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Emergency Care EX 2
Question | Answer |
---|---|
What is Capnometry? | Measurement of CO2 levels in respiratory gases |
What is a Capnograph? | The graphic display of CO2 levels as they change during breathing |
What is the most common method of capnometry? | Infrared Spectroscopy (IS) |
What are the indications for capnometry? | General anesthesia or conscious sedation, head trauma patients (require low CO2), confirm placement of ETT, evaluate effectiveness of CPR |
What factors influence CO2? | Metabolism, cardiac output, alveolar ventilation (most important) |
What does the plateau on a capnograph represent? | Exhalation |
What part of the capnograph represents inspiration? | Downstroke |
What are the advantages of Mainstream Capnography? | Fast response time between exhalation and reading on monitor (short lag time), no sample flow to reduce tidal volume |
What are the advantages of Sidestream Capnography? | Can also measure N2O, sample line is disposable, no bulky sensors/heaters at airway, can be used on non-intubated patients |
What should the PETCO2 be at the very beginning of exhalation? | 0 mmHg |
What is the normal gradient between PaCO2 and PETCO2? | 3-5 mmHg |
What are possible causes for a sudden rise in PETCO2? | Sudden increase in CO, sudden release of tourniquet, injection of sodium bicarbonate |
What color does the EX CAP change to when exposed to CO2? | Yellow |
What is the most COMMON problem with capnometers? | Contamination or obstruction of the sampling system or monitor by secretions or condensate |
What is the most SIGNIFICANT error with capnometers? | Assuming that end-expired CO2 levels can substitute for PaCO2 |
What are the Diagnostic Indications for bronchoscopy? | Visual exam of the trachea/bronchi, suspected malignancy, hemoptysis, unexplained cough, wheeze, stridor, sputum/tissue samples, bronchial washings, determine location/ extent of inhalation or aspiration injuries |
What are the Therapeutic Indications for bronchoscopy? | Secretion removal, foreign body removal, medication instillation, difficult intubation/ETT placement, place airway stent or assess function, removal of abnormal tissue or foreign material |
What are the contraindications of bronchoscopy? | Severe refractory hypoxemia, bleeding disorders, cardiovascular instability, status asthmaticus, severe obstructive airway disease |
What are the hazards and complications associated with bronchoscopy? | Hoarseness/sore throat (most common), mild epistaxis when nasal route is used, internal hemorrhage, laryngospasm/bronchospasm, hypoxemia, pneumothorax, infection |
What medications are used with a bronchoscopy? | Sedation meds, atropine to dry airways, pain meds, lidocaine to numb airways, hurricane spray, mucomyst, topical vasoconstriction (epinephrine) |
What instruments are used with a bronchoscopy? | Cytology brush, wang needle, sputum trap (Lurken's), forceps (Alligator Clips), specimen cup, preserving solution, glass slides, vent equipment |
What steps should be taken to prep the patient for a bronchoscopy? | Sign consent form, explain procedure, NPO 8 hrs prior, pulmonary work up (CXR), protime 24 hrs prior (clotting time), establish IV access, pre-procedure meds, monitor ECG and vital, supplemental O2 |
During the bronchoscopy, what needs to be monitored? | SpO2, HR and rhythm, BP, LOC, meds administered, sites biopsied, lavage volume |
What is the post care for a bronchoscopy? | Positioning - semi-fowlers for conscious patient, on side or head to the side for unconscious patients, sputum - observe for blood 24 hrs, refrain from coughing, watch for pneumothorax, NPO till gag reflux returns |