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Insp/Exp. Gases

Kevin's Inspired and Expired Gases Lecture (SIUE Nurse Anesthesia)

QuestionAnswer
What are the 4 essential features of monitoring? 1) Instrumentation 2) Observation and Vigilance 3) Interpretation 4) Intervention
What is ASA Standard I? Qualified personal must be present with patient at all times.
What is ASA Standard II? Must continually evaluate: 1) temp 2) oxygenation 3) ventilation 4) circulation
Where are expired gases sampled from? The Y piece of the ventilatory circuit
What are 3 techniques for monitoring expired gases 1) infrared spectrophotometry (IRAS) 2) mass spectrometry 3) raman scattering
Name the gases which are measured during anesthetic administration. 1) oxygen 2) CO2 3) N2O 3) inhaled agents
Is MAC determined by inspiratory sampling or expiratory sampling? Expiratory
Name two molecules which can not be measured by IRAS 1) oxygen 2) IA (they all look the same to the IRAS)
What are the two wavelengths used for IRAS? 1) 2600 2) 4300
Name the law which is used to calculate gases via IRAS. Beer-Lambert Law
Name the molecules which can be sampled via Raman scattering. 1) oxygen 2) H2O 3) CO2 3) N2O 4) inhaled agents 5) N2
Which alterations can be detected via CO2 monitoring? 1) CO 2) ventilation 3) distribution of pulmonary blood flow 4) metabolic activity 5) equipment failures 6) ETT placement (not location)
What is the gold standard for ETT verification and how is it done? CO2 monitoring 3 "blips" of at least 30 mmHg with a return to 0 mmHg each time.
Describe point A on capnogram. beginning of expiration
Describe region A to B on capnogram. expiration of dead space contents.
Describe region B to C on capnogram. expiratory upstroke.
Describe region C to D on capnogram. plateau.
Describe region D to E on capnogram. inspiration.
Which point is the number from capnometry obtained? point D on capnogram.
What will the upstroke on a capnogram look like for someone with obstructive lung disease? Will be less vertical. "Shark fin" appearance.
Which point on a capnogram is the best reflection of alveolar ventilation? point D.
What could be the problem if the baseline waveform of a capnogram does not return to 0? 1) leak in an expiratory valve. 2) exhausted soda lime. 3) rebreathing of CO2 (low FGF). 4) deliberate addition of CO2 to FGF.
What are 3 assumptions re: capnography? 1) CO2 is easily diffusible 2) no V/Q mismatch 3) no sampling error
During general anesthesia what is the "real correlation between PaCO2 and etCO2? etCO2 is 5 to 10 mmHg less then the PaCO2.
List 5 factors which decrease the accuracy of etCO2 monitoring. 1) V/Q mismatch 2) gas sampling error 3) shallow tidal volumes 4) increase expiratory phases 5) uneven alveolar emptying
What is the extreme example of V/Q mismatch called? dead space ventilation (loss of perfusion with adequate ventilation)
Name 4 diseases which would reduce the etCO2. 1) PE 2) hypoperfusion states 3) reduced pulmonary blood flow 4) COPD
Does etCO2 determine if the ETT is correctly placed in the trachea? No. Only chest X-ray.
When will etCO2 increase? when CO2 production exceeds ventilation. 1) MH 2) increased muscle activity 3) bicarb administration (Le Chatlier's principle) 4) tourniquet release 5) breaking of bronchospasm 6) decreased MV.
When will etCO2 decrease? when ventilation exceeds CO2 production. 1) decreased muscle activity. 2) hypothermia. 3) PE 4) bronchospasm 5) increased MV.
List the steps to analyzing etCO2 waveform. 1) look at the y axis (is it normal height) 2) does the waveform return to 0 mmHg 3) look at the expiratory limb (is there a sharp upstroke) 4) look at the RR
name the two types of oximetry monitoring and where they are done at. 1) FiO2 monitoring (in the inspiratory limb before the inspiratory unidirectional valve. 2) pulse oximetry (at the patient)
True or False, the oxygen analyzer ensures adequate arterial oxygenation. False. The oxygen analyzer ensures that the patient does not receive a hypoxic mixture of gas.
Name 3 types of oxygen analyzers. 1) paramagnetic 2) galvanic 3) polarographic
which electrolyte solution is used for galvanic oxygen analyzers? KOH
which electrolyte solution is used for polarographic oxygen analyzers? KCL
Polarographic oxygen analyzers is based on which law? Faraday's Law.
What physiological parameters does the pulse ox detect? 1) pulse rate 2) oxygen saturation of hemoglobin 3) fluid status
What location most accurately measures pulse ox? right ear
What will happen to CO during inspiration with positive pressure ventilation? decrease
What will happen to CO during inspiration with spontaneous ventilation? increase
Name the two technologies employed in pulse oximetry. 1) plethysmography 2) spectrophotometry
Which law does spectrophotometry employ for pulse oximetry? Beer Lambert Law
What is the Beer-Lambert Law? A=ebc Where A is absorbance (no units) e is the molar absorbtivity b is the path length of the sample - that is, the path length of the cuvette in which the sample is contained in cm c is the conc, of the compound in solution in mol L-1
What are the two wave lengths used in pulse oximetry and which types of hemoglobin do they measure? 660 nm = deoxyhemoglobin 940 nm = oxyhemoglobin
How is the pulse oximetry result expressed? As a percentage based off of the ratio of saturated Hb divided by the total Hb. (no units)
What will the saturation on pulse ox read with increased methemoglobinemia? 85%
What will happen to the pulse ox value with increased carboxyhemoglobin? Falsely elevated SpO2.
What is the error range for pulse ox when SaO2 is 70 to 100 percent? plus or minus 2 to 3%
What is the error range for pulse ox when SaO2 is 50 to 70 percent? plus or minus 3%
What factors affect pulse oximetry readings? Vital dyes Methylene blue Indigocarmine False lows Nail polish Ambient light Light emitting diode variability Motion artifact Background noise Electrocautery Low cardiac output Anemia Methemoglobin Carboxyhemoglobin
What is the relationship described by the oxyhemoglobin disassociation curve? Defines the relationship of hemoglobin saturation and oxygen tension.
What are the PaO2 values for SpO2 of 97%, 90%, 80%, and 70%? SpO2 of 97% = PaO2 of 97 SpO2 of 90% = PaO2 of 60 SpO2 of 80% = PaO2 of 50 SpO2 of 70% = PaO2 of 40
Created by: toppu2020