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dnurs 827 advanced physiology/pathophysiology for anesthesia i > Pulmonary IntraOp Monitoring & Difficult Airway Algorithm - Quiz 8 > Flashcards

Pulmonary IntraOp Monitoring & Difficult Airway Algorithm - Quiz 8 Flashcards

1
Q

What are the two lights invovled with Pulse Oximetry?

A
  • Infrared - 940nm - Oxyhemoglobin - 100% Saturation
  • Red - 660nm - Deoxyhemoglobin - 50% Saturation
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2
Q

SpO2 and PaO2

100% =

95% =

90% =

75% =

60% =

50% =

A

100% = 100+ mmHg

95% = 75 mmHg

90% = 60 mmHg

75% = 40 mmHg

60% = 30 mmHg

50% = 27 mmHg

(40%, 50%, 60% = 70, 80, 90)

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3
Q

What are the considerations in regards to Pulse Oximetry in MRI?

A

The standard pulse ox CANNOT be used, a special probe is needed

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4
Q

For Pulse Oximetry, which site detects changes quicker - the finger or the ear?

A

Ear detects changes quicker

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5
Q

What will the Pulse Ox measurement be for EndoBronchial Intubations?

A

It will go Undetected if there is no lung disease or low FiO2

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6
Q

What may cause the Pulse Ox to be inaccurate?

A

Hypotension
Hypothermia
Hypovolemia
Hypoperfusion
Peripheral Vasoconstriction
Asystole/V Fib
BP Cuff
Tourniquet

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7
Q

How does Carboxyhemoglobin (COHb) affect the Pulse Ox?

A

COHb is due to Carbon Monoxide (CO) Poisoning.

Viewed as Oxyhemoglobin by Pulse Ox and show SpO2 of 100%

(Use Co-Oximeter)

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8
Q

What is Methemoglobin (MetHb)?

A

Ferric Form of Hemoglobin that cant transport O2

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9
Q

What causes Methemoglobinemia?

A

Nitrates
Nitrites
Nitroglycerine
Nitroprusside
Benzocaine

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10
Q

How does Methemoglobin affect the Pulse Ox?

A

Methb is absorbed equally at both wavelengths

Show SpO2 of 85%

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11
Q

How does Fetal Hemoglobin & Bilirubin affect the Pulse Ox?

A

No Effect

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12
Q

What what level of hypoxemia and anemia does the Pulse Ox become inaccurate?

A

SpO2 < 30%

Hb < 3-4 gm/dL

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13
Q

What heart conditions might disturb the Pulse Ox due to Venous Pulsations?

A

Right Heart Failure

&

Tricuspid Regurgitation

(cor pulmonale)

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14
Q

What external problems may cause errors with SpO2?

A

Motion Artifact

Ambient Light Interference

Methylene Blue & Indocyanine Green

Bad Probe Position

Light Leakage from Diode

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15
Q

What does Capnography do?

A

Fast and Reliable Indicator of Esophageal Intubation, but not reliable for Endobronchial Intubation

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16
Q

What is the Gold Standard for confirming Tracheal Intubation?

A

EtCO2

17
Q

How does Aspiration Capnography work?

A
  • Gas is constantly sucked from circuit @ 50-250 mL/min
  • Analyzes CO2 via Infrared Absorption
  • Prone to Errors and Water Precipitation
18
Q

How does the Mainstream Capnography work?

A

AKA Flow-Through

Sensor attaches directly to circuit

19
Q

List

AB:

BC:

CD:

D Point:

DE:

A

AB: Start Exhalation, Dead Space Gas

BC: Exhalation, Mixing of Gas

CD: Alveolar Plateau, Alveolar Rich Gas

D Point: Highest CO2

DE: Start Inspiration

20
Q

What kind of EtCO2 Pattern is this?

A

Obstructive Pattern

EX: COPD, Bronchospasm

21
Q

What is going on in this EtCO2 Pattern?

A

Early Spontaneous Breath indicated by Curare Cleft

22
Q

What is going on in this EtCO2 Pattern?

A

Expiratory Valve Failure

or

Depleted CO2 Absorber

23
Q

What is going on in this EtCO2 Pattern?

A

Inspiratory Valve Failure

24
Q

What is going on in this EtCO2 Pattern?

A

Cardiogenic Oscillation

25
Q

What is going on in this EtCO2 Pattern?

A

Esophageal Intubation

Declining End-Tidal Values

26
Q

What is going on in this EtCO2 Pattern?

A

Surgeon Pushin on Chest

27
Q

What is the Normal End-Tidal CO2 to Arterial CO2 Gradient (dCO2)?

A

2 - 5 mmHg

Represents Dead Space

28
Q

Between PaCO2 and EtCO,2 what will always be higher?

A

PaCO2 will always be higher d/t mixing & dilution w/ dead space gases

29
Q

What Increases dCO2?

A

↓PAP

↓Cardiac Output

↓BP

Upright Position

PE

COPD

Cuff Leak, Tracheal Disruption, Bonchopleural Fistula

30
Q

What are some causes Increased EtCO2?

A
  • MH
  • Hypoventilation
  • Laparoscopy
  • Resuscitation
  • Released Tourniquet
  • Water in Sensor
  • Circuit Error
  • Bicarb
31
Q

What are causes of Decreased EtCO2?

A
  • Hyperventilation
  • Leak around Cuff
  • Decreased blood flow to Lungs
  • PE
  • ↓Cardiac Output
  • Hypothermia
  • Misplaced Sample Catheter / Small Sample
32
Q

Memorize Awake Intubation Algorithm

A
33
Q

What triggers Malignant Hyperthermia?

A

All Anesthetic Gas & Succinylcholine

34
Q

What are Early signs of Malignant Hyperthermia?

A

↑EtCO2

Tachycardia/Arrythmias

Rigid Muscles

Tachypnea & Hypoxia

Profuse Sweating

Acidosis

Mottling

35
Q

What are Late signs of Malignant Hyperthermia?

A

Hyperthermia
Circulatory Failure
Acute Renal Failure
Dark Urine
Hyperkalemia
Hypotension
Rhabdo
Severe Arrhthmnias / Cardiac Arrest
DIC

36
Q

What is the Treatment for MH?

A

Dantrolene 2.5mg/kg

or

Ryanodex 2.5mg/kg - larger volume, but expensive

dnurs 827 advanced physiology/pathophysiology for anesthesia i (11 decks)

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