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APEX-Equipment > EQUIPMENT-Resp monitors & equipment > Flashcards

EQUIPMENT-Resp monitors & equipment Flashcards

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1
Q

Define resistance

A

The force that acts opposite to the relative motion of an object (or flow)

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2
Q

Define pulmonary compliance

A

The ability of the lungs to stretch and expand.

The change in volume fore a given change in pressure

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3
Q

What are 2 types of pulmonary compliance

A
  1. Static compliance

2. Dynamic compliance

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4
Q

What does static compliance assess

A

Assesses the pressure required to keep the lung inflated inflated to a given volume when there is no air movement
Compliance when there is no airflow to keep lungs open

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5
Q

What does dynamic compliance assess

A

Assesses the pressure required to inflate the lung to a given volume when there’s airflow
Compliance of the lung/chest wall during air movement

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6
Q

What 2 factors impact dynamic compliance

A
  1. Airway resistance

2. Tendency of the lungs/chest to collapse

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7
Q

What is PIP

A

Peak inspiratory pressure

Maximum pressure in the patients airway during inspiration

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8
Q

What is plateau pressure

A

The pressure in the small airways and alveoli after the target Vt is achieved

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9
Q

What do alterations in PIP and plateau pressure indicate

A

Pressures in resistance or compliance

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10
Q

How is increased resistance manifested with PIP and plateau pressure
Examples of increased resistance

A 
PIP = increased
PP = normal

Ex: kinked tubing, bronchospasm

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11
Q

How is decreased pulmonary compliance displayed with PIP and plateau pressure

Examples

A

PIP = increased
Plateau pressure = increased

Ex: Endobronchial intubation, pulmonary edema

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12
Q

What are 5 factors that influence pulmonary compliance

A
  1. Muscle tone
  2. Degree of lung inflation
  3. Alveolar surface tension
  4. Amount of interstitial lung water
  5. Pulmonary fibrosis
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13
Q

What is the equation for dynamic compliance

A

Dynamic compliance = tidal volume/(PIP - PEEP)

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14
Q

What factor of pulmonary mechanics does plateau pressure reflect

A

Elastic recoil of the lungs and thorax during inspiratory pause

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15
Q

At what plateau pressure does barotrauma risk increase

A

P>35 cmH2O

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16
Q

What are 4 complications of elevated plateau pressure

A
  1. Ventilator-associated lung injury
  2. PTX
  3. Pneumomediastinum
  4. SQ emphysema
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17
Q

What measures can be taken to decrease the risk of barotrauma r/t increased plateau pressure

A
  1. Reduce Vt
  2. Reduce inspiratory flow (I:E ratio)
  3. PEEP
  4. Adequate sedation
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18
Q

Statis compliance equation

A

Static compliance = Tidal volume/(plateau pressure - PEEP)

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19
Q

What is the normal range for static compliance in adults and children

A 
Adults = 35 - 100 mL/cmH2O
Children = > 15 mL/cmH2O
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20
Q

What does the PIP/PP waveform look like when resistance is increased

Examples

A 
PIP = increased
PP = no change

Ex: kinked ett, bronchospasm, bronchial secretions, foreign body aspiration, airway compression

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21
Q 
What does the PIP/PP waveform look like in the following situations
Kinked ETT
Bronchospasm
Bronchial secretions
Foreign body aspiration
Airway compression
A 
PIP = increased 
PP = no change
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22
Q

What does the PIP/PP waveform look like when compliance is decreased

Examples

A 
PIP = increased
PP = increased

Ex: Endobronchial intubation, pulmonary edema, effusion, PTX, atelectasis, insufflation, ascites, T-burg, inadequate relaxation

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23
Q 
What does the PIP/PP waveform look like in the following situations:
Endobronchial intubation
PTX
Pulm edema
Atelectasis
Insufflation
T-burg
A

Both PIP and PP increased

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24
Q

What 3 physiologic processes are assessed by EtCO2

A

Metabolism
Circulation
Ventilation

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25
What does an increased alpha angle on the EtCO2 suggest
Expiratory airway obstruction
26
What does an increased beta angle on the EtCO2 suggest
Rebreathing d/t faulty inspiratory valve
27
What is measured during phase I of the EtCO2 waveform
Exhalation of anatomic dead space
28
What is measured during phase II of the EtCO2 waveform
Exhalation of anatomic dead space + alveolar gas
29
What is measured during phase III of the EtCO2 waveform
Exhalation of alveolar gas
30
What is measured during phase IV of the EtCO2 waveform
Inspiration of fresh gas, No CO2 present
31
What are examples of an increased alpha angle on EtCO2
1. COPD 2. Bronchospasm 3. Kinked ETT This indicates obstruciton
32
Why is the anatomic dead space portion of the EtCO2 curve flat
Because no gas is exchange in dead space, so CO2 isn't present
33
What are the benefits of in-line EtCO2 monitoring
1. Faster response time, no delay in reading | 2. Doesn't require water trap or pump
34
What are disadvantages of in-line CO2 monitoring
1. Attached to ETT | 2. Increases apparatus dead space
35
Where is in-line vs sidestream EtCO2 located in the breathing system
``` In-line = connected to ETT Sidestream = outside of airway ```
36
What are the advantages of sidestream CO2 monitor
Doesn't add apparatus dead space because it is located outside of the airway
37
What are 2 disadvantages of the sidestream CO2 monitor
1. Delay in reading EtCO2 | 2. Requires a water trap to prevent device contamination
38
What does airflow obstruction look like on EtCO2 waveform
Prolonged upstroke | Increased alpha angle
39
How are cardiac oscillations displayed on EtCO2
The end of the EtCO2 waveform oscillates in-time with the HR
40
What does curare cleft look like on EtCO2 waveform What does this indicate
A notch just before the beta angle Indicates: 1. spontaneous breaths during mechanical ventilation 2. Inadequate reversal during spontaneous respirations
41
What does a low EtCO2 waveform indicate
1. Hyperventilation 2. Decreased CO2 production 3. Increased alveolar dead space (HoTN, PE)
42
What can a high EtCO2 waveform indicate
1. Increased CO2 production (MH, sepsis, hyperthyroid storm) | 2. Decreased alveolar ventilation (hypoventilation)
43
What does an increased CO2 baseline on EtCO2 waveform indicate (5 examples)
1. Rebreathing 2. Exhausted CO2 absorbent 3. Incompetent expiratory valve 4. Hole of inner tube in Bain system 5. Inadequate FGF
44
How does a leak in the sample line appear on the EtCO2 waveform
Beginning of plateau is low because of dilute alveolar gas with atm air Once inspiration occurs, CO2-rich gas is pushed through the sample line resulting in a peak at the end of the plateau
45
Describe the biphasic expiratory plateau Causes Morphology of waveform
Causes = single-lung transplant Morphology = Each lung has a different time constant so there are 2 peaks. - First peak = alveolar gas from transplanted lung with normal time constant - Second peak = alveolar gas from dzd lung. Air trapping results in longer time constant
46
What conditions result in biphasic expiratory EtCO2 plateaus
Single-lung transplant | Severe kyphoscoliosis
47
What are 3 factors that can increase CO2 production and EtCO2
1. MH 2. Thyrotoxicosis 3. Tourniquet removal
48
What are 3 factors that decrease alveolar ventilation and increase EtCO2
1. CNS depressants 2. COPD 3. Residual NMB
49
What are 3 equipment malfunction scenarios that increase EtCO2
1. CO2 absorbent exhaustion 2. Unidirectional valve malfunction (open) 3. Increased apparatus dead space
50
What are 4 factors that can decrease CO2 production and EtCO2
1. Hypothermia 2. Decreased CO 3. V/Q mismatch 4. PE
51
What are 2 factors that increase alveolar ventilation and decrease EtCO2
1. Hyperventilation | 2. Inadequate anesthesia
52
What are 3 equipment related issues that decrease EtCO2
1. Esophageal intubation 2. Poor LMA seal 3. Sample line leak
53
What 4 factors are required for EtCO2 detection
1. CO2 production via metabolism 2. Adequate pulmonary BF for CO2 delivery 3. Adequate ventilation to transport CO2 to circuit 4. Intact sample line
54
What are the 4 categories that contribute to EtCO2 changes
1. CO2 production (metabolism) 2. Pulmonary perfusion 3. Adequate ventilation 4. Equipment
55
On what law is the pulse oximeter based
Beer-Lamber Law
56
What is the Beer-Lambert Law
Relates the intensity of light transmitted through a solution (blood) and the concentration of the solute (hgb) within the solution
57
What two wavelengths of light are measured | Where are they preferentially absorbed
``` Red light (660 nm) = deoxyhgb Near-infrared (940 nm) = oxyhgb ```
58
Which pulse-ox monitoring sites are more responsive
More central sites (forehead, ear) vs peripheral (toe)
59
How does the peak and trough of the pulse-ox waveform compare
Peak = greater amount of arterial blood in sample Trough = greater amount of venous blood in sample
60
What 2 physiologic factors affect pulse-ox monitoring sites
1. Vasoconstricitve effects of SNS stimulation | 2. Hypothermia
61
What is the estimated PaO2 corresponding to the following SpO2 % 90% = 80% = 70% =
``` 90% = PaO2 60 mmHg 80% = PaO2 50 mmHg 70% = PaO2 40 mmHg ```
62
What is the estimated PaO2 when SpO2 is 100%
At least 100 mmHg, but unable to extrapolate a PaO2 without drawing and ABG
63
What are 5 methods of improving SpO2 signal
1. Place a digital block 2. Warm the extremity 3. Protect the extremity from ambient light 4. Apply vasodilating cream 5. Administer an arterial vasodilator
64
What 4 factors does a pulse-ox noninvasively monitor
1. Hgb saturation 2. HR 3. Fluid responsiveness (pulse pressure variation) 4. Perfusion
65
What are 3 factors that a pulse-ox does NOT monitor
1. Anemia 2. Ventilation 3. Bronchial intubation
66
Why is the pulse-ox not a good measure of ventilation
Pt may have a normal SpO2, especially w/ supplemental O2, but it does not indicate CO2 exchange and can become hypercarbic in the presence of 100% SpO2
67
What wavelength of light does methemoglobin absorb
660 nm and 940 nm equally
68
What will SpO2 read in the presence of MetHgb | Does this over or underestimate SpO2
85% Underestimate if O2 >85% Overestimates if O2 <85%
69
What wavelength of light does carboxyhgb absorb
660 nm to the same degree as Oxyhgb
70
How does carboxyhgb affect pulse oximetry monitoring
The CarboxyHgb + OxyHgb are both read and OVER estimate SpO2
71
What are 6 causes of inaccurate SpO2 reading
1. Decreased perfusion 2. Altered optical characteristics (nail polish) 3. Non-pulsatile flow 4. Motion 5. Skin color 6. Electrocautery
72
How does nail polish alter SpO2 quality | How can it be fixed
Black, blue, and green polishes can cause inaccurate reading Fix = place probe sideways on the finger below the nail
73
How do jaundice, acrylic fingernails, polycythemia, and hgb F affect the accuracy of SpO2 monitoring
They do NOT affect the reliability of the pulse oximeter
74
How are respiratory gases analyzed
Infrared absorption spectophotometry

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