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I&M Final > Capnometry > Flashcards

Capnometry Flashcards

1
Q

*O2 consumption (uptake)

A

~ 3.5ml/(kg min)

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2
Q

*How does body weight compare to oxygen consumption

A

As body weight increases so too does the total amount of oxygen consumed; however, the amount consumed per kg decreases

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3
Q

Respiratory Quotient

A

VCO2/VO2

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4
Q

Carbohydrate Metabolism

A

RQ = 1 (50%)

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5
Q

Fat Metabolism

A

RQ = 0.71 (40%)

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6
Q

Protein Metabolism

A

RQ = 0.835 (10%)

normally a small component of metabolism

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7
Q

Lipogenesis

A

RQ = 1.0 to 1.2

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8
Q

Mixed metabolism

A

RQ = 0.82 to 0.85, (0.8)

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9
Q

8 to 10 hours after a meal, which form of metabolism dominates?

A

Fat

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10
Q

*Capnogram, Capnograph

A

A *graph of gaseous carbon dioxide concentration as a function of time

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11
Q

*Capnometer

A

An instrument for measuring gaseous CO2 concentrations (*numerical)

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12
Q

*Capnometry

A

The practice of measuring and recording gaseous CO2 concentrations (*numerical)

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13
Q

Colorimetric carbon dioxide detectors

A

Color coded around the outside to provide a reference

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14
Q

T/F Stomach acid can permanently alter the color of a colorimetric carbon dioxide detector

A

True

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15
Q

T/F False-positives may occur if the endotracheal tube is in the esophagus

A

True

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16
Q

*Capnogram Phase I

A

Dead Space/Fresh Gas
(baseline)
Devoid of carbon dioxide b/c no gas exchange occurs!

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17
Q

*Capnogram Phase II

A

Dead Space and Alveolar Gas

upstroke

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18
Q

*Capnogram Phase III

A

Alveolar Gas Plateau

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19
Q

*Capnogram Phase IV

A

Inspiration (downstroke)
OR
terminal upswing

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20
Q

*Capnogram Phase O

A

Inspiration (downstroke)

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21
Q

*Capnogram alpha angle

A

Ventilation/Perfusion status of the lung

top left corner btwn II & III

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22
Q

*Capnogram beta angle

A

End-expiration

top right corner btwn III & IV

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23
Q

Capnogram x-axis

A

Time

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24
Q

Capnogram y-axis

A

Expired PCO2

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25
Q

*Volume capnograph x and y axes

A

y: PCO2 (mmHg)
x: Volume exhaled (mL)

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26
Q

Volume capnograph Phase I

A

Anatomic deadspace volume (baseline)

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27
Q

Volume capnograph Phase II

A

Transitional volume (fast upstroke)

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28
Q

Volume capnograph Phase III

A

Alveolar volume (gradual upstroke)

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29
Q

*The sum of the three fazes of Volume capnograph

A

Tidal Volume

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30
Q

T/F Alpha angle is decreased with obstructive lung disease

A

False

It increases, making a more gradual slope up

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31
Q

Adult vs. Pediatric and Neonatal CO2 flow sensors

A

In the adult sensors deadspace is less critical, so the CO2 measurement cell and flow measurement portions are separate; In the others they are combined

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32
Q

Side-stream vs. Main-stream sensors: Delay

A

The side stream sensors have a significant delay (about half a breath cycle) as compared with the on steam; however this delay is almost always acceptable

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33
Q

Side-Stream Advantages

A

more robust
cheaper to maintain
weight of sensor on ETT or near the face is not a factor
not limited to CO2 and N2O
no added dead space to the breathing circuit

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34
Q

Main-Stream Advantages

A

no “leak in circuit”
measure high ventilatory rates
decreased artifacts from sampling (e.g. cardiogenic oscillations)

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35
Q

*Gas Sampling Accuracy

A

+/- 6 at 40 mmHg

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36
Q

*Normal Capnogram Image ???

A

Red line at ~6%

37
Q

*Abnormal Capnogram Image ???

Severe Obstructive Lung Disease

A

Red line at ~4%

Red line showing sloped phase III

38
Q

Increasing expiratory time for patients with obstructive lung disease does what?

A

Allows them to finish expiring CO2 and improves sloping phase III of the capnogram

39
Q

Progressive Slanting on the capnogram

hump decreases in size over time

A

Indicates inspiration is starting before exhalation has completed and end-tidal CO2 reading (but not actual value) decreases
Causes by obstruction in the tube or airways

40
Q

Capnogram showing slow rise in phase III, does not appear to reach a plateau
(phase II and III make a large curve)

A

Waveform morphology suggests dilution of alveolar gas with dead space gas
Suggestive of large A-a CO2 gradient
Emphysema, asthma

41
Q

ETco2 - Paco2 Gradients: Normal

A

0-7 mmHg

42
Q

ETco2 - Paco2 Gradients: Slightly Abnormal

A

7-10 mmHg

43
Q

ETco2 - Paco2 Gradients: Moderately Abnormal

A

10-13 mmHg

44
Q

ETco2 - Paco2 Gradients: Markedly Abnormal

A

> 13 mmHg

45
Q

*Describe the abnormal alveolar ventilation in patients with airway obstruction

A

Well-ventilated gas exchange units with gas containing lower PCO2 empty first; Poorly ventilated units with gas containing high PCO2 empty last
*Image: Alveoli with less dots are the well-ventilated units

46
Q

Composition of the Alveolar gas is determined by…

A 
CO2 production (metabolism, temperature)
gas transport to alveolus
gas exchange
inspired gas composition
composition of mixed venous blood
47
Q

Emptying of each alveolus into the airway is determined by…

A

airway resistance
alveolar and airway compliance
alveolar volume

48
Q

Causes of Increased P(ET)CO2

A 
Increased CO2 production and delivery to the lungs (fever, sepsis, bicarbonate administration, increased metabolic rate, seizures)
Decreased alveolar ventilation (respiratory center depression, muscular paralysis, hypoventilation, COPD)
Equipment malfunction (rebreathing, leak, exhausted CO2 absorber)
49
Q

Causes of Decreased P(ET)CO2

A 
Decreased CO2 production and delivery to the lungs (hypothermia, pulmonary hypo perfusion, cardiac arrest, pulmonary embolism, hemorrhage, hypotension)
Increased alveolar ventilation (hyperventilation)
Equipment malfunction (ventilator disconnect, esophageal intubation, complete airway obstruction, poor sampling, leak around endotracheal tube cuff)
50
Q

Causes of Increased P(A-ET) CO2

A

Pulmonary hypoperfusion, Pulmonary embolism, Cardiac arrest, Positive-pressure ventilation, High-rate/low tidal volume ventilation

51
Q

Causes of Hypoventilation

A

Respiratory center depression, destruction of neural pathways to respiratory muscles, neuromuscular blockade, respiratory muscle weakness

52
Q

Causes of Hyperventilation

A

Respiratory center stimulation, Metabolic acidosis, Mechanical Ventilation

53
Q

T/F Endobronchial intubation will cause a marked decrease in ETCO2

A

False

It would not, so watch out! That other lung isn’t getting ventilated and could be damaged as a result

54
Q

T/F Pulmonary embolism will cause a marked decrease in ETCO2

A

True

Increased deadspace

55
Q

Esophageal Intubation Capnogram

A

Decreasing humps

56
Q

Abnormal PCO2 & ETCO2

A

Check ventilator

57
Q

Abnormal PCO2 & Compliance and Resistance

A

Check breath sounds

Pneumothorax?

58
Q

Abnormal PCO2 & Circulatory variables

A

Myocaridal performance, intravascular volume, embolism

59
Q

Abnormal PCO2 & Metabolism and Temperature

A

Fever, Malignant hyperthermia

arterial blood gas

60
Q

Abnormal PCO2 Alone

A

Shunt or deadspace

61
Q

*Effect of improperly seated inspiratory valve on capnogram

A

Waveforms become taller, Phase IV slope

62
Q

*Effect of improperly seated expiratory valve on capnogram

Rebreathing

A

Phase III increases, Phase IV does not fall to zero, so baseline gradually increases

63
Q

*Converting CO2 percent to mmHg

A
  • Water vapor must be subtracted from the barometric pressure (760 - 47 =713 mmHg)
    Our value is obtained by multiplying the percentage by 7.13
64
Q

“Curare Cleft”

A

Dips in the capnogram during phase III indicating the patient is making inspiratory efforts during mechanical ventilation
*The capnogram cannot reveal the circumstances of the inspiratory effort
(Try increasing minute ventilation)

65
Q

What is the cause of a waveform with a completely flat top?

A

Hypoventilation

66
Q

“Curare Cleft” consistently in last 3rd of phase III

A

Possible inadequate muscle paralysis

67
Q

Cardiogenic Oscillations

A

Small, regular, toothlike humps at the end of the expiratory phase
Contraction and relaxation of the heart cases changes n flow during expiration

68
Q

Two types of cardiogenic oscillations: Side stream vs. Main stream

A

Side stream recognizes both types

Mainstream doesn’t recognize the type that has to do with dilution of exhaled gas with fresh inspired gas

69
Q

How does capnometry help with malignant hyperthermia patients

A

It allows you to detect it in the early stages due to massive increases in ETCO2 (before the temperature increases)

70
Q

Capnometry during acute blood loss

A

Indicates some perfusion is occurring in the face of a difficult blood pressure monitoring situation
Expect increase in CO2 levels as situation is corrected due to CO2 release from hypo perfused organs

71
Q

T/F CO2 monitoring is a good way to confirm tracheal tube placement when there is no blood flow to the lungs

A

False

The CO2 would have been washed out before intubation

72
Q

*Capnogram - Gradual increase in baseline and end-tidal CO2

A

Rebreathing due to incompetent expiratory valve, exhausted CO2 absorbant, problems with the inner tube of a coaxial, or in some cases an incompetent inspiratory valve

73
Q

*Capnogram - Prolonged plateau and slanting/prolonged inspiratory downstroke

A

Incompetant inspiratory unidirectional valve

74
Q

*Capnogram - Inconsistently increased baseline

A

Wet exhalation valve that sometimes, but not always prevents it from seating

75
Q

*Capnogram - Low end-tidal CO2, but normal shape otherwise

A

Hyperventilation of increase in dead space ventilation

76
Q

Capnogram - High end-tidal CO2, but normal shape otherwise

A

Increased CO2 production, hypoventilation, etc.

77
Q

Capnogram - increasing size of humps

A

Return to spontaneous ventilation

78
Q

Capnogram - Progressive decrease in plateau

A

large leak

79
Q

Capnogram - Drop off at end of plateau

A

small leak

80
Q

Capnogram - Sudden drop off of end-tidal CO2

A

Circuit disconnect, total obstruction, etc.

81
Q

Capnogram - Sudden decrease in end-tidal CO2 with non-zero values

A

Leak

82
Q

Capnogram - Decrease on CO2, but not necessarily to zero, resolves on it’s own

A

Small air embolus

An increasing PaCO2 to ETCO2 gradient implies an increase in dead space

83
Q

Capnogram - Sustained low PCO2 without good plateaus

A

When this occurs the PCO2 values are not a good indicator of actual alveolar CO2 concentration

84
Q

Capnogram - Sustained low PCO2 with good plateaus

A

Hyperventilation

85
Q

*Capnogram - Gradually decreasing PCO2 with good plateaus

A

Indicates Slowly decreasing cardiac output

86
Q

Capnogram - Gradually increasing PCO2 with good plateaus

A

Obstruction, increased metabolism, etc.

87
Q

Capnogram - “Roof of church”

A

Indicates a leak

88
Q

Tourniquet release

A

Temporarily increases CO2

89
Q

Sample line length and respiratory rate

A

Increasing RR leads to “sine wave” capnogram and mean CO2 value reading

I&M Final (5 decks)

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