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66 Cards in this Set
- Front
- Back
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Hypothermia occurs at what temperature
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36 deg. C 96.8 deg. F
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What area of the brain controls body thermostat?
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anterior/preoptic hypothalamus
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What fibers carry cold sensations?
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A delta fibers
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What fibers carry heat sensations?
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unmyelinated C fibers C fibers also carry pain impulses, so body can't tell pain from intense heat
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Rank order of forms of heat loss (most to least)
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Radiation Evaporation Convection Conduction
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Sympathetic mediated response to heat loss
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Inc. reased BMR, increased thyroxine secretion from thyroid
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Vascular response to heat loss
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vaoconstriction, AV shunt to deeper tissues, piloerection
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Neonate response to heat loss
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NE secretion and increased Brown fat thermogenesis Neonates cannot shiver!!
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Primary means of heat production in adult
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shivering Can increase metabolic demand up to 500%
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Pt population with greater body surface area to weight ratio
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Neonates
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Age related changes in temp. management
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Thin skin, dec. BMR, dec. sympathetic response
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Most accurate non-invasive core temp. measurement
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Esophagus Best combination of performance and safety
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Most accurate core temp. measurement
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PA catheter
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Effect of hypothermia on ODC
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shift to left
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Therapeutic hypothermia temp.
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33-35 deg. C 91-95 deg. F Decreases metabolic demands during ischemic time to prevent damage
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Causes of hyperthermia
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thyroid storm pheochromocytoma malignant hyperthermia sepsis Transfusion reaction ETOH withdrawl Impaired sweating Operative stimulation Tumor comp. of hypothalamus
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Malignant hyperthermia
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Occure w/ inh. anesthesia/sux 1 in 50,000 Genetic disorder: Ryanodine 1 Stop agent, dantrolene, cool body, give O2, support
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Temp. for heat stroke
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105-108 deg F
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Treatment for postop shivering
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Miperidine & warming
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Phase 1 of heat loss
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1 hour heat transferred away from core to periphery, no vasoconstriction due to anesthetic induced vasodilation
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Phase 2 of heat loss
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2-4 hours heat loss exceeds production
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Phase 3 of heat loss
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equilibrium heat loss = heat production
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Causes a burn pt. to lose the most heat?
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Evaporation
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Supports, insulates & protects against heat loss
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Skin
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Location of center for heat loss
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Anterior preoptic hypothalamus
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Location of center for heat gain
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Posterior hypothalamus
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Why does hypothermia decrease RR?
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CO2 production drops, and CO2 level provides respiratory drive
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Why does hyperthermia increase RR?
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CO2 production increases, and CO2 level provides respiratory drive
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Blood flow to spinal cord
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Anterior artery, 2/3 2 posterior arteries, 1/2
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Minimum frequency for BP & HR measurement during anesthesia
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q 3-5 min.
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Method using pulsations of blood flow on inflated cuff to measure BP
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Oscillometric BP
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Doppler effect
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Change in sound frequency when source moves relative to observer
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Method of using turbulent flow sound to determine blood pressure
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Auscultated BP
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Turbulent flow sounds
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Korotkoff sounds
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Gold standard for arterial BP measurement
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intra-arterial monitoring
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Variations of BP during respiratory cycle
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Pulsus alternans Indicated hypovolemia
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Wavelength that oxyhemoglobin absorbs infra-red light
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940nm
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Wavelength that deoxyhemoglobin absorbs visible red light
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660nm
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Beer-Lambert Law
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There is a linear relationship between absorbence and concentration of an absorbing species
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Pressure at which 50% of Hgb is saturated (P50)
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27 mmhg
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Every 1 mmHg drop on pressure = _______drop in O2
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3%
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Sat below which pulse ox is no longer accurate
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70% (cyanosis) Blood is shunted away from skin to vital organs
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Pa02 of 30 = SaO2 of Pa02 of 60 = SaO2 of Pa02 of 85 = SaO2 of
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60 90 96.5
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Location for pulse ox probe with least amount of lag time between oxygenation changes and display changes
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Ear lobe Finger 2nd
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Cause of continuous sat of 85% unresponsive to increase in FiO2
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CO Poisoning
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COHgb effect on Sat
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Gives false high because COHgb absorbs infra-red light at same wavelength (660nm) as oxyhemoglobin
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Methemoglobin effect on Sat
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Gives false high if sat is less than 85% and false low if sat is above 85%
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Gold standard for ETT placement
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Capnography
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CO2 / PaCO2 relationship
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within 5-7 mmHg of each other
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Issue?
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Rebreathing due to exhausted CO2 absorbant
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Issue?
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Rebreathing due to exhausted CO2 absorbent
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Issue?
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Reactive airway
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Issue?
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None. Normal Mechanical vent. waveform
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Issue?
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Reactive Airway/Possible Apnea
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Issue?
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None. Normal Spontaneous breathing pattern
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3 methods of etCO2 measurement
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Infrared Absorption Mass Spectrometry Calorimetric detection
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Only location in the body where CO2 is located in large quantities
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Lungs
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Calorimetric detection
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Easy cap Turns yellow when exposed to CO2 (only determines Presence of CO2)
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Mass Spectrometry drawbacks
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Always have a leak pooled equipment Expensive H2O and drugs may damage unit
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Mass Spectrometry advantages
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Measures CO2, Inh. Agent and O2 indpendently
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Mass Spec. draw for sampling
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~150ml/min for adults ~50ml/min for peds
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Causes of decreased etCO2
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Dead Severe bronchospasm Decreased metabolism
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4 parts of ventilation assessment
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visual inspection-chest mvmt. vol. of gas-spirometry alarms-audible metabolic byproducts-etCO2
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Most common location for vent. cicuit disconnect
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y-piece
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Causes of increase etCO2
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Rebreathing Increase metabolic process hypoventilation
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Relationship between FiO2 and PaO2?
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PaO2 is roughly 5x the FiO2 If not, then there is a V/Q mismatch
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