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Foundations of Anesthesia 1 > Respiratory&Temp Clinical Monitoring > Flashcards

Respiratory&Temp Clinical Monitoring Flashcards

1
Q

Describe what kind of etCO2 waveform this represent?

A

Normal!

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2
Q

What does each letter represent?

A

A-B = Baseline
B-C = Expiratory Upstroke
C-D = Expiratory Plateau
D = End- Tidal Concentration
D-E = Inspiration

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3
Q

Describe what kind of etCO2 waveform this represents

A

Something is hindering expiration
You have a loss of plateau, you have lost your C curve

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4
Q

What are some causes of this waveform of etCO2

A

-Bronchospasm / Asthma
-Bronchospasm/COPD
-Obstruction in the expiratory limb of breathing circuit
-Presence of foreign body in the upper airway
-Partially kinked or occluded artificial airway

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5
Q

Will normal capnography waveforms look different depending on the type of airway management?

A

yes!
ETT, LMA, Nasal Cannula, Spont.
Shape changes, but phases are universal.

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6
Q

How many phases of normal capnogram?

A

4

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7
Q

Describe the first phase of etCO2

A

The end of inspiration and the very beginning of expiration

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8
Q

What gas is being sampled in phase one of etCO2? What should it be?

A

Comes from anatomic dead space, baseline, should be around 0.
You shouldn’t be exhaling CO2 at the end of your inspiration.

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9
Q

Describe the second phase of etCO2

A

Measuring the expiratory upstroke, your active expiration

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10
Q

What gas is being sampled in phase 2 of capnography

A

Dead space and alveolar gas.
Deadspace is the air that is stagnant in your airway, not participating in gas exchange.

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11
Q

Describe the third phase of etCO2

A

records plataeu, should be nearly flat, records alveolar emptying of CO2.
LONGEST duration of measurement. etCO2 measured at the very end of the phase, just prior to phase 4

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12
Q

What phase does the etCO2 that we chart come from

A

3! very end of phase three

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13
Q

Describe the fourth phase of capnography

A

Rapid decrease in CO2 of sampled gas as a result of inspiration of O2. Should return close to 0.

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14
Q

When evaluating capnogram what things should you be evaluating

A

Respiratory Rate
Whether ventilation is spontaneous or mechanical
Value of etCO2
Shape of waveform
Presence of additional respiratory efforts

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15
Q

What about waveform will tell you the patient is rebreathing CO2

A

A waveform that fails to return to baseline during the first and fourth phase

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16
Q

Describe what kind of etCO2 waveform this represents

A

Cardiac Oscillations
Result of contraction of the heart and great vessels forcing gas in and out the lungs(?)

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17
Q

What patients are you most likely to see this waveform and why?

A

Pediatrics, due to the relative size of the heart to the thorax

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18
Q

Describe what kind of etCO2 waveform this is

A

Curare Cleft, indicative of spontaneous respiratory effort

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19
Q

When you see this capnography waveform, what might you need to do?

A

Deepen anesthetic, pt initiating spontaneous breaths

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20
Q

If you have a flat end-tidal waveform, what can this indicate?

A
  1. You tubed the goose, ya silly goose.
  2. The circuit got disconnected
  3. Not ventilating (did you turn the ventilator on?)
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21
Q

ASA standards state etCO2 monitoring should be used when propofol is administered during which specific type of procedures?

A

Endoscopy procedures

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22
Q

What is alarm fatigue

A

A form of human error occurring when a practitioner is desensitized to alarms or alerts

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23
Q

What does the COVERABCD crisis management algorithm stand for?

A

Circulation, Color
Oxygenation
Ventilation
Endotracheal tube
Review Monitors, Equipment
Airway
Breathing
Circulation
Drugs

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24
Q

Describe the circulation, color assessment

A

Determine adequacy of circulation, check pulse, blood pressure, ECG, noting oxygenation through assessment and oximetry

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25
Q

Describe the oxygen, oxygen analyzer assessment in COVERABCD

A

Check oxygen delivery system, hypoxic guard analyzer

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26
Q

Describe the ventilation, Vaporizer assessment

A

Ventilate by hand to assess breathing circuit and airway patency, assess chest excursion and auscultation, assess etCO2, and check vaporizer function.

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27
Q

Describe the endotracheal tube assessment

A

includes patiency, seal, stabilization

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28
Q

Describe the review of monitors and equipment assessment

A

ensure appropriate calibration and maintenance, review any and all equipment in contact with the patient. review the alarm parameters.

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29
Q

Describe the airway assessment in the COVERABCD algorithm

A

Check the patency of the entire airway, including the non-intubated airwar. Assess for laryngospasm, foreign body, obstruction, bronchospasm, emesis

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30
Q

Describe the breathing assessment in the COVERABCD algorithm

A

Assess pattern, rate, and depth of respirations; examine, auscultate, review etCO2 and pulse ox monitors

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31
Q

Describe the drugs assessment in the COVERABCD algorithm

A

Review drugs given, consider needed pharmacologic intervention, consider the possibility of medication admin error

32
Q

Seeing condensation in an airway device or clear mask can indicate the presence, but not the ______, of gas exchange

A

adequacy.

33
Q

Observed retractions and seesaw motion of the chest and abdomen can indicate the presence of?

A

Airway obstruction

34
Q

After the initial core temperature drop produced by the peripheral blood redistribution, what modes of heat transfer MOST contribute to hypothermia during general anesthesia?

A

Radiation

35
Q

An underdamped arterial transducer system produces ?

A

An artificially high systolic BP - overestimated BP

Underestimated DBP

36
Q

PETCO2 is usually how much less than PaCO2

A

typically 0-5mmHg less than PaCO2 due to the mixing of dead space gas

37
Q

What are the two methods of sampling gas from in an airway

A
  1. Sidestream (diverting)
  2. Mainstream (nondiverting)
38
Q

What is sidestream sampling from an airway? pros and cons

A

sample line external to the airway - aspirates an airway sample.
o Prone to kinking, clogging and water vapor
o Neonates and infants can have dampened waveforms & false low readings

39
Q

What is mainstream sampling from an airway? cons of this

A

device is placed directly inside the airway.
o Can add deadspace
o Fragile- easy to damage

40
Q

What is the most common cause of reduced etCO2

A

hypotension

41
Q

most common cause of CO2 rebreathing

A

incompetent unidirectional valve - change it

42
Q

A terminal upswing at the end of the capnogram plateau ?

A

is due to decreases in lung compliance and functional residual capacity

43
Q

Where in the anesthesia circuit would you find a Wright respirometer?

A

expiratory limb

44
Q

A pulmonary embolism would characteristically result in what kind of etCO2 change

A

a decrease in the ETCO2 relative to the PaCO2

45
Q

The primary means a newborn infant has to respond to hypothermia is

A

the increased release of norepinephrine

46
Q

3 possible reasons/themes of increased etCO2

A

Increased CO2 delivery/Production
Hypoventilation
Equipment Problems

47
Q

Name at least three causes of increased etCO2 related to an increase in CO2 delivery/production

A

Malignant hyperthermia, Fever, Sepsis, Seizures, Increased Metabolic Rate or skeletal muscle activity, Bicarb Administration/medication side effect, clamp/tourniquet release.
Laparoscopic surgery (know this one)

48
Q

Name at least three causes of increased etCO2 related to hypoventilation

A

Obesity or Pregnancy, COPD
neuromuscular paralysis or dysfunction, CNS depression, Metabolic Alkalosis (if spontaneously breathing), medication side effect

49
Q

Name causes of increased etCO2 related to equipment problems

A

CO2 absorber exhaustion, ventilator leak, rebreathing, malfunctioning inspiratory or expiratory valve.

50
Q

Name 3 reasons/themes for decreased etCO2

A

decreased CO2 delivery/production
Hyperventilation
Equipment problems

51
Q

Name at least 3 causes for decreased CO2 related to delivery/production

A

Pulmonary Hypoperfusion* due to hypotension, decreased CO
Hypothermia, Hypometabolism, PE, hypovolemia, V/Q mismatch or shunt, autoPEEP, medication side effect

52
Q

Name causes for decreased etCO2 relating to hyperventilation.

A

pain/anxiety, awareness “light” anesthesia, metabolic acidosis (if spontaneously breathing), medication side effect

53
Q

Name causes for decreased etCO2 relating to equipment problems

A

Ventilator disconnect, esophageal intubation, bronchial intubation, complete airway obstruction or apnea, sample line problems (kinks), ETT or LMA leaks

54
Q

What factors shift the oxyhemoglobin curve to the right?

A

Elevated CO2, Elevated Temperature, Elevated 2,3 - DPG, Acidosis - Elevated H+ ions (so decrease pH)

55
Q

What factors shift the oxyhemoglobin curve to the left?

A

Decreased CO2, Decreased temperature, Decreased 2,3 - DPG, Alkalosis - Decreased H+ (so increased pH)

56
Q

When the oxyhemoglobin curve shifts the right, what does this mean regarding the relationship between oxygen and hemoglobin?

A

O2 is more readily released from hgb at the tissue level

57
Q

When the oxyhemoglobin curve shifts the left, what does this mean regarding the relationship between oxygen and hemoglobin?

A

Greater attachment of O2 to hgb, thereby decreasing release to tissues

58
Q

The oxygen-carrying capacity is mainly dependent on the?

A

the amount of hemoglobin

59
Q

Does the pulse ox over or underestimate spo2 in the presence of carbon monoxide

A

Overestimates the hemoglobin saturation. CO replaces hemoglobin. Because they absorb the same red light wavelength, leading to false overestimation. left shift curve

60
Q

What is the equation for Flow? (Respiratory Flow)

A

Volume/Time

delta-V over delta-T

61
Q

What is Peak Expiratory Flow Rate (PEFR)

A

Maximum slope of the flow curve. Where flow is the greatest.

The most/ how much volume is exhaled over the shortest time.

62
Q

How does residual volume compare to normal lungs in patients with obstructive lung disease(s)?

A

They can’t get as much air out, so the residual (or left-over) volume in the lung is higher in those with obstructive lung disease.

63
Q

How does Total Lung Capacity compare to normal lungs in patients with obstructive lung disease(s)?

A

TLC is larger in patients with obstructive lung disease such as COPD.
Primarily due to the destruction of lung tissue, leading to a loss of elastic recoil, which allows the lungs to expand to abnormally large volumes, causing air trapping and resulting in lung hyperinflation

64
Q

Identify and Explain Numbers 1-4 on the image

A
  1. PEFR. Peak Expiratory Flow Rate: The most/ how much volume exhaled over the shortest time.
  2. Total Lung Capacity (TLC): The maximum amount of air that can be inhaled
  3. Residual Volume (RV): How much air is left in the lungs after expiration.
  4. Forced Vital Capacity (FVC): Total Expired Air. =TLC-RV
65
Q

How does residual volume compare to normal lungs in patients with restrictive lung disease(s)?

A

The Residual Volume decreases. As less air comes in, there is less total air left in the lungs after expiration.

66
Q

How does inspiratory flow compare to normal lungs in patients with restrictive lung disease(s)?

A

Inspiratory flow decreases. Difficult time getting air in, so less volume over time entering lungs

67
Q

How does total lung compliance compare to normal lungs in patients with restrictive lung disease(s)?

A

Decreased. You have decreased compliance so less total air can enter on inspiration.

68
Q

How does Peak Expiratory Flow Rate (PEFR) compare to normal lungs in patients with restrictive lung disease(s)?

A

Decrease. If you have less volume coming in, you will have less volume coming out. Flow is Volume over time.

69
Q

How does Forced Vital Capacity (FVC) compare to normal lungs in patients with obstructive lung disease?

A

FVC will decrease. Patients can’t exhale as much volume to do diseased/obstructed airways

70
Q

How does Forced Vital Capacity (FVC) compare to normal lungs in patients with restrictive lung disease?

A

FVC will also be decreased in restrictive lung disease patients because less air can be inhaled, meaning less will be exhaled compared to normal lungs.

71
Q

Why is there coving on obstructive lung disease flow volume loops but not in restrictive?

A

Restrictive lung disease has no problem exhaling; the problem is an inspiration. Obstructive has difficulty exhaling, making the curve cove inward.

72
Q

What is the equation for lung compliance?

A

Volume / Pressure
Delta V over Delta P

73
Q

What is lung compliance?

A

The ability of the lung to expand

74
Q

What lung pressure are we talking about when discussing lung compliance?

A

The distending pressure AKA Transmural Pressure

75
Q

Compliance is the opposite of?

A

Surface Tension and Elasticity

76
Q

equation from Fahrenheit to Celsius

A

C= 5/9(F-32)

77
Q

Equation from Celsius to Fahrenheit

A

F=9/5C + 32

Foundations of Anesthesia 1 (29 decks)

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