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Unit 6 Apex Equipment & Monitors > Respiratory Monitors & Equipment > Flashcards

Respiratory Monitors & Equipment Flashcards

1
Q

What condition can cause a falsely increased pulse oximeter value?

A

Carboxyhemoglobin

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2
Q

How does ICG, methylene blue, and indigo carmine affect SpO2?

A

Falsely reduces SpO2

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3
Q

A higher PaCO2 and EtCO2 gradient would suggest

A

increased dead space

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4
Q

A unidirectional valve that’s stuck in the open position will lead to

A

Rebreathing of exhaled CO2

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5
Q

Placing the pulse oximeter on which finger is MOST likely to cause a corneal abrasion during anesthetic emergence?

A

Index

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6
Q

Increased peak inspiratory pressure with an unchanged plateau pressure are caused by what conditions?

A

Conditions that increase airway resistance and reduced compliance (ie kinked tube, bronchospasm)

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7
Q

Increased PIP and plateau pressures are caused by what conditions?

A

Conditions that reduce airway compliance. (ie tension pneumothorax and pulmonary edema)

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8
Q

Does oxygen absorb infrared light?

A

No

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9
Q

How is oxygen concentration measured? (2)

A

Electrochemical analysis (galvanic cell or electrode) or paramagnetic analysis

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10
Q

What is the MOST reliable monitor for the detection of bronchial intubation?

A

Chest auscultation

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11
Q

What type of pulmonary compliance is a function of both airway resistance and the elasticity of the chest wall?

A

Dynamic compliance

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12
Q

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

A

Static compliance

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13
Q

What does the marked region on the capnograph represent?

A

Exhalation of anatomic dead space + alveolar gas

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14
Q

List 2 methods of CO2 analysis.

A

Mainstream (in-line)
Sidestream (diverting)

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15
Q

Which method of CO2 analysis will take longer to reveal a circuit disconnect?

A

Sidestream (diverting) because it has a longer response time. The sample must travel through long tubing before it reaches the monitor.

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16
Q
A

Kinked ETT

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17
Q
A

Cardiac oscillations

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18
Q
A

Spontaneous breaths during mechanical ventilation

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19
Q
A

Hyperventilation

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20
Q
A

Malignant hyperthermia

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21
Q
A

Exhausted soda lime

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22
Q
A

Incompetent inspiratory valve

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23
Q
A

Sample line leak

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24
Q
A

Patient with single lung transplant

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25
How do these things affect EtCO2? Opioid overdose Thyrotoxicosis Increased apparatus dead space Laparoscopy Tourniquet removal Malignant hyperthermia Incompetent unidirectional valve
Increases EtCO2
26
How do these things affect EtCO2? Hypothermia Airway obstruction Decreased cardiac output Hypotension Pulmonary embolus V/Q mismatch Esophageal intubation
Decreases EtCO2
27
Pulse oximetry is based on what law?
Beer-lambert Law
28
Oxygenated hemoglobin absorbs light at
940 nm
29
What wavelength of light is preferentially absorbed in venous blood?
Red light (660 nm) is preferentially absorbed by deoxyhemoglobin (higher in venous blood).
30
What wavelength of light is preferentially absorbed in arterial blood?
Near-infrared light (940 nm) is preferentially absorbed by oxyhemoglobin (higher in arterial blood).
31
How does the location of the pulse oximeter affect response time?
the closer the monitoring site is to the central circulation, the faster it will respond to arterial desaturation.
32
Convert these SpO2 to PaO2 SpO2 90% = ? SpO2 80% = ? SpO2 70% = ?
SpO2 90% = PaO2 60 mmHg SpO2 80% = PaO2 50 mmHg SpO2 70% = PaO2 40 mmHg
33
How does each factor affect the oxyhemoglobin dissociation curve? Hypocapnia Carboxyhemoglobin Hypothermia Methemoglobin Increased pH Fetal hemoglobin Decreased 2,3-DPG
Shifts to the Left
34
How does each factor affect the oxyhemoglobin dissociation curve? Pyrexia Thyroid storm Malignant hyperthermia Decreased pH Hypercapnia Hypoxia Increased 2,3-DPG Chronic Anemia
Shifts to the Right
35
Can SpO2 give insight about fluid responsiveness?
Yes
36
How does jaundice affect the reliability of the pulse oximeter?
It doesn't
37
How does carboxyhemoglobin affect the reliability of the pulse oximeter?
Carboxyhemoglobin absorbs the same wavelength as oxyhemoglobin. This causes the pulse oximeter to overestimate the degree of oxygen bound to hemoglobin
38
What is an acceptable margin of error for the pulse oximeterw hen the SpO2 is 70 - 100%?
the margin of error is +/- 2 - 3%.
39
What is an acceptable margin of error for the pulse oximeter when the SpO2 is 50 - 70%?
the margin of error is 3%.
40
Describe the optical characteristics of methemoglobin.
It absorbs both near-infrared light (940 nm) and red light (660 nm) equally. This can lead to erroneous readings on the pulse oximeter.
41
Do these things affect SpO2 reliability? Indocyanine green Shivering Cardiopulmonary bypass Indigo carmine Raynaud's disease Vasoconstriction Methylene blue
Affects Reliability
42
Do these things affect SpO2 reliability? Fetal hemoglobin Jaundice Acrylic fingernails Polycythemia Fluorescein
Does Not Affect Reliability
43
What is the MOST common method of measuring exhaled gases inside the breathing circuit?
Infrared absorption
44
How does Mass Spectrometry analyze an exhaled gas sample?
Bombards a gas sample with electrons creating ion fragments.
45
How does Raman Scatter Spectrometry analyze an exhaled gas sample?
Uses a high power argon laser to produce photons, which in turn collide with the gas molecules.
46
How does Piezoelectric Crystals analyze an exhaled gas sample?
Detects inspired, expired, and breath to breath changes of a particular gas by incorporating a lipid layer on the crystal.
47
How does Infrared absorption analyze an exhaled gas sample?
Different gases absorb different wavelengths of infrared light, each having a signature “fingerprint." Diatomic molecules don't absorb IR light.
48
Normal PaCO2-EtCO2 gradient
2-5 mmHg
49
PaCO2-EtCO2 gradient is increased by
any condition that blocks CO2 removal or by a leak in the breathing system
50
Does insufflation increase PaCO2-EtCO2 gradient?
No, as long as there are no leaks and the body is able to breathe off the excess CO2
51
Phase I capnograph
Exhalation of dead space
52
Phase II capnograph
Exhalation of dead space + alveolar gas
53
Phase III capnograph
Exhalation of alveolar gas (best correlates to V/Q status)
54
Phase IV capnograph
Inspiration
55
Which phase of the capnograph best correlates with ventilation-perfusion status of the lung?
Phase III
56
What part of the capnograph is where EtCO2 ultimately measured?
End of phase III
57
What is an advantage of a sidestream carbon dioxide sensor?
Less apparatus dead space
58
What is an advantage of a mainstream (in-line) carbon dioxide sensor?
Faster response time
59
​Dynamic compliance is a function of
airway resistance + lung/chest compliance.
60
Static compliance is a function of
lung/chest compliance only.
61
Normal alpha angle
100-110 degrees
62
Alpha angle location
Between phase II and III
63
Alpha angle is increased by
obstruction to expiration, such as COPD, kinked endotracheal tube, etc.
64
Normal beta angle
90 degrees
65
Beta angle location
Between phase III and IV
66
Beta angle is increased by
an inspiratory valve stuck in the open position
67
Mucus plug effect on compliance
Decreased dynamic compliance
68
Endobronchial intubation effect on compliance
Decreased static compliance
69
Pulmonary embolism effect on compliance
No change in dynamic or static compliance
70
Dynamic Compliance is measure when
gas flows into the lungs
71
Dynamic Compliance is decreased by
anything that obstructs airflow, such as a kinked endotracheal tube, mucus plug, and bronchospasm.
72
Static compliance is measured when
there is no gas flow (during the inspiratory pause)
73
Dynamic Compliance is assessed by
peak pressure
74
Static Compliance is assessed by
plateau pressure
75
Static Compliance is decreased by
anything that reduces lung compliance, such as endobronchial intubation, tension pneumothorax, pneumonia, and pulmonary edema.
76
Does pulmonary embolism affect pulmonary resistance or compliance?
Neither
77
How does Methemoglobinemia affect SpO2 readings?
Underestimates SpO2 when oxygen saturation > 85% Overestimates SpO2 when oxygen saturation < 85%
78
How does fluorescein affect SpO2 readings?
It doesn't

Unit 6 Apex Equipment & Monitors (7 decks)

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