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APEX > Equipment + Monitoring > Flashcards

Equipment + Monitoring Flashcards

1
Q

Agent most likely to cause circuit fire

A

Sevoflurane

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2
Q

What Sp02 does and does not monitor

A

Does monitor:

  • Hgb saturation
  • HR
  • fluid responsiveness

Does not monitor:

  • amount of Hgb (anemia)
  • Ca02
  • D02
  • ventilation (can have normal Sp02 with hypercarbia)
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3
Q

Best Maplesons for CV and SV

A

SV: A>DFE>B

CV: D>FE>BC>A

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4
Q

Soda lime chemical RXN

A

C02 + H20 → H2C03

H2C03 + 2NaOH → Na2C03 + 2 H20 + energy

Na2C03 + Ca(OH)3 → CaC03 + 2NaOH

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5
Q

Difference between semi open and semi closed breathing circuits

A

Semi closed allow rebreathing of exhaled gas.

→ FGF MV

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6
Q

Line isolation monitor - what does it assess and what does it tell you when it alarms

A
  • Assesses the integrity of the ungrounded power system in the OR.
  • Tells you when the OR becomes grounded, and how much current could flow thru you or a patient if a second fault occurs.
  • If it alarms, it means its alerting you to a FIRST fault (means OR has become grounded)
  • Will alarm when 2-5mA of leak current is detected
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7
Q

Mechanical events of R heart as they correspond to CVP waveform

A

A wave = RA contraction
C wave = RV contraction (specifically isovolumetric contraction + bulging of tricuspid towards RA)
X descent = RA relaxation
V wave = passive filling of RA

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8
Q

Distances from CVL insertion points to vena cava/RA junction

A 
L or R subclavian: 10cm
RIJ: 15cm
LIJ: 20cm
Femoral: 40cm
R median basilic: 40cm
L median basilic: 50cm
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9
Q

How to predict how long your agent will last

A

ML agent used per hour = Vol% x FGF (L/min) x 3

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10
Q

How to calculate volume lost to circuit compliance

A

Circuit compliance (mL/cm h20) x peak pressure (cmH20)

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11
Q

Compensation for TEC-6 DES vaporizer at elevation

A

Higher altitude → higher setting on dial

Lower altitude → lower setting on dial

At higher altitude, the [] exiting vaporizer will be whatever you set on dial, but bc atmospheric pressure is lower at elevation, the partial pressure in the breathing circuit will also be lower.

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12
Q

What can the oxygen analyzer do that other components cant

A

-Can detect an 02 pipeline crossover (o2 pressure device and proportioning systems can’t)
-Monitors 02 CONCENTRATION
-Can detect a leak in breathing circuit
→ most common is Y-piece
→ 2nd most common is C02 canister

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13
Q

What to do if the oxygen analyzer alarms

A

Turn ON the 02 cylinder, THEN kill the pipeline supply

→ if a crossover occurred and you just turn on the tank, that won’t fix the problem , because if an adequate pipeline pressure is present even if it’s not 02, the machine will still draw from the pipeline

→ any time you switch to a tank you gotta kill the pipeline

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14
Q

What are the final products of the soda lime reaction

A 
Calcium carbonate (CaC03)
Sodium hydroxide (NaOH)
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15
Q

Advantages, disadvantages of Amsorb plus (calcium hydroxide lime)

A

A: no CO production, v little Compound A production, stays moist

D: $, absorbs less C02

(Amsorb = 10L C02/100g, Soda lime = 26LC02/100g)

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16
Q

OSHA recs regarding IA agent exposure

A

Halogenated alone <= 2ppm
N20 alone <=25ppm
IA + N20 <=0.5ppm and 25ppm respectively

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17
Q

What would cause ↑ PIP and ↑ plateau pressure?

A

Means TOTAL compliance has ↓

  • Endobronchial intubation
  • Pulmonary edema
  • Tension pneumo
  • Atelectasis
  • Chest wall edema
  • Insufflation
  • Ascites
  • Tburg
  • Inadequate paralysis
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18
Q

→ of ↑ PIP with NO change in Peak pressure

A

Means resistance has ↑

  • kinked ETT
  • ETT cuff herniation
  • Bronchospasm
  • secretions/plug
  • Airway compression
  • foreign body aspiration
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19
Q

→ of ↑ alpha angle on capnograph

A

Signifies expiratory airflow obstruction: COPD, bronchospasm, kinked ETT

“Shark fin” shape

20
Q

→ of ↑ beta angle on capnograph

A

Faulty unidirectional valve

21
Q

Distance of PA from VC junction

A

25-35cm

22
Q

Complications of floating PA cath

A

PA rupture
RBBB
Complete heart block (if pre existing LBBB)
Dysrhythmias

23
Q

Things that ↑ CVP

A 
Transducer below axis
Hypervolemia
RV failure
Tricuspid stenosis or regurgitation
Pulmonic stenosis
Pulmonary HTN
PEEP
VSD
Constrictive pericarditis
Cardiac tamponade
24
Q

→ of ↑ A wave amplitude on CVP waveform

A

A wave = atrial contraction, so if the amp ↑, means atrium is emptying against a high resistance..
it’s either stenotic tricuspid valve or ↓ compliance RV.

Basically, how hard does the atrium have to squeeze..

  • tricuspid stenosis
  • diastolic dysfunction
  • myocardial ischemia
  • chronic lung disease → RV hypertrophy
  • AV dissociation
  • junctional
  • V pacing, asynchronous
  • PVCs
25
Q

Loss of A wave on CVP waveform

A

A fib, v-pacing IF the underlying rhythm is asystole

26
Q

Reasons for large V wave on CVP waveform

A
  • tricuspid regurg would be main one
  • acute ↑ intravascular volume
  • RV papillary muscle ischemia
27
Q

PAOP or PCWP waveform

A

Akin to CVP of left heart

A wave = LA contraction
C wave = MV elevation into LA during LV contraction (isovolumetric contraction)
V wave = passive left atrial filling

28
Q

Conditions in which PAOP/PCWP overestimates LVEDP

A
  • Impaired LV compliance (diastolic dysfunction)
  • MV disease (either stenosis or regurg)
  • L → R shunt
  • PPV, PEEP
  • COPD
  • pulmonary HTN
  • PAC placed in wrong zone (not zone 3)
29
Q

Factors that cause underestimation of CO with thermodilution PA cath measurement

A

-Injectate too much or too cold

30
Q

Factors that cause overestimation of CO with thermodilution PA cath measurement

A

Injectate volume too low, too warm, partially wedged PAC, thrombus on PAC tip

31
Q

Causes of ↑ Sv02

A

↓ 02 consumption: A0X application, hypothermia, cyanide (SNP)
↑ 02 delivery: ↑ Pa02, ↑ CO, ↑ Hgb

Sepsis, L → R shunt

32
Q

→ of ↓ Sv02

A

↑ 02 consumption: AoX removal, stress, pain, thyroid storm, shivering, fever
↓ 02 delivery: ↓ Pa02, ↓ Hgb, ↓ CO

33
Q

Cerebral oximetry

A
  • uses NIRS (near infrared spectroscopy)
  • measures venous 02 sat
  • it only measures regional, NOT global oxygenation
34
Q

Classification of EEG (highest to lowest)

A 
Beta (awake, induction)
Alpha (sleepy)
Theta (GA)
Delta (GA, deep sleep, brain injury)
Burst suppression (GA, CPB, hypothermia, ischemia)
Isoelectricity (super deep GA, death)
35
Q

Hypokalemia EKG

Hyperkalemia EKG

A

Hyper: narrow peaked T, short QT, wide QRS, wide PR, nodal block

Hypo: U wave, ST depression, flat T wave, long QT

36
Q

Hypocalcemia EKG

Hypercalcemia EKG

A

Hypercalcemia: short QT
Hypocalcemia: long QT

37
Q

What direction does the heart depolarize in?

What direction does it repolarize in?

A

Depolarizes base → apex and endocardium → epicardium

Repolarizes apex → base, epicardium → endocardium

38
Q

Which leads do you examine to determine axis deviation

A

Lead I and avF:

If they are Reaching toward each other (I pointing down and avF pointing up) you have R axis deviation

If they are Leaving each other (I pointing up and avF pointing down) you have L axis deviation

39
Q

→ of R axis deviation

A

COPD, acute bronchospasm, cor pulmonale, pulm HTN, PE

40
Q

→ of L axis deviation

A

Chronic HTN
LBBB
AS, AI, MR

41
Q

EKG findings of Brugada syndrome

A

RBBB, ST segment elevation in precordial leads
Most common in males from Southeast Asia
May require ICD or pad placement during surgery

Common cause of sudden nocturnal death d/t vtach/vfib, sodium ion channelopathy

42
Q

Difference between second degree HBs

A

2nd degree Mobitz type I: longer, longer drop Wenkebach (PR interval will gradually increase)

2nd degree Mobitz type II: if some Ps don’t get through you have a type 2 (if the P is there, the PR interval is consistent across the strip)

43
Q

Metabolic disturbances that can ↑ QT

A

Hypokalemia, hypocalcemia, hypomagnesemia

44
Q

Most common, flexible mode of pacemaker

A

Dual chamber AV sequential demand
DDD
Improves AV synchrony by making sure atrium contracts first then ventricle

45
Q

Modes of asynchronous pacing

A

AOO, VOO, DOO

  • pacemaker delivers a constant rate, no sensing or inhibition, can be a competitive underlying rhythm
  • pacer spike during ventricular repolarization can cause “R on T’ phenomenon
46
Q

What does the magnet do?

A

Pacemaker: usually but not always converts pacemaker to asynchronous mode

ICD: suspends ICD and prevents shock delivery

Pacemaker + ICD: shock disabled

47
Q

What can measure regional cerebral blood flow?

A 
Transcranial Doppler (measures flow velocity)
Cerebral oximeter

Jugular oximetry is the only global cerebral monitor and it is invasive

APEX (11 decks)

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