Pulm. Intraoperative monitoring and Difficult Airway Algorithm Flashcards

1
Q

T/F: Pulse oximetry is NOT a mandatory intraoperative monitor.

A

False: Pulse Oximetry is a mandatory intraoperative monitor.

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2
Q

What are the wave lengths of light for pulse oximetry and which one measures what?

A

940nm=infared light, oxyhemoglobin absorbs more of the light, corresponds to 100% saturation.

660nm=red light, deoxyhemoglobin absorbs more of this light, corresponds to 50% saturation.

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3
Q

Saturation (SpO2) and PaO2

What is the “rough rule” relating oxygen saturation reading with PaO2?

A

PaO2: Saturation:
40 70
50 80
60 90

*remember 50% saturation=PaO2 27 (Hb P50 point)

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4
Q

Limitations of pulse oximetry:

What effect does Carboxyhemoglobin (COHb) poisoning have on pulse oximetry?

A

CO poisoning is recognized as oxyhemoglobin and the reading will be SpO2 of 100%.

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5
Q

Limitations of pulse oximetry:

Methemoglobin has what effect on pulse oximetry?

What are causes of Methemoglobin?

A

Absorbs light equally at both wavelengths, shows SpO2 of 85% regardless of the true oxygen saturation. Fe2+ (ferrous) is oxidized to Fe3+ (Ferric) form and cannot transport O2. Cyanosis is seen when 15% of Hb is in methemoglobin form.

Caused by nitrates, nitrites, sulfonamides, benzocaine

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6
Q

At what level of anemia will pulse oximetry be effected? (what Hgb/Hct?)

A

Hgb 3-4

Hct 12-16

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7
Q

Why does R heart failure (cor pulmonale) or tricuspid regurgitation disturb SpO2 readings?

A

RHF and tricuspid regurg cause venous pulsations in the dependent limb. the pulse ox is designed to assume pulsations are arterial.

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8
Q

Capnography: Rapidly and reliably indicates esophageal intubation but does not reliably detect _____?

A

it does not reliably detect endobronchial intubation.

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9
Q

What sensor/monitor is the Gold Standard for tracheal intubation?

A

End-tidal CO2!!!!!!

Listen to breath sounds, and also check for chest rise and fall.

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10
Q

In the movie Revenge of the Nerds, what was the name of their fraternity?

A

Lambda, Lambda, Lambda

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11
Q

What is the difference between a capnometer and capnograph?

A

Capnometer- measures CO2

Capnograph- records and displays CO2 readings

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12
Q

What are the 2 types of capnography (CO2 detection)?

A

Aspiration: continual suction of gas from breathing circuit. Prone to water precipitation.

Flow-through: sensor attaches directly to circuit.

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13
Q

A normal I:E ratio is ___? (Inspiratory: Expiratory)

For a patient with COPD, what would be a normal I:E ratio?

A

Normal I:E = 1:2

COPD I:E = 1:3 (prolonged expiratory phase)

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14
Q

dCO2:

What is the normal EtCO2 to arterial CO2 gradient? (or difference)

A

2-5mmHg (in Steven’s lecture)

5-10 mmHg (in Levi’s lecture-Nagelhout)

dCO2 reflects alveolar dead space=alveoli ventilated but not perfused.

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15
Q

Which should always be higher, PaCO2 or EtCO2?

A

PaCO2 will always be higher than EtCO2 due to mixing and dilution with the dead space.

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16
Q

T/F: Any significant reduction in lung perfusion increases alveolar deadspace and increases dCO2 (difference between PaCO2 and EtCO2)

A

True

17
Q

What city gets more rain annually, Portland, OR or Erie, PA?

A

Erie has had an average rainfall of 42.16 inches over the last 30 years

Portland has had an average rainfall of 39.14 inches over the last 30 years

18
Q

What conditions increase dCO2? (difference between EtCO2 and PaCO2)

A
  • Pulmonary Emboli
  • COPD
  • Decreased CO or decreased blood pressure
  • Decreased pulmonary artery pressure
19
Q

What conditions increase EtCO2?

A
  • MH
  • Hypoventilation
  • Bicarbonate (transient)
  • Laproscopy (CO2 insuflation)
  • Improved blood flow to lungs after hypotension or resuscitation.
  • Tourniquet released
  • Water in capnograph sensor
  • Exhausted soda lime
20
Q

What conditions decrease EtCO2?

A
  • Hyperventilation
  • airway leak, leak around cuff
  • Decreased blood flow to lungs
  • Displaced ETT
  • Decreased CO, arrhythmias
21
Q

What is the most important determinant of how to proceed on the difficult airway management algorithm?

A

Whether or not you can ventilate the patient.

22
Q

In our solar system which two planets rotate clockwise?

A

Venus & Uranus (hehe)