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Insp/Exp. Gases
Kevin's Inspired and Expired Gases Lecture (SIUE Nurse Anesthesia)
| Question | Answer |
|---|---|
| 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 |
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