Monitoring ICU

Question 1

What is another name for Spectrophotometry?

Answer 1

Pulse Ox

Question 2

What kind of blood does the pulse ox look at ?

Answer 2

Arterial

Question 3

What is the range that a pulse ox can monitor, with it still being accurate?

Answer 3

85-100%

Question 4

Can the pulse ox distinguish between different Hbg varients?

Answer 4

NO

If patient was in fire, and carbon monoxide bound to the Hbg the pulse ox would read as a false high, it would NOT know the difference

Question 5

To be able to analyze Hbg for patient in fire, you must do what?

Answer 5

Draw an ABG

Question 6

What are other probes you can use if the patient does not have adequate perfusion to to their fingers?

Answer 6

Forehead or ear probe

Question 7

What kind of patient would you use a forehead or ear probe on?

Answer 7

A hypotensive patient or someone on vasopressors

Question 8

What is the affinity to O2 in a left shift?

Answer 8

Increased affinity: Hbg will NOT release oxygen to the tissues easily

Question 9

What is the affinity to O2 if there is a right shift?

Answer 9

Decreased affinity: Hbg WILL release oxygen to the tissues much easier

Question 10

In a left shift, what is changing?

Acidotic or alkalotic?

pH?

Temp?

CO2?

Answer 10

Alkalotic, increased affinity to oxygen, increase in pH, decrease in temp, decrease in CO2.

Question 11

In a right shift, what is changing?

Acidotic or alkalotic?

pH?

Temp?

CO2?

Answer 11

Fever and acidotic, decreased affinity to oxygen , decrease in pH, increase in temp, increase in CO2

Question 12

What does the skin look like in a left shift?

Answer 12

Cyanotic in extremities bc the oxygen wants to stay where the blood is, which is in your vital organs (middle of body)

Question 13

What does the skin look like in a right shift?

Answer 13

More flushed, bc blood isn’t worried about keeping oxygen

Question 14

What does P50 mean?

Answer 14

is the O2 tension at which 50% of Hbg is saturated, at 37 deg C, PaCO2 40 mmhg and a pH of 7.40

Question 15

What is the P50 used to understand?

Answer 15

affinity for O2

Question 16

If P50 goes UP, _____ affinity for O2
If P50 goes DOWN, _____ affinity for O2

Answer 16

decreased, increased

Question 17

SaO2 reflects the quantity of O2 being carried on _____
PaO2 is the portion of O2 dissolved in ____

Answer 17

Hbg
Plasma (in arterial blood)

Question 18

Levels of Hypoxemia

Answer 18

60-79 mmHg MILD
40-59 mmHg MODERATE
<40 mmHg SEVERE

Question 19

What should you always perform before an ABG?

Answer 19

Allens test

Question 20

How to prevent errors when doing an ABG

Answer 20

Keep sample on ice, if it cant be analyzed within 30 min
Mix blood with heparin
Eliminate any air bubbles

Question 21

What is Capnography?

Answer 21

Measuring exhaled CO2 and producing WAVEFORM (capnograph)

Question 22

What is capnometry?

Answer 22

Measuring exhaled CO2 and producing a NUMBER

Question 23

The end tidal CO2 uses what to detect changes in CO2?

Answer 23

Infrared light absorption

Question 24

What are the 3 ways of measuring CO2?

Answer 24

Sidestream analyzer, mainstream analyzer, and colorimetric

Question 25

What is a sidestream analyzer?

Answer 25

A sample gas proximal to airway and pumped into the analyzer (monitor)

Question 26

What analyzer takes tidal volume?

Answer 26

Side stream

Question 27

What is a mainstream analyzer?

Answer 27

Inline between patient and ventilator circuit

Question 28

When is a mainstream analyzer primarily used?

Answer 28

In codes

Question 29

Between the sidestream analyzer and the mainstream analyzer which one is used for intubated patients? And which one is used in non-intubated patients?

Answer 29

Mainstream: intubated patients Sidestream: non-intubated patients

Question 30

What is a colorimetric?

Answer 30

It changes color in response to amount of CO2 present.

Question 31

What is a colorimetric used to confirm?

Answer 31

Endotracheal intubation: changes color when CO2 is present

Question 32

What is a normal End Tidal CO2?

Answer 32

30-40 mmHg

Question 33

About how much less than is the PaCO2 than the End Tidal approx?

Answer 33

~5 mmHg less than PaCO2

Question 34

When is the End Tidal CO2 accurate?

Answer 34

Accurate in patients with minimal deadspace

Question 35

Why do we measure end tidal at the end?

Answer 35

End tidal gas was in contact with the alveolar surface, therefore most accurately reflects arterial CO2.

Question 36

What is it called when there is a delayed emptying of CO2 from air spaces?

Answer 36

"Sharkfin"

Question 37

In what device do we see a "sharkfin"?

Answer 37

Abnormal Capnogram

Question 38

When do you most likely see a patient with a "sharkfin" (abnormal capnogram)?

Answer 38

Intubated patients

Question 39

If there is a drop to 0mmHg what does this mean in regards to ETCO2?

Answer 39

there is a leak, esophageal intubation, or cardiac arrest

Question 40

3 types of bleeding within the skull

Answer 40

Epidural hemorrhage Subdural " " Subarachnoid " "

Question 41

2 types of bleeding in brain parenchyma?

Answer 41

Intracerebral hemorrhage Intraventricular " "

Question 42

How should you decrease any ICP?

Answer 42

Ventriculostomy for CSF drainage, craniotomy, osmotic diuretics, sedation, paralysis, semifowlers position Mannitol and Hypertonic saline infusions ICPs should be kept les than 20 mmHg

Question 43

When brain death is suspected what tests need to be ran? There is 4

Answer 43

Electroenephalogram (EEG) Cerebral Blood Flow Study Testing of brain stem reflexes Apnea test

Question 44

If respiratory movements are absent and post ABG PaCO2 is >60 mmHg (or 20 mmHg over baseline) = positive for brain death What is this test called?

Answer 44

Apnea test

Question 45

Loss of brain stem function =

Answer 45

loss of breathing reflexes

Question 46

Do we preoxygenate a patient for an apnea test?

Answer 46

Yes always