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Priniclpes Of Anesthesia > Week 5: Rep. Monitoring, Ventilation and Capnography > Flashcards

Week 5: Rep. Monitoring, Ventilation and Capnography Flashcards

1
Q

AANA and ASA standard of care

A

Continuous assessment of airway and breathing

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2
Q

What does a precordial stethoscope do

A

Hear lung and heart sounds at the same time

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3
Q

Why is a systemic approach to monitoring important and what does it entail?

A

Timely response
Habits of assessment avoids errors

“Sweep” the anesthesia field

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4
Q

What does it mean to “sweep” the anesthesia field?

A

Always looking and listening to patient, checking vitals, watching monitors

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5
Q

Crisis Management algorithm

A

COVERABCD

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6
Q

C
(in COVERABCD and what it entails)

A

Circulation

Color, BP, ECG

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7
Q

O
(in COVERABCD and what it entails)

A

Oxygenation

Check oxygen delivery system

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8
Q

V
(in COVERABCD and what it entials)

A

Ventiltaion/Vaporizer

Ventilate by hand to assess breathing circuit and airway patency.
Assess chest rise
auscultate
assess ETCO2
check vaporizer function

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9
Q

E
(In COVERABCD and what it entails)

A

Endotracheal tube

Asses patency, seal, position

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10
Q

R
(In COVERABCD and what it entails)

A

Review Monitors
Review Equipment
Review Plan

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11
Q

A
(In COVERABCD and what it entails)

A

Airway

Assess patency of unintubated airway, assess for laryngospasm, foreign body, air exchange

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12
Q

B
(in COVER ABCD and what it entails)

A

Breathing

Quality
Pattern
Rate
Depth
Listen
Review ETCO2 and SPo2

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13
Q

C
(in COVER ABCD and what it entails)

A

Circulation

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14
Q

D
(in COVER ABCD and what it entails)

A

Drugs

review drugs given

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15
Q

Important components of of airway monitoring

A

-Observe for gas exchange
-Subtle changes need intervention
-Verify placement

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16
Q

Verify ETT or LMA by:

A

-breath sounds
-chest expansion
-ETCO2

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17
Q

Muscular signs on airway issue

A

Seesaw
Stridor
Retractions

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18
Q

Pulse oximetry measures

A
  1. Heart rate
  2. Percent of oxygen saturations of hemoglobin
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19
Q

How does a pulse oximeter work?

A

Uses wavelengths of red and infrared light

oxygenated hgb and unoxygenated hgb absorb infared light at different wavelengths

one diode transits through tissue to oppositely place photosensitive diode that measures amount of absorbed red light

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20
Q

Oxyhemoglobin dissociation curve expressess

A

Relationship between O2 tension and percent of O2 saturation

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21
Q

P50 is:

A

PaO2 at which 50% of the Hgb is saturated

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22
Q

Normal P50 adult

A

26-27

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23
Q

Oxyhemoglobin dissociation curve rights shift = ______ p50

A

increaes

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24
Q

Oxyhemoglobin dissociation curve left shift = ____ p50

A

decreases

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25
Q

oxyhemoglobin dissociation curve left shift means

A

Hgb has greater affinity for O2, does not want to give away

L=love

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26
Q

Greater affinity of Hgb for oxygen means ______ to tissue

A

Less oxygen

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27
Q

Oxyhemoglobin dissociation curve right shift means

A

Hgb has less affinity for O2, OK with giving it away

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28
Q

Less affinity of Hgb for oxygen means ____ to tissue

A

More oxygen

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29
Q

What causes a left shift of the oxyhemoglobin dissociation curve?

(CO2, temp, 2-3 DPG, pH)

A

Decreased CO2
Decreased Temp
Decreased level of 2-3 DPG
Elevated pH, alalosis

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30
Q

What causes a right shift of the oxyhemoglobin dissociation curve?
(CO2, temp, 2-3 DPG, pH)

A

Elevated CO2
Elevated Temp
Elevated levels of 2,3 DPG
Decreased pH, acidosis

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31
Q

SpO2 90% = PaO2 ____
(in nml ODC)

A

60

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32
Q

SPO2 80% = PaO2____
(in nml ODC)

A

80

and SPo2 70% is PaO2 of 40 and so on

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33
Q

If ODC sfhits right, p50 ___

A

increases

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34
Q

If ODC shfits left, p50 ____

A

decreases

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35
Q

General best area for SPO2 monitor

A

More central circulation

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36
Q

What can cause poor SPO2 reading?

A

-Motion artifact
-cold temps (vasoconstriction)
-Abnormal Hgbs
-Injectable dye

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37
Q

Metheglobin and oxyhemoglobin effect on SPo2 reading

A

if true SPO2 is less than 85%, reading can be overestimated

if true SPO2 is more than 85%, reading can be underestimated

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38
Q

What does pulse oximetry do (4)?

A
  1. Provides percentage of hgb that is saturated by O2
  2. Provides HR
  3. Can monitor decreased perfusion
  4. Predicts fluid responsiveness PPV
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39
Q

Pulse oximetry does NOT (3)

A
  1. monitor DO2 or caO2
  2. monitor VENTILATION (nml SpO2 in hypercarbia)
  3. Monitor Anemia (can be anemic and be 100% saturated)
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40
Q

DO2

A

Oxygen delivery to alveoli

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41
Q

VO2

A

Consumption of oxygen by tissues

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42
Q

Boyle’s law is a relationship between

A

Pressure and Volume

(as one increases, the other decreases)

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43
Q

As pressure increases, volume _____

A

decreases (and vice versa)

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44
Q

as pressure decreases, volume _____

A

increases (and vice versa)

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45
Q

When diaphragm and intercostals contract, what happens to the thoracic cavity?

How does this happen?

A

Sightly enlarges, so pressure is decreased

Diaphragm flattens and moves inferiorly while external intercostals elevate the rib cage and move sternum anteriorly

(We are expanding the container size)

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46
Q

Is ‘quiet’ expiration active or passive?
What happens?
Does this increase or decrease volume/pressure in thoracic cavity?

A

Passive process (diaphragm and external intercostal muscles relax)

elastic lungs and thoracic wall recoil inward.

Volume is decreased, pressure is increased in thoracic cavity

(we are shrinking the container size)

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47
Q

Deep/forceful expiration is active or passive?

A

Active process

dramatically decrease volume and increase pressure

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48
Q

As bronchus constricts, diameter ______ and resistances _____

A

Diameter decreases and resistance increases

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49
Q

As resistance decreases, airflow ____

50
Q

Acetylcholine and airway resistance

A

PNS relaxes acetylcholine which CONSTICTS bronchioles = increased airway resistance

51
Q

If acetylcholine is blocked, what happens to airway?

A

Airway relaxes!

52
Q

Histamine and airway resistance

A

Histamine constricts bronchioles —>increases airway resistance —>decreases airflow

53
Q

Epinephrine and airway resistance and airflow

A

Epi is released from adrenal medulla during exercise, stress—->dilates bronchioles—?decreases airway resistance—->increases airflow

54
Q

Compliance equation

A

Change in volume
—————————
Change in pressure

55
Q

Compliance definition

A

A measure of the distensibility of a chamber expressed AS A CHANGE IN VOLUME PER UNIT OF CHANGE IN PRESSURE

56
Q

Two Factors determine lung compliance:

A
  1. Stretchability of elastic fibers within the lungs
  2. Surface tension within the alveoli
57
Q

What does surfactant do?

A

lowers surface tension and increases lung compliance

without surfactant, alveoli can’t open and close (alveoli resist expansion)

58
Q

Dynamic compliance is a function of:

A
  1. airway resistance
  2. elasticity of the chest wall
59
Q

Dynamic compliance equation:

A

Peak Inspiratory Pressure - PEEP

60
Q

Static Compliance is a function of:

A

Elasticity of the chest wall only

NOT RESISTANCE

61
Q

Static compliance equation:

A

Plateau Pressure - PEEP

62
Q

Plateau Pressure is the:

A

Pressure applied to small airways and alveoli

63
Q

Plateau Pressure is measured during:

A

inspiratory pause on the ventilator

64
Q

Goal plateau is ____. Why?

A

<30-35 cm H2O.

To preent barotrauma

65
Q

Without lung disease, compare peak expiratory pressure and plateau pressure

A

PIP is only slightly higher than PPlat. Will be very similar

66
Q

What does increased resistance look like in terms of PIP and Pplat

A

increased peak pressures without increasing plateau pressures indicate INCREASED RESISTANCE

67
Q

Does airway resistance effect PPlat? Why or why not?

A

Resistance does not effect Pplat because there is no airflow during that time (during inspiratory pause).

68
Q

Plateau pressure reflects

A

the elastic recoil of the lungs and thorax (During inspiratory pause)

69
Q

Complications of elevated plateau pressure:

A
  1. lung injury
  2. pseumomediastiunum
  3. subcutaneous ephysema
70
Q

PIP aka

71
Q

Increased PIP and unchanged PPlat, problem is:

A

Increased inspiratory gas flow OR increased airway resistance

72
Q

If PIP has increased and PP has no change, what has happened?

A
  1. Resistance has increased
    OR
  2. Inspiratory flow rate has increased
73
Q

If PIP and PPlat have increased, what has happened?

A
  1. Total compliance has decreased
    (Pelastic as increased)
    OR
    Tidal volume has increased
74
Q

What do spirometry loops provide?

A

Rapid evaluation of changes in lunch compliance and resistance

75
Q

Spirometry loops are a graphic representation of:

A

dynamic relationship between lung compliance and resistance

76
Q

Pulmonary resistance looks at

A

flow and volume

77
Q

Pulmonary compliance looks at

A

Pressure and Volume

78
Q

The flow volume loop measures:

A

Pulmonary resistance by plotting Flow (L/sec and Volume (L)

79
Q

Pressure volume loop measures

A

compliance by plotting Pressure (cm H2O) and Volume (L)

80
Q

Pressure volume loop and what part of breathing cycle measures where

A

*reference notability study pages

81
Q

PEEP effect on pressure volume loop (compliance)

A

WIth - increase of slope, better compliance
Without - Slope of curve less, low compliance. Lower inflection point

*reference notability study pages

82
Q

What is PEEP?

A

Maintenance of positive pressure within the lungs at the end of expiration

(in spontaneous pt, equivalent to CPAP)

83
Q

Why use PEEP?

A

Improves oxygenation by recruiting collapsed alveoli and decreasing shunt

84
Q

Airway pressure caclulation

A

AIrway pressure = Flow x resistance + (alveolar pressure) + Peep

85
Q

What does PEEP do?

A

Decreases airway resistance (negative pressure generated in lungs to draw in air) because it gives some pressure to begin with when pulling in air

*see PEEP video

86
Q

PEEP contraindications (5)

A
  1. Tension Pneumothorax
  2. Hypovolemic shock
  3. Bronchopleural fistula
  4. High ICP
  5. RV failure
87
Q

Ventilation monitoring in anesthesia care evaluates:

A

BOTH ventilation and oxygenation

88
Q

Ventilation monitoring in anesthesia care consists of (4):

A

-ensuring adequate minute ventilation of anesthetic (5-7) ml/kg ideal bodyweight

-Listening with precordial stethoscope to detect early changes

-Assessment of minute ventilation with rate and tidal volume

-determining patient changes to stimuli and response to drug administration (ex. rebreathing may need muscle relaxant re-dose, stimulation may need more narcotic)

89
Q

Ways to monitor CO2 (2)

A

1.disposable ETCO2 (colorimetric)
2. ABG
3. Continuous measurement of CO2 in expired gas (gas line monitor)

90
Q

Disadvantages of ETCO2

A

false positives and false negatives

91
Q

Gas line monitor gives:

A

An accurate, continuous reflection of arterial blood CO2

92
Q

ETCO2 in gas line monitor (continuous) measurement is _______ than PaCo2 in normal heart and lungs

A

2-5 torr mmhg LOWER

93
Q

How is continuous measurement of ETCO2 obtained?

A

Infared analysis: Each gas in mixture absorbs infared radiation at different wavelengths

94
Q

Nondiverting CO2 sampling line measures

A

directly from mainstream/ it is inline

gas passes between anesthesia circuit and mask adapter

95
Q

diverting/sidestream CO2 sampling line measures

A

gas from sample line tubing attached to circuit near patient and flows to monitor

gas needs scavaging

96
Q

ETCO2 Capnography records:

A

CO2 as expired lung volume throughout the phases of respiration plotted against time

97
Q

Time capnography can:

A

differentiate between normal and abnormal patterns of ventilation

(reference study notability doc)

98
Q

The shape of ETCO2 capnography can vary:

A
  1. based on mode of airway management (ETT, LMA etc.)
  2. Pt spontaneously breathing or being ventilated
99
Q

Phase one of ETCO2 capnog reflects ____ and should be ____

A

Anatomic dead space (no CO2), should be 0

100
Q

Phase 2 ETCO2 capnog is the _____ and contains _____

A

Expiratory upstroke, mix of dead space and alveolar gas

101
Q

Phase 3 ETCO2 capnog

A

Represents plateau/alveolar emptying

102
Q

Phase 4 ETCO2 monitoring

A

Rapid decrease in CO2 as a result of inspired air or O2

103
Q

*See notability study doc for details and labeling practice

104
Q

Normal alpha angle is (Degrees)

A

100-110 degrees

105
Q

Increased alpha angle means

A

Expiratory flow obstruction

106
Q

Beta angle should be ___ degrees. Why?

A

90 degrees.
Shows inspiration, capnograph should return quickly to 0

107
Q

If beta angle is increased, could mean (3):

A
  1. rebreathing
  2. Faulty inspiratory valve
  3. normal with exhausted CO2 absorber
108
Q

Causes of increased CO2 on capnographhy (3)

A
  1. From increased CO2 delivery/production
  2. Hypoventilation (withholding)
  3. Equipment problems
109
Q

Causes of decreased CO2 on capnography (3)

A
  1. Decreased CO2 deliver/production
  2. Hyperventilation
  3. Equipment problems
110
Q

Two main base ventilator pathways:

A
  1. Volume Controlled
  2. Pressure controlled

*all ventilator modes are a combination of these 2 systems

111
Q

Volume controlled mode attempts to ______ and ______ is variable based on _____

A

Achieve a pre-set TV.

Peak airway pressure is variable based on resistance, compliance.

112
Q

Pressure controlled mode attempts to ____ and _____ is variable based on ____

A

Achieve preset pressure

variable tidal volume that is based on resistance and compliance

113
Q

LMA is usually ____ mode of ventilation

A

Pressure mode

114
Q

Peak Airway Pressure (PAW) iss:

A

the total pressure needed to deliver the tidal volume

115
Q

Plateau Pressure (PPlat) is:

A

the pressure needed to distend the lungs

116
Q

Sensitivity or trigger sensitivity is:

A

Effort of negative pressure required by the patient to trigger the machine to breath

117
Q

Venous blood is captured by (in SpO2)

A

near infared light 940 nm

118
Q

Arterial blood is captured by (in SpO2)

A

Red light 660nm

119
Q

Oxy-hemoglobin dissociation curve axes

A

x: PaO2 (partial pressure of oxygen in blood)
Y: SaO2 (O2 saturation)/ SpO2

120
Q

P50

A

partial pressure of oxygen at which our pulse oximeter reads 50%

121
Q

Pressure dissociation curve tell us

A

At what pressure will oxygen dissociate from Hgb

Priniclpes Of Anesthesia (19 decks)

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