VALLEY:Echo/CO2/Ox/PN/Other Flashcards
What seven cardiac parameters are observed or estimated with two dimensional transesophageal echocardiography?
1) Ventricular wall motion
2) valve motion
(3) estimations of end-diastolic and end-systolic volumes (ejection fraction),
(4) Cardiac output
(5) Blood flow characteristics,
6) intracardiac air
(7) intracardiac masses.
refers to the presence of less than normal ventricular motion
Hypokinesis
Refers to the presence of greater than normal wall motion;
Hyperkinesis
Absence of wall motion
Akinesis
ventricle has a paradoxic outward movement.
Dyskinesis
Identify the two most sensitive monitors for detection of air emboli.
Transesophageal echocardiography (TEE) and a Doppler probe secured over the right side of the heart are the most sensitive methods of intracardiac gas detection.
Which method is the most sensitive for detecting venous air embolism?
Transesophageal echocardiography (TEE). It is 5- 10 times as sensitive as the Doppler technique.
TEE provides visual representation of air in the
right or left heart. Therefore, smaller and fewer bubbles can be detected by TEE.
Transesophageal two-dimensional echocardiography has an additional benefit: What is this benefit?
The added benefit of two-dimensional transesophageal echocardiography is evaluation of cardiac function.
Transesophageal two-dimensional echocardiography has __________than precordial Doppler ultrasound for
detecting venous air embolism.
greater sensitivity
What advantage does C02 monitoring have over pulse oximetry or vital sign monitoring?
Carbon dioxide monitoring detects acute, complete airway obstruction and extubation more rapidly than pulse oximetry or vital sign monitoring.
Identify and describe phase I of the C02 waveform.
Phase I of the CO2 waveform reflects late inspiration, during which carbon dioxide levels should be near zero.
Identify and describe phase II of the C02
waveform.
represents the emptying of connecting airways and the beginning of the emptying of alveoli.
During phase 2, As exhalation continues, gas from alveoli
in regions with relatively short conducting airways
appears and mixes with dead space gas from regions with relatively long conducting airways, resulting in an increasing C02 level
Phase II reflects a
mixture of anatomic and alveolar dead-space.
Identify and describe phase III of the C02 waveform
Phase III is the alveolar plateau. Because of uneven emptying of alveoli, the slope continues to rise gently.
Point D shows the best
approximation of alveolar C02 (end of expiration, beginning of inspiration, end tidal C02) .
Identify and describe phase IV of the C02 waveform.
As the patient inhales, C02-free gas enters the patient’s airway, and the C02 level abruptly falls to zero.
Phase IV is
inspiration.
Interpret the a (alpha) angle of the C02 waveform.
angle between Phases II and III is called the a (takeoff, elevation) angle.
Normal alpha angle _____Degrees
100-110 degrees.
Angle decreased with obstructive lung disease
Alpha (because the dead space volume takes longer to be exhaled)
The slope of Phase III depends on the
lung’s ventilation-perfusion status.
Airway obstruction and PEEP on alpha angle ?
cause an increased slope and a larger a angle