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Monitoring and Clinical Flashcards

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1
Q

ASA standard monitors

A

Oxygenation
Ventilation
Circulation
Temperature

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2
Q

Standard charting speed

A

25 mm/sec

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3
Q

Where is the circuit analyzer (O2 sensor) located?

A

On the inspiratory limb of the circuit

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4
Q

How is Oxygen analyzed?

A

Paramagnetic technology (within multi gas analyzer)
and
Polarographic fuel cells

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5
Q

Paramagnetic Technology

A

When O2 leaks through the semi-permeable membrane, a chemical reaction changes the electrical conductivity of the substrate. This variation in conductivity is directly proportional to the percent of oxygen in the flow of gases

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6
Q

Polarographic Fuel Cells

A

A stand alone analyzer in the anesthesia circuit. It has a life span of 200,000% hours, meaning that at 1% oxygen flow, the lifespan of the analyzer will be 200,000 hours. Higher concentrated oxygen flows will greatly diminish this life span. 200,000/20= 10,000 hours.

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7
Q

HMEFS

A

Heat Moisture Exchange Filter with Sampler

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8
Q

Dead Space

A

Cavities of the body that do not participate in gas exchange

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9
Q

Percentages of gases in air

A

78% Nitrogen
21% Oxygen
1% Argon, Water, Carbon Dioxide

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10
Q

Dalton’s Law

A

Law of Partial Pressure:
States that in a mixture of gases, the pressure exerted by each gas would be the same pressure it would exert if it alone occupied the container

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11
Q

Respiratory Quotient

A

The ratio of the volume of carbon dioxide expired to the volume of oxygen consumed by an organism or cell in a given period of time

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12
Q

Where does pulse oximetry work?

A 
At any protuberance:
Fingers
Ears
Tongue
Nose
Toes
Lip
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13
Q

How does pulse oximetry work?

A

A spectrophotometer uses two wavelengths of light (red and infrared) to measure the saturation of oxygen to hemoglobin in the blood by detecting the intensity and reflectance of LEDs

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14
Q

Low perfusion can result from

A 
elevated limbs
intense vasoconstriction
severe peripheral vascular disease
hypothermia
hypovolemia
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15
Q

Pulse oximetry failure rates linked to ASA standards

A

The higher the ASA standard, the higher the percentage of pulse oximetry failure. Failure rates increased from 1% to more than 7% as physical status worsend

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16
Q

Why do we use pulse oximetry during anesthesia?

A 
Oxygenation
Perfusion
Confirmation of Arrhythmia
Breathing Circuit Disconnections
Ventilation Problems
Monitoring Delivery of Anesthesia
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17
Q

Causes of Hypoxemia

A

Decrease inspired oxygen
Hypoventilation
Shunt (pulmonary)
V/Q mismatch

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18
Q

Causes of Hypoxia

A 
Hypoxemic Hypoxia: Lower than normal PAO2 (hypoxemia)
Anemic Hypoxia (decreased red blood cell count)
Circulatory Hypoxia (decrease cardiac output/perfusion)
Affinity Hypoxia (decrease release of oxygen from Hb)
Histotoxic Hypoxia (cyanide poisoning)
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19
Q

Cyanosis

A

Abnormal blue discoloration of the skin and mucous membranes, caused by an increase in deoxygenated hemoglobin level to greater than 5g/dl

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20
Q

Types of Cyanosis

A

Central Cyanosis

Peripheral Cyanosis

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21
Q

Central Cyanosis

A

Caused by disease of the heart, lungs or abnormal Hb. Seen in the tongue and lips due to desaturation of arterial blood caused by shunting of deoxygenated blood into the systemic circulation. Patients centrally cyanosed will also be peripherally cyanosed. Associated features include dyspnea, and tachypnea.

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22
Q

Peripheral Cyanosis

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A

Caused by decreased local circulation and increased extraction of oxygen in peripheral tissue. Occurs in conditions associated with peripheral vasoconstriction leading to peripheral oxygen extraction. Examples included congestive heart failure, circulatory shock, exposure to cold, and abnormalities in circulation.

23
Q

Normal Arterial Blood Gas Values

Study These Flashcards
A 
pH = 7.35 - 7.45
PaCO2 = 35-45 mmHg
PaO2 = 70 - 100 mmHg
SaO2 = 93 - 96%
HCO3- = 22 - 26 mlEq/L
%MetHb =
24
Q

Cerebral Oximetry

Study These Flashcards
A

Read in rSO2, meaning regional saturation or tissue saturation. Uses a shallow detector and a deep detector. Typical values give a range of 55% - 75% but a mix of Venous and Arterial blood will give you readings in the 70s.

25
Normal Heart Sounds
Lub - Dub
26
Stridor
Abnormal Lung Sound Wheeze like sound heard when a person breaths usually due to a blockage of airflow
27
Wheezes
Abnormal Lung Sound High pitched (musical) sounds produced by narrowed airways. Sometimes heard without a stethoscope.
28
Rales
Abnormal Lung Sounds Small clicking, bubbling, or rattling sounds believed to occur when air opens closed air spaces. Described as moist, dry, and fine, like rubbing your hair together.
29
Rhonchi
Abnormal Lung Sounds Resemble snoring and occurs when air becomes blocked or rough through airways
30
Prognathism
Stickey outey Jaw
31
Retrognathism
Recessed (small) Jaw
32
Anatomy that makes intubation more challenging
Thyromental space less than 6 cm Small mouth opening of less than 3 finger breaths
33
Mallampati Exam
MP class I = hard and soft palate, tonsillar pillars, and uvula are all visible MP class IV = hard palate is only portion visible
34
Korotkoff Sounds
Sounds to listen for when taking a non invasive blood pressure
35
Bell Vs. Diaphragm
Bell = Low Frequency Detection used for heart murmurs and bowel sounds at 20 - 100 Hz Diaphragm = High Frequency Detection used for heart and lungs at 100 - 1000 Hz
36
Basic Components of Physical Examination
``` General Survey Vital Signs Airway Thorax/Lungs Cardiovascular System ```
37
Cardinal Techniques of Examination
Inspection Percussion Palpation Ascultation
38
Basic Equipment for Physical Examination
``` Pen Light Tongue Depressor Ruler Watch (with seconds hand) Stethoscope Thermometer Reflex Hammer Sphygmomanometer ```
39
Review of Systems
Documents the presence or absence of common symptoms related to each major body system, "head to toe"
40
Personal/Social History
Describes the educational level, family of origin, current household, personal interests, and lifestyle
41
Family History
Outlines or diagrams age and health, or age and cause of death of first degree relatives while documenting specific illness in the family (Hypertension (HTN), Coronary Artery Disease (CAD), and Diabetes (DM))
42
Past History
Lists childhood & adult illnesses including medical, surgical, OB/Gyn, and psychiatric
43
How to calculate pack years for smokers
take the number of packs per day and multiply by years smoked
44
History of Present Illness (HPI)
``` CHLORIDE!!! ------------------------ CHaracter Location Onset Radiation Intensity (1 to 10 scale) Duration Exacerbation & Alleviation ```
45
Two types of Data obtained from patients
Subjective = What the patient tells you Objective = What you observe
46
Building block for professional ethics
Non-maleficence = do no harm Beneficence = do good Autonomy = patients decide what is good for themself Confidentiality
47
Three dimensions of cultural competence
Self Awareness Respectful Communication Collaborative Partnerships
48
Kubler-Ross' 5 stages of coping with death
``` Denial/Isolation Anger Bargaining Depression/Sadness Acceptance ```
49
Alcohol and Drug Use Statistics in USA
Alcohol Dependence/Abuse = 7.5% | Drug Abuse/Dependence = 2.7%
50
CAGE Questionnaire
``` CAGE!!!!!!!! ------------------- Cut down on drinking or drug abuse Annoyance towards criticism Guilt about drinking Eye opener needed? ```
51
Addiction
primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. Characterized by: impaired control over drug use, compulsive use, continued use despite harm, and craving.
52
Physical Dependence
state of adaptation that is manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist
53
Tolerance
state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time

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