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Monitoring© Jones & Bartlett Learning, LLC NOT for SALE OR DISTRIBUTION NOT for SALE OR DISTRIBUTION CONTENTS © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 3 © Jones & Bartlett Learning, LLC Monitoring© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CONTENTS ■■ Intraoperative Monitoring Standards ■■ EKG © Jones & Bartlett■■ Cuff Blood Learning, Pressure LLC © Jones & Bartlett Learning, LLC NOT FOR SALE■■ Arterial OR LineDISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ Central Venous Catheter (CVP) or CV Catheter (CVC) ■■ Pulmonary Artery Catheterization (PAC) Monitors or PA Pressure (PAP) © Jones & Bartlett Learning,■■ Mixed LLC Venous Oxygen Saturation © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION(SvO2 or MvO2) NOT FOR SALE OR DISTRIBUTION ■■ Transesophageal Echocardiograph (TEE) ■■ Leveling Transducer and Calibrating Invasive Lines ■■ Pulse Oximetry ■■ Capnography and ETCO2 © Jones & Bartlett Learning, LLC ■■ Neuromuscular Blockade© Jones Monitoring & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION ■■ Neurologic: EEG andNOT BIS FOR SALE OR DISTRIBUTION ■■ Neurophysiology Monitoring ■■ Temperature Monitoring © Jones & Bartlett Learning, LLC 83 © Jones & Bartlett Learning, LLC NOT FOR SALE© Jones OR & Bartlett DISTRIBUTION Learning, LLC. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284115147_CH03_083_136.indd 83 27/10/16 2:37 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 84 Chapter 3 Monitoring NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ 3.1 Intraoperative Monitoring Standards Basic Monitoring Standards During all anesthetics, the patient’s oxygenation, ventila- tion, circulation, and temperature should be continually © Jones & Bartlett Learning, LLC evaluated. © Jones & Bartlett Learning, LLC • Oxygenation: FiO2 analyzer; pulse oximetry NOT FOR SALE OR DISTRIBUTION • Ventilation: capnography;NOT disconnect FOR alarm SALE OR DISTRIBUTION • Circulation: EKG, blood pressure, pulse oximetry • Temperature: temperature probe No monitor, however, replaces the presence of a vigilant an- esthesia provider. Through the use of visualization, palpation, and auscultation the adequacy of circulation, ventilation, © Jones & Bartlettand temperature Learning, can be assessed. LLC The use of technology © Jones & Bartlett Learning, LLC NOT FOR SALEincreases OR your abilityDISTRIBUTION to do this monitoring quickly and NOT FOR SALE OR DISTRIBUTION efficiently, but none of these advances replaces YOU. ■■ 3.2 EKG Monitors The EKG may provide the first indication of myocardial ischemia intraoperatively. © Jones & Bartlett Learning,Lead placementLLC is important in ischemia detection.© Jones & Bartlett Learning, LLC • V5 = 75% sensitive for ischemic event NOT FOR SALE OR DISTRIBUTION• II + V5 = 80% sensitive for ischemic event NOT FOR SALE OR DISTRIBUTION • II + V4 + V5 = 98% sensitive for ischemic event 3-lead System Bipolar: one lead positive and the other negative. The 3-lead system can give pictures of the heart’s electrical activity from 3 angles. Allows monitoring of leads I, II, and © Jones & Bartlett Learning, LLC III. Only one lead can be ©examined Jones at a time.& Bartlett Lead II is best Learning, LLC NOT FOR SALE OR DISTRIBUTION for detecting P waves. NOT FOR SALE OR DISTRIBUTION Augmented Limb Leads Unipolar: right (aVR), left (aVL), and foot (aVF) Records the electrical difference between the right and left arms and the left foot (all positive leads) utilizing a © Jones & Bartlettcentral negative Learning, lead. LLC © Jones & Bartlett Learning, LLC NOT FOR SALE© Jones OR & Bartlett DISTRIBUTION Learning, LLC. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284115147_CH03_083_136.indd 84 07/11/16 3:05 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chapter 3 Monitoring 85 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION –+I RA LA – – © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION III II © Jones & Bartlett Learning, LLC + © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION+ NOT FOR SALE OR DISTRIBUTION LL Figure 3-1 EKG Lead System Monitors © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION aVR ++aVL – – © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION + aVF © Jones & Bartlett Learning,Figure 3-2 EKG Augmented LLC Leads © Jones & Bartlett Learning, LLC NOT FOR SALE© Jones OR & Bartlett DISTRIBUTION Learning, LLC. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284115147_CH03_083_136.indd 85 07/11/16 3:05 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 86 Chapter 3 Monitoring NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Figure 3-3 EKG Precordial Leads Monitors Precordial Leads (V Leads) © Jones & Bartlett Learning,Unipolar: LLC with an electrically neutral center. Each© Jonesindivid- & Bartlett Learning, LLC ual V lead is the positive pole. They are placed anatomi- NOT FOR SALE OR DISTRIBUTIONcally over areas of the left ventricle. NOT FOR SALE OR DISTRIBUTION Represent the heart’s orientation on a transverse plane, providing a three-dimensional view. Full 12-lead EKG • Standard limb leads (bipolar) © Jones & Bartlett Learning, LLC • Augmented limb leads© (unipolar) Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION • Precordial leads (unipolar)NOT FOR SALE OR DISTRIBUTION Imagining the heart’s central orientation in relation to the limb and precordial leads and picturing where the positive poles are in each lead help you to under- stand why the individual leads represent specific areas of the heart. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE© Jones OR & Bartlett DISTRIBUTION Learning, LLC. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284115147_CH03_083_136.indd 86 07/11/16 3:05 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chapter 3 Monitoring 87 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION I Vector moving towards Positive QRS the positive lead, the QRS complex upright. III Vector moving at right Equiphasic QRS angle to leads axis, the QRS complex will be © Jones & Bartlett Learning, LLC © Jones &equiphasic. Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION aVR NOT FORVector SALE moving away OR DISTRIBUTION Negative QRS from the positive lead, the QRS complex will be negative. Figure 3-4 Vector and Waveform Direction © Jones & ItBartlett is similar to takingLearning, pictures with LLC a camera from different © Jones & Bartlett Learning, LLC NOT FOR SALEangles. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION V1 and V2 represent the intraventricular septum. V3 and V4 lie approximately over the anterior left ventricle. V5 and V6 approximate the lateral left ventricular wall. Monitors © Jones & Bartlett Learning,■■ 3.3 Cuff LLC Blood Pressure © Jones & Bartlett Learning, LLC Cuff pressures are used
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