Quiz 8 - Pulm Intraoperative Monitoring & Difficult Airway

Question 1

What is dCO2?

Answer 1

It is the normal ETCO2 to PaCO2 gradient (usually 2-5mmHg

Question 2

If there is a significant reduction in lung perfusion or increase in alveolar dead space, will your dCO2 increase or decrease?

Answer 2

It will increase

Question 3

Why will PaCO2 always be higher than ETCO2?

Answer 3

this is due to mixing and dilution with the dead space gases

Question 4

What can cause an increased dCO2?

Answer 4

Anything that increases deadspace: decreased pulmonary artery pressure, PE, COPD, decreased cardiac output, upright posture.

Question 5

What is the first thing you should worry about if you have an increasing ETCO2?

Answer 5

Malignant Hyperthermia.

Question 6

Other than Malignant Hyperthermia, what are some other causes of elevated ETCO2,?

Answer 6

Hypoventilation, CO2 used for laparoscopy, Hyperthermia, tourniquet released, WATER IN CAPNOGRAPH SENSOR, Breathing circuit error (CO2 absorber exhausted, rebreathing, inadequate fresh gas flow, faulty valves)

Question 7

What are some causes of decreased ETCO2?

Answer 7

Hyperventilation, airway leak (ET tube cuff leak), decreased pulmonary blood flow, PE, decreased cardiac output, arrythmias, hypothermia, sample catheter misplaced.

Question 8

Once again, what are the normal ABG values?

Answer 8

pH:  7.4 (7.35-7.45)
PCO2:  40  (35-45)
HCO3:  24 (20-26)
PO2:  75-100
Base excess:  +/- 3

Question 9

If you have sedated a pt and are unable to intubate, what should you do?

Answer 9

Call for help.

Question 10

T/F: Pulse oximetry is a mandatory during intraoperative care?

Answer 10

Answer: True

Question 11

What is the wave length of infrared light?

Answer 11

Answer: 940 nm

Question 12

3. What is the wave length of red light?

Answer 12

Answer: 660

Question 13

4. Oxyhemoglobin absorbs more of this light and corresponds to 100% saturation?

Answer 13

Answer: Infrared Light

Question 14

5. Deoxyhemoglobin absorbs more of this light and corresponds to 50% of saturation?

Answer 14

Answer: Red Light

Question 15

6. In the pulmonary artery the mixed venous blood’s PaO2 is ____ and SpO2 saturation is ____.

Answer 15

Answer: 40, 75.

Question 16

7. What is Hb P50 point?

Answer 16

Answer: SpO2 is 50% and the PaO2 is 27 %.

Question 17

8. What is the rough rule of PaO2 and SpO2?

Answer 17

Answer: PaO2: 40,50,60, for SpO2: 70,80,90

Question 18

9. If the SpO2 is at 95 % then the PaO2 is at ____%.

Answer 18

Answer: 75

Question 19

During what procedure can a standard pulse oximetry not be used?

Answer 19

MRI; a dedicated MRI probe is needed.

Question 20

11. Which part of the body detects changes in the SpO2 pulse oximetry than the finger?

Answer 20

Answer: Ear

Question 21

12. Endobronchial intubation will usually go ___________ by pulse ox. In the absence of _____ disease or low _____.

Answer 21

Answer: undetected, lung, FiO2

Question 22

13. What can limit the pulse oximetry?

Answer 22

Answer: no pulse and low peripheral perfusion

Question 23

14. What will Carboxyhemoglobin (COhB) do to the pulse oximetry?

Answer 23

Answer: Carbon monoxide poisoning is viewed as wxyhemoglobin by the pulse ox. And shows a SpO2 of 100%, this is an overestimation of the true oxygenation.

Question 24

15. What is one way to distinguish a true SpO2 reading with carbon monoxide poisoning?

Answer 24

Answer: Co-oximeter.

Question 25

16. What is it called when Fe2 (ferrous) in Hb is oxidized to Fe3 (ferric) form and cannot transport O2?

Answer 25

Answer: Methemoglobin (MetHb)

Question 26

17. At what percent of Hemoglobin will you begin to signs of Methemoglobin?

Answer 26

Answer: 15 %

Question 27

18. What drugs cause methemoglobin?

Answer 27

Answer: nitrates, nitrites, sulfonamides, benzoncaine (Hurrican spray, nitroglycerine, nitroprusside.

Question 28

19. T/F: Methemoglobin will absorb equally at both wavelengths, be 1:1, and shows a SpO2 of 65% regardless of the true oxygen saturation.

Answer 28

Answer: False, the SpO2 will show 85%. (Everything else in the statement was true.)

Question 29

20. Methemoglobin is treated with ______ _____ or ____ ____.

Answer 29

Answer: Methylene blue, ascorbic acid.

Question 30

21. Does fetal hemoglobin and bilirubin affect pulse oximetry?

Answer 30

Answer: NO

Question 31

T/F: EtCO2 is the gold standard for tracheal intubation.

Answer 31

Answer: True

Question 32

23. Capnography rapidly and reliably indicates __________ intubation, but does not reliably detect ________ intubation.

Answer 32

Answer: esophageal, endobronchial