Pulmonary IntraOp Monitoring & Difficult Airway Algorithm - Quiz 8

Question 1

What are the two lights invovled with Pulse Oximetry?

Answer 1

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

Question 2

SpO2 and PaO2

100% =

95% =

90% =

75% =

60% =

50% =

Answer 2

100% = 100+ mmHg

95% = 75 mmHg

90% = 60 mmHg

75% = 40 mmHg

60% = 30 mmHg

50% = 27 mmHg

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

Question 3

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

Answer 3

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

Question 4

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

Answer 4

Ear detects changes quicker

Question 5

What will the Pulse Ox measurement be for EndoBronchial Intubations?

Answer 5

It will go Undetected if there is no lung disease or low F_iO₂

Question 6

What may cause the Pulse Ox to be inaccurate?

Answer 6

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

Question 7

How does Carboxyhemoglobin (COHb) affect the Pulse Ox?

Answer 7

COHb is due to Carbon Monoxide (CO) Poisoning.

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

(Use Co-Oximeter)

Question 8

What is Methemoglobin (MetHb)?

Answer 8

Ferric Form of Hemoglobin that cant transport O2

Question 9

What causes Methemoglobinemia?

Answer 9

Nitrates
Nitrites
Nitroglycerine
Nitroprusside
Benzocaine

Question 10

How does Methemoglobin affect the Pulse Ox?

Answer 10

Methb is absorbed equally at both wavelengths

Show SpO₂ of 85%

Question 11

How does Fetal Hemoglobin & Bilirubin affect the Pulse Ox?

Answer 11

No Effect

Question 12

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

Answer 12

SpO2 < 30%

Hb < 3-4 gm/dL

Question 13

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

Answer 13

Right Heart Failure

&

Tricuspid Regurgitation

(cor pulmonale)

Question 14

What external problems may cause errors with SpO2?

Answer 14

Motion Artifact

Ambient Light Interference

Methylene Blue & Indocyanine Green

Bad Probe Position

Light Leakage from Diode

Question 15

What does Capnography do?

Answer 15

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

Question 16

What is the Gold Standard for confirming Tracheal Intubation?

Answer 16

EtCO₂

Question 17

How does Aspiration Capnography work?

Answer 17

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

Question 18

How does the Mainstream Capnography work?

Answer 18

AKA Flow-Through

Sensor attaches directly to circuit

Question 19

List

AB:

BC:

CD:

D Point:

DE:

Answer 19

AB: Start Exhalation, Dead Space Gas

BC: Exhalation, Mixing of Gas

CD: Alveolar Plateau, Alveolar Rich Gas

D Point: Highest CO₂

DE: Start Inspiration

Question 20

What kind of EtCO₂ Pattern is this?

Answer 20

Obstructive Pattern

EX: COPD, Bronchospasm

Question 21

What is going on in this EtCO₂ Pattern?

Answer 21

Early Spontaneous Breath indicated by Curare Cleft

Question 22

What is going on in this EtCO2 Pattern?

Answer 22

Expiratory Valve Failure

or

Depleted CO₂ Absorber

Question 23

What is going on in this EtCO2 Pattern?

Answer 23

Inspiratory Valve Failure

Question 24

What is going on in this EtCO2 Pattern?

Answer 24

Cardiogenic Oscillation

Question 25

What is going on in this EtCO2 Pattern?

Answer 25

Esophageal Intubation Declining End-Tidal Values

Question 26

What is going on in this EtCO2 Pattern?

Answer 26

Surgeon Pushin on Chest

Question 27

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

Answer 27

2 - 5 mmHg Represents Dead Space

Question 28

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

Answer 28

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

Question 29

What Increases dCO₂?

Answer 29

↓PAP ↓Cardiac Output ↓BP Upright Position PE COPD Cuff Leak, Tracheal Disruption, Bonchopleural Fistula

Question 30

What are some causes Increased EtCO₂?

Answer 30

* MH * Hypoventilation * Laparoscopy * Resuscitation * Released Tourniquet * Water in Sensor * Circuit Error * Bicarb

Question 31

What are causes of Decreased EtCO₂?

Answer 31

* Hyperventilation * Leak around Cuff * Decreased blood flow to Lungs * PE * ↓Cardiac Output * Hypothermia * Misplaced Sample Catheter / Small Sample

Question 32

Memorize Awake Intubation Algorithm

Question 33

What triggers Malignant Hyperthermia?

Answer 33

All Anesthetic Gas & Succinylcholine

Question 34

What are _Early_ signs of Malignant Hyperthermia?

Answer 34

↑EtCO₂ Tachycardia/Arrythmias Rigid Muscles Tachypnea & Hypoxia Profuse Sweating Acidosis Mottling

Question 35

What are _Late_ signs of Malignant Hyperthermia?

Answer 35

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

Question 36

What is the Treatment for MH?

Answer 36

Dantrolene 2.5mg/kg or Ryanodex 2.5mg/kg - larger volume, but expensive