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Sp: PMI > 10. Capnography > Flashcards

10. Capnography Flashcards

1
Q

EtCO2

A

[CO2] expired gas

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2
Q

how is EtCO2 measure

A

exhaled gas analyzer (capnograph)

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3
Q

PaCO2

A

[CO2] in arteries
(slightly higher than EtCO2)

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4
Q

how is PaCO2 measured

A

arterial blood gas lab

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5
Q

PaCO2 vs EtCO2

A

PaCO2 is 3-5 mmHg higher than EtCO2

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6
Q

PaCO2 and EtCO2 normal relationship

A

proportional

incr PaCO2 = incr EtCO2

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7
Q

when can PaCO2 and EtCO2 be inversely proportional

A

drop in CO
or
low BP

PaCO2 incr
EtCO2 decr

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8
Q

capnograph

A

exhaled gas analyzer

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9
Q

capnograph measures

A

end tidal CO2
end tidal agent concentration
respiratory rate

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10
Q

water trap

A

can get overfilled w/condensation

weird end tidal readings = time to change or dump out

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11
Q

sample line occluded reading means

A

time to replace water trap
or
aspirate water with syringe

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12
Q

GA capnography

A

tubing hooks to anesthesia circuit

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13
Q

MAC capnography

A

tubing placed inside breathing mask

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14
Q

MAC capnography w/nasal cannula

A

special cannula w/capnograph line attached

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15
Q

Low CO/ Low BP

A

incr PaCO2
decr EtCO2

less CO2 taken to alveoli to be exhaled = more CO2 in blood

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16
Q

treatment for hypotension

A

bolus (20mg) of Ephedrine

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17
Q

EtCO2 is so powerful at telling us

A

whether or not hypotension is serious enough to compromised perfusion

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18
Q

hypotension accuracy can be verified by

A

EtCO2

if EtCO2 is low, then likely that BP is also low and tissue perfusion has decreased

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19
Q

low EtCO2 and Low BP indicates

A

perfusion has decreased

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20
Q

physiologic effects of hypercarbia (hypercapnia)

A
  1. respiratory acidosis
  2. central pulmonary vasoconstriction
  3. peripheral/cerebral vasodilation
  4. sympathetic response/catecholamine release
  5. CO2 narcosis
  6. possible death
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21
Q

respiratory acidosis

A

pH decrease

incr CO2
incr acid in body (H+)
decr pH

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22
Q

acidosis can cause

A

catecholamines dont work
vasopressors dont work
cardiac function depressed

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23
Q

treatment for acidosis

A

bicarbonate
incr BP

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24
Q

central pulmonary vasoconstriction

A

incr CO2 = pulmonary vasoconstriction = PVR

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25
Q

do not hyperventilate what type of pts

A

hypotensive pts

hyperventilation decr CO2
pulmonary vasodialtion

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26
Q

do not hypoventilate what type of pts

A

hypertensive pts
pts in neurosurgery
pts w/head injury

hypoventilation incr CO2
pulmonary vasoconstriction

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27
Q

peripheral/cerebral vasodilation

A

decr in SVR
incr CBF / incr ICP

incr CO2 = peripheral/cerebral vasodilation

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28
Q

at high levels CO2 can act as a

A

sedative

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29
Q

what level does CO2 trigger narcosis/suppress respiratory drive

A

70mmHg

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30
Q

1 MAC = _____ PaCO2

A

1 MAC = 200 mmHg PaCO2

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31
Q

what level does CO2 become life threatening?

A

> 120mmHg

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32
Q

test prompt – know what CO2 will do to the vasculature

A
33
Q

physiologic effects of hypocarbia (hypocapnia)

A
  1. respiratory alkalosis
  2. central/pulmonary vasodilation
  3. peripheral/cerebral vasoconstriction
34
Q

respiratory alklalosis

A

pH increase

decr CO2
decr acid (H+)
incr pH

35
Q

alkalosis is associated with

A

neuromuscular irritability
seizures

36
Q

central (pulmonary) vasodialtion

A

decr CO2 causes pulmonary vasodilation and decr PVR

37
Q

hyperventilation causes

A

decr CO2

38
Q

hyperventilation is beneficial for what pts

A

pt w/history of pulmonary hypertension

39
Q

peripheral vasoconstriction causes

A

incr SVR
decr CBF

40
Q

pts we should not hyperventilate

A

hypotensive pts

hypotension and hypocarbia is bad for cerebral perfusion

41
Q

most reliable confirmation of correct ETT placement

A

EtCO2

42
Q

secondary confirmation signs of ETT placement

A

breath sounds
chest rise

43
Q

secondary indication that tube is incorrectly placed

A

drop in SpO2

44
Q

if an ETT is placed in esophagus, what will the EtCO2 read

A

low
might be above 0 due to pt swallowing expired air

45
Q

after 1st minute of apnea, PaCO2 increases by

A

6mmHg

46
Q

after each subsequent minute of apnea, PaCO2 increases by

A

3-4 mmHg

47
Q

when during the breath does EtCO2 return to baseline?

A

during inspiration

48
Q

when during the breath is EtCO2 at its peak?

A

expiration

49
Q

curare cleft

A

pt is trying to breath over the vent
pt is making spontaneous respiratory efforts

MR could be wearing off

50
Q

treatments for curare cleft

A
  1. propofol
  2. redose paralytic or narcotic
  3. incr minute ventilation
  4. turn off vent for SV
51
Q

how does propofol treat a curare cleft?

A

short term solution
suppress respiratory drive

52
Q

how do paralytics treat curare cleft?

A

longer term solution
good if surgery has a while to go
re-dosing = less than initial paralysis dose

53
Q

re-dose roc for curare cleft

A

1-2mL

54
Q

how do narcotics treat curare cleft?

A

longer term solution
suppress resp drive
better if surgery is closer to being done

55
Q

how does increasing minute ventilation treat curare cleft?

A

lowers EtCO2
less drive to breathe

56
Q

when should you turn off the vent to treat curare cleft?

A

if the case is near the end
if we dont know cause of cleft

57
Q

2 causes of curare cleft

A

surgical manipulation
(surgeon pushing on chest)

or

pt breathing over vent

58
Q

1st step if pt is bucking on vent

A

turn vent off

then treat w/paralytic, fent, propofol, volatile agent

59
Q

COPD waveform

A

upsloping

shows prolonged exhalation times

60
Q

esophageal intubation waveform

A

small CO2 waves that disappear within a few breaths

61
Q

Causes of Hypocapnia reading on EtCO2:

A
  1. hyperventilation
  2. hypotension/low CO
  3. loose circuit connection
62
Q

low EtCO2 in Low BP/CO pts

A

false hypocapnia reading

low CO =
high PaCO2

presents as low EtCO2 because body cannot exhale as much CO2 in low CO states

63
Q

cardiogenic oscillations at end of expiration

A

cause by heart contractions displacing air from alveoli

64
Q

caridogenic oscillations are typically seen with

A

low respiratory rates

go away as pt starts breathing faster/deeper

65
Q

if cardiogenic oscilaltions persist

A

lighten anesthetic

66
Q

if waveform baseline is increased

A

CO2 absorbant is exhausted

67
Q

how do you manage a case with exhausted CO2 if you cant change it out immediately?

A

increase FGF to 5L/min

68
Q

if you see humps in waveform expiration prior to the peak what does that indicate?

A

loose capnograph tubing

69
Q

how does a sample line become occluded?

A

full water trap
capnograph tubing pinched

70
Q

stage II capnograph indication

A

erratic breathing pattern

71
Q

what if you see a small hump during inspiration phase of capnograph waveform?

A

pt is inhaling CO2 during inspiration

72
Q

causes of CO2 rebreathing?

A

mapleson circuit
faulty expiratory valve

73
Q

CO2 reading during sedation

A

is not accurate

74
Q

value of capnography during sedation

A

respiratory rate
immediate apnea diagnosis

75
Q

why is capnography better than SpO2?

A

capnography diagnoses apnea immediately

SpO2 cant diagnose until pt is hypoxic

76
Q

in hypoxia, SaO2 is ______ than what SpO2 reads.

A

lower

77
Q

larger humps on sedation capnograph indicates

A

pt is closer to waking up

78
Q

smaller humps on sedation capnograph indicates

A

pt is oversedated

treat w/chin lift/jaw thrust

Sp: PMI (18 decks)

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