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Monitoring > Focus Monitor > Flashcards

Focus Monitor Flashcards

1
Q

At what PSI does the O2 pressure alarm, alarm?

A

Below 30 PSI

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2
Q

At what weight does a tank of N2O see a dip in PSI? How many liters are left when the PSI dips?

A

Below 14.1 Lbs

400 L

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3
Q

When can proportioning devices not prevent a hypoxic mixture? Name 4

A

-Pipeline crossover
-Mechanical failure
-Broken flowmeter
-Third gas

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4
Q

Reynolds number <2000

What type of flow?
What law?
What is it dependent on?

A

Laminar

Poiseulles

Viscosity

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5
Q

Reynolds number >4000

What type of flow?
What law?
What is it dependent on?

A

Turbulent

Graham

Density

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6
Q

With fresh gas coupling, How does Tidal Volume increase?

A

-Increased FGF
-Increased Bellow height
-Increased I:E

-Decreased RR

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7
Q

With fresh gas coupling, How does Tidal Volume decrease?

A

-Decreased FGF
-Decreased Bellow height
-Decreased I:E

-Increased RR

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8
Q

What effect does FGF have on End tidal?

A

Increased FGF will lower end tidal and vice versa

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9
Q

How is compliance measured?

A

Change in volume for given change in pressure

Volume/Pressure

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10
Q

Flows less than ____ or Greater than ____ can lead to reduced vaporizer output?

A

<200mL/Min

> 15L/Min

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11
Q

How much does 1mL of liquid anesthetic produce?

A

200mL of vapor

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12
Q

What is the pumping effect? What causes it ?

A

Anything that causes gas that has already left the vaporizer to re-enter

Due to PPV
or
O2 flush valve

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13
Q

What is the calculation for how much liquid anesthetic is used per hour?

A

Vol % x FGF x 3

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14
Q

What is the boiling point of des?

A

22C

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15
Q

Which O2 analyzer needs to be calibrated daily?

A

Galvanic fuel cell

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16
Q

Which O2 analyzer has a faster response time?

A

Paramagnetic

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17
Q

Which O2 analyzer needs to be replaced over time?

A

Galvanic fuel cell (Makes sense because the other uses magnets)

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18
Q

What causes an increase in O2 consumption?

A

Sepsis
Pain
Sympathetic stimulation
Thyrotoxicosis
Fever

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19
Q

What are the 2 functions of the drive gas on a pneumatic ventilator?

A

Compress the bellows
Opens and closes the ventilator spill valve

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20
Q

What are the 2 pressure relief valves in the piston ventilator? At what pressure do they open?

A

Positive - opens at 75
Negative opens at -8

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21
Q

With a ventilator that decouples its gas flow, Vt is consistent regardless of changes in…? Name 3

A

FGF
RR
I:E

all have no effect on Vt

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22
Q

Do piston driven ventilator couple or decouple??

Gas driven couple or decouple?

A

Piston - decouples

Gas driven - couples

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23
Q

Which type of ventilator adds peep automatically?

A

Gas driven (couples) adds 2 of PEEP

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24
Q

What components are fixed in VCV? What is variable?

A

Tv
Inspiratory flow
Inspiratory time

Variable- pressure

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25
Q

What components are fixed in PCV? What is variable?

A

Fixed -
Pressure
Inspiratory time

Variable
Tidal Volume
Inspiratory flow

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26
Q

What are examples of low lung compliance states?

A

Pregnancy
Obesity
Laparoscopy
ARDS

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27
Q

What are examples of states when high PIP is dangerous and you SHOULD use PCV?

A

LMA
Neonate
Emphysema

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28
Q

What will happen to Tidal volume when using PCV with increased resistance and decreased compliance?

A

Reduced tidal volume

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29
Q

When is CPAP useful?

A

Reduces airway collapse

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30
Q

When is airway pressure release ventilation used?

A

Spontaneous ventilation

High level of CPAP throughout cycle

ARDS

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31
Q

What is a risk with IRV?

A

Auto peep or breath stacking

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32
Q

Properties of small soda lime granules?

A

High surface area which means it has high absorptive capacity

High resistance

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33
Q

Properties of large soda lime granules?

A

Low surface area (Low absorptive capacity)

Low resistance

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34
Q

What is the best mesh granule size?

A

4-8 mesh granules

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35
Q

At what pH does soda lime turn purple?

A

Below 10.3

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36
Q

If you can not change the soda lime what should you do?

A

Increase FGF and convert to semi open system

Do not increase minute ventilation

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37
Q

Granules are hydrated to? Why?

A

20%

Facilitate reaction in soda lime

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38
Q

How does silica effect CO2 absorbent?

A

-increases hardness and minimizes dust
-decreases resistance
-reduces efficacy of granules

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39
Q

What are the pros and cons of hydroxide lime

A

Pros
-less desiccation
-No CO production
-Lower risk of fire than with soda lime
-No silica

Cons
-Decreased absorptive capacity
-requires frequent replacement
-expensive

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40
Q

How much CO2 can soda lime absorb? How much can amsorb

A

26L per 100g

10.6L per 100g

41
Q

What are 4 ways to monitor for circuit disconnect?

A

Pressure
Volume
ETCO2
Vigilance

42
Q

Chief patient-related cause of increased peak inspiratory pressure?

A

Bronchospasm

43
Q

If the patient has high peak pressures but return to normal after switching to the bag, what is likely the cause?

A

Ventilator spill valve

44
Q

What is the function of the ventilator spill valve?

A

Vent excess fresh gas from the flowmeter to the scavenger

45
Q

If a high peak pressure does not return to normal after switching a patient to bag from the ventilator and the patient is not bronchospasming, what is likely the cause? Treatment?

A

Scavenger is occluded or positive pressure relief valve has failed

TIVA and hand ventilate

46
Q

How much gas must the scavenger remove? Too much? Too little?

A

Equal to FGF minus the volume of patients O2 consumption

Too much creates negative pressure

Too little creates barotrauma

47
Q

Open breathing circuit examples

Rebreathing?
Reservoir?

A

Insufflation, simple face mask, NC open drop

NO
NO

48
Q

Semi-Open breathing circuit examples

Rebreathing?
Reservoir?

A

Mapleson, circle system
-FGF > Mv

Rebreathing - NO
Reservoir - YES

49
Q

Semi-closed breathing circuit examples

Rebreathing?
Reservoir?

A

Circle system
FGF < Mv

Rebreathing - Yes (partial)
Reservoir - Yes

50
Q

Closed breathing circuit examples

Rebreathing?
Reservoir?

A

-Circle system
-Complete rebreathing
-Low FGF
-Closed APL

Rebreathing - Yes
Reservoir - Yes

51
Q

Does the circle system prevent rebreathing of CO2, O2, Anesthetic agent?

A

Prevents rebreathing of CO2

Can rebreathe O2, anesthetic agent

52
Q

What happens if a unidirectional valve is stuck open? Closed?

A

Open - rebreathing
Closed- airway obstruction

53
Q

Conduction velocity is a function of what three things?

A

-RMP
-Amplitude of action potential
-How fast it will depolarize during phase 0

54
Q

What 5 things affect conduction velocity?

A

ANS tone
Hyperkalemia
Ischemia
Acidosis
Antiarrhythmic drugs

55
Q

What is the gatekeeper between the atria and ventricles?

A

AV node

56
Q

James fiber connects?

A

atrium to AV node

S bypasses SA node

57
Q

Atrio-hisian fiber connects?

A

Atrium to HIS bundle

58
Q

Kents bundle connects?

A

Atrium to ventricle ..?

Kent is normal

59
Q

Mahaim bundle connects?

A

AV node to ventricle

60
Q

What is the absolute refractory period and when is it located?

A

No stimulus can depolarize the myocyte

-Q wave to the first 1/3 T wave

61
Q

What is the relative refractory period and when is it located?

A

Needs a strong stimulus

Last 2/3 of the T wave

62
Q

What condition causes PR interval depression?

A

Pericarditis

63
Q

What conditions can show peaked T waves?

A

Intracranial bleed, MI, LVH effects

64
Q

What is likely if a U wave is present?

A

Hypokalemia

65
Q

QT changes with hypercalcemia? Hypo?

A

Shorted QT with hyper

Prolonged with hypo

66
Q

What leads monitor the lateral side of the heart

A

I, aVL, V5, V6

67
Q

Which leads monitor the inferior side of the heart?

A

II,III, aVF

68
Q

Which leads monitor the LAD?

A

V1,V2,V3,V4

69
Q

What is a normal axis?

A

-30 and +90

70
Q

What conditions cause a Right axis deviation?

A

COPD, bronchospasm, Cor pulmonale, Pulmonary HTN, PE

71
Q

Which conditions cause Left axis deviation?

A

AS, aortic regurg, mitral regurg

72
Q

What reflex can cause sinus arrythmia ?

A

Bainbridge

73
Q

What happens when less than 0.5 of atropine is given?

A

Paradoxical bradycardia due to presynaptic muscarinic receptors

74
Q

What is glucagon for? How does it work?

A

BB or CCB overdose, increases cAMP through glucagon receptors in the myocardium

75
Q

What is the most common tachyarrhythmia and when does it occur?

A

Afib

Post op day 2-4

76
Q

During aflutter, what stops atrial impulses from being transmitted to the ventricles?

A

Refractory period

77
Q

What must be performed if afib or aflutter is older than 48 hours?

A

A TEE to rule out atrial thrombus

78
Q

What medication is used to treat PVCs?

A

Lidocaine 1mg per kg

79
Q

What is Brugada syndrome? Where and who does it happen in?

A

Sudden death at night, in southeastern Asia men

Na channel issue

RBBB and ST elevation

80
Q

What is the etiology of a 3rd degree block?

A

Lenegre’s disease or fibrotic degeneration of atrial system

81
Q

What do class 1 antidysrhythmic block?

A

Na channel

82
Q

How do 1A Na channel blockers work? What are examples?

A

Moderate depression of phase 0 and prolongs phase 3 repolarization

Procainamide, Quinidine, dispyramide

83
Q

How do 1B Na channel blockers work?

A

Weak depression of phase 0 and shortens phase 3

Lidocaine, phenytoin

84
Q

How do 1C Na Channel blockers work?

A

Strong depression on phase 0

Flecainide, propafenone

85
Q

What are class II antidysrhythmic? How do they work>

A

Beta blockers

Slow phase 4 in the SA node

86
Q

What are class III antidysrhythmic?

A

Potassium channel blockers

Prolong phase 3

Amiodarone

87
Q

What are class IV antidysrhythmic?

A

CCB

Decrease conduction velocity

Verapamil, diltiazem

88
Q

How does adenosine work? Half life?

A

Hyperpolarizes the cell through adenosine 1 receptor.

5 seconds

89
Q

What is a side effect of adenosine?

A

Bronchospasm

90
Q

When is adenosine useful?

A

SVT, WFW

91
Q

What is the most common cause of tachyarrhythmias?

A

Reentrant pathways

92
Q

WPW what is it?

A

most common pre excitation syndrome.

DELTA wave

Uses Kents bundle

Treat through ablation

93
Q

What must be monitored during an ablation?

A

Esophageal temperature - risk for thermal injury to the LA and esophagus

94
Q

What is the treatment for Afib with WPW?

A

Procainamide

95
Q

Most AV nodal reentry tachycardias with WPW are classified as ?

A

Orthodromic - Conducted through the AV node

Narrow QRS

Block AV node

96
Q

What is the antidromic pathway? What is important

A

Only 10%
Bypasses AV node
Wife QRS

Treat with procainamide or cardioversion

97
Q

What happens if a magnet is placed over an ICD WITH a pacemaker

A

Stops the ICD but not the pacemaker

98
Q

What is safer to use with a pacemaker monopolar or bipolar?

A

Bipolar

99
Q

What is contradicted with pacemakers?

A

MRI

Monitoring (10 decks)

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