Temperature Monitoring Sites

  1. Skin temperature (forehead): Normally 3°F to 4°F below core temperature. The gradient can increase with further cooling
  2. Axilla:  Common site for noninvasive temperature determination and is usually 1°F below body temperature. The probe needs be placed at the axillary artery with the arm adducted.
  3. Tympanic membrane:  Correlates well with core temperature. Intervening cerumen may enlarge the gradient with respect to core temperature.
  4. Rectal: Changes in temperature can lag behind those of core body temperature. This phenomenon is often noted during rewarming.
  5. Nasopharyngeal:  Measured at the posterior nasopharynx and reflects the brain temperature. Can be associated with epistaxis in coagulopathic or pregnant patients. Discouraged in patients with head trauma or cerebrospinal fluid rhinorrhea.
  6. Esophageal: Reflects the core temperature well. Probe should be located at the lower third of the esophagus.
  7. Blood: Can be obtained with the thermistor of a pulmonary artery catheter (PAC).

 

**Source: Clinical Anesthesia Procedures of the Massachusetts General Hospital (2010)

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Ventricular Trigeminy

Ventricular trigeminy is two consecutive sinus beats are followed by a ventricular premature beat. The wide QRS complexes without preceding P waves are ventricular premature beats.

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Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White syndrome is due to an accessory pathway connecting the atria and ventricle. Tachydysrhythmias are common. The treatment depends on whether the patient is hemodynamically stable. These patients are at high risk for ventricular fibrillation.

 

Treatment:

  • Verapamil and diltiazem, calcium channel blockers that depress AV nodal conduction, can worsen WPW.
  • Unstable patients should receive synchronized cardioversion starting at 50 J (monophasic or biphasic).
  • Definitive treatment is ablation.

**ECG Characteristics of Wolff-Parkinson-White:

  • short PR interval, less than 3 small squares (120 ms)
  • slurred delta wave upstroke to the QRS indicating pre-excitation
  • broad QRS
  • secondary ST and T wave changes

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