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Sp: PMI > 1. Anesthesia Machine > Flashcards

1. Anesthesia Machine Flashcards

1
Q

ASA mandated monitored levels

A

oxygenation
ventilation
circulation
temperature

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2
Q

blood pressure

A

pressure exterted by blood aginst the interior walls of blood vessels

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3
Q

sytolic pressure

A

systole

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4
Q

diastolic pressuyre

A

diastole

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5
Q

why is BP monitoring important

A

how we measure whether or not the patient is being adquately perfused

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6
Q

normal BP

A

120/80 mmhg

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7
Q

hypertenstion

A

> = 140/90 mmhg

high bp

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8
Q

hypotension

A

<= 90/60 mmhg

low bp

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9
Q

mean arterial pressure

A

the avg pressure in a patients arteries during one cardiac cycle

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10
Q

mean arterial pressure calculation

A

MAP = [(2*diastolic BP)+Systolic BP]/3

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11
Q

normal MAP

A

70-100 mmHG

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12
Q

pulse pressure

A

systolic pressure minus diastolic pressure

S-D

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13
Q

normal pulse pressure

A

30-40mmHG

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14
Q

ECG measures

A

heart rhythm

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15
Q

normal HR

A

60-100

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16
Q

tachycardia

A

> 100

high HR

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17
Q

bradycardia

A

<60

low HR

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18
Q

pulse oximetry

A

SpO2
percentage of heme saturated w/O2

“oxygen saturation”

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19
Q

normal SpO2

A

93-98% (on room air)

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20
Q

end tidal CO2

A

EtCO2

amount of CO in expired air

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21
Q

normal EtCO2

A

35-45mmHg

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22
Q

capnograph (EtCO2) monitor functions

A

reveals pts EtCO2
reveals pts RR

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23
Q

respiratory rate

A

RR

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24
Q

spontaneously breathing RR

A

12-20 breaths per min

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25
Q

increase pain

A

increase RR

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26
Q

narcotics

A

decrease RR

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27
Q

normal RR on ventilator

A

8-12 breaths per min

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28
Q

ventilator RR is slower than spntaneous because

A

ventilator tidal volumes are largert than spontaneous tidal volumes

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29
Q

room temp

A

23 C

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30
Q

core body temp

A

36-38C

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31
Q

purposes of anesthesia machine

A
  1. Positive pressure ventilation (PPV)
  2. anesthetize pt w/inhaled anesthetic gas
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32
Q

2 types of anesthetic gases

A

volatile agents
fresh flow gasses

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33
Q

volatile agents

A

keep pts anesthetized during surgery

stay asleep

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34
Q

types of volatile agents

A

sevo
des
iso

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35
Q

fresh gas flow types

A

O2
air
NO2

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36
Q

fresh gas flow

A

picks up and delivers volatile agent to the pt

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37
Q

O2 (fresh flow gas)

A

higher FiO2 compensates for atelectasis

some pts (lung pathology) need higher FiO2 to have adquate O2 saturation

higher FiO2 allows patient to mx adequate O2 saturation for longer periods during unexpected apnea

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38
Q

NO2 (Fresh flow gas)

A

only anesthetic gas that has analgesic properties

allows anesthetist to use lower concentrations of volatile agent

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39
Q

Air (fresh flow gas)

A

too much oxygen for too long can be toxi

higher FiO2 can cause absorption atelectasis

FiO2 above 30% and/or NO2 increase risk of airway fire

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40
Q

wall supply pressure

A

50psi

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41
Q

pt gas pressure

A

16psi

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42
Q

Diameter index safety system

A

DISS

prevents NO2 from connecting to O2 line for wall connections

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43
Q

Pin Index safety system

A

PISS

prevents connecting machine to worng gas tank

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44
Q

Flowmeter mechanical proportioning system

A

built in system that limits the % of NO2 that can be given to a pt

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45
Q

max NO2:O2 ratio

A

3:1

75% NO2
25% O2

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46
Q

Low pressure pathway order

A

Flowmeters
Common Manifold
Vaporizers
Fresh gas outlet
Inspiratory tubing
Patient
Expiratory tubing
Rebreathing bag/vent
CO2 absorber/APL valve
Exhaled gas joins fresh

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47
Q

rebreathing

A

pt rebreathes their own exhaled gas

circle system

new fresh flow is contantly added

pt continually rebreathes gas they exhale

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48
Q

rebreathing causes pressure to

A

increase

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49
Q

why do we need positive pressure

A

to ventilate!

50
Q

we dont want circuit pressure to be too high

A

lungs overinflate

51
Q

scavenging system

A

takes excess gas away from the circuit

controls the amount of pressure inside the circuit

52
Q

too much gas going to scavenging

A

circuit pressure might be too low

53
Q

too little gas going to scavenging

A

circuit pressure might be too high

54
Q

how do we control amount that goes to scavenging

A

APL valveA

55
Q

Adjustable Pressure Limiting Valve

A

control the amount of pressure inside the circuit by controlling the amount of gas that goes to scavenging

56
Q

close APL

A

increase P
clockwise

57
Q

open APL

A

decrease P
counter clockwise

58
Q

airway pressure units

A

cmH20

59
Q

as volume goes into lungs

A

pressure increases inside lungs and circui

60
Q

APL valve open, pressure gauge reads

A

0

61
Q

APL valve closed, pressure guage reads

A

increase in pressure

62
Q

max pressure when ventilating via mask or LMA

A

20cmH2O

63
Q

max pressure when ventilating via ETT

A

40cmH2O

64
Q

high pressure pathway of O2

A

carries fresh flow gas to flowmeters before pressure reduces
can bypass flowmeters w/oxygen flush valve

65
Q

oxygen flush valve

A

allows 50psi to enter circuit quickly
allows rapid pressure increase

used in circuit leaks

66
Q

if there is a circuit leak

A

wont be able to build up pressure in circuit or ventilate pt

67
Q

finding leak

A
  1. trace circuit away from pt
  2. if you cant find cause of leak, its likely the ETT cuff
68
Q

ways to increase circuit pressure

A
  1. turn up fresh gas flow (increase FR, increase P)
  2. close APL
  3. oxygen flush
  4. avoid leak in circuit
69
Q

bag mode

A

manual/spontaneous mode

ventilator is not turned on

all exhlaed gas flows through breathing bag

70
Q

when pt inhales

A

breathing bag deflates

71
Q

when pt exhales

A

breathing bag inflates

72
Q

when do we use manual/spontaneous mode

A

if pt is breathing on own

73
Q

when do we use ventilator mode

A

if pt has no drive to breath

respiratory depression

74
Q

ventilator mode

A

ventilator on
delivering positive pressure breaths

both breathing bag and ventilator are part of circuit

75
Q

what controls APL valve/amt pressure in circuit when mask breathing

A

anethetist

76
Q

what controls APL valve/amt pressure in circuit when ventilator breathing

A

anesthesia machine

77
Q

when to use breathing bag

A

short duration
pt not intubated

78
Q

when to use ventilator

A

long duration
pt intubated

79
Q

common situations for mask ventilation

A
  1. after induction before intubation
  2. mask induction
  3. failed intubation
  4. unexpected apnea
80
Q

spontaneous ventilation

A

pt breathing on won

81
Q

spontaneous ventilation machine modes

A

manual/spontaneous
pressyure support mode

82
Q

assist ventilation

A

provide larger breath (Vt) than if pt was breathing entirely on their own

deliver breath right as pt starts to inhale

83
Q

pressure support mode

A

auto assist ventilates every spontaneous breath

decreases likelihood of atelectasis

switch to manual prior to extubation to verify Vt

84
Q

mechanical ventilation

A

anesthetist breathing for pt w/ PPV

delivered by squeezing bag or using ventilator mode

85
Q

What does the Anesthetist program on the ventilator:

A
  1. set respiratory rate
    • 8-12 breaths/min
  2. set tidal volume
    • 6-8 mL/kg
86
Q

how to help pts tolerate ventilator

A
  1. Muscle rlaxants
    (long term)
  2. high dose narcotics
    (long term)
  3. propofol (short term)
87
Q

tidal volume

A

how big of a breath we decide to give pt

6-8mL/kg

88
Q

higher tidal volume generates

A

higher inspiratory pressure

89
Q

Vt / P relationship

A

directly proportional

90
Q

respiratory rate

A

how many breaths per minute we tell ventilator to give

8-12 breaths/minrespir

91
Q

respiratory rate determins

A

how long each breath is

92
Q

RR 20

A

each breath is 3 seconds

93
Q

RR12

A

each breath is 5 seconds

94
Q

slower respiratory rate

A

longer each breath
longer inspiratory time
lower pressure

95
Q

faster respiratory rate

A

shorter each breath
shorter inspiratory time
higher pressure

96
Q

peak inspiratory pressure (PIP)

A

max pressure allowed to be generated in chest with ventilator breath

stay under 35-40cmH2O

97
Q

causes of high PIP (8)

A
  1. Right mainstem intubation
  2. bronchoconstriction/
    bronchospasm
  3. coughing/bucking on ventilator
  4. trendelenburg posn
  5. insufflation of abdomen
  6. increased resistance through ETT
  7. too high tidal volume
  8. too fast respiratory rate
98
Q

ETT diameter

A

smaller: high resistance
larger: lower resistance

99
Q

Positive End Expiratory Pressure (PEEP)

A

leave a small amount of PP in the lungs at the end of expiration

prevents atelectasis

normal: 5cmH2O

only on ventilator

100
Q

Continuous Positive Airway Pressure
(CPAP)

A

leaves small amount of positive pressure in circuit at all times

constant PEEP

only in manual mode

101
Q

Common uses for CPAP

A
  1. recovery room for sleep apnea
  2. nighttime CPAP mask
  3. preoxygenation for obsese pts
  4. lung surgery intubation
  5. laryngospasm: jaw thrust w/cpap mask
102
Q

I:E Ratio

A

amount of time that is allotted for each inspiration and expiration in one breath

103
Q

normal I:E ratio

A

1:2

expiratory time is 2x as long as inspiratory time

104
Q

inspiratory time and expiratory time are

A

inversely proportional

105
Q

prolong inspiration

A

shorten expiration

106
Q

prolong expiration

A

shorten inspiration

107
Q

slow RR

A

longer inspiratory/expiratory times

108
Q

fast RR

A

shorter inspiratory/expiratory times

109
Q

increasing inspiratory time

A

lowers peak airway pressure

shortens expiratory times (air trapping)

110
Q

AUTO PEEP

A

air trapping
lungs cant exhale fully
due to short exhalation time

over time the lungs can overinflate
PIP increase
difficult ventilation

111
Q

decreasing inspiratory time

A

PIP increase

vent has to push harder/faster to force breath over shorter time

112
Q

inspiratory time

A

Ti

113
Q

normal Ti

A

2 seconds (adults)

0.3-0.5s (neonates)

114
Q

Ti vs PIP

A

inversely proportional

115
Q

volume control ventilation

A

anesthetist sets tidal volume
vent will deliver Vt regardless of the pressure needed to do so

you can set pressure guard to limit amount of PP the vent will deliver

116
Q

Volume control ventilation problems

A
  1. can gen high PIP
  2. accidentaly overinflation of lungs if you forget to change Vt
117
Q

Pressure control ventilation

A

anesthetist sets the amt of PP they want to be generated with each vent breath
lungs expand until that pressure is reached

118
Q

Pressure control ventilation (advantages)

A

lungs should never become overinflated

119
Q

pressure control ventilation problems

A

you have to tinker with the pressure to adjust tidal volume to be appropriate for weight

tidal volumes can change in surgery

120
Q

If pressure is constant, volume and resistance are

A

inversely proportional

increase resistance, less volume can go to lungs

decrease resistance, more volume go to lungs

Sp: PMI (18 decks)

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