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JW: Principles I > Anesthesia Ventilators (Kane) Exam 3 > Flashcards

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

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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

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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

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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

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5
Q

True or False

Barotrauma results from low airway pressures.

A

False

Barotrauma
is an injury resulting from high airway pressures

Slide 4

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6
Q

Compliance is the ratio of a change in ____ to a change in ____.

A

volume, pressure

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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.

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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

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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

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10
Q

True or False

On older ventilators, as fresh gas flow (FGF) increased, so did tidal volume (Vt).

A

True

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11
Q

Newer ventilators have excess FGF ____ during inspiration

A

diverted

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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

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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

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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

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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

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16
Q

True or False

Minute volume (Vm) is the sum of all tidal volumes in one minute.

A

True

Slide 6

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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.

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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

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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

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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.

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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

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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.

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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

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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

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25
Q

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

A

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

Slide 10

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26
Q

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

A

b) To limit inspiratory pressure

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27
Q

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

A

b) 10 cm H2O above peak pressure

Slide 11

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28
Q

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).

A

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

Slide 11

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29
Q

What drives the operation of bellows ventilators?

a) Electrically driven
b) Manually driven
c) Pneumatically driven
d) Hydraulically driven

A

c) Pneumatically driven

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30
Q

True/False: Driving gas inside the bellows box squeezes gas out of bellows on inspiration into lungs

A

True

then Exhalation and FGF in circuit refills bellows.

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31
Q

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

a) Ascending bellow (standing)

Slide 12

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32
Q

Asceding Bellow (Standing) ____ on expiration and ____ on inspiration.

A

Asceding Bellow (Standing) ascend on expiration and descend on inspiration.

Slide 12

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33
Q

True or False

Ascending bellows (standing) fail to rise if disconnected.

A

True

Slide 12

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34
Q

Descending Bellow (Hanging) ____ on expiration and ____ on inspiration.

A

Descending Bellow (Hanging) descends on expiration and
rises on inspiration

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35
Q

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

A

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

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36
Q

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 ↓

A

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)

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37
Q

What type of motor drives piston ventilators?

a) Electrically driven motor
b) Pneumatically driven motor
c) Mechanically driven motor
d) Hydraulically driven motor

A

c) Mechanically driven motor

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38
Q

True or False

Piston ventilators use a single circuit with no driving gas.

A

True
no additive volume from driving gas, whatever you have set is the volume you are giving, less drying, cooling and wasteful

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39
Q

Piston ventilators use dramatically (more/less) gas compared to bellows ventilators such as ____ and ____.

A

Piston ventilators use dramatically less gas compared to bellows ventilators such as Oxygen and Air.

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40
Q

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

A

All of the above

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41
Q

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

A

b) Refills even with disconnection

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42
Q

One issue with piston ventilators is that they can entrain ____________ during leaks, which ____________ oxygen and volatiles

A

One issue with piston ventilators is that they can entrain Room Air during leaks, which dilutes oxygen and volatiles

Slide 15

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43
Q

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

a) It is the most commonly used mode.

b) It delivers a preset tidal volume as a fixed parameter.

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44
Q

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

a) Vt (tidal volume), RR (respiratory rate), I:E ratio

Slide 16

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45
Q

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.

A

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

Slide 16

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46
Q

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

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

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47
Q

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

A

c) Tidal volume (Vt)

Set PIP, RR and I:E ratio

Slide 17

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48
Q

Pressure control mode can cause ____ and ____.

A

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

Slide 17

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49
Q

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.

A

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 *

Slide 18

50
Q

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.

A

b) Prevents sudden tidal volume changes due to compliance.

Kane: perfect for lost of insufflation cases; good for COPD patients

Slide 18

51
Q

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

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

Slide 19

52
Q

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.

A

d) Mandatory ventilator breaths are set.

*Kane: IMV has set VT and set RR *

Slide 19

53
Q

True or False

In intermittent mandatory ventilation, additional native breaths are at a fixed tidal volume.

A

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

Slide 19

54
Q

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

A

b) Overlapping breaths due to additional native breaths.

Slide 19

55
Q

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

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

Slide 20

56
Q

In Pressure Support ventilation, ___ and ___ time are set.

A

In Pressure Support ventilation, PIP and inspiratory time are set.

Slide 20

57
Q

True or False

In Pressure Support ventilation, Vt equates to native effort.

A

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

Slide 20

58
Q

In which ventilation modes is an apnea alarm necessary?

a) Volume control
b) Pressure control
c) Pressure support
d) SIMV

A

c) Pressure support

Slide 20

59
Q

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.

A

b) They contain variable amounts of ferromagnetic substances.

Slide 21

60
Q

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

A

All of the above

Kane: Get the right equipment to go in the MRI room or not take the equipment in the room

Slide 21

61
Q

One hazard of ventilation failure is ________ in electronic circuitry.

A. fluid
B. air
C. electricity
D. dust

A

A. fluid
Excessive humidity, cleaning fluid

Slide 22

62
Q

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

A. Disconnection from power supply
B. Extremely high FGF

Slide 22

63
Q

Leaking ____ housing is a potential hazard of ventilation failure.

A. bellows
B. cylinder
C. pipe
D. valve

A

A. bellows

If ventilator isn’t working, and patient isnt’ ventilating right, just bag em’ and call for help

Slide 22

64
Q

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

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

Slide 22

65
Q

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

A. Inadvertent bumping
C. Not adjusted for position/pressure changes
Settings are changed for Insufflation as well

Slide 23

66
Q

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

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

Slide 23

67
Q

True or False

Failing to adjust the ventilator settings for a new case can lead to incorrect ventilator settings.

A

True

Slide 23

68
Q

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

A

C. Allows anesthesia provider to devote energy to other tasks
Hands free and brain free

Slide 24

69
Q

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

A

B. Decreases fatigue

Slide 24

70
Q

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

A. Vt

Slide 24

71
Q

True or False

Ventilators can be too noisy but never too quiet

A

False
They are either too noisy or too quiet

Slide 25

72
Q

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

A. clean, fix
..some don’t get cleaned..nasty

Slide 25

73
Q

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

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

Slide 25

74
Q

Ventilators with bellows may require ____ gases, which can be expensive.

A. driving
B. inert
C. light
D. heavy

A

A. driving

Slide 25

75
Q

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

A. trace

slide 27

76
Q

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)

A

C. Parts per million (PPM)

Slide 27

77
Q

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

A

B. 10,000

Slide 27

78
Q

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

A

D. 1,000,000 PPM

Slide 27

79
Q

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

A. Pediatric anesthesia
B. Dental surgeries
D. Poorly ventilated PACUs

Slide 27

80
Q

In which year did NIOSH set maximums for PPM of trace anesthetic gas levels?

A. 1965
B. 1970
C. 1977
D. 1992

A

C. 1977

Slide 28

81
Q

Matching

Match the NIOSH Anesthetic gas to their maximum trace levels in PPM

A

Good job!

Slide 28

82
Q

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

A

B. Flushing circuit into room
C. Failure to turn off vaporizer between intubation and hooking up the circuit

Newbie mistake

Slide 29

83
Q

____ 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

A

B. Poorly fitting masks

Slide 29

84
Q

Use of ____ ETT in pediatrics can contribute to trace gas contamination.

A. uncuffed
B. cuffed
C. narrow
D. wide

A

A. uncuffed

Stage 29

85
Q

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

A

D. Scavenging system leaks
F. Spills when filling vaporizers
Desflurane will evaporate quickly - and this vaporizes into the atmosphere

Slide 29

86
Q

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

A

C. Spontaneous abortions
And Spontaneous abortions in spouses

Slide 30

87
Q

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

A

B. Liver disease
C. Cardiac disease

Slide 30

88
Q

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

A. Birth defects,
D. Infertility

Slide 30

89
Q

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

A. Cancer/mortality,
C. Impaired performance

Slide 30

90
Q

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

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

Slide 31

91
Q

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.

A

True

Slide 32

92
Q

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

A

C. To the atmosphere outside the hospital

Slide 32

93
Q

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

A

B. exhaust grill

Slide 32

94
Q

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

A

C. very economic, uncommon
They disconnect and fall out easily, so not used as often

Slide32

95
Q

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

A. Attached to central vacuum system

Slide 33

96
Q

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

A

B. Suction outlets

Slide 33

97
Q

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

A

D. 30 L/min

slide 33

98
Q

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

A

B. Prevent liquid spills

Slide 34

99
Q

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

A

B. Gas flow
Don’t turn off vaporizer

Slide 34

100
Q

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

A

C. Perform a 100% wash out at the end of the case

Slide 34

101
Q

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

A. Work on mask fit skills

Slide 34

102
Q

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

A. Incorrect gas in the pipeline
B. Incorrectly installed outlets
D. Flow control malfunction

Slide 36

103
Q

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

A

B. O2 hose attached to wrong flow meter
C. Leak in the O2 flow meter

and Incorrect cylinder attached to yoke

Slide 36

104
Q

An incorrect cylinder attached to yoke with too many washers can obliterate the __________ system.

A. DISS
B. PISS
C. NIST
D. Quick connect

A

B. PISS
(pin-index safety system)

Slide 36

105
Q

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

A. Switch from pipeline to cylinder
B. Replace the cylinder

Slide 37

106
Q

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

A. Absorbent
B. Connectors
C. Gas sampling
Disconnections

slide 37

107
Q

One of the causes of hypoventilation is ____.

A. Excessive gas flow
B. Obstruction
C. High oxygen concentration
D. Fully charged cylinder

A

B. Obstruction
High pressure alarms

Slide 37

108
Q

Which of the following are causes of hypoventilation?

A. Sufficient gas
B. Passive gas flow
C. Main machine power off
E. Patient monitor

A

C. Main machine power off

Slide 37

109
Q

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

A

B. The mask is clean
Wrapper can go into the circuit and get stuck and obstruct

Kane - “law of the jungle”

Slide 38

110
Q

Blocked inspiratory/expiratory paths can occur due to ____.

A. Absorbent wrapping
B. Properly installed tubing
C. Clean filters
D. Correct gas flow

A

A. Absorbent wrapping

Slide 38

111
Q

Hypercapnia can result from ____ due to ventilator issues by anesthesia.

A. Hypoventilation
B. Hyperventilation
C. Normal ventilation
D. Irregular breathing

A

A. Hypoventilation

Slide 39

112
Q

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

A

B. ETCO2
Increased trend

slide 39

113
Q

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

A

B. Excessive dead space

Slide 39

114
Q

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

A

D. Defect in the coaxial system
Mapleson Circuits

Slide 39

115
Q

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

A. Increased liquid in the system

Slide 40

116
Q

Anesthetic agent overdose can occur if the vaporizer is ____.

A. Underfilled
B. Overfilled
C. Properly maintained
D. Turned off

A

B. Overfilled

Slide 40

117
Q

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

A

D. Interlock system failure

Slide 40

118
Q

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

A

B. Incorrect agent in vaporizer
D. Vaporizer accidently on

Slide 40

119
Q

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

A. Change breathing system hoses and bag
C. Absorbent

and Change out the fresh gas supply hose

Slide 41

120
Q

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)

A

B. Use very high oxygen flows

Slide 41

121
Q

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

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

Slide 41

JW: Principles I (50 decks)

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