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Kates last minute set Flashcards

1
Q

Required FGF to prevent rebreathing in SV with mapleson D

A

2-3 x MV

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2
Q

Required FGF to prevent rebreathing in CV with mapleson D

A

1-2 X MV

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3
Q

most common mapleson in peds

A

mapleson D

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4
Q

To prevent rebreathing, a Bain circuit during CV/SV requires flows of

A

CV: 70 mL/kg/min
SV: 200 to 300 mL/kg/min

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5
Q

most ideal mapleson for peds <20 kg

A

mapleson E -> minimal resistance r/t no valves

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6
Q

Length of tubing in mapleson E must

A

exceed the TV

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7
Q

Required FGF to prevent rebreathing in SV with mapleson E

A

2-3 x MV

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8
Q

Required FGF to prevent rebreathing in SV with mapleson F

A

2-3 x MV

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9
Q

Similarities between maplesons and circle systems (3)

A

Accept a FGF

Supply theft with a sufficient volume of gas from a reservoir to satisfy the inspiratory flow and volume requirements

eliminate CO2

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10
Q

size specifics of corrugated tubing

A

T piece, 22 mm male fitting. 15 mm female coaxially fitting for ETT

internal volume = 400 - 500 mL / m

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11
Q

FGF in closed circle systems

A

inflow gas will exactly match metabolic needs/o2 consumption of the patient using very low flows (~250 mL/min)

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12
Q

a third of malpractice claims are related to

A

disconnections /misconnections of the circuit

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13
Q

DISS contains

A

filter, check valve, pressure gauge

nipple, nut, body

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14
Q

the delivered oxygen concentration shall not

A

decrease below 19% at the common gas outlet

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15
Q

fail safe devices are in ______

A

intermediate pressure system.

Oxygen failure supply alarm ; low pressure whistle.

FAIL SAVE DEVICES:
drager proportional valve
dates ohmeda threshold valve

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16
Q

Fail save valves are designed to

A

prevent the delivery of hypoxic gas mixtures from the machine in the event of failure of oxygen supply

pressure not flow!

INTERMEDIATE SYSTEM
Datex ohmeda threshold
drager proportional valve

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17
Q

Hypoxia prevention devices are designed to

A

prevent an operator selected delivery of oxygen concentration below 21%

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18
Q

Electrical flow sensors (3)

A

multiple different methods to measure.

must have a bag up to control and simply o2 flows

chamber fo known volume - the amount of heat required to maintain the set temperature is proportional to specific heat and gas flow rates

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19
Q

CO2 rebreathing will depend on

A 
FGF
MV
mode of ventilation (CV/SV)
CO2 production of individual patient
Respiratory waveform characteristics
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20
Q

The circle system (5 things)

A

hall mark: unidirectional flow via unidirectional valves
arranged in a circle
can be used as semi-open to closed
prevents rebreathing of co2 by chemical neutralization
allows re-breathing of other exhaled gases.

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21
Q

tec 6 vaporizer setting in changed altitude

A

normal dial concentration (%) x 760 mmHg // AMBIENT PRESSURE

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22
Q

Reservoir bags are made of

A

neoprene or rubber

Minimum pressure is 30 cmH2o and maximum is 60 cmH2o

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23
Q

vaporization is dependent on

A

vapor pressure
temperature
amount of carrier gas used

24
Q

Specifics of breathing tube

A

low resistance, flexible, kink resistance, clear plastic, acts as a reservoir, contributes negligible resistance

22 mm diameter, female fitting with machine
patient end 22 mm male fitting, coaxial 15 mm fitting

25
Gradual decrease in ETCO2 =
hyperventilation, reflects increase MV
26
Sudden decrease in ETCo2 =
PE (thrombus, fat, amniotic fluid) V/Q mismatch. Increase in PaCO2 - Petco2 gradient . Cardiac arrest Sampling error, - disconnect
27
Things in a vaporizers
wicks baffle system temperature compensating bimetallic valve concentration control dial
28
Instances when maplesons are used - 5
Pediatrics Transportation of patients Procedural sedation Weaning tracheal intubation pre oxygenation during out of OR management
29
Advantages of Mapleson F - 4
Used for both spontaneous and controlled ventilation Inexpensive, can be used with face mask or ETT Is light weight, can be repositioned easily Pollution of the atmosphere with anesthetic gases while using this system can be decreased by adapting it to scavenging system.
30
Requirements of breathing system- 5
1. Deliver the gases from the machine or device to the alveoli in the same concentration as set and in the shortest possible time 2. Effectively eliminate carbon dioxide 3. Minimal apparatus dead space 4. Low resistance to gas flow 5. Allow rapid adjustment in gas concentration and flow rate
31
Advantages of the circle system - 8
Relative stability of concentration of inspired gases conservation of moisture and heat Low resistance (but not as low as mapleson) can be used for closed-system anesthesia Can be used with fairly low flows with no rebreathing of co2 economy of anesthetics and gases can scavenge waste gases prevention of OR pollution
32
Disadvantages of circle system - 6
complex design has at least 10 connections potential of malfunctioning valves increased resistance to breathing (Compared to mapleson) less portable and convenient than mapleson system due to its bulkiness increased dead space BUT dead space ends at Y piece
33
APL valve purposes (4)
Purpose: permits PEEP during SV or allows for pressure- limited controlled respiration Releases gases to scavenge or to atmosphere User-adjustable, pressure required to open it changed by user Provides control of pressure in system
34
Gas flow needed for a semi-open CIRCLE system
10-15 L/min
35
Clinical Application of Fick's Law (7)
Allows determination of pulmonary gas exchange Diffusion Hypoxia COPD - reduced alveolar surface tension, slower induction Placental Drug Transfer 2nd gas effect Apneic oxygenation Insufflation of N2o to pneumos/abdomen
36
Alt. Associations having something to do with anesthesia machine standards (4)
Internacional Electrochemical Commission (IEC) Compressed Gas Association (CGA) Institute of Electrical and Electronic Engineers (IEEE) Federal Drug Administration (FDA)
37
US department of transportation issue regulations (7)
``` regulate: manufacture marking/labeling filling handling transport storage disposal of cylinders ```
38
Second Stage Pressure Regulator (5)
located downstream of intermediate pressure system - protects against fluctuations off pipeline pressure supply constant pressure to the flow control valves and proportioning system lowers the pressure to 14 - 35 PSI ensures oxygen is the last gas flowing
39
Low Pressure System Components (6)
``` Flowmeters Hypoxia prevention safety devices Unidirectional valves (info only) Pressure relief devices (info only) Anesthesia vaporizers/vaporizer manifold (info only) Common gas outlet ```
40
Flowmeters regulate
the flow of gases entering the breathing circuit
41
only oxygen safety feature after the flow meter =
Oxygen analyzer
42
Cylinder Label shows (3)
the compressed gas association marking system. ``` Diamond shape, name of gas, signal word with statements of hazards and measured to be taken. Hazard Status Caution words ```
43
7 safe handling procedures for cylinders
1. Never stand a cylinder upright without support 2. Never leave empty cylinders on the machine 3. Never leave the plastic tape on the port while installing the cylinder 4. Never rely on the cylinders color for identification of its contents 5. Never oil valves 6. Before any fitting is applied to the cylinder valve, particulates of dust, metal shavings, and other foreign matter should be cleared from the outlet by slowly and briefly cracking the valve a way from you and/or other personnel 7. The valve should always be fully open when a cylinder is in use. Marginal opening may result in failure to deliver adequate gas
44
copper kettle calculation
(Carrier Gas x Vapor Pressure) / Barometric Pressure - Vapor Pressure = Vapor output in mL/min then! [Vapor Output] in mL/min / [total gas] flow in mL/min
45
Open interface scavenging system
No valves! Is open to the atmosphere via "relief ports" in reservoir, avoiding build up of positive and negative pressure - must have high vacuum flow to prevent pollution of OR. requires OPEN reservoir and vacuum
46
Reservoirs in scavenging systems should match the
intermittent volume from pt expiration/gas collecting assembly to the continuous flow of the disposal system
47
"Purposes" of capnograhy (8)
1. gold standard to determine if patient is being ventilated, critical, life-saving monitor 2. used to confirm ETT/LMA placement 3. Without an airway, helps determine if pt is adequately exchanging air/oxygen 4. Guide ventilator settings (avoids too much or too little ventilation ) 5. Detect circuit disconnections 6. Detect CIRCULATORY abnormalities - (PE, occult hemorrhage/hypotension) 7. Detect excessive aerobic metabolism (Malignant hyperthermia) 8. Standard for VAE detection
48
Infrared Absorption Spectrophotometry works
- by analyzing the gas mixture - determination by proportion of gas contents - each gas in mixture absorbs infrared radiation at different wave lengths, amount of CO2 is measured by detecting its absorbable at specific wavelengths and filtering the absorbance related to other gases
49
Indications of tracheal intubation on capnogram
presence of stable CO2 waveforms for 3 breaths >30mmHG
50
Causes of rebreathing = (3)
equipment dead space exhausted CO2 absorber inadequate FGF
51
Contributors to rising CO2 when ventilation unchanged (6)
1. malignant hyperthermia 2. release of tourniquet 3. release of aortic/major vessel clamp 4. IV bicarb administration 5. insufflation of CO2 into peritoneal cavity 6. equipment defects, (expiratory valve stuck CO2 exhausted)
52
Gradual Decrease in ETCO2
likely hyperventilation, reflects increased minute ventilation
53
Rapid decrease in ETCO2
- PE, V/Q mismatch - Cardiac arrest ? Sampling error
54
Capnogram pattern in obstructive lung disease
COPD/Asthma/Bronchoconstriction/Acute obstruction - slow rate of rise in Phase ii - steep upslope of phase iii (in extreme cases may not see phase iii)
55
oxygen flush valve can function even when
the machine is off

gtown nur641 (7 decks)

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