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Critical Care > Monitoring ICU > Flashcards

Monitoring ICU Flashcards

1
Q

What is another name for Spectrophotometry?

A

Pulse Ox

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2
Q

What kind of blood does the pulse ox look at ?

A

Arterial

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3
Q

What is the range that a pulse ox can monitor, with it still being accurate?

A

85-100%

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4
Q

Can the pulse ox distinguish between different Hbg varients?

A

NO

If patient was in fire, and carbon monoxide bound to the Hbg the pulse ox would read as a false high, it would NOT know the difference

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5
Q

To be able to analyze Hbg for patient in fire, you must do what?

A

Draw an ABG

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6
Q

What are other probes you can use if the patient does not have adequate perfusion to to their fingers?

A

Forehead or ear probe

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7
Q

What kind of patient would you use a forehead or ear probe on?

A

A hypotensive patient or someone on vasopressors

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8
Q

What is the affinity to O2 in a left shift?

A

Increased affinity: Hbg will NOT release oxygen to the tissues easily

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9
Q

What is the affinity to O2 if there is a right shift?

A

Decreased affinity: Hbg WILL release oxygen to the tissues much easier

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10
Q

In a left shift, what is changing?

Acidotic or alkalotic?

pH?

Temp?

CO2?

A

Alkalotic, increased affinity to oxygen, increase in pH, decrease in temp, decrease in CO2.

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11
Q

In a right shift, what is changing?

Acidotic or alkalotic?

pH?

Temp?

CO2?

A

Fever and acidotic, decreased affinity to oxygen , decrease in pH, increase in temp, increase in CO2

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12
Q

What does the skin look like in a left shift?

A

Cyanotic in extremities bc the oxygen wants to stay where the blood is, which is in your vital organs (middle of body)

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13
Q

What does the skin look like in a right shift?

A

More flushed, bc blood isn’t worried about keeping oxygen

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14
Q

What does P50 mean?

A

is the O2 tension at which 50% of Hbg is saturated, at 37 deg C, PaCO2 40 mmhg and a pH of 7.40

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15
Q

What is the P50 used to understand?

A

affinity for O2

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16
Q

If P50 goes UP, _____ affinity for O2
If P50 goes DOWN, _____ affinity for O2

A

decreased, increased

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17
Q

SaO2 reflects the quantity of O2 being carried on _____
PaO2 is the portion of O2 dissolved in ____

A

Hbg
Plasma (in arterial blood)

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18
Q

Levels of Hypoxemia

A

60-79 mmHg MILD
40-59 mmHg MODERATE
<40 mmHg SEVERE

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19
Q

What should you always perform before an ABG?

A

Allens test

20
Q

How to prevent errors when doing an ABG

A

Keep sample on ice, if it cant be analyzed within 30 min
Mix blood with heparin
Eliminate any air bubbles

21
Q

What is Capnography?

A

Measuring exhaled CO2 and producing WAVEFORM (capnograph)

22
Q

What is capnometry?

A

Measuring exhaled CO2 and producing a NUMBER

23
Q

The end tidal CO2 uses what to detect changes in CO2?

A

Infrared light absorption

24
Q

What are the 3 ways of measuring CO2?

A

Sidestream analyzer, mainstream analyzer, and colorimetric

25
Q

What is a sidestream analyzer?

A

A sample gas proximal to airway and pumped into the analyzer (monitor)

26
Q

What analyzer takes tidal volume?

A

Side stream

27
Q

What is a mainstream analyzer?

A

Inline between patient and ventilator circuit

28
Q

When is a mainstream analyzer primarily used?

A

In codes

29
Q

Between the sidestream analyzer and the mainstream analyzer which one is used for intubated patients? And which one is used in non-intubated patients?

A

Mainstream: intubated patients
Sidestream: non-intubated patients

30
Q

What is a colorimetric?

A

It changes color in response to amount of CO2 present.

31
Q

What is a colorimetric used to confirm?

A

Endotracheal intubation: changes color when CO2 is present

32
Q

What is a normal End Tidal CO2?

A

30-40 mmHg

33
Q

About how much less than is the PaCO2 than the End Tidal approx?

A

~5 mmHg less than PaCO2

34
Q

When is the End Tidal CO2 accurate?

A

Accurate in patients with minimal deadspace

35
Q

Why do we measure end tidal at the end?

A

End tidal gas was in contact with the alveolar surface, therefore most accurately reflects arterial CO2.

36
Q

What is it called when there is a delayed emptying of CO2 from air spaces?

A

“Sharkfin”

37
Q

In what device do we see a “sharkfin”?

A

Abnormal Capnogram

38
Q

When do you most likely see a patient with a “sharkfin” (abnormal capnogram)?

A

Intubated patients

39
Q

If there is a drop to 0mmHg what does this mean in regards to ETCO2?

A

there is a leak, esophageal intubation, or cardiac arrest

40
Q

3 types of bleeding within the skull

A

Epidural hemorrhage
Subdural “ “
Subarachnoid “ “

41
Q

2 types of bleeding in brain parenchyma?

A

Intracerebral hemorrhage
Intraventricular “ “

42
Q

How should you decrease any ICP?

A

Ventriculostomy for CSF drainage, craniotomy, osmotic diuretics, sedation, paralysis, semifowlers position

Mannitol and Hypertonic saline infusions

ICPs should be kept les than 20 mmHg

43
Q

When brain death is suspected what tests need to be ran? There is 4

A

Electroenephalogram (EEG)
Cerebral Blood Flow Study
Testing of brain stem reflexes
Apnea test

44
Q

If respiratory movements are absent and post ABG PaCO2 is >60 mmHg (or 20 mmHg over baseline)

= positive for brain death

What is this test called?

A

Apnea test

45
Q

Loss of brain stem function =

A

loss of breathing reflexes

46
Q

Do we preoxygenate a patient for an apnea test?

A

Yes always

Critical Care (1 decks)

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