Equipment #1 Flashcards

Question

Vaporizer Use Variables What much gas per ml? How long will 100ml of sevo last when 3ml/min at 2% BOARDS

Answer 1

• Most volatile agents produce about **200 cc** of gas for each cc of liquid • How long will 100 cc of sevoflurane last when given at 3L/min at 2%? 3000 cc x .02 = 60 cc/minute of sevoflurane used 60cc / 200 cc per 1 cc liquid = 0.3 cc liquid used each minute 100 cc / 0.3 cc/min = 333 minutes **100 cc of sevoflurane will last 333 minutes at 3L/m at 2**%

Answer 2

• Decreases in barometric pressure cause an increase in vaporizer output • Conversely, increases in barometric pressure cause a fall in vaporizer output

Answer 3

• Desflurane vaporizer heats the agent to 39º C • This increases the vapor pressure to 1500 • Pressure sensors determine the fresh gas flow rate and the output is calculated • Desflurane is then introduced into the fresh gas flow as a gas • **Output decreases when N2O introduced ??? (canot find why- Maybe ask instructors))**

Answer 4

• CO 2 absorber • APL “Pop-off” • Unidirectional valves • Reservoir bag • Circuit hoses • Fresh gas supply

Answer 5

You should appreciate that if you need to ventilate an apneic patient with one of the previously described systems, all six will work. These six are the Mapleson A, MaplesonB, Mapleson C, Mapleson D, Mapleson E, Mapleson F, and the Bain circuit (a modification of Mapleson D). During Controlled ventilation: **D F E \> B C \> A.**

Answer 6

Reactions of CO2 in Soda Lime 1. CO2 + H2O → H2CO3 2. H2CO3 + 2NaOH (2KOH) → Na2CO3 (K2CO3) + 2H2O + heat 3. Na2CO3 (K2CO3) + Ca(OH)2 → CaCO3 + NaOH (2KOH) Composition and Size of Soda Lime Granules a. 94% **Ca**(OH)2 5% **Na**OH 1% **K**OH • Irregular granules, **4-8 mesh** – provides maximal surface area with minimal airway resistance Canister 50% airspace, 50% absorbent Indicator (**ethyl violet**) indicates exhaustion 1000 gm canister can absorb 200 L of CO 2

Answer 7

• APL vents excess gas to scavenger • U_nidirectional valves_ Disk valves Prevent rebreathing of CO 2

Answer 8

**Treachea,** **ETT** **MASk** **LMA** **Y connector** **Any other place has both in and out air**

Answer 9

• Reservoir Bag Serves as reservoir to buffer high inspiratory & exhaled gas flows Serves as a shock buffer Serves as a means of giving positive pressure **_Volume of the BAG should exceed inspiratory capacity_** The bag will maintain a pressure of 40 even as it gets bigger. • Circuit hoses 22mm fitting – different from gas outlet or scavenger Compliance is about 3cc/cmH 2 O/meter Large diameter offers almost no resistance Dead space only in areas of bi-directional flow – **Dead space ends at the Y-piece of the circuit**

Answer 10

• Mapelson A Fresh gas flow and exhaust exactly opposite of Mapelson D Very effective for spontaneously ventilating patients Requires about 200-300 mL/Kg/m fresh gas flow for controlled ventilation, 70-100 mL/Kg/m for **spontaneous** ventilation • Mapelson D Used in pediatric cases because of very low resistance Requires about 200-300 mL/Kg/m fresh gas flow for spontaneous ventilation, 70-100 mL/Kg/m for **controlled** ventilation Bain modification places fresh gas tubing within the expiratory hose Know Controlled vs spontaneous Mapleson D is also know a coaxial circuit

Answer 11

• Chronic low-level exposure to N 2 O: Spontaneous abortion Fetal malformation Cancer Neuropathy Behavioral changes • NIOSH recommendations: N 2 O \< 25 ppm Halogenated agents \< 2 ppm Halogenated agent + N 2 O \< 0.5 ppm

Answer 12

• Air turnover is the single most important factor in reducing anesthetic air pollution • 10 exchanges per hour or more is required • Fresh air enters the OR through ceiling vents and leaves through floor vents

Answer 13

• Required by JCAHO • Reduce anesthetic loss to OR by 90% • 19 mm hose, rigid enough to hold 10kg/cm • Scavenger interface Closed reservoir Open reservoir • Disposal Routes Active – to specialized wall suction at \> 30L/min Passive – to floor vents

Answer 14

Jet Ventilator Narrow catheter placed in trachea Oxygen at **25 – 30 psi** delivered for **1 – 1.5 secs x 12/min** Tidal volumes of **400 – 700 mL** obtained -Jet ventilator works on the **venturi/bernoulli** principle • High-frequency ventilator Gas transport by diffusion rather than convection

Answer 15

Commonly used on anesthesia machines • 2 components Bellows assembly Control box (Hanging bellows ventilators don’t meet standard of care) • Ventilatory cycle Closure of relief valve (to scavenger) Pressurization of bellows chamber Discontinuation of pressurization to begin exhalation Refilling of bellows from exhaled volume and fresh gas Flow Opening of relief valve to vent excess gases to scavenger • Unaffected by changes in compliance, but affected by leak

Answer 16

• During inspiratory phase, fresh gas flow adds to the tidal volume • **High FGF may significantly increase TV and minute ventilation** • Usually not seen with newer piston-driven ventilators, which can deliver very accurate TVs to patients with poor compliance or very small patients

Answer 17

* Small tidal volumes – at or less than dead space * Rapid rates – **60** or more breaths/minute * CO2 retention corrected by decreasing rate * Indicated for bronchopleural fistula, to improve oxygenation during one-lung anesthesia, tracheal reconstruction and extreme loss of lung compliance

Answer 18

• Two types available Side stream – gas sample brought to machine analyzer Main stream – analyzer positioned in gas flow • Measurement techniques Infrared – infrared light is strongly absorbed by CO 2 – Beer-Lambert Law Mass spectrometry-- not commonly done Chemical indicators

Answer 19

I. The inspiratory baseline Fresh gas rushes past the sampling site CO 2 concentration approaches zero Dead space gas at end of Phase 1 II. Expiratory upstroke (transition phase) Exiting alveolar gas contains CO 2 and causes rapid upstroke Airway obstruction may produce a decrease in slope Decrease in the alpha angle seen III. Expiratory plateau Capnogram plateaus as a stable amount of CO 2 is exhaled May have a slight incline as lung units with lower V/Q ratios empty IV. Inspiratory downstroke Fresh gas drawn past sampling site Downstroke may be slowed by an incompetent inspiratory valve

Answer 20

Increased Airway resistance

Answer 21

Rebreathing Elevated baseline – phase 1 Caused by failed expiratory valve, exhausted CO 2 absorber Can be caused by inadequate fresh gas flow in Mapelson circuits

Answer 22

Cardiac Oscillations Changes in intracardiac volume resulting in gas movement Rhythm corresponds to pulse

Answer 23

Spontaneous ventilation Sometimes called “Curare Clefts”

Answer 24

• Normally 3 – 5 mmHg • **Changes in V/Q ratio** Shunt has very little impact on end-tidal CO 2 Changes in dead space have a large impact on end-tidal CO 2 • Sample size Very small children will have small exhaled volumes. Dilution from fresh gas flow may reduce apparent end-tidal CO 2 • Machine errors

Answer 25

P50= 27mmHg PaO2, 40, 50, 60, = Sat of 70, 80, 90

Answer 26

• Makes use of light absorbance – Beer-Lambert Law • Tissue contains many absorbers of light Blood pulsations used to determine arterial absorbance • Absorbance of 2 wavelengths of light to determine oxyhemoglobin and reduced hemoglobin • Ratio formed and saturation determined

Answer 27

• Accuracy 2% x 1 standard deviation Accuracy within 2%, 68% of the time • Dyes can cause large decrease in measured saturation • Carboxyhemoglobin causes false elevation in measured saturation • Methemoglobin results in sat of 85%

Answer 28

• Cerebral oximeters obtain continuous, noninvasive cerebral oxygenation values using near-infrared spectroscopy (NIRS) technology (650 - 900 nm) • Saturations are determined by measuring the light absorbed vs. light transmitted. • Saturation levels reflect capillary oxygen saturation levels • Saturations are lower than seen with pulse oximetry and trend analysis much more diagnostic • Reduction \> 20% for more than 4 minutes indicate potential for neurologic deficits

Answer 29

Galvanic- Volts Polarographic Sensors- amps Paramagnetic analyzers- require no calibration, institaneous

Answer 30

• Ohm’s Law E = IR (E = voltage, I = amperage, R = resistance) • Power E x I = power (measured in watts) • DC vs. AC Electron flow only in one direction = DC Electron flow reverses at regular intervals = AC

Answer 31

• Impedance  resistive force in AC circuit • Impedance (Z) Z = frequency x inductance Z = 1/(frequency x capacitance) • Changes in frequency result in changes in impedance • Inductance  electrical current can be induced in a separate wire or iron core

Answer 32

• As supplied by electric utility, power is grounded • In a grounded system current will flow between the “hot” wire and any conductor (patient) with ground • If patient is touching ground only contact with the “hot” wire is needed for shock to occur

Answer 33

• AC has greater propensity to cause V-fib • Tissue damage occurs: Disruption of normal cellular electrical activity Thermal injury – may be internal along path of conductivity • **Macroshock (at 60Hz)** _1mA = threshold of perception 10-20 mA = “let go” current 50 mA = pain_ **-DRAG and DROP Question**

Answer 34

• In the OR power is ungrounded • Isolation transformer is the device that “ungrounds” the power • Line isolation monitor monitors the integrity of the isolated power system Alarm is usually set to 2-5 mA

Answer 35

* A catheter or wire in the heart can deliver high current density * As little as 20 microamps may induce V-fib * Isolation transformer does not prevent microshock * Isolation monitor will not detect risk of microshock

Answer 36

• Laser reactivity depends on wavelength: Argon – absorbed by hemoglobin and melanin • CO2 laser blocked by any type of clear- (Cornea) glass or plastic, absorbed by water, limited tissue penetration • Nd:YAG and Argon lasers require special protective eyewear, transmitted through clear materials, deep penetration, (retinal damge) • Airway fires a risk from ETT ignition

Answer 37

• Primary Response Discontinue O 2 source Remove endotracheal tube Mask ventilate with lowest possible FiO 2 • Secondary Response _Recommendations vary from author to author_ Re-intubation Short term steroid administration Antibiotic administration Bronchoscopy Ventilatory support

Answer 38

**Temperature Monitoring** • Hypothermia – body temperature less than 36 o C • Postoperative shivering increases oxygen consumption by a factor of 5 • Radiation accounts for 40% of heat loss. Convection and evaporation account for about 30% • Conduction accounts for 30% of heat loss • One MAC decreases vasoconstriction and shivering threshold by 2 – 4 o C. ## Footnote **Radation\>Convection\>Evaporation\>conduction**

Answer 39

• Three phases of intraoperative hypothermia: 1) **Redistribution** of heat from core to periphery. Occurs in 1 st hour and results in a 1 – 2 o fall 2) **Steady decline** occurs in following 2 – 3 hours 3) **Equilibration** – losses equal metabolism • Accurate core temperatures can be obtained from: PA, distal esophagus, tympanic membrane, nasopharynx • Mouth, rectum, bladder, axilla are reasonable

Answer 40

Warming Methods • Treatment of hypothermia is ideally focused on intraoperative prevention • Active rewarming – application of an external heat source: 1. -Heated blankets – conductive heat source 2. -Radiant warmers – radiant heat source 3. -Forced air warmers – convective heat source. Forced air warmers have been shown to be the most effective • Burn injuries have been associated with all types of active rewarming devices *– Use of external heat sources are contraindicated in pts with severe PVD or during hypoperfused states (i.e. aortic cross-clamping)*

Answer 41

Blood Salvage (Cell Saver) • Device anticoagulates blood as it leaves the surgical field • Cells are washed in NS and centrifuged to a HCT of 45 – 65% • Contraindications – presence of infection, malignant cells, urine, bowel contents and amniotic fluid • Washing process removes platelets and coagulation factors, but not bacteria • Leukocyte filters often used to trap bacteria

Answer 42

• BIS ranges – 100 - 90 = awake, unanesthetized patient – 90 – 70 = light to moderate sedation – 70 – 60 = deep sedation (probable amnesia) – 60 – 40 = general anesthetic state – 40 – 10 = deep anesthetic state & burst suppression – 10 – 0 = flat-line EEG pattern • Causes of unexpected BIS results/changes – Change in level of surgical stimulation – Change in level of anesthesia or sedation – Change in body temperature – Change in level of neuromuscular blockade & shivering (falsely ↑ s EMG) – Presence of high-frequency electrical device e.g. Bovie, pacemaker – Placement of temporal lead over temporal artery – Use of pressors, ketamine \*\*BIS lags behind real-time by approximately 10-15 seconds

Answer 43

Back of the machine, ball and spring, you supply the endergy. It is for the Gaslines to be plugged into the wall, only DISS for the wall. VS. the Pin Index- designed for the Tank to be hooked up to the machine.

Answer 44

hanger yoke yoke block with check valves (free floating) cylinder pressure gauge cylinder pressure regulators ventilator power inlet pipeline inlets, check valves, pressure gauges flow meter valves oxygen pressure-failure devices oxygen second stage regulator flush valve flow meter tube vaporizers check valves common gas outlet

Answer 45

Free Floating- Examle DISS- prevents gas from leaking Ball and Spring- You supply the energy (all or none) Diaphragm- Diaphram (1st and 2nd stage regulators)

Answer 46

––empty oxygen cylinder ––incorrect cylinder on oxygen yoke ––closed oxygen cylinder valve ––oxygen flow meter off ––oxygen leak within the machine or flow meter ––incomplete or absent circuit unidirectional valves ––breathing circuit leak ––inadequate ventilation

Answer 47

Oxygen E cylinder → open cylinder valve → hanger yoke system → opens free floating valve of this E cylinder AND simultaneously closes the free-floating valve of the other hanger yoke system AND activates the Bourdon Gauge to read cylinder pressure. Now back to the open free-floating valve → first stage regulator (diaphragm valve) reducing cylinder pressure to intermediate pressure, which is 45psig, and now simultaneously to the following: → oxygen pressure sensor valve → flush valve → DISS ( closes free floating valve and PREVENTS CYLINDER OXYGEN FROM ESCAPING THE GAS MACHINE !!!!!! → second stage regulator (converts intermediate pressure to low pressure or 16 psig) → to gas flow manifold (flow meters) → vaporizer → common gas outlet → down through the soda lime canister → inspiratory valve → inspiratory limb of the breathing circuit → endotracheal tube/patients lips.

Answer 48

Department of Transportation (DOT)—established requirements for the design, construction, testing, marking, labeling, filling, storage, handling, maintenance, and transportation of compressed gas cylinders National Fire Prevention Association (NFPA)—same as for CGA: contains recommendations for the location, construction, and installation of bulk oxygen systems (NFPA 50) American National Standards Institute (ANSI)—sets basic performance and safety requirements for components of anesthesia machines, endotracheal tubes and connections, pressure and vacuum, and gas pressure regulators. National Institute of Occupational Safety and Health (NIOSH) and Occupational Safety and Health Act of 1970 (OSHA)—standards to protect the health and safety of workers. Food and Drug Administration (FDA)—promulgates standards for medical devices and gases. American Society for Testing Materials (ASTM)—assesses technology and revises standards. Joint Commission on Accreditation of Hospitals (The JC)—voluntary accrediting agency.

Answer 49

Will carry more gas than anticipated, need to send back to company for recalibration.

Answer 50

Hanger yoke is actually the valved, immideatly after the O2 tank, A dual hanger yoke allows gas to be taken from the tank with the most pressure.

Answer 51

Avagadros # is 6.02 X10 \>23, Avagodras law is, any gas with one mole of occupies a volume of 22.4 liters at 1 atm and 0 degrees C.

Answer 52

Deviation from the ideal state (PV = nRT) is described mathematically by the van der Waal’s equation. Real gases deviate from this ideal state. van der Waal’s equation corrects for deviations from ideal. van der Waal’s relationship (expressed below) assumes that gas molecules have finite volume a and that gas molecules attract one another b.

Answer 53

**Application for Ficks Law of diffustion** (1) the concentration effect, (2) the second gas effect, (3) diffusion hypoxia, and (4) why turning on the N2O leads to an increase in volume (or increase in pressure) in gas spaces in the patient’s body. According to Fick’s law of diffusion, the rate of diffusion of a gas into or out of the blood is proportional to its blood solubility. Fick’s First Law – For a given solute, the major determinant of the rate of diffusion is the concentration gradient **Factors that effect Ficks Law** 1. The partial pressure difference of the gas across the membrane. 2. The area of the membrane 3. the solubility of the gas in the membrate 1. The tickness of the membrane 2. the square root of the molecular weight of gas. Gases that are more soluabe will diffuse in greater quantites into the blood - ( This is Ficks law) Ficks law explaines the diffusion of gases between a gas phase and a liquid phase.

Answer 54

Ficks law, and Grahms law.

Answer 55

You sitting and breating Applying pressure to a bag 500 ml at 2 ATM is 1000ml at 1 TM Plethysmography - (measures changes in volume) Bellows Ventilator An O2 tank will releaase 660 liters into the atmosphere

Answer 56

ET tube in autoclave

Answer 57

The ideal gas law PV=nRT n=number of moles R- universal gas constant

Answer 58

1. Permits calculation of the % concentration of a gas by dividing the partial pressure of the gas by the total pressure. 2. Permits calculation of the partial pressure of a gas by multiplying % concentration by total pressure. N2O is 80% of the atmosphere= so its partial pressure 9s 600 0.8 X 760=600 If you are in the mountains it is lower pressure. so the O2 will still be the same % but will be a lower pressure. 2L/4L O2/N20 at 710mmgh = 236mm vs 474 mm *Do not confuse with Henry's Law= amount of gas that dissolves in a liquid is proportional to the partial pressure of the gas in the gas phase.*

Answer 59

Henry's Law= amount of gas that dissolves in a liquid is proportional to the partial pressure of the gas in the gas phase. * the amount of O2 dissolved in blood 0.003 * the amount of CO2 dissolved in Blood 0.067

Answer 60

It takes energy to break from the liquid state, A liquids **heat of vaporization** is the *number of calories necessary to convert 1ml liquid into a vapor.* **Latent heat of vaporzation** is more precisely defined as the number of calries required to change 1 G of liquid into vapor without a temperature change.

Answer 61

the ratio of the amount of water vapor present in the air, to the maximum amount of vapor the air can hold at the same temp. -The more heat in the air- the more vapor it can hold

Answer 62

adiabatic cooling of the gas in the cylinder, compressed gas release (Compressed Air Tank) Joule is COOL! cryoprobe uses the Joule-Thompson effect

Answer 63

temp above which a gas cannot be liquidfied no matter how mouch pressure is applied. O2- -119 Centigrade Critical pressure- minimum pressure necessary to liquify a gas at its critcal temp.

Answer 64

the point at which a liquids vapor pressure equals that of the total atmosphere pressure. Des will boil in the moutains, because its vapor pressure will be greater than the barometric pressure

Answer 65

Math whise , flow through a tube is inversaly proportional to resitance, Omhs law allows calculation of SVR, CO, MAP and CVP

Answer 66

flow is directly proportional to 1. the pressure drop along the tube 2. the forth power of the radius inversly 1. the length of the tube 2. vicosity of the fluid If the radius is doubled- the flow increases by 16X If the radius is tripled- the flow increases by 81X It is 81 because it is 1/3⁴

Answer 67

flow is inversley proportional to viscosity

Answer 68

2000 Flow becomes turbulent when viscosity reaches critical level. Conditions that change Laminar to turbulent 1. changing directions 2. increased velocity 3. rough walled The greater the density, the less the flow When flow is high and turbulent- **Density** determines flow. When Flow is slow and laminoar- **Viscosity** determines the flow. Turbulent (orifice flow) can occurr when the length is greater than the diameter.

Answer 69

It operates on the Bernoulli principle, the lateral pressure exerted by a fluid going through a tube of varying diameter is lowest at the narrowest part, where the velocity is greatest. Used in 1. nebulizers 2. atomizers 3. high frequency jet ventilotors 4. Venturi mask

Answer 70

tension in the wall of a hollow structure is proportional to the radius. Cylinders: T = Pr Spheres: T = Pr/2 **Surfactant** is a chemical in alveoli that lowers surface tension. It is more concentrated in smaller alveoli and lowers the surface tension more in smaller alveoli than larger alveoli. In ARDS- The alvoli act like soap bubbles, small empting into big due to greater pressure inside the soap bubble.

Answer 71

Macro= voltage applied to skin or tissue, 1-25 amps can cause V-fib Micro= small volts directly to the heart, 50 microamps required to cause V-fib

Answer 72

1. power supply 2. the patient 3. the floor

Answer 73

if isolate powerline is less than 60,000 ohms or ir fault would draw more than 2mA, If the alarm goes off- It could be to much equipment plugged in, could be 1 piece of faulty equipment, identify by unplugging each piece one at a time, if not for life support measures it should be removed from the room.

Answer 74

USP/NF- writes regulations for purity of gas FDA- enforces teh purity standrsds, inspect DOT- filling and manufacturing of gas cylinders cylinder inspected every 5 years,

Answer 75

every 5 years unles special permit, up to 10 years.

Answer 76

oil, **water(most common)**, bacteria, particulate matter, and residual sterilizing solution.

Answer 77

It is a soft wood metal, tht will be come soft at high temperature and let the cas discharge from the cylinder. It does not help with overfilling, only elevated temp.

Answer 78

to remove dust and debrie from the valve, to help prevent fire or explosion when the valve is opened later.

Answer 79

2 Tubes means you just have one taper, 1 tube means you need to dual taper in one tube, so that you can accuartely dial low flow/ high flow

Answer 80

Low flow is the viscosity, High flow is the density, O2 knob is 1. fluted 2. projects beyod control knobs 3. larger in diameter than other control knobs

Answer 81

1. concentration-calibrated 2. interlock 3. must indicate the liquid level in order to prevent overfilling 4. keyed-filler devices 5. must not dicarge anestheic from vaporizer even at maximum fresh gas flows 1. agent specific 2. temp compendated 3. flow over (variable bypass) Vaporizer shoul be located between flow meter and common gas outlet (this is out side the circle system) The work station is defined by ASTM, 1. gas supply 2. ventilator 3. monitoris 4. protection devices

Answer 82

It is not varible bypass, it is ectromechanically coupled dual circuit, gas vapor blender, Des has to be heated to 39C, which delives a pressurized vapor of 1300 or 1500 Fresh gas flow never comes in contact with Des liquid, The Tech6 does not compensate for changes in elevation- The *concentration* is unaffected, but the partial pressure delivered is less, therefore you will need to increase concentration to deliver equivaent **partial pressure**. If you are asked to calculate partial pressure of des at 5% all you do is .05 X 760 =

Answer 83

Back pressure during low flow would cause and increase concentration to be delivered. Newer vaporizers decrease the size of the vaporizing chamber, vapor saturated gas cannot make its way back into the bypass channel, so the pumping effect is prevented.

Answer 84

1. incorrect agent 2. tipping 3. overfilling 4. electronic falure 5. reliance on breath by breath gas analysis,

Answer 85

they prevent retrograde flow, and minimize downstream pressure, during postive pressure ventilation,

Answer 86

1. exhaled volume 2. inspired O2 3. oxygen supply failure alarm 4. hypoxic guard system 5. anesthetic vapor concentration 6. pulse oximetery 7. blood pressure 8. ECG

Answer 87

maximum of 2 minutes.

Answer 88

1. gas collecting system 2. transfer tubing 3. scavenging interface 4. gas disposal tubing 5. active or passive gas disposal

Answer 89

1. wrong supply gas 2. defective pneumatics or mechanics 3. leaks downstream, 4. inert gas 5. dilution of inspired oxygen The link system for the N20 is the link-25 proportioning system, it allows a 3:1.

Answer 90

separates breathing system gas from driving gas.

Answer 91

1. VC 2. PaO2 \>60 3. maximal negative inspitory pressure \>20 4. normal pH 5. RR rate \<20 6.

Answer 92

10-15ml/kg slow breathing 6-8

Answer 93

1. increased ETCO2, 2. respiratory acidosis, 3. hypervntilation, 4. sympathetic activation 5. increased bleeding 6. color indcatior late signs 1. increased HR and BP 2. dysrhythmias

Answer 94

1. Calcium carbonate 2. sodium hydroxide 3. potassium hydroxide 4. heat 5. water Amsorb 1. Ca (Oh)2 2. Ca CL2 3. CaSO4 4. polyvinylpyrrolidone, 5. water Calcium hydroxide is the most abundant component of both soda lime and amsorb The reaction that takes place is known as Neutralization.

Answer 95

**Spontaneous**- A\>DFE\>CB **_Controlled_**- DFE\>BC\>A The most commonly used system for delivery of anesthetic gass and O2 to children and adults. = Semi- closed

Answer 96

on the inspiratory limb

Answer 97

THe lower pressure circuit b/c it is subject to breakage and leaks.

Answer 98

1. battery 30min 2. almars 3. monitors 4. breathing circuit pressure limited to 125cm 5. nondetachale electrical supply cord 6. cylinder supplies 7. flowmeters

Answer 99

due to compression of gasses, epansion of the breathing circuitry, gas that enters the bellows during expiration, consistis of the patient gas as well as fresh anestheitc gases.

Answer 100

lighted sylet oral J shape, 75-120 (60-80 peds)degrees. Nasal- should take shape of the paient.

Answer 101

sterilzation includes baterial spores Autoclave just uses steam. 1. 121C=15min 2. a few seconds 150C

Answer 102

* amonium componds * alcohols * glutaralehydes * hydrogen peroxide * formaldehyde * chrine Ethylene oxide- for temperature sensitive equipment. hydrogen perxoide and glutaraldehyde will destory spores.

Answer 103

1. alphat, 8-12Hz 2. beta, \>12 3. delta, -0-4Hz 4. theta. -4-7 Hz Anesthesia is theta waves - delta- sleeping beta- thinking, awak When anesthesia is incresed, you get increased amplitude, followed by isoelectric EEG at a MAC of 1.5-2

Answer 104

somatosensory evoked potentials- integrity of posterior/**dorsal** spina cord, of the **dorsal-lemniscal** system. neuromuscular blockade will not alter transmission of action potentials in the sensory tracts. Halotane effects it the least, Enflurane the most, Nitrous also effects it. Things that effect SEPs 1. temp- (effects the most) 2. hyotension 3. hypoxia 4. hypocarbia 5. isovolemic hemodilution (the least) SEPs monitor flow through the posterior spinal arteries. autitor SEPS- VIII- Most resistant to SEPs Optic monitoring appropriate for pituitary and transsphenoidal surgery Optic SEPS= most sensative, Aesthesia with minimual effect- prop. barbs, fent, _ketamine, etomidate, opieates - dont effect SEPs_ hyothermia can effect as well. **MEPs**-the wake up test measures the anterior spinal cord BIS is not effected by hypnotic agents, opioids or analgesics. The BIS is slightly increased with Ketamine.

Answer 105

measures regional blood hemoglobin stauration with near-infrared optical spectroscopy. NRIS measures all hemoglobin, pulsatile and nonpulsatile in a mixed microvascular bed. It measures objectively for hyoperfusion. It has the advantage of being used during non-pulsatile flow like that of Circulation arrest.

Answer 106

1. 21 2. 25 3. 29 4. 33 5. 37 1-5 liters per min

Answer 107

You need to work on this one and now it!!!

Answer 108

Reactions of CO2 in Soda Lime 1. CO2 + H2O → H2CO3 2. H2CO3 + 2NaOH (2KOH) → Na2CO3 (K2CO3) + 2H2O + heat 3. Na2CO3 (K2CO3) + Ca(OH)2 → CaCO3 + NaOH (2KOH)

Answer 109

***Hydrophobic*** HMEs have a hydrophobic membrane with small pores that is pleated to provide a greater surface area. High ambient temperature may decrease the effectiveness of hydrophobic HMEs. The airway resistance of hydrophobic HMEs increases only slightly if wet. ***Hygroscopic*** HMEs contain a wool, foam, or paperlike material that is coated with a chemical that helps it to retain moisture. Hydrophobic HMEs are effective at preventing the transmission of the *hepatitis C virus* than hygroscopic HMEs. if hygroscopic HMEs become wet, they may lose their ability to filter airborne pathogens and airway resistance may *increase substantially*. Are considered _more effective_ at preserving heat and humidity than hydrophobic HMEs.

Answer 110

50-Hz for 5 sec tetanic stimulation is applied, followed by a 3 second pause, then 1-Hz single twitch stimulations are applied in a series. The number of stimulations that produce a visible muscle twitch is the post-tetanic count.

Answer 111

when the ventilator is being used a portion of the fresh gas flow will contribute to the tidal volume. This effect increases if the fresh gas **flow rates** are high, if the **I:E ratio** is high, and if the patient has a **slower respiratory rate.**