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Priniclpes Of Anesthesia > Exam 2 whiteboard and study guide flahcards > Flashcards

Exam 2 whiteboard and study guide flahcards Flashcards

1
Q

OSHA recommendations halogenated agents alone

A

<2ppm

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2
Q

OSAH recommendations Nitrous oxide alone

A

<25 pm

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3
Q

OSHA recommendations halogenated agents + nitrous oxide

A

<0.5 ppm + 25 ppm

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4
Q

Full tank of oxyen (L and psi)

A

660 L, 1900 psi

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5
Q

Full tank air (L and psi)

A

625 L and 1900 psi

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6
Q

Full tank N2O (L and psi)

A

1590 L and 745 psi

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7
Q

Venous blood pulse ox light

A

near-infared light
940 nm

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8
Q

Arterial blood pulse ox

A

Red light 660nm

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9
Q

Five tasks of oxygen

A
  1. Flush the fresh gas flowmeter
  2. Powers the oxygen flush
  3. Activates fail safe mechanism
  4. Activates oxygen low pressure alarm
  5. compresses the bellows of mechanical ventilators
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10
Q

SPDD stands for

A

Supply
Processing
Delivery
Disposal

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11
Q

pipeline psi

A

50

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12
Q

oxygen cylinder supply (psi and L)

A

1900 psi
660L

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13
Q

Oxygen pressure failure device/failsafe

A

Proportioning system (hypoxic guard)

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14
Q

How does the hypoxia prevention proportioning system work?

A

Nitrous - oxygen proportioning

all final breathing mixtures must be 23-25% oxygen

ratio of NO2: O2 must not exceed 3:1

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15
Q

High pressure system location

A

Cylinder—> cylinder regulators

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16
Q

High pressure system components

A

Yoke things
cylinder things

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17
Q

Intermediate pressure system pressure

A

pipeline=50 psi
tank=45 psi

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18
Q

Low pressure system pressure

A

slightly above atmospheric but variable (14.7 or 16 psi)

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19
Q

Intermediate pressure system location

A

Pipelines—>flowmeter valves

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20
Q

Low pressure items

A

Flowmeter tubes
Vaporizers
Check valve (if present)
Common gas outlet
Manifold

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21
Q

Low pressure system pressure

A

slightly above atmospheric pressure but variable

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22
Q

Low pressure system location

A

Flowmeter tubes –>common gas outlet

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23
Q

Low pressure system components

A

Flowmeter tubes
Vaporizers
Check valves
Common gas outlet

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24
Q

If oxygen pressure falls below ____psi, the failsafe (hypoxia) will trigger an alarm

A

30 psi

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25
Q

If oxygen pressure falls below ____ psi, failsafe will stop N2O flow or reduce it proportionately

A

20

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26
Q

Failsafe device senses _________ NOT ______

A

senses pressure, not gas concentration

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27
Q

Reynold’s number

A

Density x Diameter x Velocity
_______________________________
Viscosity

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28
Q

Reynolds number tells us if:

A

Turbulent flow in flowmeter is
Laminar
Turbulent
Transitional

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29
Q

Reynold’s number <2000

A

Laminar
Flow is dependent on gas’s viscosity

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30
Q

Reynold’s number >4000

A

Turbulent flow

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31
Q

Reynold’s number 2000-4000

A

Transitional

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32
Q

First stage regulator system and pressure

A

Reduce high/variable pressure in a cylinder to lower (intermediate) pressure (40-50 psi) via diaphragm valve

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33
Q

Second stage regulator system and pressure

A

Reduces pressure from 40-50 psi (first stage) to 16-24 psi via diaphragm

=keeps flow more constant in flowmeter

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34
Q

Safe tank handling: ALWAYS

A

Protect a cylinder when carrying, it is the most fragile part

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35
Q

Safe tank handling: NEVER

A

-Stand a cylinder upright without support -lay on side instead
-Leave empty cylinder on the machine
-Leave plastic cover on the port while installing
-Use more than one washer between cylinder port and yoke
-Rely only on a cylinder’s color- READ LABEL
-Oil valves
-Remove a cylinder form a yoke without filling the space with a yoke plug (back up strategy for guarding against check valve failure(

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36
Q

Supply and examples

A

How gas enter pipeline: cylinders

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37
Q

gas enters pipeline at

A

50 psi,

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38
Q

Processing and examples

A

How the machine prepares the gas: vaporizers

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39
Q

Delivery and examples

A

How gases are brought to the patient: breathing circuit

40
Q

Disposal and examples

A

How the gases are removed: scavenger

41
Q

Proportioning device is a

A

hypoxic guard that ensures nitrous-oxygen proportioning

42
Q

Even with hypoxic guard, hypoxic mixture can occur if (4):

A
  1. wrong supply of gas in oxygen pipeline (gas crossover)
  2. defective pneumatics or mechanics
  3. Leak downstream of flow control valves
  4. intert gas administration
43
Q

Low O2 pressure:

A

Halts the supply of all other gasses in the event of supply failure

44
Q

Fail safe low O2 pressure:

A

Gate is held open by pressure (NOT concentration) in oxygen line and will close if pressure is not met

45
Q

In a power failure situation:

A

Manually ventilate your patient, TIVA

46
Q

What powers the low pressure alarms?

47
Q

Check on machine everyday (6):

A

See cardflow

48
Q

Check machine before ever case

A

see cardflow

49
Q

Desflurane and altitude

A

Higher = lower barometric pressure

requires higher setting on dial. DES because you are pressurized to 2

50
Q

Potency of Sevo

A

always the same no matter the output concentration

51
Q

concentration of sevo below sea level

A

is greater below sea level than is set on dial

but potency is the same

52
Q

Concentration of sevo above sea level

A

is less above sea level than is set on dial

but potency is the same

53
Q

Most common type of breathing circuit in US

A

circle system (semi closed very common)

54
Q

In a circle system gas enters and exits via:

A

enters from CGO by way of fresh gas delivery hose

exits in circle to scavenger via the APL valve

55
Q

Circuit leak parameters high pressure

A

occlude circuit and pressurize system to 30 cm H2O min

56
Q

Circuit leak parameters low pressure leak test

A

inflate the bulb in CGO, should stay deflated for 10 seconds

57
Q

What harm can O2 flush do(2)?

A

Cause barotrauma, especially during inspiratory phase. Do during expiratory it at all

Can dilute inhaled gasses because it adds 100% O2 to the circuit, can less depth of anesthesia

58
Q

O2 flush purpose:

A

to quickly fill the breathing circuit with oxygenO

59
Q

O2 flush volume

A

35-75 L/min

60
Q

O2 flush psi

A

50 psi (same as pipeline pressure)

61
Q

Which ventilator can be used for longest time and why?

A

Piston because they do not consume oxygen to drive the bellows (use electric)

62
Q

Which ventilator can be used for least amount of time and why

A

Pneumatic because it is driven on oxygen flow and can consume a whole cylinder in 30 minutes

63
Q

Pressure control vs volume control ventilation

A

see cardflow

64
Q

What type of ventilation is this

A

Control/mandatory

machine triggered and machine cycles

65
Q

What type of ventilation is this

A

Assisted /PSV

Patient triggered but machine cycled

66
Q

What type of ventilation is this?

A

Spontaneous

patient tripped and cycled

67
Q

5 components of scavenging system:

A
  1. gas collecting assemply
  2. Transfer tubing
  3. Interface (open or closed)
  4. Gas disposal tubing
  5. Gas disposal system
68
Q

The most important component of the scavenging system is the

A

scavenging interface

69
Q

Why is the scavenging interface important?

A

Removal of too much case would create negative pressure in circuit

Removal of too little gas could increase risk of barotrauma

70
Q

Function of the scavenging system(2):

A

1.remove excess gas from the anesthesia circuit
2. minimize environmental exposure to waste anesthetic gas

71
Q

What controls gas —> scavenger in spontaneous ventilation?

72
Q

Mapleson circuit

A

see notability doc

73
Q

What controls gas—->scavenger in mechanical ventilation?

A

Ventilator spill valve

74
Q

ABG guidlines for determining respiratory failure: Arterial PaO2:

A

<55-60 mm Hg (on O2)

75
Q

AGB guideline for determining respiratory failure: Arterial CO2

76
Q

Evidence of increased work of breathing indicating resp support need: RR and Vt

A

RR >35/min
Vt < 5 mL/kg

77
Q

Evidence of increased WOB need support: Vital capacity

A

<10-15 mL/kg

vital capacity: the greatest volume of air that can be expelled from the lungs after taking the deepest possible breath.

78
Q

Initiation of ventilatory support: Max inspiratory pressure/negative inspiratory force

A

<25 cm H2O

79
Q

Indications for initiating adult ventilatory support physical exam (3)

A

Retractions
nasal flaring
paradoxical/divergent chest motion

80
Q

Compliance definition

A

As air flows into the lungs, gas molecules encounter resistance when the strike the walls of the airway

compliance is the pressure needed to deliver a specific volume

81
Q

Effects airway resistance:

A

diameter of the airway

82
Q

Airflow is _____ related to resistance

A

inversely

as resistance decreases, airflow increases

83
Q

Compliance definition

A

A measure of the distensibility of a chamber expressed as a change in volume per unit of measure

84
Q

Compliance is the (equation)

A

change in volume/
change in pressure

85
Q

Dynamic compliance equation

86
Q

Static compliance equation

A

Pplat - PEEP

87
Q

Resistance vs compliance

A

cardflow lab game

88
Q

Pressure-volume loop looks at

A

compliance

89
Q

Boyles law

A

pressure of gas in inversely proportional to to volume of its container

90
Q

Plateau pressure is applied to

A

small airways and alveoli

91
Q

Plateau pressure is measured during

A

inspiratory pause on ventilator

92
Q

In normal lungs PIP is ______ than Pplat

A

slightly higher

93
Q

Increased Peak pressure, no change in Pplat indications (2)

A

increased resistance

Inspiratory flow rate as increased

94
Q

Increased peak pressure and Pplat (2)

A

Total compliance has decreased

Tidal volume has increased

95
Q

Calculating FiO2

A

total flow rate

96
Q

The only reliable way to measure how much is left in a nitrous tank is to

A

Weigh it because it exists as a liquid

97
Q

Change nitrous tank when pressure drops below

Priniclpes Of Anesthesia (19 decks)

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