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  • UAS Kritis 1 (T4) - Monitoring Fungsi Pernapasan - Bu HY

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    Uswatun Khasanah
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    kritis

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    10 views13 pages

    UAS Kritis 1 (T4) - Monitoring Fungsi Pernapasan - Bu HY

    Uploaded by

    Uswatun Khasanah
    kritis

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF or read online from Scribd
    Flag for inappropriate content
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    28/12/2015 (se, Physiology of respiration a Pulse Oximetry aig Respirator patio ( anestnosia creuit ka gS Pulmonary creulation owen trent ~ rth conpiuaitycthinmeasn CO ea am 7 ones co,| Doses negin cots onney/ How dows trey work? y Vy ahou Vea Venilior creut Sy Oximetry History = Becam 1980's = 1935 Carl Mathes first oximeter 1940 JR. Squires self calibrating oximeter jandard of care in the Oxygenation ‘TObjective: ‘ensure adequate oxygen concentration in inspired "988 and blood {3 Montoring ‘Lined gas oxygen analyzer with alarms (GA) 2Anerilonygen saturation(Sp02) 3 Atrial onygen tension(Po2), Oximetry History (Cont'd) + 1940's Glen Milliken aviation ear ~oximeter for use in avitation research to investigate high altitude hypoxie problems, -1964 Robert Shaw(surgeon) built a self caliberating ear oximeter Which was marketed by Howlett Packard in 1970 for Use in physiology and cardiac cathtorization laboratories Terminology Review *'Sp0, . Non invasive oxygen saturation + Sa0, + Arterial (invasive)Oxygen Saturation (oxygen bound to the hemoglobin molecules) = PaQ2. Arterial Partial Pressure, ‘oxygen dissolved in the plasma (only about 3% of total content) or PO2 = Ca02: Total amount of oxygen in the blood or the (S202. PaO. ay = Oxygen Saturation * Percentage of hemoglobin saturated with oxygen + Normal SpO2 is 95-98% + Suspect cellular perfusion compromise if less than 92% SpO2 Insure adequate airway Provide supplemental oxygen Monitor carefully for further changes and intervene appropriately What are the Normal? += 97-100% sat Good gas exchange + 90-95% sat: Mild hypoxia = <90% sat Severe hypoxia + Not all patients are the same = COPD = Anemia PULSE OXIMETRY: WHAT DOES IT DO? + MEASURES/DISPLAYS a -02 SAT OF HbG. - PULSE RATE. ~ INDICATES PERFUSION ~ PULSATE FLOW Pros of Pulse Oximeters PROS * Non-invasive = Allows continuous measurement in real time = Easy to use 28/12/2015 — eats CONS + Measures Hb saturation rather than the actual level of Hb, Only measures. ‘oxygenation status. + Does not detect carbon dioxide levels in the blood. C02 determines the ventilation status. + Measurements are not always accurate. Inaceuracy may occur due to nail polish light Interference, poor peripheral perfusion, Intravenous dyes, the presence of Carboxyhemogiobin and hemogiobinopathies, Cons of Pulse Oximetry am {8% Indications for Pulse Oximetry + Uses of Pulse Oximetry generally fall into two categories Real Time Indicator of hypoxemia End point for titration of therapeutic interventions. + # —Pros/Cons of an arterial blood gas PROS cons * Accurate * Invasive + The gold standard + Not easy to perform for measuring fon a patient respiratory status + Does not reflect measurements in realtime status Technology he pulse oximeter has Light-emitting diodes (LEDs) that produce red and infrared light + LEDs and the detector are on opposite sides of the sensor = Sensor must be place so light passes through a capillary bed Requires physiological pulsatile waves to measure saturation Requires a pulse or a pulse wave (Adequate CPR) Objectives * Understand how a pulse oximetry works (technology) * Define normal and abnormal pulse oximetry readings. * State the indications and limitations when Using a pulse oximetry in anesthesia ,POCU and ICU, = les Pulse Oximetry + Principle of operation -1 28/12/2015 ay ee Pulse Oximetry Optical plethysmography detects pulsatile changes in blood volume aSpectrophotometry measures pulsatile hemoglobin saturation Assumptions all pulsation is arterial light passes through pulsatile beds BEER-LAMBERT LAW ASSUMPTIONS: = LIGHT PASSES AS A COHERENT BEAM - DOES NOT SCATTER. * SOLUTIONS ARE HOMOGENEOUS - TISSUE DENSITY IS CONSTANT. * OPTICAL PATH LENGTH IS “PACKETS” GENERATED IN 4 SECOND. (HEIGHT OF THE WAVE). (Lux) + CYCLE - ACTIVITY FROM ONE PEAK CONSTANT. aaa = Lambert’ Law DEFINITIONS a ~—s«Beer - Lambert L + WAVE LENGTH - DISTANCE FROM Incident an ‘ONE PEAK TO THE NEXT. iow absorbing sample of |" (NANOMETERS) 2 : + INTENSITY -# OF ENERGY L Concentration ¢ I => THE ABILITY OF A SUBSTANCE TO ABSORB SPECIFIC PORTIONS OF THE LIGHT SPECTRUM, + WAVE THEORY - LiGHTIS A CONTINUOUS STREAM OF ENERGY WHICH VARIES IN AMPLITUDE AT SPECIFIC FREQUENCIES. + PACKET THEORY- LIGHT IS. ‘BUNDLES’ OF ENERGY MOVING AT TO THE NEXT. (CYCLESISEC = HERTZ) + FREQUENCY - # WAVES PER “+ path length b —> SECOND. (CYCLESISEC) = |e: DEFINITIONS(cont...) f Physics (Beer-Lambert law) “+ LIGHT EXTINCTION/ABSORPTIO! SPECIFIC FREQUENCIES, = Bears laws ‘The concentration of a liquid is exponentially Felated to tho intensity of ight that will pass through it. ae m + Lambert s Low: The distance of light t is exponent that will pa led through the liqui ily related to the Intensity of ligh through it er ~ Oxygenated hemoglobin sbsorbe a cliferent wavelength of light than does deoxygenato. Lbigag "ot" of te ee 28/12/2015 Beer-Lambert Law vans = tine A Iivans = intensity of tansmited ight Vine sty of inlgent ght fraction of ight absorption. + = stance lght ansmited tought he Rous Gam ionain FP arconraton of sttetemontin i ‘extinction coeficent of the solute {@ constant fora given acute spetiog waters PULSE OXIMETRY: HOW DOES meetiT WORK? As! "LR. PHOTOSPECTROMETR’ - HEMOGLOBIN ABSORBS LIGHT. - THE ABSORBED LIGHT VARIES WITH: * OXYGEN SATURATION * TYPE OF HEMOGLOBIN * LENGTH OF THE OPTICAL PATH. iam Photospectrometry 45} ‘Photospectrometry is a method of using light emission or absorption to determine the composition of substances. It generally involves the use of light emitters and receptors coupled with signal analyzers. fa PULSE OXIMETRY: HOW x DOES IT WORK? (cont.) ABSORBENCE CAN BE CALCULATED * EXTINCTION CO-EFFICIENTS. * OPTICAL DENSITY EQUATIONS * BEERS-LAMBERT EQUATION =a {M2 WHERE Do We USE ~ PHOTOSPECROMETRY? = Pulse OXIMETRY = Capnography = Capnometry = Co-OXIMETRY = Mass Spectrometry = Serum Glucose (glycolated Hb 2Ac) Hee Concept of Pulse Oximetry 28/12/2015 —>__ Pulse Oximetry Eeaa ee [BBE cst princine of sPo2 So wavelngte (20 and 960) ‘Staats inctonaleaturaton (ysl satiation Pulse oximeter Photodetector ‘Apulse oximeter estimates the amount of oxygen carried in the bloodstream using, Infrared technology across the skin : rs. Pulse Oximetry principles ae Pulse Oximetry a + First Principle of operation - Two main principles: — * First Principle of operation ~ 1 Infrared absorption by oxygenated and de- ‘oxygenated haemoglobin at 2 different wavelengths Hb EXTINCTION CURVES ‘= Oxygenated blood and deoxygenated blood absorb different light sources ‘Oxyhemoglobin absorbs more infrared light Reduced hemoglobin absorbs more red light, Pulse oximetry reveals arterial saturation my measuring the difference. ISOBESTIC POINTS. 28/12/2015 How does it work? * Since there are only two frequencies of light, only two substances can be distinguished. * This comparison is defined as functional saturation" OR SPo2=_*%axyhomoglobin oxyhemesiobin + reduced hemoglobin — ms ABSORPTION SPECTRA 1 os i ss CALCULATION OF SaO2 +02 Hb FRACTION = —Aes| O2Hb O2Hb + RHb + MetHb + HbF + COHb + 02 SAT OF AVAILABLE Hb = 02 SAT= _02Hb (O2Hb + RHB ‘The difference botween 02 sat and 02 Hb fraction is (MetHb + HbF + COHb + Hbx) Pulse Oximetry ‘+ Second Principle of operation - 2 ‘The success of pulse oximetry depends on its ability to measure the saturation of the arterial blood by analysis of infrared absorption of vascular bed throughout the whole pulsatile pulse cycle. jaracteristics of Common H 2 ae Spectrophotometric Name Symbol Nermal(%) Peak (nl Oxy OzHb 97 530 Reduced RHb

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