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Monitoring > Respiratory Monitors > Flashcards

Respiratory Monitors Flashcards

1
Q

What is compliance ?

A

-Change in volume for a given change in pressure

-Measures elastic properties of the lungs

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2
Q

What things influence compliance?

A

Muscle Tone
Degree of lung inflation
Alveolar surface tension
Amount of interstitial lung water
Pulmonary fibrosis

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3
Q

What is dynamic compliance?

A

Movement of the lung and chest wall

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4
Q

What is static compliance?

A

Not moving

Measures lung compliance when there is no air flow

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5
Q

What is the Peak Inspiratory Pressure or PIP?

A

Maximum pressure in the airway during inspiration

Also Dynamic compliance

Dynamic compliance = Tv / PIP-PEEP

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6
Q

What is the plateau pressure?

A

The pressure in the small airways after the Tv is delivered

Also Static compliance

**NO airflow

**Airway resistance does not effect

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7
Q

PIP or Plateau - Which is measures with no airflow?

A

Plateau (Static)

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8
Q

PIP or Plateau - Which does airway resistance effect?

A

PIP (Dynamic)

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9
Q

In an adult what is normal static compliance? In a child?

A

Adult 35-100

Child >15

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10
Q

PIP or Plateau - Which has a proven effect on barotrauma?

A

Plateau

PIP has controversial evidence

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11
Q

Examples of an increased Resistance? or Dynamic compliance? or PIP?

A

Kinked tube
ET cuff rupture
Bronchospasm
Compression of airways
Foreign body aspiration

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12
Q

Examples of Decreased compliance?

A

Endobronchial intubation
Pulmonary edema
Pleural effusion
Tension Pneumo
Atelectasis
Ascites
Trendelenburg

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13
Q

What type of compliance is a function of the elasticity of the chest wall only?

A

Static

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14
Q

What is the formula for static compliance?

A

Static = Tv / Plateau - PEEP

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15
Q

What is the formula for dynamic compliance?

A

Dynamic = Tv / PIP - PEEP

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16
Q

On the Capnograph, Where is the end-tidal measured?

A

Point D (end of expiration)

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17
Q

On the Capnograph, What is Phase 1?

A

It is the flat line

Exhalation of anatomic dead space

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18
Q

On the Capnograph, What is Phase 2?

A

Upstroke

Exhalation of anatomic dead space + alveolar gas

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19
Q

On the Capnograph, What is Phase 3?

A

Flat top line

Exhalation of alveolar gas

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20
Q

On the Capnograph, What is Phase 4?

A

Downstroke

Inspiration of fresh gas

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21
Q

What is the Alpha angle? Normal? What diseases can cause an increased Alpha Angle?

A

Normal 100-110 degrees

Obstruction
-COPD
-Bronchospasm
-Kinked tube

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22
Q

What is the Beta angle? Normal? What diseases can cause an increased Beta Angle?

A

90 Degrees

Rebreathing
-Specific to bad inspiratory valve

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23
Q

What is the mainstream (In line) monitor?

A

-Faster response
-NO water trap or pumping
-INCREASES dead space

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24
Q

What is the side stream (diverting) monitor?

A

-Has pumping and a water trap to prevent contamination

-SLOWER response time

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25
Q

Review capnograph photos

A
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26
Q

What requirements must be met to detect CO2

A

CO2 must be produced during metabolism

Adequate pulmonary blood flow

Adequate ventilation to transport to circuit

Intact sampling line

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27
Q

What does a wide AA gradient signify?

A

V/Q mismatch

-Equipment malfunction

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28
Q

Does an incompetent unidirectional valve increase or decrease EtCO2?

A

Increase

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29
Q

Does a tourniquet removal increase or decrease EtCO2?

A

Increase

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30
Q

Does an airway obstruction increase or decrease EtCO2?

A

Decrease

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31
Q

Does thyrotoxicosis increase or decrease EtCO2?

A

Increase

32
Q

Does MH increase or decrease EtCO2?

A

Increase

33
Q

Does an increase in apparatus dead space increase or decrease EtCO2?

A

increase

34
Q

Does a V/Q mismatch increase or decrease EtCO2?

A

Decrease

35
Q

Does hypotension increase or decrease EtCO2?

A

Decrease

36
Q

Does hypothermia increase or decrease EtCO2?

A

Decrease

37
Q

Does a PE increase or decrease EtCO2?

A

Decrease

38
Q

Does decreased CO increase or decrease EtCO2?

A

Decrease

39
Q

Does a laparoscopy increase or decrease EtCO2?

A

Increase

40
Q

Does esophageal intubation increase or decrease EtCO2?

A

Decrease

41
Q

Does opioid overdose increase or decrease EtCO2?

A

Increase

42
Q

Does metabolic acidosis increase or decrease EtCO2?

A

Decrease

43
Q

Does metabolic alkalosis increase or decrease EtCO2?

A

Increase

44
Q

Does sodium bicarb increase or decrease EtCO2?

A

Increase

45
Q

What waveform does oxygenated Hgb absorb light?

A

940nm (Near infrared)

46
Q

What waveform does deoxygenated Hgb absorb light?

A

660nm (Red light)

47
Q

On the waveform, where is the highest ratio atrial to venous blood?

A

At the peak (Increased)

48
Q

On the waveform, where is the where is there a greater amount of venous blood?

A

At the trough

Peak has higher arterial

49
Q

Where the sites to most to least responsive to arterial desaturation?

A

Fastest - Ear, nose, tongue, esophagus, forehead

Middle - Finger

Slow - Toe

Closer to central circulation the better

50
Q

If the pulse ox reads 90%, what is the PaO2?

A

30 point difference

PaO2 - 60

SpO2 80% = PaO2 50

SpO2 70% = PaO2 40

51
Q

What methods can improve SpO2 signal?

A

Digital Block
Warm the extremity
Vasodilate
Protect from light

52
Q

How does chronic anemia effect the oxyhemoglobin curve?

A

Shifts R

53
Q

How does MH effect the oxyhemoglobin curve?

A

Shifts R

54
Q

How does Methemoglobin and carboxy effect the oxyhemoglobin curve?

A

Shifts L

55
Q

How does Increased pH or acidosis effect the oxyhemoglobin curve?

A

Shifts L

56
Q

How does thyroid storm effect the oxyhemoglobin curve?

A

Shifts R

57
Q

How does hypoxia effect the oxyhemoglobin curve?

A

Shifts R

58
Q

How does Pyrexia effect the oxyhemoglobin curve?

A

Shifts R

59
Q

Does a Pulse Ox monitor for anemia?

A

No

60
Q

Does a Pulse Ox monitor for ventilation?

A

No

61
Q

Does a Pulse Ox monitor for bronchial intubation?

A

No

62
Q

Does a Pulse Ox monitor for flid responsiveness?

A

Yes

63
Q

Does a Pulse Ox monitor for Hgb saturation or HR?

A

Yes

64
Q

Does a Pulse Ox monitor for peripheral perfusion?

A

Yes

65
Q

Is a pulse ox useful for patients with a VAD?

A

No

66
Q

Do acrylic nails effect pulse ox?

A

No

67
Q

What color nails do not effect a pulse ox?

A

Red and Purple do not

68
Q

How does methemoglobin effect the pulse ox?

A

Absorbs light equally at 660 and 940

Will read 85% so could be high or low

69
Q

How does carboxyhemoglobin effect the pulse ox?

A

Absorbs at 660 so will be falsely high

70
Q

What is the acceptable margin of the pulse?

A

2-3%

71
Q

What is the most common way to measure exhaled gases?

A

Infared absorption

72
Q

How does shivering and tricuspid regurg effect the SpO2?

A

Falsely reduce SpO2

73
Q

What decreases the AA gradient?

A

A stuck or incompetent unidirectional valve

Will see an increase in PaCO2 and EtCO2 but the gradient gets smaller

74
Q

What increases the AA gradient?

A

Increased Dead Space

Ex: Venous air embolism

75
Q

Which monitor can not monitor O2 concentration?

A

Infrared absorption

76
Q

Which monitors can monitor O2 concentration?

A

Electrochemical analysis and paramagnetic

77
Q

Does fluorescein effect pulse ox?

A

No

Monitoring (10 decks)

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