Capnography and Ventilation Assessment Quiz
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Questions and Answers

What should be done for a patient whose ETCO2 is greater than 45mmHg?

  • Hyperventilate the patient to increase CO2 levels (correct)
  • Introduce supplemental oxygen only
  • Maintain current ventilation rate
  • Decrease ventilation to lower CO2 levels

What does a sudden loss of waveform in capnography indicate?

  • Reinforced tube placement
  • Stable circulatory function
  • Possible tube disconnection or obstruction (correct)
  • Initial alveolar exhalation

What is the role of capnography in assessing a patient's ventilation status?

  • It records heart rate fluctuations
  • It displays patient oxygen saturation levels
  • It provides ETCO2 as an indicator of ventilation (correct)
  • It measures blood PH levels directly

Which phase of the capnogram represents the inspiratory baseline?

<p>Phase 1 (A-B) (D)</p> Signup and view all the answers

What condition is indicated by a shark fin appearance in the wave form of capnography?

<p>Bronchospasm related to asthma or COPD (B)</p> Signup and view all the answers

What are the typical values for ETCO2 in a healthy individual?

<p>35-45mmHg (D)</p> Signup and view all the answers

What should be performed during CPR to ensure effective ventilation?

<p>Maintain a minimum ETCO2 of 10mmHg (D)</p> Signup and view all the answers

What does a decrease in ETCO2 levels during ventilation suggest?

<p>Hypoventilation or possible apnea (A)</p> Signup and view all the answers

What does EtCO2 measure?

<p>The partial pressure of CO2 at the end of exhalation (A)</p> Signup and view all the answers

Which process primarily describes the movement of air in and out of the lungs?

<p>Ventilation (C)</p> Signup and view all the answers

How is the total physiological dead air space calculated?

<p>Anatomic Dead Space + Alveolar Dead Space + Mechanical Dead Space (D)</p> Signup and view all the answers

What is the normal range of CO2 levels measured in capnography?

<p>35-45 mmHg (D)</p> Signup and view all the answers

Which term refers to the body’s process of regulating oxygen levels to the tissues?

<p>Oxygenation (C)</p> Signup and view all the answers

What condition can lead to low ETCO2 levels?

<p>Pulmonary embolus (C)</p> Signup and view all the answers

What happens to the respiratory rate as CO2 levels rise in the blood?

<p>It increases to expel CO2 (A)</p> Signup and view all the answers

What is the main function of pulse oximetry?

<p>Determine the percentage of oxygen saturation in the blood (C)</p> Signup and view all the answers

Which factor can cause high CO2 levels due to hypoventilation?

<p>Sedation (B)</p> Signup and view all the answers

In which situation does ETCO2 reflect cardiac output rather than ventilation?

<p>During cardiac arrest (B)</p> Signup and view all the answers

What constitutes external respiration?

<p>Gas exchange across the respiratory membrane in the lungs (A)</p> Signup and view all the answers

What is a possible complication related to flow rate in IV administration?

<p>Infiltration (A)</p> Signup and view all the answers

Which gauge size is most appropriate for administering large amounts of fluid to adolescents and adults?

<p>18 Gauge (D)</p> Signup and view all the answers

What factor contributes to decreased flow rate due to phlebitis or thrombi?

<p>Position of the patient’s extremity (D)</p> Signup and view all the answers

What complication occurs when fluid leaks into surrounding tissue during IV therapy?

<p>Infiltration (D)</p> Signup and view all the answers

Which of the following can affect the flow rate due to viscosity?

<p>Dextrose concentration (C)</p> Signup and view all the answers

What is a common characteristic of chronic obstructive pulmonary disease (COPD)?

<p>Irreversible damage to lung tissue (B)</p> Signup and view all the answers

Which symptom is typically associated with cystic fibrosis?

<p>Chronic cough (C)</p> Signup and view all the answers

What is a potential complication of aspiration?

<p>Complete airway obstruction without sound (B)</p> Signup and view all the answers

Which factor can trigger an asthma episode?

<p>Exposure to cold air (A)</p> Signup and view all the answers

What symptom is NOT typically associated with secondary infections?

<p>Weight gain (A)</p> Signup and view all the answers

What characterizes stable angina?

<p>Predictable pain, location, and severity that is relieved by rest (D)</p> Signup and view all the answers

What causes unstable angina?

<p>Ruptured plaque leading to significant coronary artery obstruction (A)</p> Signup and view all the answers

Which of the following is not a typical sign of angina?

<p>Severe headache (C)</p> Signup and view all the answers

What is the most common cause of an acute myocardial infarction?

<p>Ruptured plaque and thrombus formation (C)</p> Signup and view all the answers

What typically differentiates a STEMI from a Non-STEMI?

<p>The ECG findings revealing elevated ST segments (D)</p> Signup and view all the answers

What happens to the area of ischemic tissue surrounding an infarcted zone?

<p>It remains viable but is deprived of oxygen (D)</p> Signup and view all the answers

Which of the following best describes the pain experienced during an acute myocardial infarction?

<p>Heavy, squeezing, crushing, or tight, often with a clenched fist (B)</p> Signup and view all the answers

Which condition represents a high risk of imminent myocardial infarction?

<p>Unstable angina with longer lasting severe pain (C)</p> Signup and view all the answers

What happens during total obstruction of the bronchioles?

<p>Mucus plugs completely block airflow. (D)</p> Signup and view all the answers

Which sign or symptom is commonly associated with Status Asthmaticus?

<p>Cough with thick tenacious mucus. (B)</p> Signup and view all the answers

What characterizes the condition known as emphysema?

<p>Destruction of the alveolar walls. (D)</p> Signup and view all the answers

In emphysema, what occurs due to the breakdown of elastic fibers?

<p>Altered V/Q ratios and air trapping. (B)</p> Signup and view all the answers

What is the primary cause of dyspnea in a patient with bronchial obstruction?

<p>Increased residual volume. (C)</p> Signup and view all the answers

How does the respiratory center adapt in patients with hypercapnia from emphysema?

<p>It loses sensitivity to high CO2 levels. (D)</p> Signup and view all the answers

What can result from the formation of large alveolar air spaces in emphysema?

<p>Increased likelihood of pulmonary hypertension. (C)</p> Signup and view all the answers

Which respiratory symptoms signify a worsening asthma exacerbation?

<p>Silence in breath sounds and no respiratory rate. (D)</p> Signup and view all the answers

What is a common sign that may indicate a secondary infection?

<p>Malaise and fatigue (A)</p> Signup and view all the answers

What is a potential consequence of aspiration in the lungs?

<p>Obstruction with no sound (C)</p> Signup and view all the answers

What characterizes the onset of asthma episodes?

<p>Hypersensitivity to environmental factors (B)</p> Signup and view all the answers

What is a common indicator of chronic obstructive pulmonary disease (COPD)?

<p>Progressive tissue degeneration (A)</p> Signup and view all the answers

What is a characteristic sign of chronic bronchitis?

<p>Constant productive cough (A)</p> Signup and view all the answers

Which condition is commonly referred to as 'blue bloaters'?

<p>Chronic bronchitis (B)</p> Signup and view all the answers

What causes the thickening of bronchial walls in chronic bronchitis?

<p>Chronic irritation and inflammation (C)</p> Signup and view all the answers

Which symptom is indicative of polycythemia in a patient with chronic bronchitis?

<p>Clubbing of fingers (D)</p> Signup and view all the answers

What is a typical respiratory behavior of patients to facilitate breathing in chronic bronchitis?

<p>Sitting upright in tripod position (B)</p> Signup and view all the answers

What is the primary role of pulmonary ventilation in the respiratory process?

<p>To allow air to enter and exit the alveoli (A)</p> Signup and view all the answers

What measurement does capnography primarily provide?

<p>The amount of CO2 in the exhaled air (B)</p> Signup and view all the answers

Which type of dead space includes areas ventilated without blood flow?

<p>Alveolar Dead Space (A)</p> Signup and view all the answers

Which statement about EtCO2 is true?

<p>It is unaffected by motion and circulatory status (C)</p> Signup and view all the answers

What occurs to the respiratory rate as carbon dioxide levels decrease in the blood?

<p>It decreases to retain CO2 (D)</p> Signup and view all the answers

What happens when a patient's ETCO2 drops below 35mmHg?

<p>The patient is hyperventilating and should be hypoventilated. (B)</p> Signup and view all the answers

What could indicate a sudden increase in ETCO2 levels?

<p>Return of spontaneous circulation (ROSC). (C)</p> Signup and view all the answers

How is oxygenation primarily defined in respiratory physiology?

<p>The addition of oxygen to the body's tissues (C)</p> Signup and view all the answers

Which phase of the capnogram is characterized by the end tidal value?

<p>Phase 4 (A)</p> Signup and view all the answers

Which components are essential to the equation of gas exchange?

<p>Ventilation + Circulation + Metabolism (C)</p> Signup and view all the answers

What role does external respiration play in the body?

<p>Gas exchange across the respiratory membrane in the lungs (D)</p> Signup and view all the answers

What is indicated by a 'shark fin appearance' in a capnogram waveform?

<p>Asthma or COPD. (D)</p> Signup and view all the answers

How does the shape of the capnogram waveform change during hyperventilation?

<p>It becomes short and quick. (A)</p> Signup and view all the answers

What is a potential cause of decreased ETCO2 levels during ventilation?

<p>Apnea. (B)</p> Signup and view all the answers

What should be maintained during CPR to assess ventilation effectiveness?

<p>A minimum ETCO2 value of 10mmHg. (B)</p> Signup and view all the answers

What does a semi-quantitative capnography device measure?

<p>A qualitative range of CO2 levels. (A)</p> Signup and view all the answers

Which sign is most commonly associated with acute respiratory failure?

<p>Restlessness (D)</p> Signup and view all the answers

Which factor indicates the need for placing a supraglottic airway?

<p>Prolonged extrication (D)</p> Signup and view all the answers

What is a contraindication for using the King LT airway?

<p>Intact gag reflex (B)</p> Signup and view all the answers

Which method is NOT used to confirm proper placement of a supraglottic airway?

<p>Direct visual inspection (A)</p> Signup and view all the answers

What is a potential complication when using the King LT airway?

<p>Laryngospasm (A)</p> Signup and view all the answers

What primarily causes chronic diseases affecting the coronary arteries?

<p>Plaque buildup (C)</p> Signup and view all the answers

Which symptom is commonly associated with unstable angina?

<p>Prolonged duration of pain (A)</p> Signup and view all the answers

What is the most significant risk associated with unstable angina?

<p>High risk of imminent myocardial infarction (B)</p> Signup and view all the answers

Which of the following describes the typical duration of stable angina pain?

<p>1 to 5 minutes (D)</p> Signup and view all the answers

What process leads to the pain experienced during an acute myocardial infarction?

<p>Plaque rupture and thrombus formation (C)</p> Signup and view all the answers

Which of the following is NOT a common characteristic of angina symptoms?

<p>Mild discomfort easily ignored (D)</p> Signup and view all the answers

What term describes angina that does not follow the usual pattern and is more severe?

<p>Unstable angina (B)</p> Signup and view all the answers

Which term best describes the area of heart tissue surrounding the infarcted zone?

<p>Ischemic tissue (B)</p> Signup and view all the answers

Flashcards

Oxygenation

Refers to the process of adding oxygen to the body system - how we get O2 to the tissues.

Respiration

The process by which oxygen and carbon dioxide diffuse in and out of the blood. It occurs both internally and externally.

EtCO2

The measurement of CO2 levels in the airway at the end of exhalation. It reflects a 'snapshot' of the patient's ventilatory status.

Pulmonary Ventilation

The process by which oxygen enters and carbon dioxide exits the alveoli.

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Dead Air Space

Ventilated areas where gas exchange does not occur. This includes airways leading to alveoli, ventilated areas without blood flow, and artificial airways.

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Capnography

Represents the amount of CO2 in exhaled air.

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SPO2

The measurement of oxygen saturation levels in peripheral capillaries using a finger probe.

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Respiratory Effort

The body's response to changes in CO2 levels in the blood, controlling ventilation. This is assessed by looking at chest rise and fall, respiratory effort, breath sounds, and counting respiratory rate.

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Hypocapnia/Hyperventilation (High ETCO2)

A situation where ETCO2 levels are below 35 mmHg. The patient is breathing too fast and expelling too much CO2.

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Hypercapnia/Hypoventilation (Low ETCO2)

A situation where ETCO2 levels are above 45 mmHg. The patient is breathing too slowly and not expelling enough CO2.

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End-tidal CO2 (ETCO2)

The point in the exhaled breath where the highest concentration of carbon dioxide is found.

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Sudden Loss of ETCO2 Waveform

The abrupt loss of a capnography waveform, indicating potential problems with the breathing tube or circulatory function.

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Shark Fin Waveform

Shows a gradual rise in ETCO2, followed by a plateau, then a sharp decline, resembling a shark's fin.

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Low ETCO2

A drop in ETCO2 levels can be caused by increased breathing rate due to factors like anxiety, bronchospasm, or pulmonary embolism.

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High ETCO2

Increased ETCO2 levels occur when someone breathes slowly, holding onto CO2. Common causes include overdoses, sedation, or head trauma.

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ETCO2 and Cardiac Output

When blood flow is normal, ETCO2 reflects how well you breathe. But when blood flow is low, ETCO2 reflects how efficiently your heart pumps.

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ETCO2 in Cardiac Arrest

During cardiac arrest, no blood flow means no CO2 production unless CPR helps. Capnography helps assess CPR effectiveness.

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Large Gauge IV

A larger gauge needle (e.g., 16 gauge) is used for high-volume fluid administration in emergencies, like trauma or burns.

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Small Gauge IV

Smaller gauge needles (e.g., 22 gauge) are used for slower infusions or smaller medications, often in infants or elderly patients.

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IV Flow Rate Complications

Flow rate complications can be caused by factors like venous pressure, vein spasm, phlebitis, fluid viscosity, fluid bag size, needle size, fluid container height, needle position, tubing occlusions, and infiltration.

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IV Infiltration

Infiltration occurs when the IV catheter slips out of the vein, leaking fluid into surrounding tissues. It can be caused by poor site selection, improper cannula size, or irritating solutions.

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Bronchitis

A lung infection that causes inflammation of the bronchi and often results in a mucus buildup, leading to coughing, wheezing, and difficulty breathing.

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Asthma

A chronic lung disease characterized by inflamed airways and bronchospasm, making it difficult to breathe. Triggers include allergens, infections, and exercise.

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Cystic Fibrosis

A genetic disorder where a thick and sticky mucus builds up in the lungs, leading to chronic cough, frequent infections, and difficulty breathing.

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COPD (Chronic Obstructive Pulmonary Disease)

A collection of lung diseases characterized by progressive airway obstruction and tissue damage, leading to difficulty breathing.

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Chronic disease

A condition where the arteries, particularly coronary, renal, aortic, femoral, carotid, and cerebral, become narrowed, resulting in reduced blood flow. This can lead to heart attacks and other issues.

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Angina Pectoris

Chest pain that occurs when the heart muscle isn't receiving enough oxygen. It can happen when the heart works harder than usual.

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Stable Angina

A type of angina where the chest pain follows a predictable pattern, occurring in the same location, with similar severity and triggers. Pain typically lasts 1-5 minutes and is relieved by rest.

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Unstable Angina

A more severe form of angina where the pain is unpredictable and lasts longer than 15 minutes. It's not as easily relieved by rest or medication. Often, it's a warning sign for an impending heart attack.

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Acute Myocardial Infarction (AMI)

A serious condition where the heart muscle is deprived of blood flow for an extended period causing part of the muscle to die. Typically caused by a rupture of plaque in the arteries leading to blood clots.

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Myocardial Ischemia

A condition where the heart muscle is deprived of oxygen but not to the point of death. It's a state between stable angina and a heart attack.

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STEMI (ST-segment Elevation Myocardial Infarction)

A type of AMI characterized by a specific pattern on an electrocardiogram (ECG).

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Acute Coronary Syndrome

Refers to a group of conditions including unstable angina, STEMI, and Non-STEMI. They result from a prolonged cardiac disorder causing myocardial ischemia or infarction.

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Air trapping

Partial blockage of the bronchioles, causing air trapping and lung overinflation. Air enters the blocked areas but can't be fully exhaled, leading to increased residual volume.

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Total Bronchiole Obstruction

Complete blockage of the bronchioles, preventing air flow. This results in collapse of the affected lung tissue due to lack of oxygen.

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Status Asthmaticus

Persistent severe asthma attack unresponsive to treatment. It can be life-threatening due to oxygen deprivation and irregular heart rhythm.

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Asthma Exacerbation

Severe airway narrowing in an asthma attack, preventing any air flow. This leads to lack of breath sounds, a silent chest.

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Emphysema

Destruction of the tiny air sacs in the lungs, leading to larger, permanently inflated air spaces.

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Pink Puffers

Chronic lung disease characterized by destruction of alveolar walls and air trapping. Individuals with emphysema often appear pink due to their high oxygen levels and have a barrel-shaped chest due to chronic overinflation.

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Pneumothorax in Emphysema

A condition caused by emphysema, where the tiny air sacs in the lungs rupture, leading to a collapsed lung.

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Pulmonary Hypertension in Emphysema

High blood pressure in the arteries of the lungs caused by emphysema. It can lead to right-sided heart failure, known as cor pulmonale.

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What is EtCO2?

The measurement of carbon dioxide (CO2) levels in the airway at the end of exhalation. It provides a snapshot of the patient's ventilatory status.

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What is Dead Air Space?

Areas of the lungs that receive air but don't participate in gas exchange. These can be airways leading to alveoli, alveoli without blood flow, or even a ventilator circuit.

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What is SpO2?

The measurement of oxygen saturation levels in peripheral capillaries. It's a non-invasive test using a finger probe.

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What is Capnography?

A graph that shows the amount of CO2 in exhaled air over time. It helps us see how well someone is breathing.

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What is Respiratory Effort?

The rise and fall of the chest that shows how hard the body is working to breathe. It's assessed by looking at the chest movement, breath sounds, and counting breaths.

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What is End-tidal CO2?

It's the amount of CO2 in the breath at the point where it's highest, right at the end of exhalation.

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What causes High ETCO2?

An increase in the amount of CO2 in the breath, often indicating that someone is not breathing well.

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What causes Low ETCO2?

A decrease in the amount of CO2 in the breath, often indicating that someone is breathing too fast.

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What is End-tidal CO2 (ETCO2)?

The point in the exhaled breath where the highest concentration of carbon dioxide is found.

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What does a sudden loss of ETCO2 waveform suggest?

A sudden loss of the ETCO2 waveform can indicate problems with the breathing tube, tube dislodgement, or loss of circulation.

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What is 'Shark Fin Appearance' in a Capnogram?

This waveform resembles a shark's fin with a gradual rise, plateau, and sharp decline, indicating a delay in air movement at the alveoli.

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Why does a Bronchospasm show a 'Shark Fin Appearance' on a Capnogram?

The rise to the plateau becomes more gradual and the plateau itself becomes sloped due to delayed air movement at the alveoli.

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What does a low ETCO2 level suggest?

A low ETCO2 can indicate conditions like hyperventilation, apnea, or sedation.

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What does a high ETCO2 level suggest?

A high ETCO2 can be a sign of hypoventilation caused by factors like overdoses, sedation, or head trauma.

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COPD

A group of chronic respiratory disorders causing progressive tissue damage and airway obstruction, resulting in irreversible damage to the lungs.

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Secondary Infection

The active stage of an infection, characterized by signs and symptoms like malaise, fatigue, weight loss, low-grade fevers, night sweats, and a persistent cough that worsens and may produce blood.

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Chronic Bronchitis

A chronic lung condition characterized by inflammation and obstruction of the bronchi, often caused by smoking or exposure to pollutants. It leads to persistent cough, frequent infections, and difficulty breathing.

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What are the effects of Chronic Bronchitis?

Irreversible and progressive lung disease where the bronchi are constantly irritated, leading to inflammation, obstruction, and chronic coughing. It can cause significant changes in the bronchi.

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What are 'blue bloaters'?

Patients with advanced Chronic Bronchitis often have a bluish tint to their skin (cyanosis) due to low oxygen levels. This is often coupled with edema, and their appearance has been described as "blue bloaters".

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What are rhonchi?

The thickening of bronchial walls and increased secretions in Chronic Bronchitis lead to difficulty clearing mucus, resulting in pooling and a more pronounced wheezing sound called rhonchi.

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What are the cardiovascular consequences of Chronic Bronchitis?

Chronic Bronchitis can lead to high blood pressure in the arteries of the lungs, known as pulmonary hypertension, which puts extra strain on the heart.

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Acute Respiratory Failure

A condition where the body does not have enough oxygen or cannot eliminate enough carbon dioxide, leading to a failure of the respiratory system.

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Supraglottic Airway (SGA)

A type of airway device inserted into the pharynx to provide oxygen and ventilation, often used when other airway methods are ineffective.

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King LT Airway

A type of SGA that uses balloons to create a seal in the pharynx and esophagus, allowing for direct ventilation.

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Laryngospasm

A common complication of SGA insertion that involves the larynx spasming, making breathing difficult.

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ETCO2 Waveform

A method used to confirm SGA placement, where the device is connected to a capnography monitor to measure exhaled CO2.

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Study Notes

EtCO2

  • The process by which oxygen and carbon dioxide diffuse in and out of the blood
  • Also referred to as gas exchange occurring in two areas of the body—external and internal
  • External Respiration: gas exchange across respiratory membrane in the lungs
  • Internal Respiration: gas exchange across the respiratory membrane in metabolizing tissues (e.g., skeletal muscles).

Ventilation

  • Pulmonary Ventilation: the process by which oxygen enters and carbon dioxide exits the alveoli
  • Ventilation is the act of inhaling and exhaling.

Oxygenation

  • Refers to the act of adding oxygen to the body.
  • It explains how oxygen reaches the tissues.

SPO2

  • Saturation of peripheral capillary oxygenation
  • Pulse oximetry measures oxygen saturation levels
  • Noninvasive measurement using a finger probe
  • Indicates the percentage of oxygen bound to red blood cells
  • Note: changes in ventilation can take minutes to be detected; motion and circulatory status might cause artifacts/influence results; nail polish can also cause artifacts.

EtCO2

  • Measures ventilation status
  • Noninvasive measurement of patient's ventilatory status
  • Provides results within seconds
  • Not affected by motion or circulatory status
  • 100% sensitive and 100% specific

Dead Air Space

  • Ventilated areas not involved in gas exchange.

Capnography

  • Represents CO2 in exhaled air
  • Partial pressure of CO2 at exhalation
  • Normal range: 35-45 mmHg
  • Used with nasal prongs or attachment to BVM

Respiratory Effort

  • Healthy lungs: brain responds to CO2 levels controlling ventilation
  • Assessed through chest rise and fall, respiratory effort, breath sounds, and counting respiratory rate
  • As CO2 increases, respiratory rate should increase to blow off CO2
  • As CO2 decreases, respiratory rate should decrease to retain CO2

General Considerations

  • ETCO2 below 35mmHg indicates hyperventilation/hypocapnia. Hypoventilation is required to increase CO2 levels.
  • ETCO2 above 45mmHg indicates hypoventilation/hypercapnia. Hyperventilation is required to decrease CO2 levels.

Why use Capnography?

  • To assess when a patient is ventilated (e.g., with a SGA or ETT), using two primary and one secondary criteria.
  • Primary: Visualization, Auscultation, and Chest rise
  • Secondary: EtCO2, and EDD (other secondary criteria).

Other Considerations

  • PaCO2: Partial pressure of carbon dioxide in arterial blood gases (ABGs). Correlates with PetCO2 when ventilation and perfusion are stable.
  • Waveform: Capnogram begins before and ends with inspiration (A-E phases).
    • Phase 1 (A-B)—inspiratory baseline (low CO2)
    • Phase 2 (B-C)—exhalation upstroke (dead space gas mixes with lung gas)
    • Phase 3 (C-D)—continuation of exhalation (alveolar gas now rich in CO2)
    • Phase 4 (D-E)—start of inspiration.
  • Abnormal Values/Waveforms: Sudden loss of waveform could indicate disconnection or obstruction, a loss of circulatory function, and decreasing ETCO2 indicates potential issues such as a cuff leak, the tube being in the hypopharynx, or partial obstruction of the airway.
  • Sudden Increase in ETCO2: Indicates the return of spontaneous circulation (ROSC) or possible bronchospasm (Shark Fin Appearance).
  • Causes of Decreased ETCO2: Apnea and sedation are common causes.
  • Causes of Increased ETCO2: Hyperventilation and hypoventilation are possible causes.

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Description

Test your knowledge on capnography and its importance in assessing ventilation status in patients. This quiz covers key concepts such as ETCO2 levels, capnogram phases, and the implications of various waveform appearances. Perfect for healthcare professionals and students in respiratory science.

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