral Regurge
Pulmonary HTN
Ischemia
The v wave occurs at the RST junction
The a wave occurs just after the P wave
The v wave occurs at the end of the QRS complex
The c wave occurs after the T wave
The RV systolic pressure is usually more than 10 mm Hg higher than the PA systolic pressure
The RV diastolic and PA systolic pressure are similar
The RV diastolic pressure is lower than the PA diastolic pressure
The mean RV pressure is higher than the mean PA pressure
The pulmonary artery occlusion pressure is measured through the most proximal catheter port
Inflation of the balloon momentarily stops the flow of blood and creates a static column of blood between the tip of the catheter and the right atrium
The PAOP waveform often contains 3 positive waves (a, c, v)
During inflation of the balloon the pulmonary artery pressure changes to a right ventricular waveform
The balloon should remain inflated for at least 45 seconds to insure an optimal seal within the pulmonary artery
Air should be aspirated from the balloon with a syringe following the measurement procedure
“Overwedging” can only occur with excessive balloon inflation
The pulmonary artery occlusion pressure is lower than the mean pulmonary artery pressure
Hemodynamic pressures rise during inspiration in a patient breathing spontaneously
Hemodynamic pressures fall during inspiration in a patient receiving positive-pressure mechanical ventilation
Hemodynamic pressures should be read at end-expiration in a patient breathing spontaneously
Hemodynamic pressures should be read at peak-inspiration in a patient receiving positive-pressure ventilation
Increase CVP, CI, PCWP, & PAP
Increase CVP. Decrease CI, PCWP, & PAP
Increase CVP, PCWP, & PAP. Decrease CI.
Decrease CVP, CI, PCWP, & PAP
15-25
5-15
0-5
25-40
He most likely has right ventricular failure.
He is hypervolemic.
He is hypovolemic.
He most likely has left ventricular failure.
In the center of forehead, 2 inches from bridge of nose
At the patients temple, level with their eye
Directly above the patients eyebrow.
On the right side of the pts face, adjacent to electrode #2
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