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730 > Wk 5 > Flashcards

Wk 5 Flashcards

1
Q

Calculation of SERUM anion gap

A

Na- (CL+HCO3)

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2
Q

Elevated anion gap meaning

A

=metabolic acidosis
Implies it is the primary disorder and is not compensatory

Normal is 8-12

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3
Q

Adjusted anion gap (albumin)

A

Calculated Gap+ 2.5(4-albumin)
If has hypoalbuminemia

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4
Q

Base excess

A

Normal between -2 and +2

B.E. <-2 is metabolic acidosis (may be compensatory) =also called base deficit

B.E. >2 metabolic acidosis (may be compensatory)

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5
Q

For metabolic disorders, what is a quick way to know if respiratory compensation is appropriate?

A

If PaCO2 is approximately similar to the second two digits after pH

7.27
PaCO2: 25
HCO3: 11

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6
Q

Delta ratio

A

(Change in anion gap/change in bicarbonate)
ONLY in metabolic disorders

AGmeasured-AGnormal
HCO3normal-HCO3measured

Helps identify underlying cause of acidosis

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7
Q

Delta gap

A

Alternative to delta ratio
Measured SAG- Normal SAG (12)

Less than -6= mixed high and normal anion gap acidosis

-6 to 6 = only high anion gap acidosis

Greater than 6 = mixed high anion gap acidosis and metabolic alkalosis

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8
Q

Delta Delta

A

Is bicarbonate being conserved or excreted?
=Delta gap+measured bicarbonate

If <22 then patient is losing bicarbonate

If > 26 patient is retaining bicarbonate

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9
Q

ABG on steroids (GAPGAP steps)

A
  1. Delta gap= Measured SAG-12
  2. Delta Delta= Delta gap + serum bicarb

<22= losing bicarb, if acidosis was not previously identified there is an additional concurrent non gap acidosis

> 26= retaining bicarb, and there is additional metabolic alkalosis

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10
Q

Paramagnetic cell

A

Based on oxygen molecules unique attraction in magnetic fields (due to polarity)
-highly accurate
-compact
-durable

Displaces nitrogen dumbbell in magnetic field which is connected to a mirror- change in angle (amount of light beamed to photocell) indicates concentration of 02, greater the displacement the greater the concentration

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11
Q

Galvanic Cell

A

In-line with inspiratory limb
More oxygen over cathode means greater flow of current through galvanic cell-
Based on flow of electrons liberated by an oxidative reaction

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12
Q

Expired vs inspired oxygen

A

Expired is usually 3-5 % lower
So we inhale 21% from the atmosphere but exhale around 18%

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13
Q

What types of gases does IR absorption analysis not detect?

A

Oxygen and nitrogen

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14
Q

Simplified co2 absorpant equation

A

CO2 absorption ➡️ carbonates (CaCO3, K2CO3) + heat + water

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15
Q

Indicator for CO2 absorbent ( name and pH)

A

Ethyl violet turns purple when pH < 10.3

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16
Q

Which law governs pulse oximetry

A

Beer- lambert
-luminosity is based on distance traveled and characteristics of the medium it travels through

Detecting the ratio of light absorbed at 660 and 940nm

17
Q

Pa02 based on SpO2

A

SpO2 70. 80. 90. 93. 95. 96. 97.

PaO2. 40. 50. 60. 70. 80. 90. 100

18
Q

P50

A

Pa02 at which hemoglobin is 50% saturated (normally 26.7)

19
Q

Oxyhemoglobin right shift

A

Decreased hemoglobins affinity for oxygen

Low pH (Bohr effect)
Increased paCO2
Increased temp
Increased 2,3 DPG -glycolysis byproduct

20
Q

Left shift oxyhemoglobin

A

Increases hemoglobin affinity for oxygen

Increased pH
Low paCO2
Low temp
Low 2,3 DPG

P50 will go down

21
Q

Methemoglobin

A

Iron is in ferric state (3+) instead of 2+, typically less than <1% of normal hemoglobin, can be genetic but think drug exposure particularly nitrates (nitroprusside)

Methemoglobin impairs oxygen binding

It absorbs light equally at 660 and 940= inaccurate readings—- will read between btwn 80-85% no matter what

22
Q

Dyes and their impact on SpO2

A

Cause erroneously low SpO2
Methylene blue
Indigo carmine
Indocyanin green

23
Q

Henderson hasselbalch equation

A

Ph= pKa + log (products/reactants)

24
Q

Bohr effect

A

H+ as a product of carbonic acid dissociation (picked up co2 from tissue) displaces oxygen bound to hemoglobin and releases it to the tissue
Bicarbonate is also released into the tissue

25
Q

Oxidation and reduction reactions

A

Oil rig

26
Q

Na k pump

A

3NA OUT
2K IN

ATPase- consumes one atp

27
Q

Mass spectrometry

A

Older technology
Ionizes gas molecules and passes them through a magnetic field

Molecules with the lowest mass to charge ratio are easily deflected by the magnetic field and collected by ion collector

Identification is based on amount of deflection

28
Q

Piezoelectric gas analysis

A

the degree of frequency change in a crystal when a gas is dissolved in the surrounding liquid is proportional to the concentration- this gives us the partial pressure of the gas based on Henry’s law

29
Q

Infrared absorption analysis

A

A sample of gas is subjected to a range of infrared frequencies and the lost frequencies are measured. They can identify the gas based on what it absorbs

30
Q

Raman scattering analysis

A

The interaction of EMR with matter

Laser beam the gas to create a vibration frequency of the excited particles, the scatter spectrum of a gas is unique

31
Q

Raman scattering analysis

A

The interaction of EMR with matter

Laser beam the gas to create a vibration frequency of the excited particles, the scatter spectrum of a gas is unique

32
Q

What can IR absorption analysis NOT do?

A

Measure Oxygen and nitrogen

33
Q

Litholyme VS sodalime

A

Litholyme does not react with anesthetic gases so there’s no CO or compound A production!!

Also does not regenerate indicator dye

34
Q

Beer-Lambert Law

A

The absorbance of light by a sample is directly proportional to the concentration

35
Q

Explain Pulse Oximetry

A

Reduced Hb absorbs light at 660 and Oxy-Hb absorbs at 940nm, pulse ox is the ratio
Impacted by:
Low hematocrit, pigmentation, light sources, motion, cautery, tourniquets, hypotension

36
Q

MRI Basics

A

Manipulation of hydrogen atoms in the body

After placement in MRI H atoms are in alignment
Radio frequency pulses deflect orientation of atoms
As atoms relax back to resting state the energy emitted is used to produce the image

37
Q

Magnetic field in MRI

A

Strength in Tesla is 0.15-3.0
1T=10,000 Gauss
Quality of the image depends on the strength of the field

38
Q

Ferromagnetic

A

Iron! Co, Ni, Gd
Spontaneous groups of atoms are aligned in the material to create a very strong magnetic interaction
-leads to complete alignment with magnetic fields=strong (quantum mechanics lol)

39
Q

Describe MRI VS x-ray in terms of ionizing radiation

A

X-ray is high on the EMR spectrum and is ionizing radiation (ie it has enough energy to remove an electron)
MRI is non-ionizing

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