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Week 2 Flashcards

(52 cards)

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1
Q

What are the two principles of pulse oximeter

A

Optical plethysmography

Spectrophotometry

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2
Q

What are the new pulse oximeter features

A

Perfusion
Pulse amplitude
Trends
Error message
MRI suitable

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3
Q

What pulse oximeter value is considered low

A

Less than 90%

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4
Q

How do you calibrate a pulse oximeter

A

Cannot be calibrated

Each brand has its own empirically derived calibration

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5
Q

What end tidal CO2 is equivalent to 35-45 mmHg

A

5-6%

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6
Q

What are the uses for CO2 monitor

A

OR

Critical care

Whenever sedation is used

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7
Q

What does a end-tidal assess

A

ETT placement

Adequacy of perfusion during CP resuscitation

Metabolic study

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8
Q

What are the two ways CO2 monitors express levels

A

Capnometer

Capnography

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9
Q

What is phase 1 of the end-tidal

A

Inspiratory baseline

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10
Q

What is phase 2 of the end-tidal

A

Expiratory upstroke

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11
Q

What is phase 3 of the end-tidal

A

Expiratory plateau

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12
Q

What is phase 4 of end-tidal

A

Expiratory downstroke

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13
Q

What is the principle of operation of a CO2 monitor

A

Uses infrared absorption spectroscopy

Measures partial pressure of CO2 in exhaled gas

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14
Q

What are the two types of CO2 monitors

A

Mainstream

Side stream

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15
Q

What are mainstream CO2 monitors

A

Direct measurement of total CO2 in exhaled gas

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16
Q

What are side stream CO2 monitors

A

Samples exhaled gas in intubates patients and spontaneously breathing patients

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17
Q

When do you calibrate a CO2 monitor for accuracy

A

Regular intervals

Two points of calibration: 0-5%

H2O vapor, ATM anesthetic vapors and nitrous affect the use and accuracy

In side-stream water trap, filter, and nafion tubing is needed

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18
Q

Uses for exhaled nitric oxide

A

Marker for asthma diagnosis

Monitor response to anti-inflammatory medication

Monitor adherence to asthma therapy

Predict upcoming asthma exacerbation

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19
Q

Calibration of exhaled NO monitor

A

Using at least three points (0, usually 200 and 500ppb)

Medical grade air is not recommended as a zero point

Don’t need to do daily

Confirm temp, pressure, humidity

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20
Q

Define transcutaneous monitoring

A

Continuous non-invasive O2 and ventilation monitoring

Through sensors detects blood gases diffuse through the skin

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21
Q

What are the two types of transcutaneous O2 and CO2 monitors

Study These Flashcards
A

Stand alone

Can be two separate sensors or one
For both parameters

Provides real-time readings, trends, histograms, thermistor’s temp, and alarms

22
Q

What is the principle of the transcutaneous O2 and CO2 monitors

Study These Flashcards
A

Electrodes are placed on skin and with additional can read SpO2

Values and not always the same as the true values

(TcPO2=PaO2 tcPCO2 > PaCO2)

23
Q

Principle of operation for tcPO2 sensors

Study These Flashcards
A

Mini polygraphic Clark electrode

Electrode heats skin to 109-113 F

Arterial blood supply to dermal capillary increases

O2 diffuses through the sensors membrane to the cathode where it is measured

24
Q

Calibration of tcPO2

Study These Flashcards
A

Two point calibration

A drop of solution with no free O2
Ambient Air (21%)

Zero with additional drop of electronic

After zeroed expose to ambient air for several minutes to set high point.

25
Principle of operation for tcO2 sensor
Uses mini severinghaus electrode Skin is heated to 108-113 F Arterial blood increased to dermal CO2 diffuses to sensor to react with electrolyte solution H+ and HCO3 ions are formed CO2 is then determined (Henderson-Hasselbalch equation)
26
How is tcPCO2 calibrate tcPCO2 using one point
Expose electrode to 5% CO2 for several minutes Preformed every 4 hrs during continuous
27
Calibrating the tcPCO2 using two points
Expose the electrode surface to 5-10% CO2 for several minutes Preformed at least during 24hrs of continuous use, after membrane and electrolyte change or if doubts about reliability Readings should be within 4mmHg
28
What causes discrepancies in tcPCO2 & tcPO2 monitor
Skin O2 consumption Heating of underlining skin Impaired peripheral circulation Shock Low core temperature
29
What influences the response time of the transcutaneous monitor
Material and size of the cathode Electrolyte and pH used in sensor Membrane material
30
What are the non-physiological factors that affect transcutaneous monitor
Ambient air temp Humidity Barometric pressure Membrane thickness Rate of O2 and CO2 diffusion across membrane New ones make adjustments
31
What is the hazard of the transcutaneous monitoring
Elevated temp of the electrode can lead to burns
32
How do you troubleshoot transcutaneous monitors
Identify problem Issue with sensor placement, functionality, and the patient condition
33
What are the types of apnea monitors
Impedance pneumography Thermistor, proximal AW pressure, CO2 sensor Mattress pressure pads Pneumatic abdominal pressure
34
What does Impedance pneumongraphy measure
Detect changed in electrical impedance
35
What does Thermistor, proximal AW pressure, CO2 sensor monitors measure
Carbon dioxide sensors
36
What does the mattress pressure pads measure
Motion sensor
37
What does the pneumatic abdominal sensor monitor
Changes in pressures with expansion/contraction
38
How often does a apnea monitor need to be calibrated
Not excessively but functional self-test
39
What are the uses of calorimetry
T2D CHF Lung disease Indirect used by athletes Trainers and doctors
40
How does indirect calorimetry work
Estimation of energy expenditure Measures inspired and expired gas flows, volumes, and concentrations Used for MV and spont patients Open and closed circuit
41
How does the open circuit calorimetry work
Uses O2 and CO2 analyzers, volume measuring device, and a mixing chamber Measures consumption and expenditure to calculate energy
42
How do you ensure accuracy of indirect calorimetry
Stable FiO2 Leak free
43
How do you calibrate indirect calorimetry
Calibrate: analyzers, pressure transducer, and a flow sensor Gas analyzers done automatically and once a day Pressure transducers and flow sensors are calibrated at specific time intervals (2-6 months) or whenever indicated
44
How does the closed circuit indirect calorimetry
Differs from open only in how it measures O2 consumption Uses volumetric spirometer, mixing chamber, CO2 analyzer, and CO2 absorber
45
What does the esophageal pressure catheter measure and what does it consist of
Used to estimate pleural pressure Consist: Ballon-tipped catheter attached to a pressure transducer Tip is placed in the lower third of the esophagus
46
Who do we use esophageal pressure catheter
Allows for differentiation of: Chest wall Lungs Resp. Mechanics Parenchymal stress Limiting peak-end-inspiratory trans pulmonary pressures Monitoring vent synchrony
47
Who is the EsophPC contraindicated for how is it inserted
Esophageal varices, tumor, ulceration, or diverticulitis Nasal insertion is preferred Check with x-ray Replaced every 29 days
48
How do you troubleshoot esophageal pressure catheters
Ensure proper position Address: Leaks Improper inflation Analyze waveform Use occlusion test to verify correct function
49
Principle of operation of the esophageal pressure catheter
Ballon placed in lower third of esophagus Proximal end connected to transducer Transducer can be incorporated in MV Pressure transducers are automatically calibrated
50
How do you calibrate O2 analyzer
Two points (21-100%) Oxygen shock and long time of recovery (galvanic) Galvanic must be replaced Daily checks
51
What are galvanic
Galvanic or polarographic cells are electrochemicals Cells: Self energizing Consist of anode and a cathode Semipermeable membrane and electrolyte
52
What are polarographic
External electric source Electrochemical sensor to measure changes in partial pressure of O2 Contains an anode and a cathode Contains an electrolyte

Clinical Instruction (2 decks)

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