Lecture 30: Peri-anesthesia monitoring and complications-IV

Question 1

What do you check to monitor patients oxygenation

Answer 1

1. SPO2
2. Pulse rate
3. Change in SV

Question 2

What does SPO2 tell you

Answer 2

Oxygenation

Question 3

What does pulse rate tell you that ECG does not

Answer 3

If the heart is actually beating

Question 4

What is a normal PaO2

Answer 4

95 (80-100)mm Hg

Question 5

What is normal SaO2

Answer 5

98 (95-100) %

Question 6

What is normal PvO2

Answer 6

45 (40-45) mm Hg

Question 7

What is normal SvO2

Answer 7

75 (70-75)%

Question 8

What is the ideal maintenance of SPO2

Answer 8

95%

Question 9

What is the minimum for SPO2

Answer 9

90%

Question 10

SPO2 is an estimate of ___

Answer 10

SaO2

Question 11

What is the definition of hypodermic

Answer 11

PaO2 <60mm Hg

Question 12

A PO2 of 60mmHg is equal to __SO2%

Answer 12

90%

Question 13

How do you assess accuracy of SPO2

Answer 13

1. Waveform- constant/ good waveform
2. Pulse rate/rhythm matches actual HR or PR

Question 14

What can affect reliability of pulse ox

Answer 14

Motion, pigment, tissue perfusion, thickness of tissue

Question 15

Where do you place pulse ox probe

Answer 15

Tongue, lips, toes, toe nails

Question 16

If pulse ox not working what can you apply to tongue and what does it do

Answer 16

Dry cause- cushioning effect- prevent collapsed capillary

Question 17

What is definition of cyanosis

Answer 17

deoxyhemoglobine >5g/dl

Question 18

Cyanosis corresponds with what SPO2 and PaO2 values

Answer 18

SPO2 <80%
PaO2 50mm Hg

Question 19

T or F: pink MM always means adequate oxygenation

Answer 19

False

Question 20

If you can’t reliably assess low SPO2 what do you do

Answer 20

Arterial blood gas- check PaO2

Question 21

What is gold standard for assessing oxygenation level

Answer 21

Arterial blood gas analysis

Question 22

What are 5 causes of hypothermia

Answer 22

1. Low FiO2
2. Hypoventilation
3. V/Q mismatch
4. Diffusion impairment
5. Right to left shunt

Question 23

What should you do if low FiO2 is causing hypoxemia

Answer 23

Check O2 flow meter is on and check source of O2 (is it empty)

Question 24

What do you do for hypoxemia caused by hypoventilation

Answer 24

Manual or mechanical ventilation

Question 25

V/Q mismatch is very significant in what species

Answer 25

Large animals

Question 26

How do you tx V/Q mismatch

Answer 26

Avoid/treat atelectasis, improve BP if hypotensive

Question 27

What can cause diffusion impairment leading to hypoxemia

Answer 27

Pneumonia, pulmonary edema, pulmonary parenchymal disease

Question 28

What are some causes of Right to left shunt

Answer 28

1. Patent foramen ovale 2. Ventricular septum defect 3. Pulmonary embolism

Question 29

What is the easiest way to prevent hypoxic situations during anesthesia induction

Answer 29

Pre-oxygenate with mask for minimum of 3 minutes

Question 30

How long do you have til hypoxemia if you don’t preoxygenate

Answer 30

30 secs

Question 31

How long do you have if before hypoxemia if you preoxygenate with mask for 3 minutes

Answer 31

187 secs

Question 32

When actually pushing the drugs, what do you want to do to avoid respiratory depression/ apnea

Answer 32

Slow titration/ injection and only use enough to induce

Question 33

You should wait __after each injection of induction agent to see maximum effect

Answer 33

30 seconds

Question 34

What 4 things are involved in BOAS

Answer 34

1. Stenotic nares 2. Hypoplastic trachea 3. Everted laryngeal saccules 4. Elongated soft palate

Question 35

How do you prevent hypoxemia in brachycephalic breeds during ax recovery

Answer 35

1. Keep intubated until absolutely impossible 2. Keep sternal 3. Monitor SPO2

Question 36

What is a plethysmograph

Answer 36

Pulse oximeter waveform

Question 37

Each triangle of a pulse ox represents __

Answer 37

Each heart beat

Question 38

Area under the curve of a pulse ox is proportional to __

Answer 38

Stroke volume

Question 39

Looking at the Plethysmograph and SV is a great tool to assess ___

Answer 39

Degree of clinical effects of arrhythmias

Question 40

What do blue and red circles and arrows indicate. Which is worse clinically, top or bottom photo

Answer 40

Red circles- VPC, corresponding with red arrow showing decrease SPO2/SV Blue: normal sinus rhythm corresponding with blu arrows showing normal SPO2/ and good SV Top photo is worse because the SPO2, therefore the SV decrease more with a VPC than in bottom photo