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Definition
measures Functional saturation oxyHgb/ OxyHgb + Deoxy Hgb
principle monitor to alerting about an emergency. |
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| measures fractional saturation OxyHgb/ all Hgb |
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Term
Oxygenation
Objective: To ensure adequate oxygen concentration in the inspired gas and the blood during all anesthetics. |
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Definition
Methods:
(1) Inspired gas: During every administration of general anesthesia using an anesthesia machine, the concentration of oxygen in the patient breathing system shall be measured by an oxygen analyzer with a low oxygen concentration limit alarm in use.*
(2) Blood oxygenation: During all anesthetics, a quantitative method of assessing oxygenation such as pulse oximetry shall be employed.* Adequate illumination and exposure of the patient are necessary to assess color. |
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Definition
| "non-useful" stuff that should be less than 5% (COHb, Methb, etc) |
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| a pitch difference in beep |
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| independent of actual art saturation (it's confused)- methemoglobin |
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| 1st oscillation = SBP, last = DBP, muffled=MAP |
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| more distal= higher SBP and lower DBP |
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| measure MAP and calculate SBP/DBP |
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| calculates MAP and reads SBP/DBP |
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| Reflection from an art line measures |
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| brachial (use as last resort only) |
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| Stopcocks, air, etc. For best waveform...limit stopcocks |
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| NOT a measure of tissue oxygenation or ventilation monitor |
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Definition
| first hour of anesthesia, rapid decrease in temp (1.5°C) loss of vasoconstriction |
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Definition
| happens over 2-4 hr period, gradual loss of temp |
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Definition
| set point reached, vasoconstriction |
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| Outcomes of hypothermia 1-2C drop |
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Definition
| 3x wound infection, delayed emergence, 3x cardiac morbid outcomes |
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Definition
| 6% decrease in metabolism for every 1°C decrease in temp |
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| DONT monitor temp in bladder |
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Definition
| monitor 1/4 to 1/3 in distal esophagus (where you hear max heart sounds |
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Definition
| forced air convection, insulation |
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| For every 1 unit refrigerated PRBC or 1 L of room temp fluid |
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Definition
| patients temp will drop 0.25° C |
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| Side stream capnography is most common...problems |
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Definition
| delay/lag time and you can pull of FGF (especially in infants that have a low MV to begin with, this dilutes CO2 reading) |
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| Where do you read ETCO2 on wave |
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Definition
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Definition
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| numerical representation of CO2 concentration |
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Definition
| continuous graph of CO2 concentration over time |
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Definition
| continuous measurement of capnography |
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| 5 things you measure on a capnogram |
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Definition
| Height, frequency, rhythm, baseline, shape |
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Definition
cylinders
receives high, variable pressure gas from cylinders and reduces and regulates it.
gas lines proximal to flow valves
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Term
| Intermediate Pressure system |
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Definition
pipeline inlets
pneumatic protion of master switch
o2 failure device
o2 flush
flow control valves
most of what we use ?? |
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Term
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Definition
begins downstream of the flowmeters to the common gas outlet
slightly above atmospheric pressure
piping
flowmeters
hypoxia prevention device (link 25)
unidirectional valves
Auxilary flow meter-where you plug in NC or venti mask
nitrous and o2 interlock system
common gas outlet
vaporizer mounting system
pressure reliefe devices
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Term
| All manufacturers are required to follow ASTM standards |
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Definition
TRUE
must have low pressure sensor and inspired o2 sensor |
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Term
| Master switch and machine is off..what will still work? |
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Definition
| Battery charger, O2 flush and electric outlets will still work |
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| Pipeline supply monitored |
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Definition
| on pipeline side of check valve, keep backup tank closed |
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Definition
>30psig
Spring pressure overcome and valve will be in open position |
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Definition
| 5 second alarm will sound |
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| 2nd stage pressure regulator |
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Definition
| is in the intermediate pressure zone |
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Definition
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Definition
| turn them counterclockwise to turn on |
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| Where do you read the ball on the indicator |
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Definition
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| Where do you read the float on the indicator |
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Definition
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Definition
| N20 and O2 linked sprocket system. Prevents 100% N20 administration, 25% O2 is lowest administration |
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Definition
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Definition
| low pressure system: >50ml/min is significant for a leak |
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| Pressure reducing device: 2000psig |
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Definition
| 45psig in the high pressure syste |
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| Pipeline gauge is before check valve so |
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Definition
| cylinder pressure doesn’t affect the reading |
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Definition
| 4x service pressure, 150ml leak |
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Definition
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Definition
| : intermediate system, upstream of O2 and N2O, further decreases pressure |
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| What cylinder is required by standard to be on the back of the anesthesia machine |
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Definition
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| Decrease pressure to 45psig for |
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Definition
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Definition
| vaporizer made of copper and bronze |
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Definition
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| What causes pumping effect |
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Definition
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Definition
| Halothane and Iso could be used in the same vaporizer, be careful. Could overdose your patient if a more potent agent is put in the place of a weaker one |
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Definition
| divided into 2 parts: vaporizing chamber and bypass |
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Definition
| Press/pump effect, wrong agent, tipping, etc |
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Definition
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| Internal diameter of common gas outlet |
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Definition
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Definition
| diameter indexed safety system |
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Definition
| area between 2 concentric circles |
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| Check valves on cylinders use |
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Definition
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Definition
| the most common single source of injury (39%); nearly all incidents were related to misconnects or disconnects. |
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| All modern vaporizers are |
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Definition
| agent specific, capable of delivering a constant concentration of agent regardless of temperature changes or flow through the vaporizer. |
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Definition
Gas travels past an electron beam and the ions get stripped of an electron.
Positively charged ions are sped up by traveling thru a magnetic field and slammed into a detector. The rate at which the ions hit the detector is proportional to their concentration |
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Definition
Infrared light is beamed through sample. The intensity of transmitted light is measured
Most common measure used in the OR |
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Term
| Colorimetric Carbon Dioxide Analysis |
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Definition
CO2 forms an acidic solution in water. Paper with aqueous solution and pH sensitive dye
Foam nose looking thing you may use in the ER or ICU |
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Definition
| Usually found on the inspiratory limb of the anesthesia circuit and used to detect the administration of a hypoxic mixture. NOT a monitor of arterial oxygenation! |
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Definition
| numerical representation of CO2 concentration. |
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Definition
| continuous graft of CO2 concentration over time. |
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Definition
| continuous monitoring of the capnogram. |
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| We use ETCO2 to estimate PaCO2 |
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Definition
ETO2 is not a good measure of PaO2)
Wave form and numerical readings can give us all sorts of information if you know how to read them. |
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Term
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Definition
Draw 50-500cc min (usually 200cc)
Delay in reading proportionate to length of connection, filter and water trap
Measuring core must be protected from fluids (water vapor)
Sample port should be as close to the patient as possible
CO2 accurate within .05 if RR <60 breaths/min |
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Term
| Potential Issues of Side Stream Capnography |
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Definition
Faster sampling rates decrease lag time and produce more reliable readings.
Low fresh gas flows can create a situation. If the sampling flow rate exceeds the airway gas flow the sample will be diluted by fresh gas flow.
Used to verify endotracheal tube placement. |
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Term
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Definition
I saw it go through the cords!
Bilateral chest rise.
Fine mist in endotracheal tube.*
Auscultation of bilateral breath sounds.
CO2 waveform beyond the 6th breath.*
Maintenance of arterial oxygen saturation. |
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| There are some rare waveforms seen with esophageal intubation |
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Definition
| CO2 waveform will not rule out mainstem intubation. |
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Definition
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Definition
Ventilation and perfusion are appropriately matched
CO2 is easily diffusible across the capillary-alveolar membrane
No sampling error |
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Definition
Arterial CO2 = 35 – 45 mmHg
End tidal CO2 normally 2-5 mmHg lower
The difference represents the normal V/Q mismatch.
V/P 0.8 Under anesthesia the ETCO2 – PaCO2 gradient is about 5-10 mmHg
V/Q disturbance can change this gap.
Sampling problems can also change the gap. |
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Definition
Anything that decreases lung perfusion will result in a widened gap.
Decreased cardiac output Decreased blood pressure
Embolic events Seated position
COPD Additions to the circuit |
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Definition
Perfusion without ventilation causes very little change in the arterial – end tidal CO2 gradient. You will need to look at the alveolar to arterial O2 gradient.
[fiO2 x (760-47)] – 40/.8 = alveolar oxygen arterial oxygen must be read from the ABG |
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| Increased dead space ventilation does not |
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Definition
| respond well to increased oxygen administration. |
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Term
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Definition
PaCO2 = CO2 production
alveolar ventilation (CO2 elimination)
Remember: minute vent – dead space = alveolar ventilation |
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Term
| Things that increase EtCO2 |
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Definition
▲ in production ▲ in elimination
Hyperthermia hypoventilation
Sepsis rebreathing CO2
MH
Muscular activity |
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| Things that decrease EtCO2 |
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Definition
▲ in production ▲ in elimination
Hypothermia Hyperventilation
Hypometabolism Hypoperfusion
Embolism |
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| Drastic decreases in EtCO2 indicate possible life threatening events. |
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Definition
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Definition
Oximetry depends on the observation that oxygenated and reduced hemoglobin differ in their absorption of red and infrared light
pecifically, oxyhemoglobin (HbO2) absorbs more infrared light (960 nm), whereas deoxyhemoglobin absorbs more red light (660 nm) and thus appears blue, or cyanotic, to the naked eye. The change in light absorption during arterial pulsations is the basis of oximetric determinations (Figure 6–22). The ratio of the absorptions at the red and infrared wavelengths is analyzed by a microprocessor to provide the oxygen saturation (SpO2) of arterial blood |
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Term
| Because carboxyhemoglobin (COHb) and HbO2 absorb light at 660 nm identically, |
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Definition
| pulse oximeters that compare only two wavelengths of light will register a falsely high reading in patients with carbon monoxide poisoning. Methemoglobin has the same absorption coefficient at both red and infrared wavelengths. |
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Term
| methemoglobinemia causes a falsely |
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Definition
| low saturation reading when SaO2 is actually greater than 85% |
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Term
| Methhemoglobemia causes a falsely high reading |
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Definition
| if SaO2 is actually less than 85% |
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