contraindication for esophageal stethoscope
hx of esophageal varies or strictures, bariatric surgery
what does standard V require you monitor
ventilation, oxygenation, cv status, body temp, neuromuscular function and status, patient positioning.
red light is how many nm and is absorbed by
660, deoxyhemoglobin
infrared light is how many nm and is absorbed by
940, oxyhemoglobin
what law is the basis for pulse ox
beer lamberts
absence of end tidal CO2 is indicative of
esophageal intubation, accidental disconnect from breathing system, cardiac arrest
ETCO2 is __ lower than ABG
2-5
A to B
baseline. sample comes from deadspace and contains no CO2. should equal 0
b to c
exp upstroke. mix of dead space and alveolar gas
c to d
exp plateau - records alveolar emptying of CO2
D
end tidal concentration represents rapid decrease in CO2 conc
D - E
descent to original baseline. rapid decrease of CO2 as patient breathes in
normal PR
.12-.2sec
QRS
.06 to .10sec
QT
anesthetics inhibit central thermoregulation by interfering with ___ function
hypothalmic
causes of high ETCO2
mh, fever, hypoventilatin, CNS depressent, met alka, bicarb admin, skeletal muscle activity, sz
causes of low ETCO2
hypothermia, low cardiac output, hypovolemia, pain, anxiety, hyperventilation, hypotensive
if ETOC2 wave isnt returning to baseline what is happening
rebreathing - exhausted CO2 absorber, inadequate fresh gas flow
sloping of plateau phase (phase3) is indicative of
prolongation of expiration, obstruction, v/q mismatch, COPD, emphysema, kinked ETT/ anything that makes breathing out take longer
what do you see in patient with spontaneous insp asynchronous with controlled ventilation
curave cleft
two types of infrared spectrometry
mono and poly
mono absorption spectrum is ___ of halogenated agents, while poly is ___
similar , different
which monitor must be programmed with the agent selected
monochromatic
which monitor can measure both gases simultaneously if you change from one agent to another
poly
raman spectrometry uses
scattered light
what does the respirometer/ventimeter on the old anesthesia machine measure.
TV and min vent (digital now)
where is the resp/ventimeter located on the old AGM
exhalation limb
what does peak insp pressure monitor
positive pressure created by mechanical ventilation of the lungs
why would low pressure alarm sound
disconnect, leak
what is the high pressure alarm usually set at
40
excessive airway pressure may indicate __ pulm compliance
low… pulm edema, paralytic wearing off, COPD, ARDS, asthma
if high pressure alarm is going off check for
kink or mucous plug
is ecg a measure of heart function?
no
standard 1mv change represents a deflection of __mm on paper strip
10
since R and L ventricular performance is parallel in healthy hearts, ___ can also be assessed by CVP
LV filling
stimulation of ulnar nerve causes contraction of
adductor pollis muscle
stimulation of facial nerve causes contraction of
orbitcularis oculi
which muscle recovers faster from neuromuscular blockage?
orbitcularis oculi
which med is a depolarizing paralytic
succs. activates the receptors first then blocks them afterwards - fassiculation
which agents give you a fade?
non-depolarizers - roc vec panc
does 4 twitches guarantee they are going to breathe well?
no - represents 70%
3 twitches
75-80% para
2 twitches
80-85% para
1 twitches
90-95% para
no twitches
100% paralyzed
how does tetany work
actely is released into receptor site. TOF may elicit a response.
tentany MOA
competitive antagonism
with non-depolarizers, what do you see in tetany
fade
what is oliguria defined as
UOP
what provides early evidence of cerebral ischemia
eeg
4 types of evoked potentials
visual , auditory , somatosensory, motor
goal is to titrate concentration of anesthesia to maintain BIS near
60
BIS less than 60 indicates
high probability of unresponsiveness and low prob of awareness
what should you use during a carotid surgery to monitor oxygen
cerebral oximetry monitoring
what represents burst suppresssion
20
what BIS number is light mod sedation
80
what alters evoked potentials
general anesthesia
alpha angle increased
exp air flow obstructed… copd, bronchospasm, kinked ett
beta angle increased
rebreathing
during spinal/epidural anesthesia hypothermia occurs secondary to
internal redistribution of heat.
sympathetic blockade causes
vasodilation w peripheral pooling of blood
you dont lose twitches until what percent are blocked
70