Quiz 2 Flashcards
6 things to monitor under standards
- ventilation (clinical obsv and expired CO2)
- oxygen (clinical obsv and pulse ox)
- Cardiovascular status (EKG)
- Temp
- neuromuscular
- patient positioning
wavelength absorbed by deoxyhemoglobin
660nm (Red)
wavelength absorbed by oxyhemoglobin
940nm (infrared)
Law that pulse ox is based on
Beer Lamberts Law
pulse ox reads as a ratio of red/infrared light
Reasons for inaccurate pulse ox measurements (6)
- hypoperfusion (vasoconstriction, hypothermia, hypotension)
- motion artifacti
- methylene blue
- Anemia (Hgb < 5)
- cautery interference
- Abnormal Hgb
what makes oxygen saturation curve shift to left?
- decreased PCO2
- decreased temp
- Alkalosis
what makes oxygen saturation curve shift to right?
- Increased PCO2
- Increased Temp
- Acidosis
Chest movement does not confirm what?
Ventilation
value of precordial/esophageal stethoscope?
- assurance of ventilation
- detect changes in breath sounds
what do you place the stethoscope precordial bell?
Suprasternal notch
What does an absense of an ETCO2 waveform mean? (3)
- esophageal intubation
- accidental disconnect
- cardiac arrest
what does ETCO2 data display?
- Adequacy of ventilation
- confirms placement
ETCO2 # vs Arterial CO2 #
ETCO2 2-5 lower
sharkfin capnograph means?
bronchospasm/asthma/COPD
short building then tall building capnograph means? or could also be?
increasing ETCO2/hypoventilation
also: hypercapnic, MH, Thyroid issue, increased BP, CO2 absorbing from insufflation in Lap case
decreasing/shorter buildings capnograph? Could also mean?
decreasing ETCO2/hyperventilation
also: hypotension, decreased C.O. (MI), slowing metabolism
whole ETCO2 waveform same size but trending up screen. Could also be what?
Rebreathing CO2 (could be faulty inspiratory valve)
Notch in ETCO2? name and what it is
Curare Cleft - when paralysis is wearing off and diaphram starts to move a bit
wavelength of light 3.3um, similar spectrum as agents, and monitor must be programmed with agent selected
monochromatic infrared spectrometry
wavelength 7-13um, spectrum different from agents, monitor can identify agent, monitor can describe concentration of gas and multiple gasses
polychromatic infrared spectrometry
alarm that detects lack of minimum inspiratory pressure, could signify disconnect or leak in system?
Low pressure alarm
methemaglobinemia and CO poisoning will read what on pulse ox?
- ~85%
- 100%
what could a wider CO2 to ETCO2 gradient/discrepancy mean?
Shunt
Where is ETCO2 actually measured on waveform
D (second corner of top plateau)
Where is Inhalation on ETCO2 waveform
A-B: initial bottom of plateau
rapid passing of MIXED GAS through upper airway in ETCO2 waveform?
B-C: first upstroke of waveform
Records alveolar emptying of CO2 on ETCO2 waveform/?
C-D: Expiratory plateau (normal is flat)
Another breath in on waveform?
D-E: next inhalation - down stroke of waveform
Alarm that may indicate low pulm compliance?
high peak inspiratory alarm
1 mV change on ECG monitor is same as?
10mm change on paper strip
Frequency of TEE?
5 mHz
CVP/RAP determine?
RV end diastolic volume
in healthy hearts this should mirror LV as well
biggest heat loss for surgery?
Open bowel - larger the incision, the larger the heat losse
what muscle does Ulnar nerve stimulate?
Adductor pollicis
what muscle does Facial nerve stimulate?
orbicularis oculi
where do NMBs work?
Post-synaptic cleft
definition of Oliguria
< 0.5ml/kg/hr
indications for foley
- CHF
- Renal
- shock
- surgeries with large fluid shifts
- intraop diuretics
used when surgical procedure is associated with potential for neurological injury.
Evoked potentials
- spinal fusion, craniotomy
efferent – stimulate at head and monitor at periphery
Motor evoked potential
afferent pathway to brain, start at feet ( periphery) and monitor at head
somatosensory evoked potentials
what monitoring needs a baseline before drug admin and needs to stay within 10-20% of baseline
Cerebral Oximetry
