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Equipment > Module 7 > Flashcards

Module 7 Flashcards

1
Q

Duties of the anesthesia machine

A

Deliver Oxygen

Remove CO2

Must deliver inhalation agents & work in a rebreathing system

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2
Q

What are vents in the ICU?

A

Open circuit that don’t use absorbent & have gas warming & humidification techniques

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3
Q

Ventilator functions to

A

Remove carbon dioxide

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4
Q

Oxygenation is the

A

Intake of oxygen

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5
Q

Carbon dioxide elimination is dependent upon

A

Ventilation, with non CO2 containing gases & the amount of CO2 in the alveoli

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6
Q

The effects of oxygenation are best shown by

A

The partial pressure of oxygen in the arterial blood

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7
Q

How is oxygenation improved?

A

By adding oxygen to the inspired gas

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8
Q

😃

A

😁

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9
Q

Physiological dead space is

A

Anatomical or Alveolar

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10
Q

What is dead space

A

The volume of ventilated air that doesn’t participate in gas exchange

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11
Q

Total dead space is called

A

Physiological dead space

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12
Q

What is anatomic dead space

A

The volume of air that fills the conducting zones of the respiratory airways, including the nose, trachea & bronchi; 30% of tidal volume

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13
Q

What is physiological dead space?

A

The volume of air ini the respiratory zone that doesn’t participate ini gas exchange

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14
Q

In the health adult, alveolar dead space is

A

Negligible

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15
Q

When does physiological dead space increase?

A

In lung disease states, making physiological dead space equal to anatomic dead space

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16
Q

Quantity of carbon dioxide produced dictates

A

Minute ventilation

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17
Q

What is the only method for eliminating carbon dioxide other than ECMO & cardio pulmonary bypass

A

Breathing

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18
Q

Spontaneous ventilation is normal conditions results in

A

PaCO2 of around 40

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19
Q

A normal person produces how much carbon dioxide/min?

A

200mL

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20
Q

What’s needed to maintained a normal CO2 level

A

Alveolar ventilation must be 200mLs/min, but anatomic dead space means ventilation must be at least 300mL to maintain 200mL of alveolar ventilation

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21
Q

Is ventilation essential for oxygenation?

A

No

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22
Q

How much oxygen does a normal adult person consume

A

250mL/min

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23
Q

When breathing oxygen, the pulmonary represents

A

Approximately 12 minutes worth of consumption

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24
Q

If connected to an oxygen supply, oxygen is unlimited & survival is limited by

A

Carbon dioxide accumulation, not hypoxia

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25
Q

What is the respiratory quotient?

A

Ratio between carbon dioxide production & oxygen consumption (0.8)

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26
Q

What is work of breathing

A

Work done to move gas into & out if the lung during spontaneous ventilation; this work is caused by the elastic properties of the kung & chest wall & the work needed to overcome resistance of the airways

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27
Q

The elasticity of the lung & chest wall is

A

Typically 70% of the total work of breathing

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28
Q

The force exerted by the ventilator is measures in

A

Pressure

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29
Q

Ventilator pressure is used to overcome

A

Compliance & resistance & the pressure results in tidal volume & inspiratory flow

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30
Q

Changes in tidal volume can be achieved by

A

Changes in inspiratory pressure or flow

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31
Q

When inspiratory flow matches tidal volume

A

Inspiratory pressure varies

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32
Q

When inspiratory flow matches pressure

A

The tidal volume varies

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33
Q

When utilizing volume mode

A

Peak pressure varies

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34
Q

When utilizing pressure mode

A

Tidal volume varies

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35
Q

Frequency, tidal volume, flow & I:E ration are all

A

Interdependent

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36
Q

Inspiratory pause is considered to be apart of the

A

Inspiratory phase

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37
Q

By adding inspiratory pause, time is consumed & flow rate

A

Will have to increase ini order to maintain the cycle time

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38
Q

If you change the expiration in the I:E ration

A

Something else must decrease

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39
Q

Endotracheal tube affects

A

Lung function by increasing resistance, the retention of secretions & lack of humidification (at the same time, lung function can be improved if there’s an upper airway obstruction & the tube provides conduit for ventilation)

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40
Q

Mechanical ventilation also causes

A

Consistent & predictable ventilation patterns & specific modes can improve ventilation/lung function

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41
Q

What are the pros & cons of suctioning?

A

Suction can remove secretions & improve oxygenation

Can cause harm by causing negative airway pressure, which can result in atelectasis

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42
Q

Positive pressure ventilation causes an increase in

A

Thoracic pressure, which can decrease blood flow & return the heart & cause decrease in cardiac output

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43
Q

Barotrauma is

Volumetrauma is

A

Too much pressure

Too much volume

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44
Q

Barotrauma & volumtrauma are manifested as

A

Pneumothorax or more suddenly by physiologic changes related to alveolar overstretching

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45
Q

Damage can be related to

A

Shear stress from opening & closing of the alveolar, corrected by heat but can increaser dead space & reduced cardiac output

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46
Q

Decreased compliance will result in

A

A greater share of the tidal volume & the effects of PEEP

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47
Q

Tidal volumes should be

A

6-8mL/kh

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48
Q

Maximal alveolar pressures, only slightly greater than 30-40cm of water are associated with

A

Lung injury, which causes alveolar damage, leading to pulmonary edema, activation of inflammatory cells & local production of inflammatory mediators, which are then leaked into systemic circulation

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49
Q

What can cause hypercapnia

A

Tidal volumes of 6mL/kg & low peak airway pressure

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50
Q

IRV ventilation can

A

Increase mean airway pressure & minimize peak airway pressures

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51
Q

Mean airway pressure corresponds to

A

Outfielder recruitment & increased oxygenation

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52
Q

Inadequate alveolar emptying can be the result of

A

Breath stacking & auto PEEP

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53
Q

Most ventilators utilize

A

Electricity or compressed gases to function

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54
Q

Ventilators that function solely on pneumatic gases are

A

Used in transport & ini MRI

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55
Q

Common drive mechanism are

A

Bellow & Piston

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56
Q

What are the 4 different types of drive mechanisms

A

Bellow
Piston
Turbine
Solenoids

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57
Q

Bellows are either

A

Ascending or Descending & are based on the movement during Exhalation

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58
Q

Which bellow is preferred

A

Ascending, since gravity doesn’t play a role; provides visibility

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59
Q

What pressure is used to to drive bellows

A

High pressure; 100% oxygen is used as driving gas, but it quickly utilizes oxygen reserve

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60
Q

if air is used as a driving gas & a perforation occurs…

A

Low oxygen concentration can occuree

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61
Q

The mixing of driving gas & circuit gas can

A

Dilute concentrations of inhaled anesthetics & cause hypoventilation

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62
Q

Piston ventilators use

A

An electric motor to drive piston to cause gas to flow, improving accuracy of tidal volume

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63
Q

A leak occurring at thee piston diaphragm can

A

Cause loss of circuit gs to the room & hypoventilation

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64
Q

Example of a Turbine ventilator

A

Drager

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65
Q

A turbine ventilator is a spinning turbine that

A

Produces a driving gas pressure

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66
Q

Higher RPM are associated with

A

Higher pressure

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67
Q

Turbine are required for

A

Control of circuit pressures, volume, & flows

68
Q

A solenoid is a

A

Magnet wrapped by a coil of water

69
Q

What is the key element in opening & closing the valve

A

Time, which then regulates gas flow

70
Q

Solenoid have an

A

On/Off action

71
Q

Servo uses an

A

Electrical motor to rotate a shaft that controls something else; they can be on/off, but are better utilized when they are finally controlling valves

72
Q

A decelerating inspiratory flow has what advantages

A

Max pressure is minimized

Risk of barotrauma is decreased

Alveoli are kept expanded

73
Q

Longer pressure plateau

A

Decreases venous return & cardiac output

74
Q

Declining inspiratory flow

A

Allows time for gas redistribution at the end of inspiration

75
Q

What is expiratory retard

A

Introduces a constricted orifice during exhalation so that the expiratory flow rate is slowed, which allows for more laminar flow & better emptying of the lung

76
Q

Fresh gas typically flows

A

Continuously from the common gas outlet & some ventilators fresh gas flows directly into the ventilatory bellows

77
Q

Gas compression is explained with Boyles Law

A

Increased pressure=decreased volume

78
Q

For every 10cm of water

A

1% of volume is lost due to gas compression

79
Q

Compliance of the anesthesia circuit

A

Causes volume losses by expanding hoses (why delivered tidal volume is frequently less than desired

80
Q

n controlled breathing modes, the patient

A

Cannot contribute any effort towards the work of breathing

81
Q

In controlled breathing if the volume is the fixed parameter

A

You are required to program the tidal volume, RR, & I:E ratio

82
Q

What does the ventilator calculate?

A

Inspiratory time, flow from the respiratory rate & I:E ratio

83
Q

Peak airway pressure is directly related to?

A

Airway resistance

84
Q

Peak airway pressure is inversely related to?

A

Lung compliance

85
Q

Worsening airway resistance & compliance can place the patient at risk for…

A

Barotrauma is no pressure limit is set

86
Q

In the pressure control mode…

A

Pressure is fixed & peak airway pressure is set along with the respiratory rate & I:E ratio

87
Q

The the pressure control mode, inspiratory pressure is varied to match

A

The set peak airway pressure

88
Q

How is flow delivered in pressure co trip mode?

A

High flows are delivered at the start of inspiration & the flow is rapidly diminished while maintaining the pressure constant, leading to a longer time for gas redistribution.

89
Q

Tidal volume is directly proportional to

A

Lung compliance

90
Q

Tidal volume is inversely proportional to

A

Airway resistance

91
Q

Assist & support modes means the patient & ventilator

A

Contribute to the work of breathing

92
Q

Assisted & supported ventilation modes, while decreasing vent dysynchrony can

A

Facilitate the transition to spontaneous breathing while maintaining minute ventilation

93
Q

Explain how assist control works

A

When the patient makes an effort to breath, the negative airway pressure triggers the ventilator to deliver a set tidal volume. As long as the patient triggers the vent more than a set rate, a controlled breath isn’t delivered

94
Q

What is proportional assist ventilation?

A

Tidal volume correlates to the respiratory effort; the more negative pressure, the larger the tidal volume delivered

95
Q

Explain pressure support ventilation

A

Pressure is equivalent of assist control ventilation; clinician sets peak airway pressure & the trigger (popular in the ICU)

96
Q

Explain low pressure modes

A

Are believed to match the resistant effort of the inner tracheal tube, allowing tidal volumes to match the patients respiratory effort

97
Q

Hat is intermittent mandatory ventilation

A

Patient is guaranteed a set number of mechanical breaths but between breaths, the he patient can spontaneously breath; these spontaneous breaths may be assisted, resulting in breath stacking & barotrauma

98
Q

What mode of ventilation was created to prevent breath stacking

A

SIMV (synchronized intermittent mandatory ventilation)

A breath is delivered at the beginning/end & there’s an observation window that allows for spontaneous breathing. Any breath in the window is not a trigger for assist control or pressure support

99
Q

CPAP modes are adjusted by

A

APL valve and I provide continuous positive airway pressure; same as adding PEEP

100
Q

Utilizing APL CPAP can cause

A

Air trapping or worsening oxygenation & ventilation in patient with obstructing lung physiologic

101
Q

High frequency ventilation is how many breaths/minute

A

150

102
Q

What are the 3 types of high frequency ventilation modes

A

High frequency positive pressure

High frequency jet ventilation

Airway pressure release ventilation

103
Q

High frequency positive pressure ventilation utilizes what and rates are…

A

Utilizes nasotracheal tube with small volumes at rates of 60-120 breaths/min; exhalation is passive and this is typically us r in airway & thoracic surgeries & may require special ventilator

104
Q

High frequency jet ventilation is

A

For short term procedures that use a high pressure source of oxygen; done during emergency & suspension laryngoscopy; provide passive oxygenation during apnic periods; exhalation is passive & CO2 accumulation is common

105
Q

The 2 major ventilators, Drager & GE display

A

Airway pressure
Time waveform
Numeric tidal volume & numeric peak airway pressure

106
Q

GE ventilator uses

A

Bag in bottle configuration

107
Q

What are the 2 gas circuits used in GE?

A

High pressure oxygen

Air to squeeze a visible ascending bellows

108
Q

In the GE machine, the bellows are pushed down and cause

A

The gas contained in the bellows to be pushed through the CO2 absorber & mixes with fresh gas flow & continues through the inspiratory limb; exhaled gas is passed down to the expiratory limb & back to bellows via unidirectional valves; pressure must exceed 2.5cm of water during exhalation for valves to open; excess gas is sent to scavenging system preventing build up ; drive comes from the anesthesia machine pipeline or the cylinder supply

109
Q

All Drager use

A

Piston ventilations

110
Q

The piston allows for

A

Precise calculation of tidal volumes

111
Q

Why is the ventilator in front of the unidirectional inspiratory valve

A

Decreases the compressible gas volume & increase accuracy of the tidal volume measurements

112
Q

In the Drager, what happens when the machine is turned on?

A

APL valve is bypassed & has no effect

113
Q

What is the purpose of the fresh gas decoupling valve

A

Closes during inspiration & prevents fresh gas flow from increasing tidal volume

114
Q

What is the advantage of the piston drive ventilator

A

No gases are required for it to function which reduces cost & wasted gas

No automatic PEEP

High precision of the delivered tidal volume

Quiet

115
Q

What are the disadvantages to piston ventilator?

A

The electric motor can wear out & fail & it’s hidden within the machine

It’s quiet

116
Q

In the turbine ventilator

A

The fan can change RPM rapidly that delivers circuit pressure & flows; seeds of 70,000RPM

117
Q

The turbine ventilator is depending on

A

Feedback with comes from accurate & precise system sensor measurements of time, pressure & flow ( ICU quality ventilation)

118
Q

The servos use

A

A volume reflector & software control service to drive the gas modules & vaporizer; the volume reflector replaces the bag in a bottle design; can electrically function as a flow or pressure generator

119
Q

What are the 2 most common ventilators

A

Bag in the bottle

Piston Driven

120
Q

What causes over pressurization in the airway

A

Coughing

Excessive setting

When O2 valve is pressed during inspiration, sending pipeline O2 flow directly to the lungs ( this is prevented by pressure limits)

121
Q

The ventilator can cause

A

Hypothermia

Dehydration

Drying of secretions

Incorrect settings causing hyper or hypocarbia secondary to excessive tidal volumes causing decreased preload

Obstruction hidden from view can decrease air flow

122
Q

ICUs use an

A

Open system

123
Q

What should be tested together to verify the excess of gas will be released once it he bellows are full to prevent sustained pressure

A

Scavenger system & ventilator relief valve

124
Q

When the ventilator is active and no flows are on, the bellows…

A

Should NOT LEAK/lose volume

125
Q

Explain the ascending gas drive ventilator or a bag in bottle type

A

The gas generates inspiratory flow similar to when an anesthetist squeezes the breathing bag, forcing air to move I. Th breathing circuit

126
Q

Leaks in the bellows can cause

A

dilution it gas or loss of agent; without a means of escape, the addition of fresh gas flow into the breathing circuit would cause excessive volume & pressure

127
Q

When does the ventilator relief valve open?

A

Only during expiration & releases gas to the scavenging system in an amount equal to the fresh gas flow per minute

128
Q

Which bellows are safer? Hanging or standing?

A

Both are safe & capable of showing the user a disconnect as long as an appropriate monitor is used; when there’s a disconnect, easier to see in the ascending bellows (gravity)

129
Q

What can decrease tidal volume in hanging bellows

A

Water gathering inside them

130
Q

Piston driven ventilators don’t use a driving gas & therefore…

A

Will not deplete the oxygen cylinder during a pipeline failure

131
Q

What is the driving force of the piston?

A

Electricity; if oxygen pipeline pressure fails, mechanical ventilation will continue

132
Q

With turbine ventilators, inspiratory flow is generated by

A

Spinning impeller; tidal volume/inspiratory pressure is sensed by flow & pressure sensors; impeller spins at a slow speed continually, which facilitates spontaneous respirations & efficient gas mixing throughout the breathing circuit

133
Q

What is the max pressure

A

40

134
Q

Ventilators settings can contribute to

A

Lung injury

Atelectasis

Postoperative pulmonary complications

135
Q

What are the goals of protection or open lung ventilation?

A

Prevent volumtrauma

Prevent barotrauma

Prevent lung inflammation due to alveolar wall stress

Minimize atelectasis & avoid hyperoxemia

136
Q

What does volume control look like?

A

Even shark fins

137
Q

What does pressure control look like?

A

Box with a slope

138
Q

What does pressure support look like?

A

Box slope & dip

139
Q

What does SIMV look like?

A

Quicker up slope, longer/ uneven down slope

140
Q

In volume control ventilation the desired tidal volume is

A

Delivered at a constant flow

141
Q

In volume control, the ventilator is volume limited &

A

Time cycled; inspiration is terminated when the desired tidal volume is delivered or is there’s an excessive pressure reached

142
Q

In volume control, the peak inspiratory pressure is uncontrolled &

A

Rises as the patient compliance decreases ir airway pressure resistance increases

143
Q

Tidal volume is adjusted to prevent atelectasis & respiratory rate is adjusted to

A

Keep end tidal CO2 at the desired level

144
Q

What are the best tidal volumes and what is most effective to avoids atelectasis & ventilator induced lung injury?

A

5-7ml/kg

PEEP & alveolar recruitment maneuver

145
Q

In pressure controlled ventilation

A

The max pressure is set & the cycle is controlled by the time with a decelerating flow pattern

146
Q

In a decelerating flow pattern

A

Inspiratory flow is strongest early in inspiration to reach the set pressure quickly & then declines the flow just sufficient to maintain the set pressure although this can increase mean airway pressure & may decrease venous return & cardiac output

147
Q

Tidal volume is uncontrolled & changes

A

As compliance or resistance changes

148
Q

What happens in Katie to with low compliance such as obese

A

Pressure control may result in increased tidal volume at lower peak airway pressures compared to volume control ventilation.

149
Q

SIMV can be either

A

Pressure or volume based & can be used for full or partial support

150
Q

Why was pressure control ventilation with volume guarantee created?

A

To address the problem that tidal volume & pressure modes vary

151
Q

How does pressure control ventilation with volume guarantee work

A

Delivers a volume breath at the set tidal volume determining the patients compliance & then the inspiratory pressure can be adjusted for the next breath

152
Q

Pressure support is responsible for

A

Patients efforts delivering pressure to the airway once effort is sensed, thus ONLY useful for patients who are spontaneously breathing

153
Q

Is there a minimum minute ventilation in pressure support

A

No, even though some allow backup apnea setting

154
Q

What vent mode is helpful during maintenance or emergence?

A

PSV

155
Q

How do you use CPAP mode

A

Select PSV mode but adjust pressure to 0 & then add PEEP

156
Q

PEEP prevents

A

Airway & Alveolar collapse, atelectasis

Mai rains functional residual capacity

157
Q

Does CPAP assist with ventilation?

A

No

158
Q

Why do modern ventilators have large tidal volume ranges

A

Greatly increased accuracy of the tidal volume delivered

Compensation or decoupling of fresh gas flow, especially when small tidal volumes are utilized for PEDs

159
Q

Fresh gas decoupling or tidal volume compensation allows for

A

Much more accurate delivery volume

160
Q

Is tidal volume accuracy a problem in pressure control

A

No

161
Q

What is the most common preventable ventilator mishap

A

Disconnection

162
Q

Most common site for disconnection

A

Between the breathing circuit & endotracheal tube at the Y piece

163
Q

What electronic monitors monitor of leaks

A

Capnography & pressure volume based alarms

164
Q

What is the common mistake after intubation

A

Failure to initiate ventilation

165
Q

What is the first step of MB is suspected?

A

Withdrawal the triggering agent

166
Q

What else can be done with MH?

A

Hyperventilate with 100% oxygen

Increasing fresh gas flows

Changing circuit components & granules

167
Q

How long should you flush line for MH

A

10L for 20 minutes

104/ minutes

Equipment (5 decks)

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