Clinical Monitoring - Quiz 2 Flashcards
Standard V - Monitoring
Oyxgenation
Ventilation
Cardiovascular Status
Thermoregulation
Neuromusdcular Function & Status
Positioning
How does Pulse Ox Work?
Two Lights
- Red - absorbed by dexoyHGB
- Infrared - absorbed by oxyHGB
- Lights pass between two diodes through arterial bed
- Computer does its thing
Beer Lambert’s Law
Absorption of light by a solute to its concentration and at a given wavelength.
What can cause inaccurate Pulse Ox readings?
- Hypoperfusion - vasoconstriction, hypothermia, hypotension
- Motion aritifact
- Methylene blue
- Anemia: < 5g/dl
- Cautery Interference
What does not completely assure adequate gas exchange?
Airway Movement
Failure to intubate is ________, Failure to recognize misplacement is __________
Problematic
Catastrophic
Value of Precordial/Esophageal Stethoscope
Provides continuous assurance that ventilation is happening
Useful to detect changes in breath sounds
Esophageal stethoscope
Soft, plastic catheter with a balloon at the end
Only used with Intubated pts.
Can cause bleeding/irritation
What happens if esophageal stethoscope slides into trachea?
Gas leak around ETT
What does abscence of ETCO2 waveform indicate?
Esophageal Intubation
Accidental d/c from circuit
Cardiac Arrest
Difference between ETCO2 and Arterial CO2
ETCO2 is 2-5 torr lower
- A-B: Baseline, End of Inspiration, Beginning of Expiration
- B-C: Expiratory Upstroke - dead space + alveolar expiration
- C-D: Alveolar Emptying CO2
- D: Actual End-Tidal
- D-E: Rapid return to baseline after exhaling CO2
Gas Analyzer
Continual analysis of inhaled & exhaled respiratory and anesthetic gases
- Mass Spectrometry
- Infrared Spectrometry
- Monochromatic
- Polychromatic
- Raman Spectroscopy
Mass Spectrometry
Measures and reports all of patient’s gas simultaneously
Monochromatic Infrared Spectrometry
- 3.3 micrometer light passed through anesthetic gas sample.
- Absorption of Halogenated agents is at this wavelength
- Must set monitor to agent
Polychromatic Infrared Spectrometry
- 7-13 micrometer light pass through anesthesia gas
- Absorption of halogenated agents are different at this wavelength
- Monitor automatically identifies inhaled anesthetic
- Monitor can tell the concentration of gas being given
- Monitor can measure multiple agents at the same time
Raman Spectroscopy
Determines composition and concentration of gas in patient’s airway using the “Raman scattered light”
Peak Inspiratory Pressure Gauge
Measures positive pressure created by mechanical vent
- Low Pressure Disconnect
- Alarm
- Circuit Disconnect
- Leak in System
High Peak Inspiratory Pressure
- Alarm for pressure > 40cm H2O
- May indicate low pulmonary compliance
- Check for obstruction in system
Human Senses for Monitoring
Hand on Bag
Chest Movement
Listening with Precordial Stethoscope
Electrocardiography
NOT a measure of heart function - you can have a normal ECG with no cardiac output
LBBB needs to be stress tested if they dont have any history.
Monitoring Body Temperature
- All Pediatric Patients under general
- Body can’t compensate for hypothermia under general d/t hypothalamic interference
- Spinal/Epidural hypothermia d/t internal redistribution of heat. Sympathetic system causes vasodilation.
Peripheral Nerve Stimulation
- Pulse Generator
- Two Electrodes
- (+) Proximal Nerve
- ( - ) Distal Nerve
Common Sites for Monitoring Neuromuscular Function
Ulnar Nerve - pollicus muscle
Facial Nerve - orbicularis oculi muscle
