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APEX > Equipment & Monitoring > Flashcards

Equipment & Monitoring Flashcards

1
Q

What components are present in the high pressure system of the AGM? What is the gas pressure?

A

-Hanger Yoke
-Yoke block w/check valves
-Cylinder Pressure Gauge
-Cylinder pressure regulators
Gas pressure = cylinder pressure

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2
Q

What components are present in the intermediate pressure system of the AGM? What is the gas pressure?

A

-Pipeline inlets
-Pressure gauges
-Ventilator power inlet
-Oxygen pressure failure system
-Oxygen second-stage regulator
-Oxygen flush valve
-Flowmeter valve

Gas pressure = 50 PSI (pipeline) and 45 PSI (cylinder)

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3
Q

What are the components of the low pressure system?

A

Flowmeters
Vaporizers
Check valves (if present)
CGO

Gas pressure = slightly above atmospheric pressure

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4
Q

What are the 5 tasks of oxygen in the AGM?

A

-O2 pressure failure alarm
-O2 pressure failure device (failsafe)
-O2 flowmeter
-O2 flush valve
-Drives the ventilator

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5
Q

What are the maximum pressures and volumes for cylinders?

A

Air = 1,900 PSI and 625 L
Oxygen = 1,900 PSI and 660 L
Nitrous Oxide = 745 PSI and 1590L (20.7 lb when full, 14.1 lb when empty)

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6
Q

List 3 safety relief devices that prevent a cylinder form exploding when the ambient temperature increases

A

-Never expose to temps > 130F (57C)

  1. Fusible Wood’s plug that melts at high temperatures
  2. Frangible disk that ruptures under pressure
  3. Valve that opens at elevated pressures
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7
Q

Give 4 examples of how the hypoxia prevention safety device (proportioning device) can allow for a hypoxic mixture

A
  1. Pipeline crossover
  2. Leak distal to flowmeter valves
  3. Admin of a 3rd gas
  4. Defective mechanic or pneumatic components
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8
Q

Oxygen pressure failure device

A

-Failsafe
-Shuts off nitrous when oxygen drops below 20 PSI

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9
Q

Describe the structure and function of the flowmeters

A

Variable orifice constant flow
-The annular space is the space between the indicator float and the side wall of the flow tube. It is narrowest at base, and widest at the top

-Base = laminar flow (Poiseulle) based on viscosity
-Top = turbulent flow (Graham) based on density

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10
Q

An AGM uses FGF coupling .. how do you determine total TV that will be delivered to patient

A
  1. Convert FGF to mL/m
  2. Multiple mL/m x I:E ratio
  3. Calculate MVe
  4. Add MVe plus the #2
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11
Q

When using a ventilator that couples FGF to TV, what types of ventilator changes will impact the Tv delivered to the patient

A

Vt increases with: decreased RR, increased I:E ratio (1:1), increased FGF, increased bellows height

Vt decreases with: increased RR, decreased I:E ratio (1:2), decreased FGF, decreased bellows height

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12
Q

What does the oxygen analyzer measure, and where is it located?

A

Monitors oxygen concentration and is the only device downstream of the flowmeters that can detect a hypoxic mixture.

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13
Q

Oxygen flush valve

A

35 - 75 LPM
50 PSI

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14
Q

Describe the function of the ventilator spill valve in relation to using the O2 flush valve

A

The spill valve is closed during inspiration so if you press the oxygen flush valve during inspiration … the patient is at high risk for barotrauma

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15
Q

What is desiccation

A

Water is required to facilitate the reaction of carbon dioxide with CO2 absorbent. The granules are hydrated to 13 - 20% by weight. When the absorbent is devoid of water, it is desiccated.

It produces carbon monoxide des > iso > sevo and compound a with sevo

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16
Q

What are the OSHA recommendations regarding inhalation anesthetic exposure

A

Halogenated agents alone < 2 ppm
Nitrous oxide alone < 25 ppm
HA + NO < 0.5 and 25 ppm

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17
Q

Which mapleson circuit is most efficient for spontaneous ventilation? Which one for controlled Ventilation?

A

Spontaneous
A > DFE > CB

CMV

DFE > BC > A

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18
Q

What conditions decrease pulmonary compliance? How does this affect the peak pressure and plateau pressure?

A

D/t decreased static compliance (PIP and PP increase)

-endobronchial intubation
-pulmonary edema
-pleural effusion
-tension pneumothorax
-atelectasis
-chest wall trauma
-abd. insufflation
-ascites
-t-burg

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19
Q

What conditions increase pulmonary resistance? PP vs PIP

A

D/t reduction in dynamic compliance (PIP increases, PP unchanged)

-kinked ETT
-ETT cuff herniation
-Bronchospasm
-Secretions
-Airway compression
-Foreign body aspiration

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20
Q

Describe the four phases of normal capnograph

A

1 = exhalation of anatomic dead space
2 = exhalation of anatomic dead space and alveolar gas
3 = exhalation of alveolar gas
4 = inspiration of fresh gas that does not contain CO2

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21
Q

Describe the significance of the alpha and beta angles on the capnograph

A

Alpha = resistance. airflow obstruction. COPD, bronchospasm, kinked ETT
Beta = increased with some breathing

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22
Q

Pulse oximeter basics

A

Beer Lamber Law
660 nm (deoxyHgb)
940 nm (oxyHgb)

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23
Q

What conditions impair the reliability of pulse oximeter

A

Vasoconstriction, hypothermia, reynaud’s
carboxyhgb (absorbs 660nm same degree as oxygenated Hgb)
metHgb (absorbs 660 and 940 equally)
methylene blue, indocyanine green, indigo carmine
CPB, LVAD

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24
Q

What affects the accuracy of the NIBP cuff

A

Length = 80%
Width = 40%

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25
Q

Falsely increased BP

A

BP cuff too small
BP cuff too loose
Below level of the heart

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26
Q

Falsely decreased BP

A

BP is too large
Deflated too rapidly
Above level of the heart

27
Q

How does the site of measurement affect BP monitoring

A

As the pulse moves from the aortic root toward the periphery, the systolic pressure increases, the diastolic pressure decreases, and the pulse pressure widens. MAP remains constant throughout the arterial tree

*At aortic root, SBP is the lowest, DBP is the highest, PP is the most narrow
*At dorsalis pedis, SBP is the highest, DBP is the lowest, PP is the most wide

28
Q

How does the arm position affect NIBP?

A

Located above the heart, BP reading will be falsely decreased

Located below the heart, BP reading will be falsely increased

*For every 10 cm, BP changes by 7.4 mmHg
*For every inch, BP changes by 2 mmHg

29
Q

Systolic BP = what on an a-line

A

Peak of waveform
Diastolic = trough

30
Q

Contractility on an a-line is measured by? Stroke volume?

A

Upstroke
SV = AUC

31
Q

Damping and interpretation of the high pressure flush test

A

High pressure flush helps us determine this when we observe oscillations that result

-Optimally dampened = 1 oscillation
-Under dampened = Lots of oscillations (SBP overestimated, DBP underestimated)
-Over dampened = No oscillations (SBP underestimated, DBP overestimated) d/t air bubble, clot, low flush bag pressure

32
Q

How do you determine the appropriate distance to thread a central line

A
  1. Distance from site of entry to vena cava
  2. Distance from VC junction to where catheter tip should be placed
  3. Add them together
33
Q

Insertion site to the vena cava

A

Subclavian = 10 cm
IJ right = 15 cm
IJ left = 20 cm
Femoral = 40
Median basilic rt, lt (40,50)

34
Q

VC –> Catheter tip

A

Right atrium = 0 - 10 cm
RV = 10 - 15 cm
PA = 15 - 30 cm
PAOP = 25 - 35 cm

35
Q

Discuss the 3 waves, 2 descents on CVP tracing

A

a = RA contraction
c = tricuspid valve elevation into RA (after QRS)
x = downward movement of contracting RV (ST)
v = RA passive filling (T wave)
y = RA empties through tricuspid valve

36
Q

when do you lose an a wave on the cvp

A

a fibb, v-pacing w/underlying asystole

37
Q

what causes an increased a wave on cvp

A

stenosis
MI
chronic lung dx = RVH
av dissociation
junctional rythm
PVCs

38
Q

What causes a large v wave on cvp

A

tricuspid regurg
increase in intravascular volume
rv papillary muscle ischemia

39
Q

where should the tip of the PAC locate

A

west zone 3
part > p venous> p alveolus

40
Q

equation for mixed venous oxygen saturation

A

sao2 - vo2/ (q * 1.34 * hgb * 10)

41
Q

What are the 12 leads

A

Bipolar (3) I - III
Limb (3) avr, avl, avf
Precordial (6) v1-v6

42
Q

Name the region of the heart & leads

A

II, III, avf = inferior, RCA
I, avL, v5, v6 = lateral, circumflex
v1 - v4 = LAD

V1 & V2 (septum) V3 & V4 (anterior)

43
Q

right axis deviation

A

anything with the lungs

44
Q

left axis deviation

A

chronic HTN
LBBB
As
AI
MR

45
Q

Class IA, IB, IC antiarrythmics

A

Na Channel Blockers

IA = quinidine, procainamide, disopyramide
moderate depression of 0, prolongs phase 3 repolarization
IB = Lidocaine, Phenytoin
shortened phase 3 repol
IC = flecainaide, propaferone
strong depression of phase 0

46
Q

Class II antiarythmics

A

BB - slows phase 4 depolarization in the SA node

47
Q

Class III antiarythmics

A

K Channel BLockers
Amio, Bretyium

Prolongs phase 3 repolarization (prolongs QT)
increases effective refractory period

48
Q

Class IV antiarrythmics

A

Ca Ch Blockers
Decreasing conduction velocity through AV node

Verapamil, Diltiazem

49
Q

EKG findings w/WPW

A

Delta wave d/t ventricular preexcitation
Short PR interval < 0.12 seconds
Wide QRS
Possible T wave inversion

50
Q

What conditions increase the risk of torsades de pointed?

A

POINTES
P = phenothiazines
O = Other meds (methoadone, droperidol, amio)
I = ICH
N = No known cause
E = electrolytes … low K, Ca, Mg
S = syndromes (romano-ward, timothy)

51
Q

Five indications for cardiac pacemaker insertion

A

Symptomatic diseases of impulse formation (SA node disease)
Symptomatic diseases of impulse conduction (AV node disease)
Long QT syndrome
Dilated CM
Hypertrophic obstructive cardiomyopathy

52
Q

Pacemaker identification code

A

1 = chamber paced
2 = chamber sensed
3 = response to sensed event
4 = programmability
5 = can peace multiple sites

53
Q

What conditions increase the risk of failure to capture?

A

Potassium high or low
Low CO2 (intracellular K+ shift)
Hypothermia
MI
fibrotic tissue around pacing leads

54
Q

Cerebral oximetry utilizes NIRS

A

-CBV = 1 part arterial to 3 parts venous, 75% of the blood in the brain is on the venous side of circulation
-NIRS cannot detect pulsatile blood flow, it is primarily a measure of venous oxyhemoglobin saturation and oxygen extraction
-greater than 25% change in baseline = reduction in cerebral oxygenation

55
Q

Beta waves

A

high frequency
low voltage
awake mental stimulation or light anesthesia

56
Q

Alpha waves

A

awake, but restful state

57
Q

Theta

A

GA and normal sleep with kids

58
Q

Delta

A

GA, deep sleep, brain ischemia or injury

59
Q

Burst suppresion

A

GA, hypothermia, CBP, cerebral ischemia

60
Q

GA and brain waves

A

increased beta wave
theta, delta waves predominate during GA
deep GA produces burst suppression
1.5 - 2 MAC = complete suppression

61
Q

name 2 drugs that reduce the reliability of the BIS value

A

nitrous oxide (increaases the amplitude of high-frequency activity and reduces the amplitude of low frequency activity)

ketamine increases high frequency amplitude

62
Q

Macro vs micro shock

A

Macro = large current, external surface of the body. Skin offers high resistance so it takes a larger current to induce ventricular fibrillation

Micro = small current, directly to myocardium

63
Q

Thresholds for macro/micro shock

A

Macro
1 mA = perception
5 mA = harmless threshold
10 - 20 mA = let go current
50 mA = LOC
100 mA = vfibb

Micro
10 microamps = max allowable in OR
100 microamps = vfibb

64
Q

What is the role of the line isolation monitor?

A

Assesses the integrity of the ungrounded power system in the OR. Tells you how much current could flow through you if a second fault occurs

Alarms when 2 - 5 mA is detected
Unplug your last equipment you plugged in if it alarms!!

APEX (18 decks)

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