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Emergency Care EX 2

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
Created by: ashconrad417