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Apex Review > Respiratory monitors and equipment 2 > Flashcards

Respiratory monitors and equipment 2 Flashcards

1
Q

Describe an airflow obstruction capnograph.

A

prolonged upstroke with increased alpha angle

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2
Q

Examples of an airflow obstruction include

A

COPD, bronchospasm, kinked ETT

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3
Q

Describe cardiac oscillations capnograph

A

oscillations in the capnograph waveform from C to D

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4
Q

Cardiac oscillations are more common in

A

children because of close proximity of the heart to the lungs

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5
Q

Cardiac oscillations are caused by the

A

heart beating against the lungs

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6
Q

What is a curare cleft?

A

spontaneous breaths during mechanical ventilation

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7
Q

If present during spontaneous ventilation, the presence of a curare cleft suggests

A

inadequate muscle relaxant reversal (lack of synchronization between intercostal muscles and diaphragm)

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8
Q

Why might we see low EtCO2?

A

hyperventilation
decreased CO2 production
increased alveolar dead space

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9
Q

Examples of low EtCO2 due to hyperventilation include

A

light anesthesia, metabolic acidosis

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10
Q

Examples of low EtCO2 due to low Co2 production include

A

hypothermia

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11
Q

Examples of low EtCO2 due to increased alveolar dead space include

A

hypotension
pulmonary embolism

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12
Q

Why could we see increased EtCO2 with a normal plateau?

A

increased CO2 production or decreased alveolar ventilation

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13
Q

Examples of increased EtCO2 due to increased CO2 production include

A

MH, sepsis, fever, hyperthyroidism

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14
Q

Examples of increased EtCO2 due to decreased alveolar ventilation include

A

hypoventilation
narcotics

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15
Q

How do we know if the capnography is due to inspired CO2?

A

look at the baseline. it does not return to zero–> rebreathing

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16
Q

Why could we see rebreathing?

A

exhausted CO2 absorbent
incompetent expiratory valve
hole in the inner tube of a Bain system
inadequate FGF with Mapleson circuit
rebreathing under the drapes in a patient who is not intubated

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17
Q

An incompetent inspiratory valve will appear on capnography as

A

a decreased slope during the inspiratory phase (widened beta angle)
waveform may or may not reach zero, depending on the FGF

18
Q

What would a leak in the sample line during positive pressure ventilation appear as?

A

the beginning of the plateau is low because alveolar gas is diluted when atmospheric air is aspirated into the sample line

19
Q

When could a biphasic expiratory plateau occur?

A

single-lung transplant b/c alveolar gas from the transplanted lung and the diseased lung may have different time constants

20
Q

Causes of increased EtCO2 include

A

increased CO2 production and delivery to the lungs
decreased alveolar ventilation
equipment malfunnction

21
Q

Causes of decreased EtCo2 include

A

decreased CO2 production and delivery to the lungs
increased alveolar ventilation
equipment malfunction

22
Q

For EtCO2 to be detected, the following requirements must be met:

A
  1. CO2 must be produced during metabolism
  2. There must be an adequate pulmonary blood flow to deliver CO2 to the lungs for elimination
  3. There must be an adequate ventilation to transport CO2 to the breathing circuit
  4. There must be an intact sampling system
23
Q

What are the two things that you must consider when answering a question about changes in end-tidal CO2?

A
  1. What is the cause?
  2. Does this affect the PaCO2 to EtCO2 gradient
24
Q

Equipment malfunction that can cause increased EtCO2 includes

A

rebreathing
CO2 absorbent exhaustion
unidirectional valve malfunction
leak in breathing circuit
increased apparatus dead space

25
Q

Equipment malfunction that can cause decreased EtCO2 includes

A

Ventilator disconnect
esophageal intubation
poor seal with ETT or LMA
sample link leak
airway obstruction
apnea

26
Q

What are examples of increased alveolar ventilation that can result in decreased EtCO2

A

hyperventilation
inadequate anesthesia
metabolic acidosis (if spontaneous ventilation)
medication side effect

27
Q

What are examples of decreased alveolar ventilation that can result in increased EtCO2?

A

hypoventilation
CNS depression
residual NMB
COPD
high spinal
neuromuscular disease
metabolic alkalosis
medication side effect

28
Q

What are causes of increased CO2 production and delivery to the lungs that can result in increased EtCO2?

A

increased BMR
malignant hyperthermia
thyrotoxicosis
fever
sepsis
seizures
laryngoscopy
tourniquet or vascular clamp removal
sodium bicarbonate administration
shivering
increased muscle tone (after NMB reversal)
medication side effect

29
Q

What are causes of decreased CO2 production and delivery to the lungs that can result in decreased EtCO2?

A

decreased BMR
increased anesthetic depth
hypothermia
decreased pulmonary blood flow
decreased cardiac output
hypotension
pulmonary embolus
V/Q mismatch
medication side effect
pain/anxiety (if breathing spontaneously)

30
Q

Select the statements that MOST accurately describe pulse oximetry (select 2).
a. oxygenated hemoglobin absorbs light at 940 nm
b. at the peak of the waveform, the ratio of arterial blood to venous blood is reduced
c. it is based on the Beer-Lambert law
d. it is based on the Doppler effect

A

a. oxygenated hemoglobin absorbs light at 940 nm
c. It is based on the Beer-Lambert law

30
Q

Select the statements that MOST accurately describe pulse oximetry (select 2).
a. oxygenated hemoglobin absorbs light at 940 nm
b. at the peak of the waveform, the ratio of arterial blood to venous blood is reduced
c. it is based on the Beer-Lambert law
d. it is based on the Doppler effect

A

a. oxygenated hemoglobin absorbs light at 940 nm
c. It is based on the Beer-Lambert law

31
Q

The pulse oximeter is based on the _______

A

Beer-Lambert Law

32
Q

What does the Beer Lambert law describe?

A

it relates the intensity of light transmitted through a solution (blood) and the concentration of the solute (hemoglobin) within the solution

33
Q

Red light is absorbed at

A

660 nm

34
Q

Red light is preferentially absorbed by

A

deoxyhemoglobin (higher in venous blood)

35
Q

Near-infrared light is absorbed at

A

940 nm

36
Q

Near-infrared light is absorbed by

A

oxyhemoglobin (higher in arterial blood)

37
Q

As a general rule, monitoring sites ________________ have faster response times

A

closer to the central circulation
(forehead and ear will be more responsive than the toe)

38
Q

What is the SpO2 equation?

A

SpO2= oxygenated hbg/ (oxygenated hbg + deoxygenated Hbg) x 100%

39
Q

At the trough of the pulse waveform, there is a

A

greater amount of venous blood in the tissue sample

40
Q

At the peak of the pulse waveform, there is a

A

greater amount of arterial blood in the tissue sample

41
Q

When SpO2 is monitored on the head or esophagus, the Trendelenburg position can cause

A

venous engorgement resulting in a falsely decreased SpO2 measurement

Apex Review (224 decks)

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