Monitor INDICATIONS BENEFITS COMPLICATIONS CONTRAINDICATIONS

ECG  HR None None

To all patients
 To all
 Particular usefulness for:
1. Pt. with pre-existing lung disease
2. One lung ventilation
3. Neonate (at risk of ROP)
How does it work?
 It combine both: oxymetry and
Pulse- plethemography
1. Oxymetry : depends on
Oxy (Lambar-Beer law)
Oxygenated (HbO2) and
deoxygenated Hb differ in their
absorption of red &infra red light
Oxygenated Hb absorps more
infrared (960nm)
Deoxygenated Hb absorps more
red (660nm)
So, Oxymetry analyze Ration of
absorption to give O2 sat.
2. Plethesmography:
Identify arterial pulsation
So, it allows for correction of
light absorption from non-
pulsatile blood (i.e. in
venous/tissue)
 Rhythm
 Detect arrhythmia
 N-ischemia (Diagnostic if ST>1mm+1-T
wave inversion)
 Conduction abnormality
 Peacemaker malfunction
 Electrolyte abnormalities:
- K:………………
- K:……………..
- Ca:……………
- Ca++:……………
 Lead IIarrhythmia + inferior wall ischemia
 Lead V5 antero-lateral ischemia
 SPaO2  ? Pressure Necrosis None
 HR
 Wave form  tissue perfusion  Carboxy HB (COHb)
Carbon Monoxide poisoning
It absorbs light @660nm equally Other Modalities:
to HbO2 1. Mixed venous oxygen sat
False high reading (SVO2) through PA catheter
2. Non invasive Brain
 Methemoglobine: Oxymetry (rSO2)
has same absorption of light @ - Applied over forehead
red and infrared like HbO2 - Measure: arterial, venous
fixed reading @85% (whether and capillary O2 sat.
real SPaO2>85% or less) - N = 70%
- low sat. in:
1. arrest
2. hypothermia
3. severe hypoxia
4. cerebral embolism

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Monitor INDICATIONS BENEFITS COMPLICATIONS CONTRAINDICATIONS

 To confirm ETT position  Monitor ventilation  Mainstream: heavy may

 To confirm adequate ventilation  Detect: - ETT malposition kink ETT
 To monitor CO2 esp. if ICP -Circuit disconnection  Sides stream with high
 Can detect air embolism:  Diagnose: - MHsudden aspiration
sudden drop ETCO2 ETCO2 give false low reading
TYPES (due toMR) in paeds. (common
1. Flow-THROW (mainstream)  Wave form:-Bronshospasm/COPD problem)
-sensor applied @ Y place -Rebreathing
-heavylinking of ETT -M.relaxant fade
-zeroing access during -Lung perfusion None
ETCO2 inspiration  ETCO2–PaCO2 gradients (2-5mmHg)
does NOT detect -If increased:
rebreathing Reflect alveolar dead space
2. Aspiration (side stream):- (ventilation but no perfusion)
-Common due to significationin lung perfusion :
-High aspiration :rate of *air embolism
250ml/min: (in Paeds may *CO
entrain inspired gas flow dilute ETCO2 *BP
ETCO2 reading) alveolar dead space
air in dead space dilute expired CO2
- Low aspiration = 50ml/min. ETCO2
may underestimated ETCO2 changes high gradient
-Can detect rebreathing
-Contain two cells:
1. CO2 cells
2. sample cell
Then, compare infra-red
absorption in sample cell
containing ETCO2 and CO2
free cell
NB: Both type depends on CO2 absorption
of infra-red light
1. Beat – Beat observation (for  BP, syst. & diast. & mean 1. Needs skilled person  If no collateral
immediate action):  HR 2. Bleeding/hematoma  If pre-existing vascular
- High risk  Wave form 3. Arterial damage/thrombosis insufficiency
Art. - Hypotensive anaesth. Hypovolemia ( in size during 4. Distal ischemia (e.g. Raynud's)
Line - If using vaso-active drugs inspiration) 5. Infection
2. Frequent ABG Rate of up-stroke (indicate contritility) 6. Inadvernent drug injection: -
3. More accurate (esp. in low BP) Rate of down-stroke (indicate SVR)  S/S: - severe pain
4. If non-invasive is Not applicable  CO measurement (new) -distal blanching

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Monitor INDICATIONS BENEFITS COMPLICATIONS CONTRAINDICATIONS

- Obese -blistiring
-Burn  Treatment
1. STOP inject
2. Leave the canula in place
3. Dilute irritants with
hepsol(heparine saline)
4. Reverse spasm & pain –
1% lidocain 5-10ml
5. Vasodilator: papavarin
40mg
6. Prevent thrombosis:
-stellate ganglion block
or - guanithidine block
(20mg + 500 u heparin
in 30ml NS and keep
cuff for 20 min.
1. To guide fluid replacement in  N – 0-5mmHg 1. Immediate : 1. Renal cell tumor extending to RA
2. Infusion of caustic drugs & TPN  by Hypovolemia -Arrythemia (endocardium 2. T-valve vegetation
3. Aspiration of air embolism (?)  by : -CHF irritation) 3 ? if anticoagulation
4. Insertion of trans cutaneous pacing -PE -Bleeding 4 ? if ipsi-lateral carotid end –
CVP 5. IV access in poor peripheral lines -Tamponade -Pneumothorax arteryectomy
-Fluid Overload -Damage to main structures
-IPPV (caraotid, esophagus,
 NB: in CHF  small IVF challenge thoracic duct)
 marked CVP -Cardiac perforation
-Catheter embolization
2. Delayed:
-Infection
-Thrombosis
-Cardiac rupture
1. Cardiac: -CAD with LV dysfunction  Measure : (NORMAL VALUES)  Immediate:  If pre-existing LBBB
P.A. -valvular HD (Mean) -Arrythmia risk of complete heart
-CHF 15  30 -Bleeding block
Cath. 2. Pulmonary :-ARDS (?) - PAP (10  20) -Damage to lung/heart  WBW syndrome
-Severe COPD 5  15 -Knotting  Ebstein Anomaly
3. Complex fluid management: -PA rupture (Tricusp malformation)
-shock - PCWP 5-15 (10)  >50% mortality arrythmia
-acute RF  Late:
-acute burn  Calculate: -CO -Embolization
-hemorrhagic pancreatitis -CI -Pul. infarction (migrated

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Monitor INDICATIONS BENEFITS COMPLICATIONS CONTRAINDICATIONS

4. Specific procedures: -SVR cath./continuosly inflated

-cardiac surgery -PVR balloon)
-aortic x-clamp (AAA) -valve damage
-sitting craniotomy (air NB: How to identify RV from PA? -cardiac rupture
embolism) 1. Pressure reading
-portal systemic shunt (?) 15  30
5. High risk Obstetrics RV:
0

15  30
PA:
10
2. Pressure wave

RV (upstroke)
Blood ejection

PA

downstroke

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