Equipment EXAM Flashcards
A 34-year-old female is undergoing laparoscopic tubal ligation. Her vital signs are: BP - 110/74 mmHg, P - 70/min, R - 10/min. Her mean arterial pressure is approximately
86 mmHg
The formula for MAP is:
MAP = (SBP) + 2(DBP)/ 3
Why is the MAP formula as it is ?
Because the time spent in diastole is approximately twice the time spent in systole, a time-weighted average is used to calculate mean arterial pressure (MAP).
According to the American Society for Testing and Materials F1850-00 standard, an anesthesia machine must have:
an exhaled volume or ventilatory carbon dioxide monitor
The ASTM F1850-00 standard requires monitoring of breathing system pressures,.
exhaled tidal volume, ventilatory carbon dioxide, anesthetic vapor concentration, inspired oxygen concentration, oxygen supply pressure, arterial saturation, arterial blood pressure and electrocardiogram
In addition, the anesthesia workstation must have a
3-tiered prioritized alarm system.
In the central venous pressure tracing below, ventricular contraction corresponds to:
B. The buldging of the tricupid valve during contraction
The risk of occupational exposure to inhaled anesthetic agents is higher with:
an open scavenger
Unless used correctly, the risk of occupational exposure is higher with
an open interface.
Open scavenging systems require an
active disposal system for effective scavenging.
When calculating the cardiac output using the Fick principle: What must be determined?
Mixed Venous Oxygen content must be determined
The Fick principle states that the
amount of oxygen consumed equals the difference between arterial and mixed venous oxygen content multiplied by the cardiac output.
Ficks’ principle, Therefore cardiac output is equal to:
Oxygen consumption/A-V oxygen content difference
In adults, the distance from the ventricular port to the tip of a pulmonary artery catheter is:
20 cm
The ventricular port on a PA catheter is how far from the tip?
20 cm from the tip;
PA catheter: the distance of the proximal port is
30 cm.
Ventricular arrhythmias are NOT induced by electrosurgical units as a result of the:
frequency of the current applied
In contrast to the current from the line power (60 Hz), electrosurgical units (ESUs) use
ultrahigh frequencies (0.1 - 3 MHz) to avoid the induction of arrhythmias.
ESUs use a large return pad for the
dispersal of exiting electrical current to avoid burns at the exit site.
Inspired and expired gases that can be measured using infrared absorption analysis include:
carbon dioxide, desflurane
Most anesthetic gases and carbon dioxide are now measured by
infrared absorption analysis.
Nonpolar gases such as oxygen and nitrogen do not
absorb infrared light and must be measured by other means.
Process capable of removing or destroying all viable forms of microbial life, including bacterial spores, to an acceptable assurance level.
Sterilization
Process of reducing the number of microbial contaminants to a relatively safe level.
Sanitization
Process capable of destroying most microorganisms but, as ordinarily used, not bacterial spores.
Disinfection
Process that renders inanimate items safe for handling by personnel who are not wearing protective attire.
Decontamination
The normal gradient between PaCO2 and ETCO2 is approximately:
2 - 5 mmHg and reflects alveolar dead space.
Increasing PaCo2 and ETCO2 gradient ?
Any significant reduction in lung perfusion increases alveolar dead space, diluting expired CO2 and increasing the gradient.
During the delivery of an anesthetic in the CT scanning suite, oxygen from the E-cylinder is being used. The patient is intubated and spontaneously ventilating with 94% oxygen and 6% desflurane. Sixty minutes into the case the pressure of the E-cylinder has fallen from 2000 psi to 1100 psi. From this information, the fresh gas flow is estimated to be:
4.8 - 5.2 L/min
The content of oxygen in an E-cylinder is about
660 L when full, at a pressure of 2000 psi.
Flow loop demonstrates reduced flow during both inspiration and exhalation without changes in lung volume.
Indicate Kinking ETT
The effect of methemoglobinemia on the pulse oximetry reading is to:
cause a reading of 85% regardless of the actual saturation
Methemoglobin has the same
absorption coefficient at both red and infrared wavelengths causing a reading of 85% regardless of the actual hemoglobin saturation
For accurate blood pressure measurement, the width of the blood pressure cuff should be:
20 - 50% greater than the diameter of the extremity
The accuracy of any method of blood pressure measurement depends on
proper cuff size.
The cuff’s bladder should extend at least
halfway around the extremity and the width of the cuff should be 20 - 50% greater than the diameter of the extremity
Interchanging the position of the APL valve and the fresh gas inlet transforms a Mapleson A circuit into a:
Mapleson D circuit which is better suited for controlled ventilation
Elevation of the baseline of the capnogram indicates_______caused by
rebreathing. This could be the result of an incompetent expiratory valve or an exhausted carbon dioxide absorber
At or below which of the following pressures is it recommended that the E-cylinder of oxygen be changed?
1000 ps
An incompetent inspiratory valve causes_____How does the graph is affected?
part of the expired gas to flow back into the inspiratory limb and allows these exhaled gases to be inspired with the next breath. This results in a delay in the initiation of Phase IV of the capnogram
Concerning the use of lasers, as wavelength______absorption by water_______
increases: increase
As wavelength increases the energy of the laser light
decreases.
Wavelength and energy of the laser light have a _____relationship
Inversely proportional relationship
As wavelength increases, There is increased absorption by water and
decreased tissue penetration and coagulation.
Corneal damage is more likely with
longer wavelength lasers (CO2 laser)
Retinal damage is more likely with
shorter wavelength lasers (YAG laser).
Advantages of non-diverting (flowthrough) capnographs include:
no aspiration of gas from the circuit
Non-diverting capnographs measure
carbon dioxide passing through an adaptor placed in the breathing circuit. The weight of the sensor can cause traction on the tracheal tube. However, since the sensor is in the gas stream, no aspiration of gas is required.
In order for leakage current to be perceptible to touch, the current must exceed
: 1.0 mA
Most current leaks are
Imperceptible
In order to be felt, leakage current must exceed
1.0 mA
Leakage of 100 mA or greater is capable of
Causing V FIB
Regular atrial rhythm and a regular ventricular rhythm, but no relationship between the P wave and the QRS complex. This rhythm constitutes a______What kind of treatment and intervention is needed?
complete heart block, also known as a 3rd degree block. Immediate treatment is required if cardiac output is reduced and consideration should be given to insertion of a pacemaker.
Small circuit leaks will have little effect on minute ventilation when using a:
pressure-cycled ventilator because cycling will be delayed until the pressure limit is met.
ventilators are no longer approved for use in the anesthesia circuit.
Hanging-bellows ventilators
Some patients are at increased risk for hand ischemia secondary to radial artery catheterization because of an incomplete palmar arch. The approximate percentage of patients with incomplete palmar arch is:
5%
Some patients are at increased risk for hand ischemia secondary to radial artery catheterization because of an
incomplete palmar arch.
About five percent of patients have incomplete palmar arches and
lack adequate collateral blood flow.
As compared to non-rebreathing circuits, disadvantages of the circle system include:
higher system resistance
Disadvantages of the circle system include:
greater size
decreased portability, increased complexity, increased risk of disconnection, increased system resistance and difficulty in predicting inspired gas concentrations during low fresh gas flows.
With a properly functioning carbon dioxide absorber, inspired carbon dioxide levels should be
approach zero in the circle system.
The tracing below is noted during the insertion of a pulmonary artery catheter. As the catheter is advanced further: the diastolic pressure wil
increase
Determinants of bobbin position in the flowmeter include: (Select 2)
gas molecular weight at high-flow rates
changes in atmospheric pressure
At low (laminar) flow rates the bobbin height is determined by
gas viscosity.
At high (turbulent) flow rates the bobbin height is determined by
gas density.
Gas density is directly proportional to the,
molecular weight of the gas (DMW -> Density/molecular weight)
bobbin height during high flows is determined also by
molecular weight.
Problems inherent with the dye-dilution technique of measuring cardiac output include:
background indicator buildup
The dye-dilution technique introduces the problems of
indicator recirculation
arterial blood sampling and background indicator buildup.
The need for a return electrode to the electrocautery can be eliminated if:
bipolar electrodes are used
Bipolar electrodes confine
current propagation to a few millimeters, eliminating the need for a return electrode.
Pulse oximetry changes seen in carbon monoxide poisoning include a(n):
falsely increased SpO2 levels
Because carboxyhemoglobin and oxyhemoglobin absorb light at
660 nm identically, pulse oximeters will register a falsely high reading in patients with carbon monoxide poisoning.
A 53-year-old man is undergoing a laparoscopic cholecystectomy. He is currently receiving 6% desflurane and oxygen at 3 L/min. A ventilator lacking fresh-gas-flow compensation is set to: TV = 700, Rate = 9, I:E = 1:2. This patient’s minute ventilation is:
7.3 L/min. Because the ventilator’s spill valve is closed during inspiration, fresh gas flow contributes to the minute ventilation (MV). With I:E = 1:2, fresh gas flow contributes to the MV 33% of the time. This results in an increase of minute ventilation of 1 L/min. The patients total MV is therefore (0.7 L)(9 breaths/min) + 1 L = 7.3 L.
Central venous pressure measurements should be made:
at the end of exhalation
Measurement of CVP is made with a______What should CVP pressure be measured?
water column or transducer. The pressure should be measured during end expiration.
During exhalation, sticking of the spill valve of the ventilator can result in: .
the application of positive end-expiratory pressure
The ventilator has its own pressure-relief valve, called the
spill valve, which is closed during inspiration and open at the end of exhalation
Sticking of the spill valve results in
abnormally elevated airway pressure during exhalation.
The decline in core temperature during the first hour of general anesthesia is largely due to:
redistribution of heat to cooler peripheral tissues
Temperature decreases during general anesthesia can be grouped into _____phases
3 phases
