Exam 2 Fall2 2023 Flashcards
What are examples of decreased pulmonary compliance?
Pneumothorax, pulmonary embolism, insufflation of the abdomen, Trendelenburg, tense, muscles, bronco construction 
What are two causes of increased PIP with unchanged plateau pressures
Increased inspiratory, gas flow
Increased airway resistance - kinked ETT, secretions, foreign body, aspiration, bronchospasm, airway compression, ETT cuff herniation 
On a flow loop, what direction would a spontaneous breath travel
Clockwise
The loop will also begin left of the Y access due to the initial negative pressure
True or false peep increases compliance?
True
Name contraindications to peep?
Tension pneumothorax
Hypovolemic shock
Bronco, plural fistula
High intracranial pressure
Right ventricular failure
What can detect early changes in breathing?
Listening with precordial or esophageal stethoscope
 what is the goal minute ventilation?
5 to 7 mL per kilogram, ideal body weight
How much lower should ETco2 be than PaCo2 in normal heart and lungs?
ETco2 should be 2-5 mmHg lower than PaCo2 in normal heart and lungs
On end tidal capnography, what does point D represent
End tidal CO2 that shows up on monitor
Describe phase, 1 of end tidal capnography
Includes points a and b
Exhalation of anatomic dead space
Describe phase 2 of end tidal capnography
Includes points, b and c
Exhalation of anatomic dead space and alveolar gas
Describe phase 3 of end tidal Capnography
Includes points, C and D
Exhalation of alveolar gas
Describe phase 4 of end tidal capnography
Includes points D and E
Inspiration of fresh gas that does not contain carbon dioxide
The alpha angle is measured where and what is the normal angle degree?
Measured at point C
Normal equals 100 to 110°
What are causes of increased alpha angle?
Expiratory airflow obstruction
COPD, bronco spasm, kinked ETT
Where is Beta angle measured and what is the normal angle degree?
Measured at point D
Normal angle is 90°
What are causes of increased beta angle?
Rebreathing
Faulty inspiratory valve
What is the formula for determining time left in a cylinder gas cylinder
Total tank capacity divided by total tank pressure multiplied by remaining given pressure equals liters left in tank. May need to divide this by liters per minute to get minutes remaining.
What is the color service pressure and capacity of an oxygen tank?
Oxygen tanks are green service pressure is 1900 psi, capacity, 660 L
What is the color service pressure and capacity of nitrous oxide cylinder?
Nitrous oxide is blue service pressure is 750 psi tank capacity is 1600 L
What is the cylinder color service pressure and capacity of a cylinder of air?
Cylinder color is yellow service pressure is 1900 psi cylinder capacity is 625 L
Name the five tasks of oxygen within the gas machine
1 flows to the fresh gas flow meter
2 powers, the oxygen flush
3 activates, failsafe mechanism
4 activates, oxygen, low pressure alarm
5 compresses the bellows of mechanical ventilators
What is the outside diameter of the common gas outlet? And what is the pressure delivered at the outlet?
Outer diameter is 22 mm pressure delivered at the outlet is 5-8 PSI
What is the most fragile part of the anesthesia machine?
Flow meters
Flow control valves regulate the amount of flow into what type of flow tube
Thorpe
Flow meters are located downstream from all safety devices and alarms, except
The oxygen analyzer
The flush valve is required by standard to deliver how many liters per minute
35 to 75 L per minute
If flush valve is required to fill breathing circuit with oxygen, what phase of ventilation should this be down to prevent bot trauma?
Expiratory phase
The flush valve delivers what quantity of O2 per minute
35 to 75 L per minute
In the hypoxic guard, considering nitrous, oxygen and oxygen, what is the minimum oxygen, concentration and ratio
Minimum of, 23 to 25% oxygen three to one ratio
There’s only one system that determines that oxygen is present what is it?
Inspired oxygen analysis
What are the two types of sensors in current use?
Electro, chemical, galvanic, fuel cell and paramagnetic analyzer
The tech six is heated to what degree Celsius producing a vapor pressure of approximately 1500 mmHg
Heated to 39°C
The low pressure systems consist of
Includes the vaporizer, common gas, outlet, manifold, check valves. Low pressure is 16 psi and is the pressure after the second stage regulator. It begins at the flow meter and ends at the common gas outlet.
Intermediate pressure begins and ends where
Begins at the pipeline ends at flow meter valves
High-pressure begins and ends where
Begins at the cylinder, ends at the cylinder regulator
What does low pressure leak test evaluate
Integrity of the machine from flow control valves to the common gas outlet
Barrel trauma risk increases when plateau pressure exceeds
35 cm/H20
Define plateau, pressure and when it is measured
The pressure in the small airways and LØVË after target title volume is delivered. It is measured during inspiration pause, and there is no airflow so airway resistance does not affect plateau pressure.
Increased peak, inspiratory, pressure and increased. Plateau pressure is a result of decreased compliance, causes of decreased compliance.
Endo bronchial intubation
Pulmonary edema
Pleural effusion
Tension pneumothorax
Atelectasis
Chest wall
Abdominal insufflation
Ascites
Trendelenburg position
In adequate muscle relaxation
Increased positive inspiratory pressure with no change in plateau pressure can result from resistance has increased, or inspiratory. Flow rate has increased what are examples of increased resistance
Kinked and endotracheal tube
Endotracheal tube, cough, herniation
Bronco spasm -think of white bronco OJ resistance
Bronchial secretions
Compression of the airway
Foreign body aspiration
On capnography an increased, alpha angle suggests what
Expiratory airway obstruction
In capnography an increased beta angle, suggest what
Rebreathing due to a faulty inspiratory valve
What are the two methods of carbon dioxide analysis?
Mainstream in line
Sidestream diverting
At what point in the cap graph is entitle carbon dioxide measured
Point D, which is the beta angle and beginning of inspiration
On the cap graph phase 1 which is point A to point B what is happening?
Exhalation of an anatomic dead space
On the cap Graff phase 2, which is represented by points B to see what is happening
Exhalation of anatomic, dead space, and alveolar gases
On the cap graph phase 3, which is also points C an D what is happening?
This is exhalation of LVL our gas, and also were entitled CO2 measurement takes place
On the cap graph phase 4, which is also points D and E what is happening?
Inspiration of fresh gas that does not contain carbon dioxide. This is also where beta angle is.
What is normal angle of the alpha angle at point C
100 to 110° an increase suggest obstruction
Where is the beta angle measured?
Point D
The beta angle is normally a 90° angle. What does an increased angle suggest?
Rebreathing typically from a faulty inspiratory valve
On the capnography, how will airflow obstruction look and water examples of what caused this
Prolonged up, stroke with increased alpha angle
COPD, bronco spasm, kinked, ETT
What are causes of cardiac oscillations on capnography?
Caused by the heart beating against the lungs, more common and children, because they heart is close to the lungs
What does cure rare cleft capnography look like and what causes this?
Normal alphabet angles, with a slight indentation just before the beta angle from spontaneous breaths during mechanical ventilation, suggest inadequate muscle relaxant reversal, or a lack of synchronization between intercostal muscles and diaphragm
On capnography, what does low entitle CO2 appear like and water causes
Plateau phase as well below normal caused by hyper ventilation, decreased carbon dioxide production or increased LVL, our dead space, examples, light, anesthesia, metabolic, acidosis, hypothermia, hypotension, pulmonary embolism
What does elevated entitle CO2 with normal plateau look like on capnography and what are examples or cause?
Be sure to look at baseline. It returns to zero so it is not considered rebreathing. It’s either caused by increased carbon dioxide production or decreased LVL ventilation causes are MH, sepsis, fever, hyperthyroidism, hypo, ventilation, narcotics.
On capnography inspired carbon dioxide what does it look like and what are causes?
Look at the baseline it does not return to zero. This is rebreathing carbon dioxide causes exhausted, absorbent, incompetent expiratory valve hole in the inner tube of vein in adequate Mapleton circuit or rebreathing, under drapes of a patient not intubated.
On the cap ground, what does incompetent inspiratory valve look like?
It looks more like a ski hill on expiration. There’s a widened beta angle part of the exhale breath. Re-enters the respiratory limb.
On capnography, what does a leak in sample line during positive pressure ventilation look like
Normal with a knob at the end right before inspiration, positive pressure during inspiration pushes the CO2 rich gas through the sample line, which results in the peak
On capnography explained by phasic expiratory plateau what does this look like what causes it?
There is a big valley in the middle. It’s caused after a single lung transplant valve or gas from the transplanted long and the disease long have different time constants there are two peaks one for each lung
Name three causes of increased entitle CO2
Increased CO2 production and delivery to the lungs, such as MH thyrotoxicosis and tourniquet removal
Decreased LVL ventilation, such as CNS, depressant drugs, COPD, residual, neuromuscular, blockade
Equipment malfunction, CO2, absorbent, exhaustion, unit, directional valve, malfunction, increase dead space
What are causes of decreased entitle CO2?
Decreased CO2 production and delivery to the lungs, hypothermia, decreased cardiac output, VQ mismatch, pulmonary embolus
Inadequate anesthesia
Equipment, malfunction, esophageal, intubation, poor seal with an LMA, sample line leak
What is the best Mapleton circuit for spontaneous ventilation and what is the worst?
Best is a worst is B all dogs bite
What is the best and worst Mapleton circuits for controlled ventilation
Best is D and worst is a don’t be arrogant
