CICM SAQ 2010.1 Q11

The following set of questions relate to invasive arterial blood pressure monitoring.

11.1 The above series of figures represents waveforms obtained simultaneously from different arterial sites from the same patient. Assuming optimal dynamic responses, list the likely sites A-E.

11.2. The image below represents a tracing of an arterial waveform.

  • (a) What procedure has been performed?
  • (b) What is your impression of the fidelity of the arterial system? Give two (2) reasons.

11.3 List the important pieces of information that could be obtained from an arterial waveform tracing.


Answer

Answer and interpretation

11.1. The above series of figures represents waveforms obtained simultaneously from different arterial sites from the same patient. Assuming optimal dynamic responses, list the likely sites A-E.

  • A- central aorta
  • B- proximal UL
  • C- Distal UL or LL
  • D- Proximal LL
  • E- Distal UL or LL

11.2. The image below represents a tracing of an arterial waveform.

(a) What procedure has been performed?

  • Fast flush test

(b) What is your impression of the fidelity of the arterial system? Give two (2) reasons.

  • Underdamped trace – Multiple oscillations and systolic overshoot

11.3 List the important pieces of information that could be obtained from an arterial waveform tracing.

  • Systolic, diastolic, mean and pulse pressures
  • Heart rate and rhythm
  • Effect of dysrhythmias on perfusion
  • ECG lead disconnect
  • Continuous cardiac output using pulse contour analysis
  • Specific waveform morphologies might be diagnostic – eg slow rising pulse in AS, pulsus paradoxus in tamponade
  • Systolic pressure variation or pulse pressure variation may be useful in predicting fluid responsiveness.

Exams LITFL ACEM 700

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CICM

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

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