Anesthesia Ventilators (Kane) Exam 3 Flashcards
1
Q
What are anesthesia ventilators primarily designed to do?
a) Monitor patient vitals
b) Administer medication
c) Ventilation and oxygenation
d) Measure blood pressure
A
c) Provide/augment patient ventilation and oxygenation
Slide 2
2
Q
On anesthesia workstations, what does the ventilator replace?
a) Flowmeter
b) Vaporizer
c) Reservoir bag
d) Pressure gauge
A
c) Reservoir bag
Slide 2
3
Q
What type of ventilation did older ventilators primarily provide?
a) Pressure control ventilation
b) Controlled mandatory ventilation (CMV)
c) Assist-control ventilation
d) High-frequency ventilation
A
b) Controlled mandatory ventilation (CMV)
Kane: Old machine don’t do much but never failed; Not fancy ; No PEEP on the machine and have to add a device ; Only VT, RR
Slide 3
4
Q
What are the limitations of older ventilators regarding inspiratory pressure? Select 3
a) They couldn’t provide PEEP
b) They couldn’t provide high enough inspiratory pressure
c) They maintained constant inspiratory pressure
d) Offered only volume control ventilation
A
a) They couldn’t provide PEEP
b) They couldn’t provide high enough inspiratory pressure
d) Offered only volume control ventilation
Slide 3
5
Q
True or False
Barotrauma results from low airway pressures.
A
False
Barotrauma
is an injury resulting from high airway pressures
Slide 4
6
Q
Compliance is the ratio of a change in ____ to a change in ____.
A
volume, pressure
Slide 4
7
Q
What happens when there is a decrease in compliance in a volume-controlled breathing system?
a) Increase in Vt as volume is used to expand the system
b) Decrease in Vt as volume is used to expand the system
c) No change in Vt
d) Vt becomes constant
A
b) Decrease in Vt as volume is used to expand the system
Kane: Compliance is the balloon.
First time blow up the balloon, the balloon is very hard to blow up, can’t get a lot of volume in b/c the stiffness of the balloon is excessive.
Slide 4
8
Q
How do newer ventilators compensate for system compliance in pressure-controlled modes?
a) They increase the pressure delivered
b) They alter the volume delivered
c) They decrease the pressure delivered
d) They maintain constant volume delivery
A
b) They alter the volume delivered
Slide 4
9
Q
What is peak pressure?
a) Minimum pressure during the inspiratory phase time
b) Maximum pressure during the inspiratory phase time
c) Average pressure during the inspiratory phase time
d) Pressure at the end of the expiratory phase
A
b) Maximum pressure during the inspiratory phase time
Slide 4
10
Q
True or False
On older ventilators, as fresh gas flow (FGF) increased, so did tidal volume (Vt).
A
True
Slide 5
11
Q
Newer ventilators have excess FGF ____ during inspiration
A
diverted
Slide 5
12
Q
How does fresh gas compensation achieve its purpose? Select 2
a) By preventing fresh gas flow (FGF) from affecting tidal volume (Vt)
b) By measuring Vt and adjusting the volume of gas delivered by the ventilator
c) By decreasing the respiratory rate
d) By increasing the inspiratory pressure
A
a) By preventing fresh gas flow (FGF) from affecting tidal volume (Vt)
b) By measuring Vt and adjusting the volume of gas delivered by the ventilator
Slide 5
13
Q
What is inspiratory pause time?
a) Time during which lungs are deflated at a fixed volume/pressure
b) Time during which lungs are held inflated at a fixed volume/pressure
c) Time during which the ventilator is paused
d) Time during which the patient is not breathing
A
b) Time during which lungs are held inflated at a fixed volume/pressure
INSPIRATORY PLATEAU
Slide 5
14
Q
The I:E
ratio is the ratio of the ____ phase time to the ____ phase time. Normal I:E ratio is ____.
A
The I:E ration is the ratio of the inspiratory phase time to the expiratory phase time.
Normal I:E ratio is 1:2
Slide 6
15
Q
What is inverse ratio ventilation?
a) When inspiratory phase time is shorter than expiratory phase time
b) When inspiratory phase time is equal to expiratory phase time
c) When inspiratory phase time is longer than expiratory phase time
d) When expiratory phase time is longer than inspiratory phase time
A
c) When inspiratory phase time is longer than expiratory phase time
2:1
Slide 6
16
Q
True or False
Minute volume (Vm) is the sum of all tidal volumes in one minute.
A
True
Slide 6
17
Q
The spill valve is the valve in the ventilator that allows excess gases to be sent to the ____ system during ____.
A
The spill valve is the valve in the ventilator that allows excess gases to be sent to the scavenging system during exhalation.
Slide 7
18
Q
The exhaust valve is a valve that opens to allow driving gas to exit the ____ housing during ____ in the ventilator cycle
A
The exhaust valve is a valve that opens to allow driving gas to exit the bellows housing during inhalation in the ventilator cycle
Slide 8
19
Q
What are the two types of compliance that can affect ventilation?
a) Inspiratory and expiratory compliance
b) System and patient compliance
c) Static and dynamic compliance
d) High and low compliance
A
b) System and patient compliance
Slide 9
20
Q
Which of the following statements about leaks in mechanical ventilation are true? (Select 2)
a) Leaks can occur around the tracheal tube or supraglottic device.
b) Leaks cause an increase in tidal volume (Vt) that can be easily compensated by the ventilator.
c) Leaks can lead to a decrease in tidal volume (Vt) that cannot be compensated by the ventilator.
d) Leaks are not a significant factor affecting ventilation.
e) Proper placement of the tracheal tube can worsen leaks.
A
a) Leaks can occur around the tracheal tube or supraglottic device.
c) Leaks can lead to a decrease in tidal volume (Vt) that cannot be compensated by the ventilator.
Slide 9
21
Q
Bellow ventilators are double circuit with (select 2)
a) Compress air
b) Driving gas supply
c) Fresh Gas Flow
d) NitrOx
A
b) Driving gas supply
c) Fresh Gas Flow
Slide 10
22
Q
Which gases can be used as the driving gas in bellows ventilators?
a) Only oxygen
b) Either air or nitrogen
c) Either oxygen, air, or a mix
d) Only nitrogen
A
c) Either oxygen, air, or a mix
Some ventilators can switch between driving gases during a loss of pressure.
Slide 10
23
Q
Fresh gas flow is equal to ____?
A
Minute Volume (Vm)
If oxygen using flow control (1-2 L/min) + Vm (4-5 L/min)
Pt gets what’s in the bellows (Vm) + what you turn on in the flow meters
Slide 10
24
Q
What do the controls of bellows ventilators regulate?
a) Flow and volume only
b) Timing and pressure only
c) Flow, volume, timing, and pressure
d) Temperature and humidity
A
c) Flow, volume, timing, and pressure
Slide 10
25
What must bellows ventilators have in terms of alarms? Select 2
a) Low and medium priorities
b) High, medium, and low priorities
c) Only low-pressure alarms
d) Both low-pressure and high-pressure alarms
e) Only high-pressure alarms
f) No specific alarm requirements
b) High, medium, and low priorities
d) Both low-pressure and high-pressure alarms
*Low-pressure alarms are d/t big leaks or disconnections. High-pressure alarms are kinks or complete occlusions*
## Footnote
Slide 10
26
What is the primary function of the pressure-limiting mechanism in bellows ventilators?
a) To regulate temperature
b) To limit inspiratory pressure
c) To control the speed of the bellows
d) To limit expiratory pressure
b) To limit inspiratory pressure
## Footnote
Slide 11
27
What is a recommended set-point for the pressure-limiting mechanism in the bellows?
a) 5 cm H2O above peak pressure
b) 10 cm H2O above peak pressure
c) 15 cm H2O above peak pressure
d) 20 cm H2O above peak pressure
b) 10 cm H2O above peak pressure
## Footnote
Slide 11
28
Which of the following statements about the components of bellows ventilators are true? (Select 3)
a) The pressure-limiting mechanism limits expiratory pressure.
b) A good set-point for the pressure-limiting mechanism is 20 cm H2O below peak pressure.
c) The bellows assembly is an accordion-like device.
d) The clear plastic cylinder housing allows observation of bellows movement.
e) The clear plastic cylinder housing has a built-in alarm system.
f) The clear plastic cylinder housing has a scale on the side for rough estimation of tidal volume (Vt).
c) The bellows assembly is an accordion-like device.
d) The clear plastic cylinder housing allows observation of bellows movement.
f) The clear plastic cylinder housing has a scale on the side for rough estimation of tidal volume (Vt). - *might be able to see big changes if there is a leak in the system*
## Footnote
Slide 11
29
What drives the operation of bellows ventilators?
a) Electrically driven
b) Manually driven
c) Pneumatically driven
d) Hydraulically driven
c) Pneumatically driven
## Footnote
Slide 12
30
True/False: Driving gas inside the bellows box squeezes gas out of bellows on inspiration into lungs
True
*then Exhalation and FGF in circuit refills bellows.*
## Footnote
Slide 12
31
Which type of bellow is considered safer?
a) Ascending bellow (standing)
b) Descending bellow (hanging)
c) Both are equally safe
d) Neither is safe
a) Ascending bellow (standing)
## Footnote
Slide 12
32
Asceding Bellow (Standing) ____ on expiration and ____ on inspiration.
Asceding Bellow (Standing) **ascend** on expiration and **descend** on inspiration.
## Footnote
Slide 12
33
# True or False
Ascending bellows (standing) fail to rise if disconnected.
True
## Footnote
Slide 12
34
Descending Bellow (Hanging) ____ on expiration and ____ on inspiration.
Descending Bellow (Hanging) **descends** on expiration and
**rises** on inspiration
## Footnote
Slide 12
35
What happens to a descending bellow if it becomes disconnected?
a) It rises due to gravity
b) It descends due to gravity
c) It remains in place
d) It inflates
b) It descends due to gravity
*Kane: So if not hooked up and you looked over the bellows expand, they might have expanded coz you exhaled or b/c you have a leak and the gravity just pulled the bellows down. Easier for you to be fooled if you just glanced over the bellows every now and then*
## Footnote
Slide 12
36
Match each bellows problem with its potential consequence:
1. Improper bellows seating
2. Hole in bellows
3. Scavenging system closed
a) Alveolar hyperinflation/barotrauma
b) Inadequate ventilation
c) Waste gases vented to room
d) If driving gas is O2, pts FiO2 ↑; if air, then FiO2 ↓
**1 - b) Inadequate ventilation**
**2 - a) Alveolar hyperinflation/barotrauma
b) Inadequate ventilation
d) If driving gas is O2, pts FiO2 ↑; if air, then FiO2 ↓**
*Kane: If driving gas is O2, better off b/c driving gas getting into the bellows are going to the lungs and pt is getting more FiO2*
**3 - c) Waste gases vented to room**
*Kane: There is a dial on the scavenging system that can be open/closed based on how big the scavenging balloon gets
If completely closed, it will vent gases to the atmosphere (might cause issues to providers)*
## Footnote
Slide 13
37
What type of motor drives piston ventilators?
a) Electrically driven motor
b) Pneumatically driven motor
c) Mechanically driven motor
d) Hydraulically driven motor
c) Mechanically driven motor
## Footnote
Slide 14
38
# True or False
Piston ventilators use a single circuit with no driving gas.
True
*no additive volume from driving gas, whatever you have set is the volume you are giving, less drying, cooling and wasteful*
## Footnote
Slide 14
39
Piston ventilators use dramatically (more/less) gas compared to bellows ventilators such as ____ and ____.
Piston ventilators use dramatically **less** gas compared to bellows ventilators such as **Oxygen** and **Air**.
## Footnote
Slide 14
40
Which of the following are features of a piston ventilator? (Select all that apply)
a) Doesn’t alter tidal volume (Vt) based on compliance
b) Very small piston chamber
c) Accurate tidal volumes
d) Hidden on machine with no visual ventilation
e) Very quiet
All of the above
## Footnote
Slide 14
41
What is a problem associated with piston ventilators that is similar to descending bellows?
a) Alters tidal volume based on compliance
b) Refills even with disconnection
c) Requires high maintenance
d) Uses a driving gas circuit
b) Refills even with disconnection
## Footnote
Slide 15
42
One issue with piston ventilators is that they can entrain ____________ during leaks, which ____________ oxygen and volatiles
One issue with piston ventilators is that they can entrain **Room Air** during leaks, which **dilutes** oxygen and volatiles
## Footnote
Slide 15
43
Which of the following statements are true about volume control mode? (2)
a) It is the most commonly used mode.
b) It delivers a preset tidal volume as a fixed parameter.
c) It may cause excessive expiratory pressure.
d) It adjusts tidal volume based on patient compliance.
a) It is the most commonly used mode.
b) It delivers a preset tidal volume as a fixed parameter.
## Footnote
Slide 16
44
In volume control mode, what parameters can be set?
a) Vt, RR, I:E ratio
b) Vt, PIP, I:E ratio
c) Vt, I:E ratio, PEEP,
d) Vt, RR, FiO2
a) Vt (tidal volume), RR (respiratory rate), I:E ratio
## Footnote
Slide 16
45
What is a potential complication of using volume control mode in ventilation? Select 2
a) Hypoventilation
b) It may cause excessive inspiratory pressure.
c) Hyperventilation
d) It allows for setting Vt, RR, and I:E ratio.
e) Additional breaths are given at the machine's preset tidal volume.
**b) It may cause excessive inspiratory pressure.**
*Kane: A lot of times see high inspiratory pressure b/c go from a supine position to T-burg or insufflate abdomen*
**e) Additional breaths are given at the machine's preset tidal volume.**
*Kane: Set a rate of 700, 10, then every cycle of the machine is 700, 10 automatically whether early or late or conscious, DON’T CARE anything about the patient b/c this will always be the parameters*
## Footnote
Slide 16
46
What is a characteristic of pressure control mode? Select 2
a) Tidal volume changes with resistance and compliance.
b) The pressure is adjusted based on the patient's needs.
c) Preset pressure is quickly achieved during inspiration.
d) It does not require setting the I:E ratio.
a) Tidal volume changes with resistance and compliance.
c) Preset pressure is quickly achieved during inspiration.
*Kane; Tell the pressure to deliver ANY VOLUME but as long as not go above SET PRESSURE*
## Footnote
Slide 17
47
Which parameter is NOT typically set in pressure control mode?
a) Peak Inspiratory Pressure (PIP)
b) Respiratory rate (RR)
c) Tidal volume (Vt)
d) I:E ratio
c) Tidal volume (Vt)
*Set PIP, RR and I:E ratio*
## Footnote
Slide 17
48
Pressure control mode can cause ____ and ____.
Pressure control mode cause **atelectasis** and **hypoventilation**.
*Kane: preventing barotrauma b/c shutting off with preset pressure but HYPOVENTILATING and causing ATELECTASIS in the patient; maybe need to set higher PIP so the machine gives more volume before it shuts off*
## Footnote
Slide 17
49
What is the primary goal of volume guarantee pressure-control mode?
a) To maintain a constant respiratory rate.
b) To achieve a preset pressure during inspiration.
c) To maintain tidal volume by adjusting peak inspiratory pressure over several breaths.
d) To ensure a constant I:E ratio.
c) To maintain tidal volume by adjusting peak inspiratory pressure over several breaths.
*Kane: The machine will adjust itself to maintain what it’s been doing or what it has a pattern of *
## Footnote
Slide 18
50
Which of the following is a benefit of volume guarantee pressure-control mode?
a) Prevents excessive inspiratory pressure.
b) Prevents sudden tidal volume changes due to compliance.
c) Ensures constant expiratory pressure.
d) Maintains a fixed respiratory rate.
b) Prevents sudden tidal volume changes due to compliance.
*Kane: perfect for lost of insufflation cases; good for COPD patients*
## Footnote
Slide 18
51
Which of the following are true about assist control ventilation? (Select 2)
a) Breath is triggered by a predetermined negative pressure.
b) Breath is at preset tidal volume.
c) Allows for variable tidal volumes based on patient effort.
d) Only provides mandatory breaths without patient initiation.
a) Breath is triggered by a predetermined negative pressure.
b) Breath is at preset tidal volume.
*Kane: Patient initiates breath in addition to machine’s preset parameters ; Machine realizes there’s NEGATIVE PRESSURE pulling against it when it delivers, it’s another breath with set VT; The more volume in a minute the pt gets, the more the pt stacks*
## Footnote
Slide 19
52
What is true about intermittent mandatory ventilation?
a) Only mandatory breaths are delivered.
b) Additional native breaths are at a fixed tidal volume.
c) It does not allow "stacking."
d) Mandatory ventilator breaths are set.
d) Mandatory ventilator breaths are set.
*Kane: IMV has set VT and set RR *
## Footnote
Slide 19
53
# True or False
In intermittent mandatory ventilation, additional native breaths are at a fixed tidal volume.
False
Additional native breaths at **variable** Vt
*Kane: when have negative pressure that triggers extra breaths, ONLY get the volume pt pulls with inspiratory pressure*
## Footnote
Slide 19
54
What does "stacking" refer to in intermittent mandatory ventilation?
a) Delivering breaths at preset times only.
b) Overlapping breaths due to additional native breaths.
c) Delivering breaths with a fixed pressure.
d) Triggering breaths based on negative pressure
b) Overlapping breaths due to additional native breaths.
## Footnote
Slide 19
55
Which of the following are features of SIMV? (Select 2)
a) Synchronizes ventilator-driven breaths with spontaneous breaths
b) Provides backup to weaning ventilator
c) Requires fixed tidal volume
d) Does not synchronize with spontaneous breaths
a) Synchronizes ventilator-driven breaths with spontaneous breaths
b) Provides backup to weaning ventilator
*Kane: Ventilator knows that negative pressure has been created but it MAKES THE PT. WAIT a few seconds before it allows to take another breath*
## Footnote
Slide 20
56
In Pressure Support ventilation, ___ and ___ time are set.
In Pressure Support ventilation, **PIP** and **inspiratory** time are set.
## Footnote
Slide 20
57
# True or False
In Pressure Support ventilation, Vt equates to native effort.
TRUE
*Kane: Pressure Control/Support
used for weaning ;Support the alveoli so not have to do the effort to expand them for every single breath*
## Footnote
Slide 20
58
In which ventilation modes is an apnea alarm necessary?
a) Volume control
b) Pressure control
c) Pressure support
d) SIMV
c) Pressure support
## Footnote
Slide 20
59
Why are standard anesthesia machines typically not used in MRI environments?
a) They are too noisy.
b) They contain variable amounts of ferromagnetic substances.
c) They are not powerful enough.
d) They are not compatible with modern software.
b) They contain variable amounts of ferromagnetic substances.
## Footnote
Slide 21
60
Which of the following are solutions for using ventilators in MRI environments? (Select all that apply)
a) MRI compatible machines
b) Anesthesia machine kept outside in hallway
c) Machine bolted to wall
d) Aluminum tanks or pipeline gas supply
All of the above
*Kane: Get the right equipment to go in the MRI room or not take the equipment in the room*
## Footnote
Slide 21
61
One hazard of ventilation failure is ________ in electronic circuitry.
A. fluid
B. air
C. electricity
D. dust
A. fluid
*Excessive humidity, cleaning fluid*
## Footnote
Slide 22
62
Which of the following hazards are causes of ventilation failure? Select 2
A. Disconnection from power supply
B. Extremely high FGF
C. Fluid in hydrolic systems
B. Extremely low FGF
E. Non-occluding the spill valve
A. Disconnection from power supply
B. Extremely high FGF
## Footnote
Slide 22
63
Leaking ____ housing is a potential hazard of ventilation failure.
A. bellows
B. cylinder
C. pipe
D. valve
A. bellows
*If ventilator isn't working, and patient isnt' ventilating right, just bag em' and call for help*
## Footnote
Slide 22
64
Which of the following ventilatory hazards can lead to loss of breathing system gas? Select 2
A. Leak in system
B. Extremely high FGF
C. Failure to occlude spill valve
D. Fluid in mechanical housing
A. Leak in system
C. Failure to occlude spill valve - *the valve does not close properly when it is supposed to and breathing system gas is allowed to escape willy nilly*
## Footnote
Slide 22
65
Which of the following can lead to being a hazard d/t incorrect ventilator settings? Select 2
A. Inadvertent bumping
B. Properly adjusted settings for new case
C. Not adjusted for position/pressure changes
D. Ventilator turned on for x-rays
A. Inadvertent bumping
C. Not adjusted for position/pressure changes
*Settings are changed for Insufflation as well*
## Footnote
Slide 23
66
The ventilator might have incorrect settings and be a hazard if turned **off** for ____.
A. x-rays
B. MRIs
C. CT scans
D. ultrasounds
A. x-rays
*They don't want motion in the chest for the x-ray, so they you turn it off.. and forget to turn the ventilator back on*
## Footnote
Slide 23
67
# True or False
Failing to adjust the ventilator settings for a new case can lead to incorrect ventilator settings.
True
## Footnote
Slide 23
68
Which of the following is an advantage of using a ventilator?
A. Increases fatigue
B. Requires constant manual adjustment
C. Allows anesthesia provider to devote energy to other tasks
D. Produces irregular rate and rhythm
C. Allows anesthesia provider to devote energy to other tasks
*Hands free and brain free*
## Footnote
Slide 24
69
What is one of the benefits of a ventilator in terms of provider workload?
A. Decreases the need for monitoring
B. Decreases fatigue
C. Increases the complexity of the task
D. Requires more attention
B. Decreases fatigue
## Footnote
Slide 24
70
One of the advantages of a ventilator is that it produces a more regular rate, rhythm, and ____.
A. Vt
B. pressure
C. I:E ratio
D. flow
A. Vt
## Footnote
Slide 24
71
# True or False
Ventilators can be too noisy but never too quiet
False
They are either too noisy or too quiet
## Footnote
Slide 25
72
One disadvantage of a ventilator is that its components are hard to ____ or ____.
A. clean, fix
B. see, feel
C. start, stop
D. use, maintain
A. clean, fix
*..some don't get cleaned..nasty*
## Footnote
Slide 25
73
Which of the following are disadvantages of using a ventilator? Select 2
A. Loss of "feel"
B. Components are easy to clean or fix
C. Lack user-friendliness
D. May require driving gases...in-expensive
A. Loss of "feel" - *feel the negative pressure in the reservoir bag and breath with the patient as they take spontaneous breaths as they wake up*
C. Lack user-friendliness
*Older versions lack all of the desired modes*
## Footnote
Slide 25
74
Ventilators with bellows may require ____ gases, which can be expensive.
A. driving
B. inert
C. light
D. heavy
A. driving
## Footnote
Slide 25
75
The concentration of a gas far below what is needed for anesthesia or detected by smell is called __________ gas concentrations.
A. trace
B. volatile
C. odorless
D. inert
A. trace
## Footnote
slide 27
76
Trace gas concentrations are typically written in which unit?
A. Percent (%)
B. Parts per billion (PPB)
C. Parts per million (PPM)
D. Milligrams per liter (mg/L)
C. Parts per million (PPM)
## Footnote
Slide 27
77
1% of a 1,000,000 PPM gas is equivalent to ____ PPM.
A. 1,000
B. 10,000
C. 100,000
D. 1,000,000
B. 10,000
## Footnote
Slide 27
78
What is the concentration of 100% of a gas in PPM?
A. 1,000 PPM
B. 10,000 PPM
C. 100,000 PPM
D. 1,000,000 PPM
D. 1,000,000 PPM
## Footnote
Slide 27
79
In which situations are higher levels of trace gas concentrations typically seen? Select 3
A. Pediatric anesthesia
B. Dental surgeries
C. Well-ventilated PACUs
D. Poorly ventilated PACUs
E. Outpatient clinics
F. Emergency rooms
A. Pediatric anesthesia
B. Dental surgeries
D. Poorly ventilated PACUs
## Footnote
Slide 27
80
In which year did NIOSH set maximums for PPM of trace anesthetic gas levels?
A. 1965
B. 1970
C. 1977
D. 1992
C. 1977
## Footnote
Slide 28
81
# Matching
Match the NIOSH Anesthetic gas to their maximum trace levels in PPM
Good job!
## Footnote
Slide 28
82
What is a common cause of operating room contamination of trace volatile gases related to vaporizers? Select 2
A. Well fitting masks
B. Flushing circuit into room
C. Failure to turn off vaporizer
D. Use of cuffed ETT
B. Flushing circuit into room
C. Failure to turn off vaporizer *between intubation and hooking up the circuit*
*Newbie mistake*
## Footnote
Slide 29
83
____ during bag masking can lead to operating room contamination of trace volatile gases.
A. Overinflation
B. Poorly fitting masks
C. Rapid induction
D. Slow exhalation
B. Poorly fitting masks
## Footnote
Slide 29
84
Use of ____ ETT in pediatrics can contribute to trace gas contamination.
A. uncuffed
B. cuffed
C. narrow
D. wide
A. uncuffed
## Footnote
Stage 29
85
Which of the following are potential sources of operating room contamination of trace volatile gases? Select 2
A. Perfectly sealed masks
B. Use of DLT
C. Turning off vaporizer
D. Scavenging system leaks
E. Low fresh gas flows
F. Spills when filling vaporizers
D. Scavenging system leaks
F. Spills when filling vaporizers
*Desflurane will evaporate quickly - and this vaporizes into the atmosphere*
## Footnote
Slide 29
86
Which of the following is a reported increase associated with atmospheric trace gas vapor exposure?
A. Increased fertility
B. Improved performance
C. Spontaneous abortions
D. Lowered cancer risk
C. Spontaneous abortions
*And Spontaneous abortions in spouses*
## Footnote
Slide 30
87
Exposure to atmospheric trace gas vapor has been linked to increases in which of the following diseases? Select 2
A. Skin disease
B. Liver disease
C. Cardiac disease
D. Renal diseases
B. Liver disease
C. Cardiac disease
## Footnote
Slide 30
88
Select all the conditions that have shown increases in studies with atmospheric trace gas vapor exposure. Select 2
A. Birth defects
B. Improved cognitive function
C. Renal disease
D. Infertility
A. Birth defects,
D. Infertility
## Footnote
Slide 30
89
Which of the following are reported effects of atmospheric trace gas vapor exposure? (2)
A. Cancer/mortality
B. Enhanced physical endurance
C. Impaired performance
D. Lowered stress levels
A. Cancer/mortality,
C. Impaired performance
## Footnote
Slide 30
90
Select all the components or functions associated with scavenging systems: Select 2
A. Collect gases from anesthesia equipment
B. Remove gases outside the work environment
C. Remove gases inside the work environment
D. Increase anesthesia concentration in the room
A. Collect gases from anesthesia equipment,
B. Remove gases outside the work environment
| Opening - the bag fills more
Closing - the bag fills less and vents
## Footnote
Slide 31
91
# True or False
The air in a passive scavenging system that vents trace volatile gas is filtered and adjusted for humidity and temperature before being exhausted to the atmosphere.
True
## Footnote
Slide 32
92
In a passive system to vent trace volatile gas, where is the entire volume of air exhausted?
A. Back into the operating room
B. Into a filtered container
C. To the atmosphere
D. Into the hospital's central HVAC system
C. To the atmosphere *outside the hospital*
## Footnote
Slide 32
93
Disposal tubing from the anesthesia machine is attached to the ____________ and trace volatile gas is removed with room air to the outside of the hospital.
A. central HVAC system
B. exhaust grill
C. Air conditioner
D. Floor drain hole
B. exhaust grill
## Footnote
Slide 32
94
The passive system to vent trace volatile gas is ____ and ____.
A. very expensive, commonly used
B. very uncommon, too loose
C. very economic, uncommon
D. very efficient, frequently used
E. very unreliable, rarely seen
C. very economic, uncommon
*They disconnect and fall out easily, so not used as often*
## Footnote
Slide32
95
Which of the following is a requirement for an active system for a scavenging system to vent trace volatile gas?
A. Attached to central vacuum system
B. Must provide low volume (20 L/min)
C. Needs frequent maintenance
D. Requires less of suction outlets far from the anesthesia machine
A. Attached to central vacuum system
## Footnote
Slide 33
96
To function effectively, an active system scavenging system to vent trace volatile gas needs plenty of ____ and *close* to the anesthesia machine.
A. Air filters
B. Suction outlets
C. Power outlets
D. Gas tanks
B. Suction outlets
## Footnote
Slide 33
97
An active system to vent trace volatile gas must be able to provide a high volume of:
A. 15 L/min
B. 20 L/min
C. 25 L/min
D. 30 L/min
D. 30 L/min
## Footnote
slide 33
98
To prevent contamination of the OR of trace gas into the atmosphere, it is important to ____.
A. Keep the vaporizer on during intubation
B. Prevent liquid spills
C. Place the anesthesia machine far from the exhaust grill
D. Use a faulty mask
B. Prevent liquid spills
## Footnote
Slide 34
99
Turning off the ____ during intubation helps to prevent contamination of trace gas into the atmosphere.
A. Vaporizer
B. Gas flow
C. Exhaust grill
D. Anesthesia machine
B. Gas flow
*Don't turn off vaporizer*
## Footnote
Slide 34
100
To ensure all traces of gas are removed at the end of a case, you should:
A. Increase liquid spills
B. Turn on the vaporizer
C. Perform a wash out
D. Turn on the gas flow
C. Perform a 100% wash out *at the end of the case*
## Footnote
Slide 34
101
Which of the following actions help prevent contamination of trace gas into the atmosphere?
A. Work on mask fit skills
B. Turn off gas flow during maitenence
C. 99% wash out at end of case
D. Place anesthesia machine close to intake grill
A. Work on mask fit skills
## Footnote
Slide 34
102
Common causes of hypoxic inspired gas mixture include: Select 3
A. Incorrect gas in the pipeline
B. Incorrectly installed outlets
C. Correct cylinder attached to yoke
D. Flow control malfunction
E. Flow control operational
A. Incorrect gas in the pipeline
B. Incorrectly installed outlets
D. Flow control malfunction
## Footnote
Slide 36
103
Which of the following can cause a hypoxic inspired gas mixture? Select 2
A. Correct cylinder color
B. O2 hose attached to wrong flow meter
C. Leak in the O2 flow meter
D. Outlets properly installed
E. Correct cylinder attached to yoke
B. O2 hose attached to wrong flow meter
C. Leak in the O2 flow meter
*and Incorrect cylinder attached to yoke*
## Footnote
Slide 36
104
An incorrect cylinder attached to yoke with too many washers can obliterate the __________ system.
A. DISS
B. PISS
C. NIST
D. Quick connect
B. PISS
(pin-index safety system)
## Footnote
Slide 36
105
To address hypoventilation due to insufficient gas, one should: Select 2
A. Switch from pipeline to cylinder
B. Replace the cylinder
C. Power off the main machine
D. Disconnect the breathing system
A. Switch from pipeline to cylinder
B. Replace the cylinder
## Footnote
Slide 37
106
Breathing system leaks leading to hypoventilation can be found in: Select 3
A. Absorbent
B. Connectors
C. Gas sampling
D. Main machine power switch
E. Patient monitor
A. Absorbent
B. Connectors
C. Gas sampling
*Disconnections*
## Footnote
slide 37
107
One of the causes of hypoventilation is ____.
A. Excessive gas flow
B. Obstruction
C. High oxygen concentration
D. Fully charged cylinder
B. Obstruction
*High pressure alarms*
## Footnote
Slide 37
108
Which of the following are causes of hypoventilation?
A. Sufficient gas
B. Passive gas flow
C. Main machine power off
E. Patient monitor
C. Main machine power off
## Footnote
Slide 37
109
What does it indicate if the plastic is wadded up and stuffed in the mask?
A. The mask is dirty
B. The mask is clean
C. The mask is broken
D. The mask is unused
B. The mask is clean
*Wrapper can go into the circuit and get stuck and obstruct*
| *Kane - "law of the jungle"*
## Footnote
Slide 38
110
Blocked inspiratory/expiratory paths can occur due to ____.
A. Absorbent wrapping
B. Properly installed tubing
C. Clean filters
D. Correct gas flow
A. Absorbent wrapping
## Footnote
Slide 38
111
Hypercapnia can result from ____ due to ventilator issues by anesthesia.
A. Hypoventilation
B. Hyperventilation
C. Normal ventilation
D. Irregular breathing
A. Hypoventilation
## Footnote
Slide 39
112
Hypercapnia can be caused by absorbent failure and can be detected by an increase in ____ trend.
A. SpO2
B. ETCO2
C. Heart rate
D. Respiratory rate
B. ETCO2
*Increased trend*
## Footnote
slide 39
113
One of the causes of hypercapnia is __________ due to long tubing.
A. Increased airflow
B. Excessive dead space
C. Reduced oxygen supply
D. Improved ventilation
B. Excessive dead space
## Footnote
Slide 39
114
Which of the following can lead to hypercapnia?
A. Hyperventilation due to ventilator issues
B. Absorbent success
C. Less dead space from long tubing
D. Defect in the coaxial system
D. Defect in the coaxial system
*Mapleson Circuits*
## Footnote
Slide 39
115
What can cause an anesthetic agent overdose due to a tipped vaporizer?
A. Increased liquid in the system
B. Decreased liquid in the system
C. No change in liquid levels
D. Reduced vaporizer function
A. Increased liquid in the system
## Footnote
Slide 40
116
Anesthetic agent **overdose** can occur if the vaporizer is ____.
A. Underfilled
B. Overfilled
C. Properly maintained
D. Turned off
B. Overfilled
## Footnote
Slide 40
117
What system failure can lead to the simultaneous use of two vaporizers, potentially causing an overdose?
A. Electrical system failure
B. Cylinder system failure
C. Gas flow system failure
D. Interlock system failure
D. Interlock system failure
## Footnote
Slide 40
118
Possible reasons for an anesthetic agent overdose include:
**Select 2**
A. Properly functioning vaporize
B. Incorrect agent in vaporizer
C. Interlock system success
D. Vaporizer accidently on
B. Incorrect agent in vaporizer
D. Vaporizer accidently on
## Footnote
Slide 40
119
Which of the following should be changed to prevent inadvertent exposure to volatiles? (Select 2)
A. Breathing system hoses and bag
B. Check valves
C. Absorbent
D. Flowmeters
A. Change breathing system hoses and bag
C. Absorbent
*and Change out the fresh gas supply hose*
## Footnote
Slide 41
120
What method is recommended for cleaning out the anesthesia machine?
A. Use low oxygen flows
B. Use very high oxygen flows
C. Use the main flowmeter for supplemental oxygen
D. Reduce the fresh gas flow (FGF)
B. Use very high oxygen flows
## Footnote
Slide 41
121
To address inadvertent exposure to volatiles, it is necessary to: Select 2
A. Remove vaporizers
B. Use axillary flowmeter
C. Keep absorbent
D. Utilize low fresh gas flow
A. Remove vaporizers
B. Use axillary flowmeter for supplemental oxygen
*Removing volatile machine can help with MH patients and people with EXTREME post-op N/V*
## Footnote
Slide 41
