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Anesthesia Prinicples > Capnography (Exam I) > Flashcards

Capnography (Exam I) Flashcards

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1
Q

What are the effects of hypercarbia?

A
  • Respiratory Acidosis
  • ↑ CBF
  • ↑ PVR
  • K⁺ shift intravascularly
    -Increase ICP
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2
Q

Where is the EtCO2 measured on the waveform?

A

Beta angle

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3
Q

What are the effects of hypocarbia?

A
  • Respiratory alkalosis
  • ↓ CBF
  • ↓ PVR
  • K⁺ shift intracellulary
  • Blunts respiratory drive
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4
Q

What is the Bohr equation?
What is it used for?

A

Used to calculate physiologic dead space

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5
Q

What is the best method to confirm endotracheal tube placement?

A

Capnography

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6
Q

Differentiate high-speed (real-time) and low speed (trend capnography).

A
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7
Q

How much gas do side-stream analyzers utilize?

A

200 mL/min sample rate

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8
Q

What is the most common method for capnographic sampling, side-stream or main-stream sampling?

A

Side-stream

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9
Q

What are the benefits of main-stream sampling?

A
  • No time delay
  • quicker rise time
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10
Q

What approximate difference is there between PaCO₂ and EtCO₂ ?

A

5 mmHg

ex. PaCO₂ will be 40 mmHg vs EtCO₂ at 35 mmHg

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11
Q

What color is the CO₂ chemical indicator?
What color does it change to in the presence of CO₂ ?

A

purple → yellow

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12
Q

What waveform does EtCO2 rely on?

A

IR light absorption
*The greater the CO2 in sample, the less IR light reaches the detector

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13
Q

What is the center of the chemical indicators?

A

litmus paper

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14
Q

When using a capnograph, how close must a CO₂ reading be to the actual value?

A

+/- 12%

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15
Q

What are requirements of an ETCO2 monitor?

A

-Must disclose interference cause by ethanol, acetone, halogenated volatiles
-Have high Co2 alarm for inhaled and exhaled CO2
-Have alarm for low exhaled CO2

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16
Q

What are the inspiratory phases of the capnograph?

A

Phase 0

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17
Q

What are the expiratory phases of the capnograph?

A

Phases I, II, and III

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18
Q

When would the CO₂ reading of a capnograph be 0 mmHg ?

A

Phase I

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19
Q

Which phase of the capnograph would be representative of alveolar CO₂ ?

A

Phase III

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20
Q

Where on the capnograph is EtCO₂ measured?

A

Phase III

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21
Q

What is a phase IV in the capnograph? Why does it occur?

A

Upstroke at the end of Phase III resulting from collapse of alveoli.

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22
Q

What is phase I of the capnograph?

A

inspiration ends, lungs recoil, gas in circuit and anatomic dead space exists

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23
Q

What is phase II of the capnograph?

A

CO2 rich alveolar gas; normally sleep

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24
Q

What is the alpha angle?

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A

Emptying of the alveoli and transition to dead space

25
What is phase III? What would cause a greater slope?
Uneven emptying of last alveoli; slope should rise gently Greater slope with airflow obstruction
26
What could cause an inadequate seal?
-Leak -Cuff not inflated -Crack in tubing -Tubing connections aren't tight
27
What patient populations might exhibit a Phase IV on their capnograph?
- Obese - Pregnant
28
What phases are separated by the β angle?
Phase III and 0
29
What degree should the α angle have? What occurs with increase to the angle's degree?
- 100 - 110° - Increased angle occurs with **expiratory airflow obstruction** (COPD, ETT, bronchospasm, etc)
30
What degree should the β angle have?
90°
31
What situations/conditions would cause an increase in the β angle?
- Bad inspiratory valve - Rebreathing - Low VT w/ tachypnea
32
What type of capnograph is depicted below?
Mechanical Ventilation
33
What type of capnograph is depicted below?
Spontaneous Ventilation
34
What is occurring with the capnograph below?
Inadequate ETT seal
35
What might be occurring based on the two capnographs below?
Faulty Inspiratory Valve
36
What is occurring with the capnograph below?
Likely sample line leak
37
What is occurring with the capnograph below?
Hyperventilation (resulting in a ↓ EtCO₂)
38
What is occurring with the capnograph below?
Hypoventilation (resulting in steady ↑ EtCO₂)
39
What is occurring with the capnograph below?
Airway obstruction or breathing circuit obstruction
40
What is occurring with the capnograph below?
Cardiac oscillations
41
What is occurring with the capnograph below?
Rebreathing (note the increasing baseline)
42
What is occurring with the capnograph below?
Curare Cleft (NMBDs are wearing off)
43
What is occurring with the capnograph below?
Ventilator overbreathing
44
What is occurring with the capnograph below?
Esophageal Intubation (the ol' tubed goose)
45
Capnometry
Measurement and quantification of inhaled and exhaled CO2 concentrations
46
Capnography
Method of CO2 measurement and a graphic display over time breath by breath
47
Equipment malfunctions that cause decreased EtCO2
-Ventilator disconnect -Esophageal intubation -Airway obstruction -Poor Sampling - ETT/LMA cuff leak
48
Physiological causes of decreased EtCO2
-Hypothermia -PE -Cardiac arrest -Hemorrhage -Hypotension -Hyperventilation
49
Equipment causes of increased EtCO2
-Rebreathing -Exhausted EtCO2 absorber -Leak in circuit -Faulty inspiratory/expiratory valves
50
Physiological causes of increased EtCO2
-Inc. Metabolic rate -Fever -Sepsis -Seizures -Thyrotoxicosis -Inc CO -Bicarbonate administration -Hypoventilation -COPD
51
What are causes of hypoventilation trends on a capnograph and what intervention needs to done?
-Bronchospasm -Insufflated abd -Not breathing enough while hand bagging -Increase Vte (RR or VT)
52
What do you see on a capnograph with hyperventilation and what do we need to do?
EtCO2 decreases -We need to decrease Vte
53
How many times do you have to bag the patient to confirm placement after intubation?
3
54
What can cause the rapid decrease in EtCO2?
-Esophageal intubation (usually) -Severe laryngospasm
55
What causes a shark fin presentation?
Obstruction either by exhalation of patient or the analyzer -ANYONE who smokes -COPD -too much PEEP -Kinked tubing
56
Can a shark fin presentation be normal?
Yes for COPD patient
57
What is the difference in the presentation between rebreathing/bad soda line and hypoventilation?
The EtCO2 doesn't come back to baseline between breaths like it does in hypoventilation
58
What can cause cardiac oscillations?
Normally seen in super skinny patients and then you see the movement of the heart
59
When would you do a pulse check based on a capnograph?
When you notice a very sudden/different wave compared to the ones that were observed during cardiac arrest

Anesthesia Prinicples (7 decks)

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