The Monitoring Of End Tidal Co2

PCO2 decreased during rapid breathing because more CO2 was removed from the blood than normal. Each breath expels a certain amount of CO2. If the breathing rate increases, then more CO2 is expelled.

-Use of indiscriminate sedatives, benzos, and opioid’s, especially in post-op patient who retains Co2, may suppress the ventilator drive and lead to respiratory failure

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

The Ventilatory threshold was reached at 5 minutes or stage 3 for patient 92 C. The ventilatory threshold is important because it indicates the point at which the blood lactate acid increases non-linearly. It indicates that there is an increase in the lactate acid level in the blood as well as the excess carbon dioxide (Kenny et al., 2015). The increase in carbon dioxide will stimulate chemoreceptors to increase ventilation. The ventilatory threshold is related to the anaerobic threshold which refers to the increase in carbon dioxide and indicates that the body has shifted towards anaerobic metabolism (Kenny et al., 2015).

Developed in 1941, the American Society of Anesthesiologists (ASA) classification was created to establish a scoring system (I to V) for the evaluation of a patient’s general health and comorbidities immediately before an operative procedure. (Sakad, Keats) This score is designed to identify surgical patients at risk for developing postoperative complications, taking into account the patient’s physical state and neglecting the surgical impact (type, complexity and urgency). It has been established as a significant predictive factor for perioperative risk assessment, perioperative mortality, complication rates, and postoperative outcomes in multiple surgical specialties. ( Menke, Wolters, Prause, Conners) Similarly, our data shows a good predictability of mortality by the ASA PS. It has undergone slight modification by the ASA to a scale of 6 numbers and is now widely used for preoperative

If a doctor notices an imbalance or symptoms, such as shortness of breath, difficult breathing, confusion, and nausea, an arterial blood gas analysis or commonly known as ABG, is order for further evaluation. An ABG is performed to measure the partial pressure of oxygen (PaO2), carbon dioxide (PaCO2), and the pH of an arterial blood sample. Other values measured in a ABG are oxygen content (O2CT), oxygen saturation (SaO2), and bicarbonate (HCO3-). In an ABG blood is taken from an artery in your wrist, arm, or groin. Once the sample is taken, the doctor will be able to diagnose several diseases. If the values are out of range one must know the functional ranges which are, PaCO2 (35-45mmHG), pH (7.35-7.45), and HCO3 (22-26mEq/L) should express a high/lower number than what is

Although ventilation is not usually provided during the apnoeic period, some anaesthetists will give a single breath, or several gentle breaths, to both confirm that mask ventilation is possible and reduce the development of hypercapnia, acidaemia, and hypoxia. Some guidelines advocate use of mask ventilation for this reason in patients at elevated risk of hypoxia, for example, the pregnant patient.4,5

Decreased cerebral perfusion as a risk factor for postoperative delirium is supported by a recent study which associated low preoperative regional oxygen saturation as measured by a cerebral oximeter (Morimoto et al., 2009).

When a patient can exhale only a small volume, all lung volumes will be smaller than normal, including FVC and FEV1 (REF 16). With COPD, there is obstruction of the airways, which slows respiratory flow (REF 16). With the increased airway resistance and decreased expiratory flow rates, FEV1 is reduced (REF 16). With the airway obstruction in the bronchioles causing air trapping in the lungs, FVC is also reduced (REF 16).

Patients should be able to respond, be aware of surrounding (Liddle, 2013). In this case, Ajay after roused, reported of feeling cold dry mouth, cried and complained of pain, which shows that he was awake. Whereas, level of consciousness vary with depths and time as it depend on many factors such as anaesthetics, duration of surgery and patient’s pain stimulation (Sinclair & Faleiro, 2006). As stated above, opioid is known as respiratory suppressants and it produce analgesia via receptors. Those are two factors that affect on consciousness level. Additionally, Sinclair & Faleiro (2006) also found temperature contribute in delaying recovery of consciousness. Neurological and respiratory disturbance affects brain tissue. This changes explain Ajay’s temperature is hypothermia with 35.0oC thus affect his consciousness level. Nevertheless, other study argued that long period of time patients been in theatre and anaesthesia leads to hypothermia (Liddle, 2013). Furthermore, Ajay has symptoms of thirst, drowsiness and confusion, which could be caused by uraemia results in dehydration in loss of blood or fluid during surgery (Sinclair & Faleiro,

The pneumonia in Mr Smith’s right lung is causing inflammation of the parenchyma, leading to consolidation in the alveoli that is restricting compliance and oxygen diffusion.1 This results in a mismatch of ventilation/perfusion (V/Q) in Mr Smith’s right lung, one of the most common causes of hypoxia, or low partial pressure of oxygen in arterial blood (PaO2), as V/Q match is critical for efficient gas exchange.1

SAQ2. Why is it important when measuring a subject’s FEV that they only perform the measurement after a maximal inspiration? What kind of respiratory condition

One of the many benefits is monitoring the effectiveness of CPR that is favored among paramedics, continuous monitoring in Emergency Rooms and ICU during ambulatory transport for confirmation of accurate placement of ETT (endotracheal tube). It offers a rapid alarm for ventilator disconnection which is identified by a flat line on the capnogram. It also provides an early warning signs of shock, displaying a decreased numeric value in ETCO2. This has implications with any patient that is at risk for shock, especially trauma and cardiac patients. Patients who are suffering from hyperthermia when their metabolism is suppressed and their internal temperature is on critical overdrive--increasing their ETCO2 levels significantly. ETCO2 is also used among asthmatic patients and those with anxiety disorders by teaching them how to effectively control their breathing. Furthermore, it has been verified that in postoperative patients especially “high risk”-those with obstructive sleep apnea and those receiving high doses of opioids for pain management are more of an increased risk of adverse respiratory events and through proper patient monitoring through use of ETCO2 can prevents such undesired events. “Capnography can serve as a rapid assessment and triage tool for critically injured patients and victims of chemical exposure. It provides the ABCs in less than 15 seconds.”-Krauss, Heightman, JEMS,

Therefore, PC can be considered a component of protective strategies for lungs.3 As several studies have shown that limiting the peak pressure spares more normal areas of the lungs from overinflating. During pressure control ventilation change in lungs characteristic such as compliance and airway resistance would cause changes in volume and flow.1-3 However, this is opposite during volume control ventilation. Consequently, change in lung characteristics would cause changes in pressure. For instance, increasing airway resistance will increase the amount of pressure require to deliver the volume, thus increasing the peak airway pressure. The major disadvantage of PC is that the tidal volume and minute ventilation or volume per minute (VE) reduces when lungs characteristics

Providing anesthesia for lung transplantation (LT) is considered by many to be a major feat in cardiothoracic anesthesia. Some say it involves the most complex manipulation of cardiothoracic physiology, especially when cardiopulmonary bypass (CPB) is not used. There are many indications for end-stage pulmonary disease, from obstructive lung disease to pulmonary vascular disease. Traditionally, ventilation strategies for this population included tidal volumes of 8-12ml/kg to prevent atelectasis and zero PEEP to prevent a shunt of blood flow (Slinger, 2012). This strategy proved to cause harm during the periorperative period. Research now indicates that a reduction in tidal volume with added PEEP not only decreases atelectasis, but it also reduces pulmonary inflammatory response (Coppola, Froio, & Chuimello 2014). These patients already have a decreased respiratory reserve, therefore inducing an inflammatory mediated response with ventilation settings can be detrimental and should be avoided at all costs by the nurse anesthetist. It is imperative for the nurse anesthetist understand the necessity of lung protective ventilation strategies in LT.