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gtown nur641 > Kates last minute set > Flashcards

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
Q

Gradual decrease in ETCO2 =

A

hyperventilation, reflects increase MV

26
Q

Sudden decrease in ETCo2 =

A

PE (thrombus, fat, amniotic fluid)

V/Q mismatch. Increase in PaCO2 - Petco2 gradient .

Cardiac arrest

Sampling error, - disconnect

27
Q

Things in a vaporizers

A

wicks
baffle system
temperature compensating bimetallic valve
concentration control dial

28
Q

Instances when maplesons are used - 5

A

Pediatrics

Transportation of patients

Procedural sedation

Weaning tracheal intubation

pre oxygenation during out of OR management

29
Q

Advantages of Mapleson F - 4

A

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
Q

Requirements of breathing system- 5

A
  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
Q

Advantages of the circle system - 8

A

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
Q

Disadvantages of circle system - 6

A

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
Q

APL valve purposes (4)

A

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
Q

Gas flow needed for a semi-open CIRCLE system

A

10-15 L/min

35
Q

Clinical Application of Fick’s Law (7)

A

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
Q

Alt. Associations having something to do with anesthesia machine standards (4)

A

Internacional Electrochemical Commission (IEC)
Compressed Gas Association (CGA)
Institute of Electrical and Electronic Engineers (IEEE)
Federal Drug Administration (FDA)

37
Q

US department of transportation issue regulations (7)

A 
regulate:
manufacture 
marking/labeling
filling
handling 
transport
storage
disposal of cylinders
38
Q

Second Stage Pressure Regulator (5)

A

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
Q

Low Pressure System Components (6)

A 
Flowmeters
Hypoxia prevention safety devices
Unidirectional valves (info only)
Pressure relief devices (info only)
Anesthesia vaporizers/vaporizer manifold (info only) 
Common gas outlet
40
Q

Flowmeters regulate

A

the flow of gases entering the breathing circuit

41
Q

only oxygen safety feature after the flow meter =

A

Oxygen analyzer

42
Q

Cylinder Label shows (3)

A

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
Q

7 safe handling procedures for cylinders

A
  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
Q

copper kettle calculation

A

(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
Q

Open interface scavenging system

A

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
Q

Reservoirs in scavenging systems should match the

A

intermittent volume from pt expiration/gas collecting assembly to the continuous flow of the disposal system

47
Q

“Purposes” of capnograhy (8)

A
  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
Q

Infrared Absorption Spectrophotometry works

A
  • 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
Q

Indications of tracheal intubation on capnogram

A

presence of stable CO2 waveforms for 3 breaths >30mmHG

50
Q

Causes of rebreathing = (3)

A

equipment dead space
exhausted CO2 absorber
inadequate FGF

51
Q

Contributors to rising CO2 when ventilation unchanged (6)

A
  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
Q

Gradual Decrease in ETCO2

A

likely hyperventilation, reflects increased minute ventilation

53
Q

Rapid decrease in ETCO2

A
  • PE, V/Q mismatch
  • Cardiac arrest
    ? Sampling error
54
Q

Capnogram pattern in obstructive lung disease

A

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
Q

oxygen flush valve can function even when

A

the machine is off

gtown nur641 (7 decks)

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