Prepared by: Glaiza Mae B.

Olivar SN-DOSCST

The cardiac monitor is a device that shows the electrical and pressure waveforms of the cardiovascular system for measurement and treatment. Parameters specific to respiratory function can also be measured. Because electrical connections are made between the cardiac monitor and the patient, it is kept at the patient's bedside.

Purpose: The cardiac monitor continuously displays the cardiac electrocardiogram (EKG) tracing. Additional monitoring components allow cardiovascular pressures and cardiac output to be monitored and displayed as required for patient diagnosis and treatment. Oxygen saturation of the arterial blood can also be monitored continuously. Most commonly used in emergency rooms and critical care areas, bedside monitors can be interconnected to allow for continual observation of several patients from a central display. Continuous cardiovascular and pulmonary monitoring allows for prompt identification and initiation of treatment.

Description: The monitor provides a visual display of many patient parameters. It can be set to sound an alarm if any parameter changes outside of an expected range determined by the physician. Parameters to be monitored may include, but are not limited to, electrocardiogram, noninvasive blood pressure, intravascular pressures, cardiac output, arterial blood oxygen saturation, and blood temperature. Equipment required for continuous cardiac monitoring includes the cardiac monitor, cables, and disposable supplies such as electrode patches, pressure transducers, a pulmonary artery catheter (Swan-Ganz catheter), and an arterial blood saturation probe.

Preparation As the cardiac monitor is most commonly used to monitor electrical activity of the heart, the patient can expect the following preparations. The sites selected for electrode placement on the skin will be shaved and cleaned causing surface abrasion for better contact between the skin and electrode. The electrode will have a layer of gel protected by a film, which is removed prior to placing the electrode to the skin. Electrode patches will be placed near or on the right arm, right leg, left arm, left leg, and the center left side of the chest. The cable will be connected to the electrode patches for the measurement of a fivelead electrocardiogram. Additional configurations are referred to as three-lead and 12-lead electrocardiograms. If noninvasive blood pressure is being measured, a blood pressure cuff will be placed around the patient's arm or leg.

The blood pressure cuff will be set to inflate manually or automatically. If manual inflation is chosen, the cuff will only inflate at the prompting of the health care provider, after which a blood pressure will be displayed. During automatic operation, the blood pressure cuff will inflate at timed intervals and the display will update at the end of each measurement. Disposable pressure transducers require a reference to atmosphere, called zeroing, which is completed before monitoring patient pressures. This measurement will occur once the patient is comfortably positioned since the transducer must be level with the measurement point. The pressure transducer will then be connected to the indwelling catheter. It may be necessary for as many as four or five pressure transducers to be connected to the patient. The arterial blood saturation probe will be placed on the finger, toe, ear, or nasal septum of the patient, providing as little discomfort as possible, while achieving a satisfactory measurement.

Cardiac monitors display such vital signs as heart rate, pulse, and blood pressure for patients in the intensive care unit.

Aftercare After connecting all equipment, the health care provider will observe the monitor and evaluate the quality of the tracings, while making size and position adjustments as needed. The provider will confirm that the monitor is detecting each heartbeat by taking an apical pulse and comparing the pulse to the digital display. The upper and lower alarm limits should be set according to physician orders, and the alarm activated. A printout may be recorded for the medical record, and labeled with patient name, room number, date, time, and interpretation of the strip.

Maintenance and replacement of the disposable components may be necessary as frequently as every eight hours, or as required to maintain proper operation. The arterial saturation probe can be repositioned to suit patient comfort and to obtain a tracing. All connections will be treated in a gentle manner to avoid disruption of the signal and to avoid injury to the patient.

Normal results The monitor will provide waveforms and/or numeric values associated with the patient status. These may include, but are not limited to, heart rate, arterial blood pressure, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, left atrial pressure, cardiac output, arterial blood saturation, and blood temperature. Furthermore, these values can be used to calculate other values, or parameters, or used to diagnose and treat the patient's condition.

Patient movement may cause measurement errors; the patient will be requested to remain motionless. Depending on the mobility of the patient, assistance should be provided by the health care provider prior to changing from a laying down position to sitting or standing. As the patient's condition improves, the amount of monitoring equipment may be decreased. However, the electrocardiogram and arterial blood saturation probe should be expect to remain attached until discharge is imminent.

An electrocardiogram (ECG) is a test that records the electrical activity of the heart.

How the Test is Performed You will be asked to lie down. The health care provider will clean several areas on your arms, legs, and chest, and then attach small patches called electrodes to the areas. It may be necessary to shave or clip some hair so the patches stick to the skin. The number of patches used may vary. The patches are connected by wires to a machine that turns the heart's electrical signals into wavy lines, which are often printed on paper. The test results are reviewed by the doctor.

You usually need to remain still during the procedure. The health care provider may also ask you to hold your breath for a few seconds as the test is being done. Any movement, including muscle tremors such as shivering, can alter the results. So it is important to be relaxed and relatively warm during an ECG recording. Sometimes this test is done while you are exercising or under minimal stress to monitor changes in the heart. This type of ECG is often called a stress test.

How to Prepare for the Test Make sure your health care provider knows about all the medications you are taking, as some can interfere with test results. Exercising or drinking cold water immediately before an ECG may cause false results.

How the Test Will Feel An ECG is painless. No electricity is sent through the body. The electrodes may feel cold when first applied. In rare cases, some people may develop a rash or irritation where the patches were placed.

Why the Test is Performed An ECG is used to measure:

Any damage to the heart How fast your heart is beating and whether it is beating normally The effects of drugs or devices used to control the heart (such as a pacemaker) The size and position of your heart chambers

An ECG is a very useful tool for determining whether a person has heart disease. Your doctor may order this test if you have chest pain or palpitations.

Normal Results Heart rate: 60 to 100 beats per minute Heart rhythm: consistent and even

What Abnormal Results Mean

Abnormal ECG results may be a sign of Abnormal heart rhythms (arrhythmias) Cardiac muscle defect Congenital heart defect Coronary artery disease Ectopic heartbeat Enlargement of the heart Faster than normal heart rate (tachycardia) Heart valve disease Inflammation of the heart (myocarditis) Changes in the amount of electrolytes (chemicals in the blood) Past heart attack Present or impending heart attack Slower than normal heart rate (bradycardia)

Risks There are no risks. No electricity is sent through the body, so there is no risk of shock. Considerations The accuracy of the ECG depends on the condition being tested. A heart problem may not always show up on the ECG. Some heart conditions never produce any specific ECG changes. If you have had a heart attack or have heart disease, you may need more than one ECG. Your doctor will tell you when you need the next one. There is no reason for healthy people to have yearly ECG testing unless they have a family or personal history of specific heart diseases or other medical conditions that affect the heart.

The medical practice or technique of cauterization is the burning of part of a body to remove or close off a part of it in a process called cautery, which destroys some tissue, in an attempt to mitigate damage, remove an undesired growth, or minimize other potential medical harmful possibilities such as infections, when antibiotics are not available.

The practice was once widespread for treatment of wounds. Its utility before the advent of antibiotics was effective on several levels:
useful in stopping severe blood-loss and preventing exsanguination to close amputations, useful in preventing infections, including complications from septicemia.

Actual cautery is a term referring to the white-hot irona metal generally heated only up to a dull red glow that is applied to produce blisters, to stop bleeding of a blood vessel, and other similar purposes. The main forms of cauterization used today in the first world are electrocautery and chemical cautery where both are, for example, prevalent in the removal of unsightly warts. Cautery can also mean the branding of a human, either recreational or forced. Accidental burns can be considered cauterization as well.

History Cauterization was used to stop heavy bleeding, especially during amputations. The procedure was simple: a piece of metal was heated over fire and applied to the wound. This would cause tissues and blood to heat rapidly to extreme temperatures in turn causing coagulation of the blood thus controlling the bleeding, at the cost of extensive tissue damage. Cautery is described in the Hippocratic Corpus.The cautery was employed for almost every possible purpose in ancient times: as a counterirritant, as a haemostatic, as a bloodless knife, as a means of destroying tumours, etc. Later, special medical instruments called cauters were used to cauterize arteries. The technique of ligature of the arteries as an alternative to cauterization was later improved and used more effectively by Ambroise Par.

Electrocautery
Electrocauterization is the process of destroying tissue using heat conduction from a metal probe heated by electric current. The procedure is used to stop bleeding from small vessels (larger vessels being ligated) or for cutting through soft tissue. Unlike electrocautery, electrosurgery is based on generation of heat inside tissue, using electric current passing through the tissue itself, and when used to stop bleeding, is technically referred to as electrocoagulation. Electrosurgery techniques are used in the treatment of skin cancers via electrodessication and curettage. Electrocauterization is preferable to chemical cauterization because chemicals can leach into neighbouring tissue and cauterize outside of the intended boundaries.

Chemical cautery Many chemical reactions can destroy tissue and some are used routinely in medicine, most commonly for the removal of small skin lesions (i.e. warts or necrotized tissue) or hemostasis. The disadvantages are that chemicals can leach into areas where cauterization was not intended. For this reason, laser and electrical methods are preferable, where practical. Some cauterizing agents are:
Silver nitrate: Active ingredient of the lunar caustic, a stick that traditionally looks like a large match-stick. It is dipped into water and pressed onto the lesion to be cauterized for a few moments. Trichloroacetic acid Cantharidin: An extract of the blister beetle that causes epidermal necrosis and blistering; used to treat warts.

Nasal cauterization If a person has been having frequent nose bleeds, it is most likely caused by an exposed blood vessel in their nose. Even if the nose is not bleeding at the time, it is cauterized to prevent future bleeding. The different methods of cauterization include burning the affected area with acid, hot metal or lasers. Such a procedure is naturally quite painful. Sometimes liquid nitrogen is used as a less painful alternative, though it is less effective. In the few countries that permit the use of cocaine for medicinal purposes, it is occasionally used topically to make this procedure less uncomfortable; cocaine being the only local anesthetic which also produces vasoconstriction, making it ideal for controlling nosebleeds. More modern treatment uses Silver Nitrate, a local anesthetic is applied and the procedure is generally painless. The nose may run for up to a week after the procedure.

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