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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
Review capnograph photos
26
What requirements must be met to detect CO2
CO2 must be produced during metabolism Adequate pulmonary blood flow Adequate ventilation to transport to circuit Intact sampling line
27
What does a wide AA gradient signify?
V/Q mismatch -Equipment malfunction
28
Does an incompetent unidirectional valve increase or decrease EtCO2?
Increase
29
Does a tourniquet removal increase or decrease EtCO2?
Increase
30
Does an airway obstruction increase or decrease EtCO2?
Decrease
31
Does thyrotoxicosis increase or decrease EtCO2?
Increase
32
Does MH increase or decrease EtCO2?
Increase
33
Does an increase in apparatus dead space increase or decrease EtCO2?
increase
34
Does a V/Q mismatch increase or decrease EtCO2?
Decrease
35
Does hypotension increase or decrease EtCO2?
Decrease
36
Does hypothermia increase or decrease EtCO2?
Decrease
37
Does a PE increase or decrease EtCO2?
Decrease
38
Does decreased CO increase or decrease EtCO2?
Decrease
39
Does a laparoscopy increase or decrease EtCO2?
Increase
40
Does esophageal intubation increase or decrease EtCO2?
Decrease
41
Does opioid overdose increase or decrease EtCO2?
Increase
42
Does metabolic acidosis increase or decrease EtCO2?
Decrease
43
Does metabolic alkalosis increase or decrease EtCO2?
Increase
44
Does sodium bicarb increase or decrease EtCO2?
Increase
45
What waveform does oxygenated Hgb absorb light?
940nm (Near infrared)
46
What waveform does deoxygenated Hgb absorb light?
660nm (Red light)
47
On the waveform, where is the highest ratio atrial to venous blood?
At the peak (Increased)
48
On the waveform, where is the where is there a greater amount of venous blood?
At the trough Peak has higher arterial
49
Where the sites to most to least responsive to arterial desaturation?
Fastest - Ear, nose, tongue, esophagus, forehead Middle - Finger Slow - Toe Closer to central circulation the better
50
If the pulse ox reads 90%, what is the PaO2?
30 point difference PaO2 - 60 SpO2 80% = PaO2 50 SpO2 70% = PaO2 40
51
What methods can improve SpO2 signal?
Digital Block Warm the extremity Vasodilate Protect from light
52
How does chronic anemia effect the oxyhemoglobin curve?
Shifts R
53
How does MH effect the oxyhemoglobin curve?
Shifts R
54
How does Methemoglobin and carboxy effect the oxyhemoglobin curve?
Shifts L
55
How does Increased pH or acidosis effect the oxyhemoglobin curve?
Shifts L
56
How does thyroid storm effect the oxyhemoglobin curve?
Shifts R
57
How does hypoxia effect the oxyhemoglobin curve?
Shifts R
58
How does Pyrexia effect the oxyhemoglobin curve?
Shifts R
59
Does a Pulse Ox monitor for anemia?
No
60
Does a Pulse Ox monitor for ventilation?
No
61
Does a Pulse Ox monitor for bronchial intubation?
No
62
Does a Pulse Ox monitor for flid responsiveness?
Yes
63
Does a Pulse Ox monitor for Hgb saturation or HR?
Yes
64
Does a Pulse Ox monitor for peripheral perfusion?
Yes
65
Is a pulse ox useful for patients with a VAD?
No
66
Do acrylic nails effect pulse ox?
No
67
What color nails do not effect a pulse ox?
Red and Purple do not
68
How does methemoglobin effect the pulse ox?
Absorbs light equally at 660 and 940 Will read 85% so could be high or low
69
How does carboxyhemoglobin effect the pulse ox?
Absorbs at 660 so will be falsely high
70
What is the acceptable margin of the pulse?
2-3%
71
What is the most common way to measure exhaled gases?
Infared absorption
72
How does shivering and tricuspid regurg effect the SpO2?
Falsely reduce SpO2
73
What decreases the AA gradient?
A stuck or incompetent unidirectional valve Will see an increase in PaCO2 and EtCO2 but the gradient gets smaller
74
What increases the AA gradient?
Increased Dead Space Ex: Venous air embolism
75
Which monitor can not monitor O2 concentration?
Infrared absorption
76
Which monitors can monitor O2 concentration?
Electrochemical analysis and paramagnetic
77
Does fluorescein effect pulse ox?
No

Monitoring (10 decks)

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