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mixed venous, CO, flotrac, clear sight, TEE,ventilation, oxygenation, 02 diss curve review Flashcards | StudBud
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mixed venous, CO, flotrac, clear sight, TEE,ventilation, oxygenation, 02 diss curve review
mixed venous, CO, flotrac, clear sight, TEE,ventilation, oxygenation, 02 diss curve review
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1
what causes loss of end tidal waveform
dislodge ett
disconnected ett
sudden loss of circ: PEA/PE
low cardiac output state
Apnea
2
3 artial wave form anaylsis devices to derive CO
LIDCORAPID
PICCO
FLOTRAC
3
what causes prolonged expiration?
asthma
v/q mismatch
copd
bronchospasm
obstruction of expired gas flow
4
right shift in 02 curve
increased 2,3, -DPG
lets go of 02, like SShb
acidosis
increased c02
"right releases", decreased affinity
hyperthermia
5
of the 02 diss curve shifts left, the P50:
:)
decreases
6
under normal conditions, adult human blood has a P50 of _____ mmHg
:)
26-27
7
Bohr effect
influence of pH and Pc02 on hgb02 diss. curve
exlpains how higher c02 and H+ ion levels affect 02 delviery and transport
8
obstructive disease will show was on flow loop
cant get air out (copd, asthma)
from small airways closing during exp
from small airway
reduced peak flow rate sloping of exipartory limb
9
algorithm used to determine SA02 baed on light absoprtion is dervided from
beer-lambert law
:)
10
High CO, low Sv02 indicates (3)
anemia
high V02 (02 consumption)
hypoxia
11
reduced 02 hbg absorbs more light than oxyhemoglobin at:
red wavelength between 650 and 750 NM
:)
12
lamberts law pulse ox
longer path light must travel = more light absorbed
light absorbed is proportional to length of path
shorter the path in narrow artery
light emitted from source travels through artery
longer path in wide artery
13
conditions causing left shift of 02 diss curve: carbon methemoglobin:
caused by toxic reactuibs to oxidant drugs: LA (i.e. prlocaine)
caused by nitrate poisoning (nitroprusside OD)
ferric state doesnt combine with 02
iron molecule in ferric state (Fe 3+)
treat with methylene blue
14
capnometry encompassess:
no waveform
:)
measurement and display of ETC02 value
all means of measuring C02
15
capnogram is a
continuous display of c02
:)
16
what would hyperventilation look like on capnogram
wont be as tall, narrow, many
:)
17
TEE abnormal wall motion: akinesia
may be associated with MI
:)
absence of wall motion
18
TEE uses what to get image
:)
piezoelectric elements to absorb, reflect, or scatter light
19
capnogram non diverting/mainstream monitor:
measures gas directly within breathing system
no scavenging necessary
only measures c02 and n02
minmal time delays
increased deadspace
20
what can cause rebreathing on capnogram?
inadequate FGF
depleted absorber
21
High CO, High Sv02 indicates (4)
hypervolemia
sepsis
excessive blood flow
excessive vasoactive therapy
22
LOW CO, high Sv02 indicates (3)
anesthesia
is there adequate CO?
hypothermia
not a lot of metablic demand
23
Beers law, pulse ox
hemoglobin absorbs light
more hb in finger= more light absorbed
amount of light absorbed is proportional to concentration of hb in vessel
24
2,3 DPG is increased:
in fetal/neonate hemoglobin
:)
by blood transfusions
25
what causes curare clefts
pt is mechanically ventilated
spont. resp effort in anesthetied pt
pt paralyzed
26
TEE abnormal wall motion: dyskinesia
hallmark of MI and ventricular aneurysm
correlates with paradocial movement
outward movement during systole
27
decreased ETC02 from:
decreased c02 production
low cardiac output state
hyperventilation-acidosis
equipment problems
decreased c02 delivery
pain
28
pressure-volume loop volumes provide insight into
:)
lung compliance
29
what is occuring
prolonged expiration
:)
30
pulse ox uses ____ to differentiate pulsatile pflow
plethysmography
:)
31
restrictive disease will show was on flow loop
cant get air in
neuro musc disorders
scarring, interstitial disease
normal or heightened peak exp flows
narrow loop reflecting reduced vital capacity
sarcodosis, obesity
32
suppressed Bohr effect seen in:
i.e. hyperventilation with hypocapnia
lower C02 concentrations
33
capnogram diverting/sidestream monitor:
risk of contamination from secretions
extracts gsa from sample tubing near pt
need for scavening
minimal increase in deadspace
34
flow/volume, whats on horizontal axis whats on vertical axis
vertical: flow
horizontal: volume
35
In a right shift of 02 curve, conditions favor _____. This is associated with
the release of 02 from Hgb to tissues
ass. w/ increased tissue metabolism
ass. w/ increased 02 demand
36
flow-volume loop volumes provide insight into
:)
pulmonary resistance
37
pulse ox measures
:)
HR and % of SA02
38
Pulse ox is ______ ratio
oxyhemoglobin/deoxyhemoglobin ratio
:)
39
capnogram D
end tidal concentration
:)
40
flow volume loops are used to assess what test
PFTs
:)
41
capnogram uses
infrared analysis
:)
42
capnography records:
measurement and display of both ETC02 value and capnogram
:)
measurement of c02
43
what is occuring
rebreathing - waveform fails to return to baseline
:)
44
how artial wave form anaylsis devices derive CO
directly measure fluctuation is arterial pressure and HR
estimates beat-to-beat stroke volume
45
oxyhemoglobin absorbs more light than reduced 02 hbg aborbs at:
:)
infrared wavelengths 900-1000nm
46
of the 02 diss curve shifts right, the P50:
increases
:)
47
pressure/volume, whats on horizontal axis whats on vertical axis
vertical: volume
horizontal: pressure
48
capnogram D-E
inspiration
descent to original baseline
49
conditions causing left shift of 02 diss curve: carbon monoxide poisioning:
binds with 02 creates carboxyhemoglobin, 200 times affinity of 02.
inhibits peripheral utilization of 02
prevents offloading of 02
impairs oxidative phosphorylation at cell level
misleading high reading on 02 sat
50
capnogram A-B
anatomic deadspace
baseline
anatomic deadspace
51
what does this show
barotrauma risk
overventilation
52
capnogram C-D
expiratory platea
alveolar gas
53
spirometry loop assesses what two relationships
pressure and volume
flow and volume
54
pulse ox is ____ accurate between 80-100%
2%
:)
55
clearsight: whats required, how does it work
assess absorption of infrared light
cuff dynamically inflates/deflates to track brachial artery BP
finger cuff
no invasive lines
56
according to Bohr effect in 02 diss curve, excess H+ ions
happens in hypercapnia
cause Hgb to change its conformational shape
happens in acidosis
lowering affitinty for 02
right shift
57
2,3 DPG is decreased:
left shift
:)
in hypophosphatemia
58
when is the pulse ox within 5% accurate
:)
when below 80%
59
increased ETC02 from:
increased c02 delivery
equipment problems
malignant hyperthermia
hypoventilation
inreased c02 production
60
SeXy DARLing!
at SiX hundred, Deoxyhb Absorbs Red Light
:)
61
TEE abnormal wall motion: hypokineasia
contraction that is less vigorous than normal
:)
62
two types of spirometry loops, what do they assess
pressure and volume
assesses change in lung compliance and resistance
63
flotrac requires
:)
arterial line
64
what is occuring
loss of end tidal waveform
:)
65
what would hypoventilation look like on capnogram
:)
tall, not as many
66
capnogram B-C
expiratory upstroke
deadspace and alveolar gas
67
what is occuring?
:)
curare clefts
68
mixed venous 02 sat (sv02) is
reflex 02 "left over" after tissues remove whats needed
the % of 02 bound to hgb in blood returning to right side of heart
69
left shift in 02 curve
decreased c02
decreased 2,3, -DPG
hypothermia
"left leches", increased affinity
alkalosis
hangs onto 02, like met-hb
70
LOW CO, low Sv02 indicates (3)
aka low output syndrome
HF
PE
hypervolemia
71
conditions that alter or have altered hbg, can result in false readings
sickle cell anemia
carboxygehemoglobin
(methlyene blue)
inj. dyes
(indigo carmine)
methemoglobin
72
in a left shift of 02 curve, means a ______ saturation for a given P02
higher
(increased affinity of Hgb for 02)
73
the ability to more readily deliver & release 02 to cell areas & tissues that have _______ is a result of the Bohr effct
and produce more CO2
i.e. heart and brain
have: a higher metabolism
74
the P50 on 02 diss. curve correspons to the Pa02 at which:
50% of hgb is saturated
:)
75
ventilation is the difference between
ETC)2 and PAC02
approx 5 Torr, up to 10
