Standard monitors provide essential information about a patient's oxygenation, ventilation, circulation, and temperature during medical care. Pulse oximetry noninvasively measures oxygen saturation but can be affected by factors like low blood flow, dyes, or carbon monoxide poisoning. Electrocardiography uses electrodes to detect heart rate and rhythm abnormalities. Noninvasive blood pressure measurement derives systolic and diastolic pressures from cuff inflation algorithms while arterial lines directly measure pressure waves. Capnography monitors exhaled carbon dioxide to assess ventilation. Temperature can be measured at different sites but the pulmonary artery, tympanic membrane, and esophagus provide most accurate core readings.
Pediatrics - Pulse Oximetry and Clubbing (concise)Dima Lotfie
How to use pulse oximeter in pediatrics age group? How does it work? what are the indications and limitations? What are the normal values?
Overview of clubbing in pediatrics, grades and the clinical significance.
Pulse oximetry is a noninvasive method for monitoring a person's oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within 2% accuracy (within 4% accuracy in the worst 5% of cases) of the more desirable (and invasive) reading of arterial oxygen saturation (SaO2) from arterial blood gas analysis.
Pediatrics - Pulse Oximetry and Clubbing (concise)Dima Lotfie
How to use pulse oximeter in pediatrics age group? How does it work? what are the indications and limitations? What are the normal values?
Overview of clubbing in pediatrics, grades and the clinical significance.
Pulse oximetry is a noninvasive method for monitoring a person's oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within 2% accuracy (within 4% accuracy in the worst 5% of cases) of the more desirable (and invasive) reading of arterial oxygen saturation (SaO2) from arterial blood gas analysis.
How Pulse oximeter works- Principle and Limitations I SpO2 I Respiratory Phys...HM Learnings
How Pulse oximeter works- Principle and Limitations I SpO2 I Respiratory Physiology I COVID
The slides will discuss about
1. Introduction
2. Principle of Pulse oximeter
3. Limitation of Pulse oximeter
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
Pulse oximeter – how does it work and how can it be used in home care?Silverline Meditech
Sliverline Meditech, is a leading Suppliers & Exporters of Pulse Oximeter In India & Other Home Health Care Products. A pulse oximeter is the most important monitoring tool in modern anaesthesia practice. Feel free to call us at +91-79-2689 0389.
SpO2 stands for peripheral capillary oxygen saturation, an estimate of the amount of oxygen in the blood. More specifically, it is the percentage of oxygenated haemoglobin (haemoglobin containing oxygen) compared to the total amount of haemoglobin in the blood (oxygenated and non-oxygenated haemoglobin).SpO2 is an estimate of arterial oxygen saturation, or SaO2, which refers to the amount of oxygenated haemoglobin in the blood.
How Pulse oximeter works- Principle and Limitations I SpO2 I Respiratory Phys...HM Learnings
How Pulse oximeter works- Principle and Limitations I SpO2 I Respiratory Physiology I COVID
The slides will discuss about
1. Introduction
2. Principle of Pulse oximeter
3. Limitation of Pulse oximeter
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
Pulse oximeter – how does it work and how can it be used in home care?Silverline Meditech
Sliverline Meditech, is a leading Suppliers & Exporters of Pulse Oximeter In India & Other Home Health Care Products. A pulse oximeter is the most important monitoring tool in modern anaesthesia practice. Feel free to call us at +91-79-2689 0389.
SpO2 stands for peripheral capillary oxygen saturation, an estimate of the amount of oxygen in the blood. More specifically, it is the percentage of oxygenated haemoglobin (haemoglobin containing oxygen) compared to the total amount of haemoglobin in the blood (oxygenated and non-oxygenated haemoglobin).SpO2 is an estimate of arterial oxygen saturation, or SaO2, which refers to the amount of oxygenated haemoglobin in the blood.
The goal of hemodynamic monitoring is to assess the cardiovascular state of the patient, define their reserve and monitor response to treatments and time. Resuscitation efforts are essentially aimed at restoring and sustaining tissue wellness through maintaining an adequate amount of oxygenated blood flow to the metabolically active tissues. We need to monitor pressure, flow and function. To accomplish these goals one must be able to measure arterial pressure and all its components (i.e. waveforms), cardiac output and stroke volume as well as the adequacy of flow. Presently, there are several devices that can estimate the arterial pressure waveform from a finger plethysmographic device. They are very accurate until profound circulatory collapse makes peripheral pulse not representative of central pressures. These devices can also estimate stroke volume by intuiting the arterial pressure waveform in a fashion similar to that performed by the numerous minimally invasive hemodynamic monitoring devices we now have now. These non-invasive devices can quantify functional hemodynamic monitoring dynamic parameters. Also, pulse oximeter pleth density signals vary with pulse volume into the finger or skin and the pleth variability can also be used as a surrogate of pulse pressure variation. Furthermore, bioreactance can measure both cardiac output and intrathoracic fluid content through surface electrodes. Finally, end-tidal CO2 transiently varies with venous return, increasing if blood flow increases. So both eh bioreactance device and end-tidal CO2 can be used to identify cardiac output changes in response to a passive leg raising maneuver. Thus, one can measure arterial pressure waveforms and cardiac output continuously, assess volume responsiveness and monitor therapy. Finally, the dynamic changes in tissue O2 saturation (StO2) measured by near infrared spectroscopy of the thenar eminence during a vascular occlusion test defines peripheral circulatory insufficiency and local blood flow independent of arterial pressure. Furthermore, heart rate variability decreases with increasing cardiovascular stress and can be readily measured in real time from the R-R intervals of the surface ECG signal. Finally, the measure of urine output, skin temperature and sensorium all define effective tissue blood flow as reasonable end-points to resuscitation, if the patient is not overwhelmingly ill. When these measures are coupled to a treatment approach know to improve outcome, there is little reason to believe that such completely non-invasive approaches will be inferior to invasive ones in the management of the critically ill patient.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
3. Pulse Oximetry
Limitations to pulse oximetry:
vasoconstriction, movement, shivering,
methemoglobin, carboxyhemoglobin, methylene
blue
Non-pulsatile (venous) flow is
discounted
Light is absorbed at different
wavelengths
940 nm
(infrared)
660 nm (red)
Probe emits light across a tissue
bed
OxyHb DeOxyHb
S = (AC/DC)660
(AC/DC)940
Normal SpO2 > 94%
Target SpO2 > 90%
5. EKG
• 3-Electrode System
• Leads I, II, and III
• Lead II is best for detecting P waves and sinus rhythm
• 5-Electrode System
• V5 is 75% sensitive for detecting ischemic events; II + V5 is 80% sensitive; II +
V4 + V5 together is 98% sensitive
6. Noninvasive Blood Pressure
• MAP is primary measurement; SBP and DBP are derived from algorithms
• Cuff too small = falsely HIGH BP. Cuff too big = falsely LOW BP
7. Arterial Pressure Monitoring
• Indications
• Beat-to-beat BP monitoring
• Repeated blood sampling
• Complications
• infection, thrombosis, hematoma, distal ischemia, and air embolism, and
hemorrhage
Transducer Setup
• Zeroing = exposes the transducer to air-fluid interface at any
stopcock, thus establishing Patm as the “zero” reference
pressure.
• Leveling = assigns the zero reference point to a specific point on
the patient; by convention, the transducer is “leveled” at the
right atrium.
** Every difference of 10cm = 7.5mmHg
If transducer reads a MAP of 75 at the level of the heart
but the brain is 20 cm above that level, the brain has a
MAP of 60
8. Capnography
• Measures exhaled CO2
• With normal respiratory physiology, you can expect PaCO2 to be a
value 6 higher than ETCO2 due to dead space ventilation
• Capnogram Phases
I. Dead space gas exhaled
II. Transition between airway and alveolar gas
III. Alveolar plateau
IV. Inspiration
10. References
• Adriano, A and Skanchy, J. 2018 CA-1 tutorial textbook. 12th Edition. Stanford University Medical
Center Department of Anesthesiology. 2018. Retrieved from
http://ether.stanford.edu/ca1_new/Final-%202018%20CA-
1%20Tutorial%20Textbook.Smartphone%20or%20Tablet.pdf
• Mark JB, and Slaughter TF. Cardiovascular monitoring. In Miller RD (ed), Miller’s Anesthesia, 6th
ed. Philadelphia: Elsevier Churchill Livingstone, 2005.
• Moon RE, and Camporesi EM. Respiratory monitoring. In Miller RD (ed), Miller’s Anesthesia, 6th
ed. Philadelphia: Elsevier Churchill Livingstone, 2005.
• Morgan GE, Mikhail MS, and Murray MJ. Clinical Anesthesiology, 4th ed. New York: McGraw-Hill
Companies, Inc., 2006.
• Narang J, and Thys D. Electrocardiographic monitoring. In Ehrenwerth J, and Eisenkraft JB (eds),
Anesthesia Equipment: Principles and Applications. St. Louis: Mosby, 1993.
• Marino, P. Marino’s the ICU Book, 4th Edition. Philadelphia: Wolters Kluwer/Lippincott, Williams, &
Wilkins, 2014.
• Torp, K. Pulse Oximetry. In Faust’s Anesthesiology Review, 4th ed. Philadelphia: Elsevier Saunders,
2015.
Editor's Notes
Vigilant monitoring is key to critical care and patient safety. ICU bedside providers must have a good understanding of how monitors work in order to interpret the data and make sound clinical decisions.
Oxygenation, ventilation, circulation and temperature are the key parameters that must be monitored during intensive care.
Pulse oximeters have two components, a probe and a computerized unit. The probe is placed on the patient’s finger or toe. In small infants the probe may cover the entire hand or foot.
The probe has a LED light and photodetector. The light is shone through the patient’s tissues.
Oxygenated and deoxygenated hemoglobin absorb the light at different wavelengths - oxyhemoglobin at 940 nanometers and deoxyhemoglobin at 660 nanometers. The ratio of wavelength absorption is converted to a percentage and displayed on the pulse oximeter and referred to as the “SpO2”. Normal SpO2 is > 94%.
Since it the arterial oxygen saturation that is of interest, the pulse oximeter discounts any non-pulsatile flow such as that from venous blood, capillaries and tissues.
Pulse oximetry requires a regular pulse for proper data collection and accurate recording of the SpO2.
Disruption of a regular pulse detection can lead to erroneous SpO2 recordings. Examples include:
Vasoconstriction from hypothermia, vasoactive medications, or hypotension
Dysrhythmias such as atrial fibrillation, ventricular tachycardia or other abnormal cardiac rhythms
Shivering and electrocautery can also interfere with accurate SpO2 readings
Disruption of the wavelength absorption ratio can also lead to false SpO2 recordings, for example injectable dyes lead to falsely low values whereas carbon monoxide poisoning can lead to falsely elevated SpO2 values
Electrocardiograms are standard monitors for ICU patients.
Using a 3-electrode setup: Allows monitoring of Leads I, II, and III, but only one lead (i.e. electrode pair) can be examined at a time while the 3rd electrode serves as ground.
Lead II is best for detecting P waves and sinus rhythm
Using a 5-electrode setup: Four limb leads + V5 (left anterior axillary line, 5th intercostal space)
V5 is 75% sensitive for detecting ischemic events; II + V5 is 80% sensitive; II + V4 + V5 together is 98% sensitive
Most automated blood pressure cuffs use a technique called oscillimetry where cuff inflation leads to occlusion of blood flow, slow release of cuff pressure allows resumption of blood flow, and oscillations associated with turbulent resumption of flow are recorded. The point of maximal oscillation amplitude corresponds to mean arterial pressure. With oscillemetry, the systolic and diastolic blood pressures are derived from algorithms. If the blood pressure cuff is too small, the BP will be falsely high. If the cuff is too large, the BP will be falsely low
Arterial lines are invasive and can be painful for patients during placement.
Indications for placing an arterial line include close BP monitoring (for example when using vasopressor or inotrope medications) and repeated blood sampling (such as arterial blood gas samples).
Complications include, pain, bleeding, hematoma, infection, thrombosis and ischemia.
Arterial lines are placed most commonly in the radial artery but can also be placed in femoral, brachial, or dorsalis pedis arteries. Sterile technique should be used.
A-line monitor systolic and diastolic blood pressure directly by detecting the pulse beat against fluid filled pressure tubing which is connected to a transducer. The transducer converts the pressure sensed into systolic and diastolic values which are displayed on a monitor. The arterial line set-up system must be ”zeroed” which exposes the system to atmospheric pressure and establishes Patm as zero. When the system is again closed to the atmosphere, any pressure encountered is arterial pressure. Since water columns can also exert pressure when affected by gravity, the transducer is typically kept level with the body area of interest. For BP, this is usually the level of the heart.
Capnography is the measure of exhaled carbon dioxide. Capnography is displayed as a waveform on the monitor with each phase of the wave corresponding to each phase of the respiratory cycle or breath.
The beginning of exhalation is dead space. This is followed by the transition between airways and alveolar gas. As the waveform levels off, it corresponds to the alveolar plateau, or end-tidal carbon dioxide. Finally, as inspiration starts again, the waveform should reverse flow and drop to zero.
Routinely monitored in the ICU
Sites
Pulmonary artery = “Core” temperature (gold standard)
Tympanic membrane - correlates well with core; approximates brain/hypothalamic temperature
Esophagus - correlates well with core
Nasopharyngeal - correlates well with core and brain temperature
Rectal - not accurate (temp affected by LE venous return, enteric organisms, and stool insulation)
Bladder - approximates core when urine flow is high
Axillary - inaccurate; varies by skin perfusion
Skin - inaccurate; varies by site
Oropharynx – good estimate of core temperature; recent studies show correlation with tympanic and esophageal temperatures
