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SRNA4TopicsAnesthesia > APEX: Monitoring I Respiratory > Flashcards

APEX: Monitoring I Respiratory Flashcards

1
Q

CO2 Waveform consistent with obstruction can show

A

Elevated peak with normal plateau pressure

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2
Q

Conditions associated with elevated peak pressure and normal plateau pressure : ETT

A

Kinked ETT

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3
Q

Conditions associated with elevated peak and normal plateau pressure : lungs and other

A

Bronchospasm

Aspiration of foreign body

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4
Q

What is elevated peak pressure and normal plateau pressure indicates?

A

Reduction in dynamic compliance caused by increased airway resistance.

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5
Q

Assessment of Pulmonary Resistance and compliance: Resistance formula

A

Resistance = P(airway) - P (alveolar) / Gas flow rate

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6
Q

Defined as the force that acts opposite to the relative motion of an object?

A

Resistance

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7
Q

What is the definition of compliance?

A

Change in Volume/ change in pressure

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8
Q

Change in volume for a given changes in pressusre

A

Compliance

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9
Q

What does compliance measure?

A

The elastic properties of the lungs and chest wall

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10
Q

What is compliance influenced by? DAMAP

A 
Degree of lung inflation
Alveolar surface tension
Muscle tone
Amount of interstitial lung water
Pulmonary fibrosis
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11
Q

What is dynamic compliance?

A

The compliance of the lungs /chest wall DURING air movement

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12
Q

Dynamic compliance is the pressure

A

required to inflate the lung to a given volume is a

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13
Q

Static means

A

Not moving

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14
Q

Static compliance measures

A

Lung compliance where there is NO AIRFLOW

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15
Q

Static compliance is the pressure

A

required to keep the lung inflated to a given volume

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16
Q

Static compliance is the function

A

of the tendency of the lung/chest to collapse. Since there is no airflow during this measurement there is no resistance to overcome

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17
Q

Dynamic compliance is a function of

A

Function of AIRWAY RESISTANCE and the TENDENCY OF THE LUNG/CHEST WALL to COLLAPSE

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18
Q

The significance of peak inspiratory pressure and plateau pressure

A

The peak inspiratory and plateau pressure provide key insight to a patient’s airway resistance and LUNG-THORACIC COMPLIANCE

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19
Q

Peak inspiratory Pressure (PIP)

A

Is the maximum pressure in the patient’s airway during inspiration

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20
Q

What is PIP affected by?

A

Because air flow is flowing into the airway during inspiration, PIP is affected by airway resistance and lung-thoracic compliance

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21
Q

Dynamic compliance FORMULA

A

Tidal volume / Peak pressure- PEEP

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22
Q

What is plateau pressure?

A

the pressure in the small airways and alveoli after the target TV is delivered.

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23
Q

Plateau pressure is the pressure in the small airways and alveoli after the target TV is delivered. Does airway resistance affect plateau pressure? why/why not?

A

Since there is no airflow at this time, airway resistance does not affect plateau pressure.

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24
Q

Plateau pressure reflects the

A

elastic recoil of the lungs and thorax during the inspiration pause (no gas i s moving in or out) of the lungs

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25
Q

What is BAROTRAUMA risk is high ?

A

Risk increases when plateau pressure exceeds 35cm/H2O

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26
Q

What are complications of ELEVATED plateau pressure?

A

Ventilator-associated lung injury
Pneumothorax
Pneumomediastinum
SC emphysema

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27
Q

IF Barotrauma exists, you should aim to

A

Reduce plateau pressure by reducing TV, inspiratory flow and PEEP. Sedation is helpful

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28
Q

Static compliance formula

A

Tidal volume / Plateau pressure - PEEP

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29
Q

In the adult, the normal static compliance is

A

35-100 ml/cm H2O

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30
Q

In the Child, the normal static compliance is

A

> 15cm /cm H2O

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31
Q

If PIP is increase and PP increase then: Total complaince has ________or TV has _______

A

Total compliance has decreased

TV has increased

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32
Q

If PIP is increased and no changed in PP then: Total compliance has________ or TV has _______

A

Resistance has increase OR Inspiratory flow rate has increased.

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33
Q

Compliance with : Endobronchial intubation?

A

Decreased

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34
Q

Compliance with : Pulmonary edema

A

Decreased

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35
Q

Compliance with : Pleural effusion

A

Decreased

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36
Q

Compliance with : Tension pneumothorax

A

Decreased

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37
Q

Compliance with : Atelectasis

A

Decreased

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38
Q

Compliance with : Chest wall edema

A

Decreased

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39
Q

Compliance with : Abdominal insufflation

A

Decreased

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40
Q

Compliance with : Ascites

A

Decreased

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41
Q

Compliance with : Trendelenburg position

A

Decreased

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42
Q

Compliance with : Inadequate muscle relaxation

A

Decreased

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43
Q

Increase resistance in airway with

A

Bronchial secretion
Compression of the airway
ETT cuff HERNIATION
FB aspiration

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44
Q

Phase I (A-B) represents

A

Exhalation of anatomic dead space (flat before phase II)

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45
Q

Phase II (B-C) represents

A

Exhalation of anatomic dead space+ ALVEOLAR GAS.

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46
Q

Upstroke is phase

A

II

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47
Q

Phase III (C-D) represents

A

exhalation of alveolar gas.

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48
Q

Plateau phase is

A

III

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49
Q

Phase IV represents

A

Inspiration of fresh gas that DOES NOT CONTAIN CO2

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50
Q

Illustrated by return of waveform to baseline

A

Phase IV

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51
Q

Capnography measures

A

ETCO2 concentration over time.

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52
Q

Capnography measures 3 main things?

A

Assessment of metabolism
Circulation
Ventilation

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53
Q

CO2 concentration gradient

A

From the tissues to the breathing circut

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54
Q

What is the final product of aerobic metabolism?

A

Carbon dioxide

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55
Q

CO2 diffuses airway then from the tissues on, what happen?

A

from the tissue and enters the venous circulation, From here, the CO determines the rate of transfer towards the lungs. In the lungs, CO2 follows a concentration gradient as it diffuses across the alveolar capillary membrane. Once the CO2 in the alveolus, ventilation is the process by which CO2 is removed from the body

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56
Q

What point in the CO2 waverform is ETCO2 measure?

A

Point D

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57
Q

Normal ETCO2

A

35-40 mmHg

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58
Q

The alpha angle is

A

Airway obstruction reading

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59
Q

Where is the alpha angle measure?

A

Point C

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60
Q

Normal alpha angle is

A

100-110 degreers

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61
Q

An increase alpha angle means

A

EXPIRATORY AIRFLOW OBSTRUCTION such as COPD, bronchospasm or a KINKED ETT TUBE.

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62
Q

Alpha angle is between

A

the first expiration upstroke and the plateau line

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63
Q

Beta angle is

A

REBREATHING reading

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64
Q

The beta angle is measure at what point

A

point D

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65
Q

When the patient inspires, the capnography should immediately

A

return to zero because fresh gas flow does not contain CO2

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66
Q

The beta angle is increased indicating

A

Rebreathing

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67
Q

Causes of Rebreathing

A

Faulty unidirectional valves

Exhausted CO2 absorbent

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68
Q

If Expiratory vale is faulty you will notice 2 things about the waveform

A

Beta angle become WIDER DURING INSPIRATORY

Baseline does not return to zero

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69
Q

Middle of case expiratory valve malfunction

A

Increased the FGF to finish case

after, took valve assembly and flipped the disc over

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70
Q

2 Methods of CO2 analysis

A

Mainstream (in line)

Sidestream (diverting )

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71
Q

In what CO2 analysis methods is the device attached to the ETT

A

Mainstream (in line)

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72
Q

What CO2 analysis method has a faster response time,

A

Mainstream , does not require a water trap or pumping mechanism

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73
Q

Benefits mainstream (in line) CO2 analysis

A

Because it’s attached to the ETT , it does not increase apparatus dead space as well as adds extra weight

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74
Q

Sidestream (diverting) CO2 analysis location

A

Located outside of the airway

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75
Q

Sidestream uses what kind of mechanism?

A

A pumping mechanism continuously aspirate the gas sample from the breathing circuit, and for this reason, the response time is slower.

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76
Q

CO2 analysis method with a water trap

A

Sidestream ; to prevent contamination of the device.

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77
Q

Identify caused of the abnormal waveform if there is a PROLONGED UPSTROKE

A

Airflow obstruction

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78
Q

Identify caused of the abnormal waveform if there is a INCREASED ALPHA ANGLE

A

Airflow obstruction
COPD
Bronchospasm
Kinked ETT

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79
Q

Identify caused of the abnormal waveform if there is a CARDIAC OSCILLATION

A

Heart beating against the lungs

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80
Q

CARDIAC OSCILLATION more common in ? why?

A

In children, close proximity of heart to the lungs

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81
Q

Identify caused of the abnormal waveform if there is a CURARE CLEFT

A

Spontaneous breaths during mechanical ventilation

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82
Q

Identify caused of the abnormal waveform if there is a CURARE CLEFT, If presents during spontaneous ventilation , suggests

A

INADEQUATE MUSCLE RELAXANT (lack of synchronizaiton between intercostal muscles and diaphragm)

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83
Q

Low ETCO2 indicates

A

Hyperventilation
Decrease CO2 production
Increased alveolar dead space

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84
Q

BP and CO2

A

Hypotension leads to CO2 production

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85
Q

Elevated ETCO2 with normal plateau?

A

Make sure you look at the baseline and that it returns to zero. Its not rebreathing. Occurs with increased production of CO2 or DECREASED ALVEOLAR VENTILATION

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86
Q

Baseline not returning to zero is

A

rebreathing

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87
Q

Inadequate FGF with mapleson circuit lead to

A

Rebreathing

88
Q

Widened beta angle

A

Incompentent unidirectional valve

89
Q

Patient with single lung transplant and CO2 waverform

A

Alveolar gas from transplanted lung and the diseased lung have different time constants
The first peak is alveolar GAS FROM TRANSPLANT(normal time constant)
The second peak is alveolar GAS from DISEASED Lung.

90
Q

Leak in sample time CO2 waveform?

A

The beginning of the plateau is low, because dilution of alveolar gas at atmospheric air is aspirated into the sample line. NOT SEEN WITH SPONTANEOUS VENTILATION.

91
Q

Hyperventilation from increased MV lead to this electrolyte imbalance?

A

Metabolic acidosis

92
Q

For ETCO2 to be detected, what must be met?

A

CO2 must be produced during metabolism
Adequate pulmonary blood flow to deliver CO2 to lungs
Adequate VENTILATION to transport CO2 to the breathing circuit
INTACT SAMPLING SYSTEM

93
Q

When answering question about ETCO2, answer these 2 things

A

What is the cause?

Does this affect the PaCO2 to ETCO2 gradient?

94
Q

Causes of changes in ETCO2 can be divided into

A

Changes in CO2 Production: Impaired pulmonary perfusion, or /and Impaired ventilation
Equipment malfunction

95
Q

Normal PaCO2 to EtCO2 gradient

A

2-5 mmHg

96
Q

A wide PaCO2 to EtCO2 gradient suggests

A

V/Q mismatch/ OR equipment malfunction

97
Q

PaCO2 is _____Than EtCO2

A

Higher

98
Q

The first thing that should come to mind with wide PaCo2 to EtCO2 gradient

A

INCREASED DEAD SPACE (such as hypotension, reduced CO / PE etc)

99
Q

Increase Basic Metabolic RATE ( increase VO2) affect CO2 how ?

A

Increased CO2 (increased production)

100
Q

MH affect CO2 how ?

A

Increased CO2 (increased production)

101
Q

Thyrotoxicosis affect CO2 how ?

A

Increased CO2 (increased production)

102
Q

Fever affect CO2 how ?

A

Increased CO2 (increased production)

103
Q

Sepsis affect CO2 how ?

A

Increased CO2 (increased production)

104
Q

Seizures affect CO2 how ?

A

Increased CO2 (increased production)

105
Q

Laparoscopy affect CO2 how ?

A

Increased CO2 (increased production)

106
Q

Tourniquet or vascular clamp removal affect CO2 how ?

A

Increased CO2 (increased production)

107
Q

Sodium bicarbonate administration affect CO2 How?

A

Increased CO2 (increased production)

108
Q

Anxiety affect CO2 How?

A

Increased CO2 (increased production)

109
Q

Pain affect CO2 How?

A

Increased CO2 (increased production)

110
Q

Decrease BMR (Vo2) affect CO2 How?

A

Decreased CO2 production and delivery to the lungs.

111
Q

Increased anesthetic depth affect CO2 How?

A

Decreased CO2 production and delivery to the lungs.

112
Q

Hypothermia affect CO2 how?

A

Decreased CO2 production and delivery to the lungs.

113
Q

Decreased pulmonary blood flow affect CO2 how?

A

Decreased CO2 production and delivery to the lungs.

114
Q

Decreased cardiac output affect CO2 how?

A

Decreased CO2 production and delivery to the lungs.

115
Q

Hypotension affect CO2 how?

A

Decreased CO2 production and delivery to the lungs.

116
Q

Pulmonary Embolusm affect CO2 how?

A

Decreased CO2 production and delivery to the lungs.

117
Q

V/Q mistmatch affect CO2 how?

A

Decreased CO2 production and delivery to the lungs.

118
Q

Medication side effect affect CO2 HOw?

A

Decreased CO2 production and delivery to the lungs.

119
Q

Main mechanism of Increased ETCO2

A

Decreased alveolar ventilation

120
Q

Decreased alveolar ventilation causes : RESP

A

Hypoventilation
COPD
Metabolic alkalosis (If spontaneous ventilation)

121
Q

Decreased alveolar ventilation causes: NEURO

A

CNS depression
Residual NMB
High spinal
NM disease

122
Q

Main Cause of DECREASED ETCO2

A

Increase alveolar ventilation

123
Q

Increased alveolar ventilation causes : RESP

A

Hyperventilation

Metabolic acidosis

124
Q

Can cause either increase or decrease alveolar ventilation

A

Medication side effect

125
Q

Inadequate ventilation on alveolar ventilation

A

Increase Alveolar ventilation

126
Q

Equipment malfunction that would cause Increased ETCO2

A 
Rebreathing
CO2 absorption exhaustion
Unidirectional valve malfunciton
Leak in breathing circuit
Increased apparatus dead space
127
Q

Equipment malfunction that would cause Decreased ETCO2

A 
Ventilator disconnect
Esophageal intubation
Poor seal with ETT or LMA
Sample line leak
Airway obstruction
Apnea
128
Q

The pulse oximeter utilizes which Law

A

Beer-Lambert Law

129
Q

Pulse oximeter emits ____

A

2 wavelenghts of light

130
Q

Pulse oximeter emits 2 wavelengths of light

A

oxygenated blood better absorbs near infrared light (940nm)

Deoxygenated blood better absorbs red light (660nm)

131
Q

What does the pulse oximeter really look at ?

A

Ration of light absorption during the peak of the waveform relative to the trough of the waverform.

132
Q

At the peak of the waveform, the

A

Ratio of arterial blood to venous blood is INCREASED>

133
Q

The beer-lambert law relates

A

the intensity of light transmitter through a solution and the concentration of the solute within the solution. in this instance, the solution is blood and the solute is hemoglobin

134
Q

The oxygen saturation determines

A

the color of the blood. Comparing the ratio of light absorption in arterial and venous blood.

135
Q

Red light is preferentially absorbed by

A

Deoxyhemoglobin (higher in venous blood)

136
Q

Near infrared light is preferentially absorbed by

A

Oxyhemoglobin (higher in arterial Blood )

137
Q

For pulse ox, the amount of light absorbed

A

Changes throughout the pulse cycle

138
Q

At the trough of the pulse ox waveform,

A

There is a greater amount of venous blood in the tissue sample

139
Q

At the peak of the pulse ox waveform,

A

There is greater amount of arterial blood in the tissue sample.

140
Q

SPO2 formulation

A

Oxygeated Hgb / Oxygenated Hgb + Deoxygenated

x 100%

141
Q

SPO2 response time, as a general rule

A

The closer the monitoring site to the central circulation, the faster it will respond to ARTERIAL desaturation.

142
Q

Central monitoring sites are more resistant to the

A

vasonconstrictive efrects of SNS stimulation and hypothermia

143
Q

Sites of SPO2 From MOST to LEAST RESPONSIVE: FAST

A

Fast = EAR, nose, Tongue, esophagus forehead

144
Q

Sites of SPO2 From MOST to LEAST RESPONSIVE: Middle

A

FINGER

145
Q

Sites of SPO2 From MOST to LEAST RESPONSIVE: SLOW

A

TOE

146
Q

When SPO2 is monitored on the head or esophagus,

A

THE Trendelenburg position can cause venous engorgement resulting in a FALSELY DECREASED SPO2 measurement.

147
Q

SPO2 90%= PaO2 is ______

A

60 mmHg

148
Q

SPO2 80%= PaO2 is ______

A

50 mmHg

149
Q

SPO2 70%= PaO2 is ______

A

40 mmHg

150
Q

SPO2 monitoring is most useful when the patient’s

A

PaO2 aligns with the steep portion of the Oxyhemoglobin dissociation curve.

151
Q

Left shift mean _____affinity

A

think L “Love to hold” Increased

152
Q

Right shift mean ______Affinity

A

Decreased affinity (R for released)

153
Q

CADET FACES RIGHT

A

Increased CO2
Acidosis (Increase H+) (decrease pH)
Increased 2,3, DPG
Increased temperature

154
Q

LEFT shift is associated with

A

Decreased CO2
Alkalosis (decreased H+) (Increased pH)
Decreased 2,3 DPG
Decreased Tempature

155
Q

Once the SPO2 reaching 100% on the plateau portion of the curve, you are no longer able to extrapolate the PaO2; it could be

A

100 or 500mmHg, either way the SPO2, will read 100%

156
Q

5 Methods to improve the SPO2 signal

A 
Performance of a digital block
Warming the extremity
Protecting the extremity from light
Vasodilating crea
Administer an arterial vasodilator.
157
Q

Pulse oximeter is a useful monitor of

A

Vascular compression

158
Q

Pulse ox is not a good monitor or

A

Ventilation
Anemia
Bronchial intubation

159
Q

The pulse oximeter is a noninvasive monitor of

A

Hemoglobin saturation
Heart rate
Fluid responsiveness

160
Q

Useful to asses perfusion?

A

Pulse oximeter

161
Q

May be compressed during mediatinoscopy

A

The brachiocephalic (innominate) artery

162
Q

Innominate artery supplies blood to

A

right arm, head and neck

163
Q

First branch of the aortic arch?

A

Innominate artery

164
Q

Third branch off the AORTA

A

Innominate

165
Q

What are the 2 branches off the aorta

A

Left and right coronary arteries.

166
Q

Where do you place pulse ox probe to monitor foot perfusion in the lithotomy position?

A

Placement on the toe

167
Q

Pulse ox can monitor for shoulder arthroscopy?

A

Brachial artery compression during shoulder arthroscopy

168
Q

Does the pulse oximeter monitor anemia?

A

NO

169
Q

SPO2 monitors the

A

% of hemoglobin bound with oxygen

170
Q

If the Hgb is fully saturate with oxygen, then the

A

SPO2 will continue to read 100%

171
Q

2 parameters highly depended on the amount of Hgb

A 
Oxygen carrying capacity (CaO2)
Oxygen delivery (DO2)
172
Q

May overestimated SPO2 with

A

Severe anemia.

173
Q

Does the pulse oximeter monitor VENTILAITON

A

NO

174
Q

Alveolar oxygen equation

A

Alveolar oxygen = FiO2 x (Pb - PH2O) - PaCO2/RQ

175
Q

Just because a patient does not desaturate does not mean

A

The Endotracheal tube is not positioned in the left or right bronchus.

176
Q

Assessment of bronchial intubation is better accomplished by

A

Presencee of bilateral breath sounds
Chest X-ray
Visualizing the CARINA through a fiberoptic bronchoscope.

177
Q

Bronchial intubation and PIP

A

ACUTE rise in PIP during volume controlled ventilation may signal a bronchial intubation . As you withdraw the ETT, the peak inspiratory pressure and the pressure and flow volume should return to baseline.

178
Q

How does the LVAD affect pulse ox reading?

A

Unlike a healthy heart that delivers pulsatile flow to the body, the LVAD supplements the failing myocardium with non-pulsatile flow.

179
Q

How does the carboxyhemoglobin affect Pulse ox reading

A

Carboxyhemoglobin absorbs the same wavelength as oxyhemoglobin. This causes the pulse ox to overestimate the degree of oxygen bound to hemoglobin.

180
Q

Nail polish and pulse ox reading

A

False reduction in SPO2

181
Q

Pulse ox has a margin of error

A

2-3 percent when the SPO2 is between 70–100%

182
Q

Margin of error for pulse ox 50-70%

A

3%

183
Q

Dysfunctional oxygen species include

A

Methemoglobin

Carboxyhemoglobin

184
Q

Methemoglobin absorbs

A

660nm ; 940 nm equally

185
Q

Methemoglobin absorption

A

the 1:1 absorption ratio is read as 85%

186
Q

Methomoglobin falsely underestimated SPO2 if O2 sat

A

> 85 %

187
Q

Methomoglobin falsely overestimated SPO2 if O2 sat

A

< 85%

188
Q

Carboxyhemoglobin absorbs

A

660nm to the same degree as O2-Hgb

189
Q

Decreased perfusion affecting SPO2

A

vasoconstriction
Hypothermia
Hypoperfusion
Raynaud’s syndrome

190
Q

Altered optical characteristics affecting pulse ox

A

Dyes such as methylene blue,

Indocyanine green, and INDIGO CARMINE

191
Q

Nail polish colors affecting pulse ox

A

Black
Blue
Green

192
Q

Non-pulsatilve flow affecting pulse ox

A

CPB

LVAD

193
Q

Motion artifact that affects pulse ox

A

shivering

movement and positioning of patient.

194
Q

Factors that DO NOT AFFECT reliabiity of pulse ox

A

Jaundice
Hgb F and S
Polycythemia
Acrylic finger nails.

195
Q

What is the most common method of measuring exhaled gases inside the breathing circuit?

A

infrared absorption (each gas as signature fingerprint)

196
Q

The greater the partial pressure of a gas inside the breathing circuit,

A

The greater the partial pressure of that gas delivered to the gas analyzer.

197
Q

Infrared absorption spectrophotometry determines

A

Concentration and identities of all sample gases simultaneously

198
Q

Does OXYGEN absorbed infrared light?

A

No

199
Q

Concentration of OXYGEN MUST BE MEASURE BY WHAT MEANS?

A
  1. GALVANIC CELL or clark electrode

2. PARAMAGNETIC ANALYSIS

200
Q

What is mass spectometry?

A

Bombards a gas samples with electrons creating ion fragments

201
Q

New tool that can detect, inspired, expired and breath to breath changes of a particular gas by incorporating a lipid layer on the crystal?

A

Piezoelectric crystals.

202
Q

Which phase of the CO2 waveform BEST corresponds to the ventilation-perfursion status?

A

Plateau phase (phase III)

203
Q

CO2 follows a concentration gradient as it exits the body

A

Blood > lungs> Airway > Sample line or atmosphere.

204
Q

Infraed anaylysis is the most common method of measuring

A

CO2,
N2O
Halogenated anesthetics.

205
Q

Molecules that contain 2 or more dissimilar atoms do what?

A

absorb Infrared light

206
Q

Why can’t infrared analysis measure oxygen, helium, nitrogen or xenon

A

Becauses these species only contain ONE TYPE OF ATOM

207
Q

Sampling methods with less apparatus dead space

A

Sidestream.

208
Q

Response time with sidestream is

A

Slower

209
Q

Red light 660nm is preferentially absorbed by

A

Reduced Hgb

210
Q

Near infrared light (990nm) is preferentially absorbed by

A

HgbO2

211
Q

SPO2 and mmHG

40, 50, 60

A

70, 80,90 respectively

212
Q

Determinants of dynamic compliance are

A

PEEP
PIP
TV

213
Q

No changes in dynamic or status compliance with this?

A

PE

214
Q

This causes decreased dynamic compliance

A

Mucus plus

215
Q

This causes Decrease static compliance

A

Endobronchial intubation

SRNA4TopicsAnesthesia (47 decks)

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