MONITORING: RESP Side notes Flashcards
Capnographs that may cause radiant heat
Mainstream
Oxygenated absorb light at
660nm
Deoxygenated absorb light at
960 nm
Mandatory respiratory monitors during GA
Pulse oximeter Capnography Inspired O2 analyzer Disconnect alarm (also direct visualization)
Beta angle is between phases III and
0 is usually about 90 degrees , may used to assess rebreathing.
Inspiratory valve failure indication of Co2
Widening of the B angle with an elevation of both phases 0/ I and III
An early sign of MH
Rapidly rising end-tidal CO2, carbon dioxide, if unresponsive to hyperventilation .
Oxygenation is most easily measured by
pulse oximetry.
Things that my results in falsely low saturation reading
Methylene blue
Indocyanine green
Indigo carmine
Isolsulfan blue.
Best location for esophageal probe is
Lower third of the esophagus
Correlates well with core temperature
Tympanic membrane.
Esophageal probe.
Which phase of the capnography correlates with alveolar equillibrium (or alveolar gas plateau)?
End of phase III.
During GA, ETCO2/PACO2 gradient is
5-10 mmHg
Exhausted CO2/ incompetent expiratory valve will show on the monitor as
Tracing not going back to baseline
Slow rate of rise in CO2 waveform indicates
COPD
Obstructed ETT
If inspired CO2 does not return to zero, 2 possible caues.
Incompetent expiratory valve in ventilator
Exhausted Co2 absorbent.
What determines the extent of intrapleural pressure 2nd to PEEP?
Pulmonary compliance
PPV settings (CPAP and PEEP)
increase intrathoracic pressure . Pulmonary compliance determines the extent of this pressure. Small changes in pressure cause large change in lung volume
The maximum setting of CPAP expiratory pressure without the use of artificial airway is
15 cm H2O
Expiratory pressure > 15cm H2) require
artificial airway du to the risk of gastric regurgitation and aspiration.
The major effect of PEEP on the lungs is to
Increased FRC
The goal of PEEP is to
Improve the patient’s arterial oxygenation
Employing PEEP elevated the
FRC and TV to a value greater than the closing capacity to result in improved compliance and a degree of resolution of ventilation /perfusion mismatch and the degree of pulmonary shunting.
The constant pressure from PEEP or CPAP act to
Stabilize and maintain expansion of the alveoli
When excess PEEP is added (greater than 20cm H2O) Which negative effects occur
Pneumomediastinum
Subcutaenous emphysema
Pneumoretroperitoneum
Pneumopericardium
Excessive PEEP and WOB
Increased by reducing lung compliance and increasing dead-space ventilation
Ventilatory component that increase the risk of barotrauma
Young age
Vent setting with high RR , there is stacking of breaths
Increase TV 10-15ml/kg
Which of the following is the highest circuit pressure generated during an INSPIRATORY cycle?
PEAK INSPIRATORY PRESSURE (PIP)
PIP is an indication of
Dynamic compliance of the lungs
Is there any contraindications to analyzing anesthetic gases during any procedure requiring inhalational anesthesia?
NO
Gases measured by standard OR gas analyzers include
Oxygen
Nitrogen
Anesthetic agent
Which oxygen analyzer is self -calibrating?
Paramagnetic
Which statement is true regarding pulse oximetry?
(A) Pulse oximetry artifact is due to excessive
ambient light, motion, and methylene ,blue dye.
In the normal capnograph, what does Phase III indicate?
Alveolar gas plateau
What causes an increased end-tidal carbon dioxide?
CNS depression
Where is the best location to monitor blood pressure
or patients undergoing right shoulder arthroscopy in
the beach chair position?
LUE
Which oxygen analyzer works by using the oxygen
molecules’ unique attraction into magnetic fields?
Paramagnetic oxygen sensor
Which o the following minimizes Phase I temperature
loss?
Forced air warming
What is the maximum allowable current leakage in
the operating room?
10 MicroAm
What monitor alarms when a high current ow to the
ground exists?
Line isolation monitor
What humidity levels are appropriate or the operating
room?
50-55%
During in usion o multiple units o packed red
blood cells, what temperature is needed to avoid
hypothermia?
(A) 37°C
Which principle included in radiation safety?
(A) Time
(B) Distance
(C) Shielding
What nerve injury may result rom prolonged pressure
involving bag mask ventilation?
(A)Trigeminal and Facial nerves
What does an “a” wave represent in a CVP tracing?
Atrial contraction
When comparing sites or placement o a central
venous catheter, which site carries the greatest risk or
pneumothorax?
Subclavian vein
What results when stimulating the ulnar nerve?
Contraction of the adductor pollicis
Rationale: Recovery rom neuromuscular blockade
is observed in the
orbicularis oculi prior to the adductor
pollicis when using peripheral nerve stimulation.
Range: Mean right atrial pressure
(1-10);
Mean pulmonary artery pressure
(10-20);
Pulmonary artery occlusive pressure range
5-15
When monitoring central venous pressure (CVP), what
causes the loss o “a” waves?
Atrial fibrillation
Following intubation you are unable to palpate the
tracheal tube cu in the sternal notch. T e breathing
bag compliance is decreased. Breath sounds are unilateral. Where is the endotracheal tube most likely
positioned?
Bronchus
What is your greatest concern when in ating the pulmonary artery balloon?
Pulmonary artery rupture
