ICU Monitoring and ECG Applications

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Questions and Answers

Which of the following conditions would NOT typically warrant continuous electrocardiographic monitoring?

  • Post-cardiac surgical procedures
  • Traumatic cardiac contusion
  • Stable angina (correct)
  • Acute myocardial infarction

Placing ECG limb leads over bony prominences is primarily intended to:

  • Improve detection of subtle ST segment changes
  • Increase the accuracy of heart rate measurement
  • Minimize the risk of electrode detachment
  • Reduce interference from muscle contractions (correct)

The 'modified lead II' configuration is most commonly used in:

  • Stress testing
  • Routine ICU monitoring (correct)
  • Electrophysiology studies
  • Holter monitoring

Compared to the monitor setting, the diagnostic setting for ECG monitoring typically has a:

<p>Higher bandwidth, suitable for detailed waveform analysis (A)</p> Signup and view all the answers

Continuous ECG monitoring is beneficial in patients undergoing fluid resuscitation because it assists in:

<p>Tracking changes in heart rate and rhythm (D)</p> Signup and view all the answers

When would selecting the diagnostic ECG mode be most advantageous?

<p>To evaluate for potential myocardial ischemia (C)</p> Signup and view all the answers

Electrocardiographic monitoring in the ICU is primarily used to:

<p>Diagnose and manage cardiac arrhythmias (C)</p> Signup and view all the answers

What results from the overinflation of the balloon during pulmonary artery catheterization?

<p>Pressure tracing that continues to rise to high levels (C)</p> Signup and view all the answers

What is the primary purpose of the pulmonary artery catheterization?

<p>To sample mixed venous oxygen saturation (C)</p> Signup and view all the answers

Which zone of the lungs is best for obtaining an uninterrupted column of blood during pulmonary artery catheterization?

<p>Zone III (B)</p> Signup and view all the answers

What occurs when the mean airway pressure is greater than the pulmonary venous pressure in zones I and II?

<p>Collapse of the pulmonary vasculature (D)</p> Signup and view all the answers

What should be done to ensure appropriate advancement of the catheter after obtaining a pulmonary capillary wedge tracing?

<p>Deflate the balloon and withdraw 1 mL (A)</p> Signup and view all the answers

What is the primary reason for monitoring ST segments in patients with coronary artery disease?

<p>To detect myocardial ischemia (A)</p> Signup and view all the answers

Where should lead placement be for optimal detection of inferior wall ischemia?

<p>In the V5 position along the anterior axillary line (C)</p> Signup and view all the answers

What preparation is necessary before electrode placement for electrocardiographic monitoring?

<p>The skin should be clean and dry (A)</p> Signup and view all the answers

What is the typical electrical potential available for skin surface monitoring in myocardial ischemia patients?

<p>0.5 to 2.0 mV (B)</p> Signup and view all the answers

Which type of leads is considered superior for detecting arrhythmias compared to lead II?

<p>Esophageal leads (B)</p> Signup and view all the answers

What is a common complication related to the use of electrocardiographic monitoring?

<p>Technical error or equipment malfunction (C)</p> Signup and view all the answers

Which electrode material is commonly used for electrocardiographic monitoring?

<p>Silver–silver chloride gel (B)</p> Signup and view all the answers

How can difficulty with low electrical signals in monitoring be resolved?

<p>Reapplying the electrode after cleaning the skin (A)</p> Signup and view all the answers

What can significantly reduce the electrical resistance of the stratum granulosum in electrocardiography?

<p>Cleansing the skin (D)</p> Signup and view all the answers

What effect does decreasing damping have on the oscillating frequency?

<p>It increases the oscillating frequency. (D)</p> Signup and view all the answers

Which of the following factors increases damping in the system?

<p>Using more compliant connecting tubing. (D)</p> Signup and view all the answers

What happens to systolic and diastolic pressure readings in cases of excessive damping?

<p>Systolic pressure is underestimated and diastolic pressure is overestimated. (B)</p> Signup and view all the answers

How is the damping coefficient of a system determined?

<p>By applying and releasing a square pressure wave. (D)</p> Signup and view all the answers

What effect does air in the transducer dome or tubing have on the system?

<p>It increases system damping. (C)</p> Signup and view all the answers

Which statement best describes continuous-wave Doppler devices?

<p>They continuously transmit and receive sound waves. (B)</p> Signup and view all the answers

What is the primary consequence of an underdamped system?

<p>Overestimation of systolic pressure. (B)</p> Signup and view all the answers

What determines the resonant frequency of a system in relation to damping?

<p>Both natural frequency and damping coefficient. (D)</p> Signup and view all the answers

What condition is necessary for a Doppler shift to occur?

<p>Blood must move relative to the transducer. (D)</p> Signup and view all the answers

What role does the angle correction play in Doppler measurements?

<p>It adjusts for velocity measurement accuracy. (A)</p> Signup and view all the answers

What is the optimal damping coefficient for ensuring minimal effect on amplitude?

<p>0.7 (B)</p> Signup and view all the answers

What is the consequence of overdamping in a measuring system?

<p>Decreased frequency response (C)</p> Signup and view all the answers

Which artery is most commonly preferred for invasive blood pressure monitoring?

<p>Radial artery (B)</p> Signup and view all the answers

What might cause an overestimation of systolic pressure in blood pressure monitoring?

<p>Distal occlusion of the radial artery (B)</p> Signup and view all the answers

What complication is most commonly associated with arterial catheters?

<p>Infection (A)</p> Signup and view all the answers

Why might women have a lower incidence of arterial thrombosis compared to men?

<p>Different hormonal levels (C)</p> Signup and view all the answers

What is the typical incidence of arterial occlusion when cannulating patients with 20-gauge Teflon catheters?

<p>10% (C)</p> Signup and view all the answers

What is the primary artery supplying blood to the hand, in terms of dominance in the population?

<p>Ulnar artery (A)</p> Signup and view all the answers

What effect can distal occlusion of the radial artery have on pressure readings?

<p>Overestimation of systolic pressure (B)</p> Signup and view all the answers

What typically occurs when overdamping affects a measuring system?

<p>Loss of detail in pressure readings (D)</p> Signup and view all the answers

Flashcards

Pulmonary artery catheterization

A procedure to monitor heart filling pressures and mixed venous oxygen saturation.

Herniation of balloon

Occurs when an inflated balloon moves over the catheter tip, causing pressure issues.

Three lung zones

Areas defined by airway and vascular pressure relationships affecting catheter position.

Thermodilution cardiac output

Measurement technique using thermistor-tipped catheter to assess heart output.

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Ventricular tachyarrhythmias

Abnormal fast heart rhythms that can be detected during catheterization.

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Doppler Shift

The change in frequency of a wave in relation to an observer moving relative to the source of the wave.

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Resonant Frequency

The frequency at which a system naturally oscillates with the greatest amplitude.

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Damping Coefficient

A parameter that measures the ability of a system to dissipate energy, affecting oscillation decay.

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Compliant Tubing

Flexible connecting tubing that can absorb pressure waves, increasing damping.

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Continuous-Wave Transducer

A device with two crystals for continuously transmitting and receiving ultrasound waves.

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Flow Velocity Measurement

Determining the speed of moving blood cells based on the frequency of reflected ultrasound waves.

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Angle Correction

Adjustment made to account for the angle of the doppler effect during flow measurement.

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Damping Effects on Pressure

Underestimation of systolic pressure and overestimation of diastolic pressure due to excessive damping.

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Under-damped Systems

Systems that oscillate with less damping, producing larger peak oscillations.

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Acoustic Gel

Substance used to couple ultrasonic waves to tissue for better sound transmission.

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Electrocardiographic Monitoring

The use of ECG to assess heart activity, particularly for myocardial ischemia risk.

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Lead II Position

An electrocardiographic lead placement that enhances P-wave voltage recognition.

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V5 Position

Electrode placement along the anterior axillary line, used for detecting ischemia.

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Hypokalemia Detection

Identifying low potassium levels during treatments like diabetic ketoacidosis via ECG.

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Stratum Granulosum Resistance

Layer of skin with high electrical resistance that can be reduced before electrode placement.

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Electrode Material

Electrodes typically use silver-silver chloride gel for monitoring ECG signals.

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Complications of ECG

Issues arising from technical errors or faulty equipment during electrocardiography.

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Skin Preparation for ECG

Cleaning the skin to remove oils and dead cells before electrode placement.

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Esophageal Leads

Electrodes placed in the esophagus, better for arrhythmia detection but hard to use in awake patients.

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Physiologic Monitoring

Monitoring to detect and aid in managing abnormalities in ICU patients.

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Modified Lead II

A specific configuration for routine ECG monitoring to reduce noise.

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Continuous Electrocardiography

Real-time monitoring of heart rate, arrhythmias, and pacemaker function.

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Diagnostic vs Monitor Settings

Different bandwidth settings for ECG based on purpose; diagnostic has wider bandwidth.

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Arrhythmias

Irregular heartbeats that can be detected through ECG monitoring.

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Myocardial Ischemia

A condition that may be detected during ECG monitoring, indicating reduced blood flow to the heart.

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Clinical Applications

Specific instances where ECG monitoring is applied, such as after surgery or trauma.

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Underdamping

A condition where rapid pressure changes cause oscillations within the system.

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Overdamping

A condition that decreases the frequency response, leading to slow reactions to pressure changes.

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Natural Frequency

The frequency at which a system naturally oscillates without external forces.

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Allen Test

A test performed to assess the blood supply of the hand prior to arterial catheterization.

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Vascular Complications

Problems occurring due to vascular procedures, such as arterial occlusion.

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Arterial Occlusion

Blockage of an artery that can lead to insufficient blood flow.

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Radial Artery

The preferred artery for invasive blood pressure monitoring due to ease of access.

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Catheter Complications

Adverse effects resulting from the use of catheters, including infections and occlusions.

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Gender Differences in Thrombosis

Women have a lower incidence of arterial thrombosis compared to men; thrombi in women are often temporary.

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Study Notes

Intensive Care Monitoring

  • Physiologic monitoring is used in ICU for high-risk patients
  • Monitoring is selected and applied to detect pathophysiological abnormalities
  • Monitoring helps to adjust therapy to appropriate physiological endpoints

Electrocardiography

  • Continuous ECG monitoring tracks heart rate and detects arrhythmias
  • Evaluates pacemaker function and helps identify myocardial ischemia or electrolyte abnormalities
  • Monitoring is important for patients at risk of arrhythmias, acute myocardial infarction, and electrolyte imbalances
  • ECG monitoring helps in diagnosing and treating potential issues

Clinical Applications

  • Lead placement: Modified Lead II configuration is best for routine monitoring; placement over shoulders minimizes noise.
  • Lead V1 positioning is useful for anterior and lateral wall ischemia; Modified V5 (CS5) positioning is beneficial for patient positioning issues.
  • Complications: Loose electrodes, poor connections, and electrical equipment malfunction can cause issues
  • 60 Hz interference may cause issues, and reapplying electrodes may solve signal reception problems

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