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principles of anesthesia i > Capnography (Exam I) > Flashcards

Capnography (Exam I) Flashcards

1
Q

T/F
Capnography is one of the standards set out by the AANA/ASA?

A

True

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2
Q

What 3 statuses do we learn from capnography?

A

Ventilation
Metabolism
Cardiovascular

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3
Q

What are the effects of hypercarbia?

A

Respiratory Acidosis
↑ CBF
↑ PVR
K⁺ shift intravascularly

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4
Q

What are the effects of hypocarbia?

A

Respiratory alkalosis
↓ CBF
↓ PVR
K⁺ shift intracellularly
Blunts respiratory drive

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5
Q

What 5 things does capnography provide us information regarding?

A

Pulmonary blood flow
Aerobic metabolism
Placement of ETT/LMA
The integrity of the breathing circuit
Cardiac Output

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6
Q

What is the Bohr Equation?
What is it used for?

A

To calculate physiologic dead space

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7
Q

What is physiologic dead space?

A

Anatomic DS + Alveolar DS

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7
Q

What is anatomic dead space?

A

Comprised of the conducting zones:
Nose, pharynx, larynx, trachea, and bronchi

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8
Q

What is capnometry?

A

Measurement and quantification of inhaled or exhaled CO2 concentrations

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8
Q

What 7 conditions can cause an increase in Alveolar DS?

A

Hypovolemia
Pulmonary Hypotension
Pulmonary embolus
Ventilation of nonvascular airspace
Obstruction of precapillary pulmonary vessels
Obstruction of the pulmonary circulation by external forces
Overdistention of the alveoli

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9
Q

What is the best method to confirm endotracheal tube placement?

A

Capnography

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10
Q

Differentiate high-speed (real-time) and low speed (trend) capnography

A

High-speed: user can interpret information about each breath
Slow-speed: appreciation of the expired and inspired trend

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11
Q

How much gas do side-stream analyzers utilize?

A

50-200 mL/min

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12
Q

What is the most common method for capnographic sampling, side-stream or main-stream?

A

Side-stream

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13
Q

What are the benefits of main-stream sampling?

A

No time delay
Quicker rise time

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14
Q

End-Tidal CO2 is measured at what point on the ETCO2 waveform?

A

Phase III

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15
Q

What 3 main categories can cause an increased PetCO2?

A

Increased CO2 production and delivery to the lungs
Decreased Alveolar Ventilation
Equipment malfunction

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16
Q

What 3 main categories can cause a decreased PetCO2?

A

Decreased CO2 production and delivery to the lungs
Increased Alveolar Ventilation
Equipment malfunction

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17
Q

What is the approximate difference between PaCO₂ and EtCO₂?

A

5 mmHg
ex. PaCO₂ will be 40 mmHg vs EtCO₂ at 35 mmHg

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18
Q

What problems can increase the difference between PaCO₂ and EtCO₂?

A

V/Q mismatch
Breathing patterns that fail to deliver alveolar gas
Problems with the capnograph

19
Q

Clinical measurement of EtCO₂ is dependent primarily on what factor?

A

Infrared light absorption

20
Q

What color is the CO₂ chemical indicator?
What color does it change to in the presence of CO₂ ?

A

purple → yellow

21
Q

Can the CO₂ chemical indicator still change color with an esophageal intubation?

A

Yes

22
Q

When using a capnograph, how close must a CO₂ reading be to the actual value?

A

+/- 12%

23
Q

What are the monitor requirements for capnography?

A

Manufacturers must disclose interference caused by ethanol, acetone, halogenated volatiles

Must have a high CO2 alarm for inhaled and exhaled CO2

Must have an alarm for low-exhaled CO2

24
Q

What are the inspiratory phases of the capnograph?

A

Phase 0

25
Q

What are the expiratory phases of the capnograph?

A

Phases I, II, III

26
Q

When would the CO₂ reading of a capnograph be 0 mmHg?

A

Phase I

27
Q

Which phase of the capnograph would be representative of alveolar CO₂?

A

Phase III

28
Q

What is Phase IV on the capnograph? Why does it occur?

A

Upstroke at the end of Phase III resulting from collapse of the alveoli

29
Q

Phase IV can be seen in what population?

A

Pregnant
Obese

30
Q

What phases are separated by the α angle?

A

Phases II and III

31
Q

What degree should the α angle have?
What occurs with an increase to the angle’s degree?

A

100 - 110°
Angle increases with an expiratory airflow obstruction (COPD, bronchospasm, kinked ETT)

32
Q

What phases are separated by the β angle?

A

Phases III and 0

33
Q

What degree should the β angle have?

A

90°

34
Q

What situations/conditions would cause an increase in the β angle?

A

Bad inspiratory valve
Rebreathing
Low VT w/ tachypnea

35
Q

What type of capnograph is depicted below?

A

Mechanical Ventilation

36
Q

What type of capnograph is depicted below?

A

Spontaneous Ventilation

37
Q

What is occurring with the capnograph below?

A

Inadequate ETT seal

38
Q

What could be happening in the capnography below?

A

Faulty inspiratory valve

39
Q

What is occurring with the capnograph below?

A

Sample line leak

40
Q

What is occurring with the capnograph below?

A

Hyperventilation (resulting in a ↓ EtCO₂)

41
Q

What is occurring with the capnograph below?

A

Hypoventilation (resulting in steady ↑ EtCO₂)

42
Q

What is occurring with the capnograph below?

A

Airway obstruction or breathing circuit obstruction

43
Q

What is occurring with the capnograph below?
In what population is this primarily seen?

A

Cardiac Oscillations
Pediatrics

44
Q

What is occurring with the capnograph below?

A

Rebreathing (note the increasing baseline)

45
Q

What is occurring with the capnograph below?

A

Curare Cleft (NMBDs are wearing off)

46
Q

What is occurring with the capnograph below?

A

Ventilator Overbreathing

47
Q

What is occurring with the capnograph below?

A

Esophageal intubation (the ol’ tubed goose)

principles of anesthesia i (8 decks)

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