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NUNA 690 - Principles > Respiratory Monitoring > Flashcards

Respiratory Monitoring Flashcards

1
Q

To what aspects can the anesthetist be attentive for “simple observation” monitoring?

A 
Chest rise and fall
Circuit bag movement/feel
TV and end expiratory TV
Color of lips/nails/blood/conjunctiva
Work of breathing
Respiratory rate and depth
Rocking (obstruction), puffing (patent)
Airway noise
Air felt on palm
Precordial stethoscope sounds
Tube fog
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2
Q

Disadvantages of precordial/esophageal stethoscopes?

A

Contraindicated for esophageal varices and cannot detect diffusion abnormalities

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3
Q

Where do you place the precordial chest piece?

A

4th ICS and LSB

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4
Q

What would the stethoscope finding of a “mill wheel murmur” indicate? What would end-tidal gas analysis show? CVP?

A

Air embolism; increased nitrogen, decreased CO2; increased CVP

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5
Q

How do you calculate appropriate tidal volumes?

A

6-8 ml/kg of IDEAL body weight

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6
Q

Positive inspiratory pressures should not exceed __ to __ cm H2O.

A

35; 40

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7
Q

Insufficient tidal volume will fail to control what 3 factors?

A

ETCO2, keep alveoli expanded, and deliver volatile anesthetic drugs

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8
Q

What variables on an ABG indicate oxygenation? Ventilation? Acid-base status?

A

PaO2 and Oxyhgb Sat; PaCO2; pH, bicarb, base excess

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9
Q

5 causes of hypoxia

A

Hypoxemia, anemic hypoxia, circulatory hypoxia, affinity hypoxia, histiocystic hypoxia

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10
Q

Causes of hypoxemia

A

Low FiO2, hypoventilation, shunt, diffusion limitations

Most common cause of hypoxia

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11
Q

Cause of anemic hypoxia

A

Not enough hgb

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12
Q

Cause of circulatory hypoxia

A

Insufficient cardiac output

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13
Q

Cause of affinity hypoxia

A

Decreased release of O2 (hypothermia, increased pH, CO poisoning)

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14
Q

Cause of histiocystic hypoxia

A

Cell won’t accept delivery of O2 (cyanide poisoning)

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15
Q

What effect does high hgb have on cyanosis?

A

Cyanosis occurs at a higher PaO2 since there are more deoxygenated hgb present even though PaO2 may be adequate; conversely, anemic patients rarely have cyanosis even with low PaO2.

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16
Q

PO2 of 40, 50, 60 = O2 Sat % of __, __, __

A

70; 80; 90

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17
Q

Average oxygen consumption at rest is _ to _ __ O2/kg/minute

A

2; 4; mL

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18
Q

VO2 formula

A

FiO2-FeO2 x Vm/weight in kg

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19
Q

DO2 (lungs) formula

A

FiO2 x Vm/weight in kg

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20
Q

What effect does increasing FiO2 have if SaO2 is near 100%?

A

Very little effect

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21
Q

What factors have the greatest effect on VO2 and DO2?

A

CO and hgb level; CV is the limiting factor for DO2 to tissues.

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22
Q

Alveolar air equation

A

FiO2 x (Pb-Pwv) - PaCO2/RQ

PAO2 shortcut: FiO2 x6

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23
Q

PaO2 shortcut

A

FiO2 x5

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24
Q

DO2 (tissues) equation

A

CaO2 (mls/dL) x CO (mls/min)/kg/100

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25
Q

CaO2 equation

A

(hgb x oxyhgb x 1.39) + (0.003 x PaO2)

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26
Q

Why doesn’t CPR perfuse the periphery?

A

CPR cannot achieve sufficient pressure (<50 torr SBP) to perfuse periphery; only central organs and brain get perfused.

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27
Q

What are the dual wavelengths of light used in pulse oxymetry?

A

660 (red) and 940 (infrared) nm pass through the tissue and vascular beds via LED

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28
Q

Pulse oxymetry requires ________ blood flow.

A

pulsatile

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29
Q

What can cause errors in pulse oxymetry?

A

COHgb (false high); MetHgb (If SaO2 >85%, SpO2 low; if SaO2 <85%, SpO2 high); improperly fitting probe (false low); SpO2 <60% (false low); poor perfusion; anemia (false low in Hct <24%); IV methylene blue (false low); blue nail polish (false low); ambient fluorescent light (false high); excessive motion (false low)

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30
Q

What is the disadvantage of using the toe for monitoring pulse oximetry?

A

Desat/resat detection slow

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31
Q

Under which condition is nose pulse oxymetry unreliable?

A

Trendelenburg position

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32
Q

What oxymetry probe site can be used for burn patients?

A

Tongue

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33
Q

Name 6 valid oxymetry probe sites.

A

Finger, toe, nose, earlobe, tongue, cheek

34
Q

How is capnography measured? What are the two locations for measurement chamber placement?

A

Infrared absorption; mainstream and sidestream

35
Q

What conditions will result in increased CO2 readings? (8)

A

Increased production - fever, physical activity, seizures, sepsis, hyperthyroidism, trauma and burns, high carb diet

Inefficient evacuation - hypoventilation

36
Q

What conditions will result in decreased CO2 readings? (7)

A

Poor transport - hypotension, decreased cardiac output, right to left pulmonary shunt
Decreased production - hypothyroidism, hypothermia, paralysis/motionless patient
Increased evacuation - hyperventilation

37
Q

What is the relationship between minute ventilation and ETCO2?

A

Inverse

38
Q

What is the relationship between VO2 and ETCO2?

A

Direct

39
Q

What are some equipment malfunctions that can cause increased ETCO2? Decreased?

A

Rebreathing, exhausted CO2 absorber, leak in ventilator circuit

Ventilator disconnect, esophageal intubation, complete airway obstruction, poor sampling, leak around ETT cuff

40
Q

Describe the phases of a normal capnograph.

A

The appearance of a normal capnograph is fairly rectangular; phase I represents dead space expiration with no rise from baseline; phase II is the sharp rise from baseline that represents mixed dead space and alveolar gas expiration; phase III is the plateau period that signifies alveolar gas expiration and plateau; phase 0 stands for inspiration; phase IV (?) is an upswing that occurs at the end of phase III.

41
Q

What does a capnography tracing look like with esophageal intubation?

A

Rapidly extinguishing uncharacteristic waveform (small waves)

42
Q

What do regular dips in the end-expiratory plateau of capnography signify?

A

Underventilated lungs or patients recovering from NMB

43
Q

What does an upward shift in baseline in capnography mean?

A

Rebreathing of carbon dioxide or miscalibration

44
Q

What does a capnography waveform look like with restrictive lung disease?

A

Rounded corners of waveform/sloping downstroke due to air readily exiting the lungs and difficulty getting air into the lungs.

45
Q

What is the appearance of a capnography waveform with obstructive pulmonary disease?

A

The plateau phase slopes from low to high due to difficulty with expiration.

46
Q

How do cardiogenic oscillations change capnography?

A

The plateau slopes from high to low with rippling waves representing mediastinal vibrations.

47
Q

What will a nasal cannula capnography waveform look like?

A

Rounded corners of the wave/no plateau due to lack of seal

48
Q

What is a factor that can cause inaccurate low ETCO2 readings with nasal cannula sidestream measurement?

A

Mouth breathing

49
Q

How are airway resistance and dynamic compliance related?

A

Inversely

50
Q

When is dynamic lung compliance measured?

A

During times of gas flow/active inspiration

51
Q

______ _________ measured using peak pressures can change from breath to breath while _____ __________ mostly remains unchanged.

A

Airway resistance; lung compliance

52
Q

When can static lung compliance be measured?

A

During times without gas flow such as inspiratory pause or end inhalation

53
Q

What pressure is used to measure static lung compliance?

A

Plateau pressure

54
Q

Plateau pressure __ peak pressure

A

Less than

55
Q

Indicates compliance without effects of airway resistance

A

Plateau pressure/static lung compliance

56
Q

Which is a more accurate measure of lung compliance? Dynamic compliance or static compliance?

A

Static compliance

57
Q

What can cause unusual changes to static lung compliance?

A

Insufflation, rigidity

58
Q

What can cause an increase in peak inspiratory pressure and plateau pressure?

A

Increase in TV or decrease in pulmonary compliance (pulmonary edema, trendelenburg, pleural effusion, ascites, abdominal packing, peritoneal gas insufflation, tension pneumothorax, endobronchial intubation)

59
Q

What can cause an increase in peak inspiratory pressure without an increase in plateau pressure?

A

An increase in inspiratory flow rate or airway resistance (kinked ETT, bronchospasm, secretions, foreign body aspiration, airway compression, ETT cuff herniation)

60
Q

List 3 pulmonary function tests

A

Forced expiratory volume, forced vital capacity, forced expiratory flow

61
Q

What is a diffusion capacity test?

A

Carbon monoxide is inhaled and then measured; tracks gas ability to cross alveolar-capillary membrane; a reduction in diffusible SURFACE AREA can be identified; can ID shunt, VQ mismatch, fibrosis, emphysema.

62
Q

What is FEV1? Normal results?

A

Forced expiratory volume over one second; a PFT used to identify airway resistance.

80% of vital capacity

63
Q

What is FEV 25%-75%? Normal results?

A

Forced Expiratory Flow between 25% and 75% of exhaled breath; normal is 4-5 liters/second; the 25-75% portion is effort independent and therefore the most objective measurement of airway resistance in MEDIUM airways and the most sensitive indicator of SMALL airway obstructive disease.

64
Q

What is FEF 25%-75% in restrictive disease?

A

Normal results (4-5L/sec)

65
Q

What is FEV1/FVC ratio? Normal results?

A

Forced Expiratory Volume over Forced Vital Capacity. This ratio declines with age, with normal at least 80%.

66
Q

What happens to the FEV1/FVC ratio with obstructive lung disease?

A

It decreases because with obstruction, the patient has difficulty exhaling and therefore will be able to move less air in 1 second.

67
Q

What happens to the FEV1/FVC ratio with restrictive lung disease?

A

It increases or remains normal; since lungs have reduced compliance, air will leave the lungs quickly and easily. Since the overall lung capacity is reduced, the amount exhaled in the first second makes up a larger percentage of the total than normal.

68
Q

How do lung volumes in restrictive lung disease compare to normal lung volumes?

A

Reduced TLC, FRC, RV, FVC, and FEV1; FEV1/FVC ratio preserved

69
Q

How do lung volumes in obstructive lung disease compare to normal lung volumes?

A

Enlarged TLC, RV, FRC; reduced ERV.

70
Q

Pressure volume loops are an indicator of lung __________.

A

Compliance/distensibility

71
Q

Pressure volume loops move counter-clockwise during _____________ ventilation.

A

positive pressure; they remain completely to the right of the y-axis during positive pressure ventilation except during pressure support when the negative pressure breath trigger occurs briefly to the left of the y-axis

72
Q

Pressure volume loops move clockwise during _________ _________.

A

spontaneous respiration; they also move left of the y-axis during inspiration and go left of the y-axis during expiration

73
Q

Higher pressure moves the loop farther ______ in pressure volume loops.

A

right

74
Q

In pressure volume loops, slope represents _____ _________. Flatter slope mean _________ and steeper slope means ________ __________.

A

Lung compliance; decreased; increased compliance

75
Q

What is the morphology of a pressure-volume loop on an overdistended lung?

A

The top develops a flattened tail to the right as pressure continues to rise with no corresponding increase in volume.

76
Q

What is the approximate shape of a normal flow volume loop?

A

An upside-down ice cream cone; flow goes clockwise

77
Q

What is the appearance of a flow volume loop with restrictive lung disease?

A

Shape is normal; lung volumes are smaller; flows are reduced

78
Q

What is the appearance of a flow volume loop with obstructive lung disease?

A

Shape is caved in on the top right (shark fin appearance) indicating expiratory obstruction (rate of flow decreases toward end expiration); lung volumes are larger; flows are reduced

79
Q

What is the morphology of a flow volume loop with tracheal stenosis/fixed obstruction?

A

Rounded/flat top and bottom portion; flows cannot reach high rates with fixed obstruction.

80
Q

What is the appearance of a flow-volume loop with variable EXTRATHORACIC obstruction and why?

A

Inspiratory curve is flattened and expiratory curve is normal; during inspiration, the pressure around the airway exceeds intratracheal pressure. (“like a straw collapsing”)

NUNA 690 - Principles (5 decks)

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