Section 2: Instruments & Techno

Question 1

In which publication is the purity of medical gases specified?

Answer 1

The purity of medical gases is specified in the United States Pharmacopoeia

Question 2

What agency enforces the purity of medical gases in the United States?

Answer 2

enforced by the Food and Drug Administration (FDA).

Question 3

Which United States government agency regulates matters affecting the safety and health of employees in all industries?

Answer 3

The U.S. government regulates matters affecting the safety and health of employees in all industries through the Department of Labor (DOL}.

Question 4

In 1970, the U.S. Congress passed the Occupational Health and Safety (OSHA) Act. Which two executive-branch agencies were created to carry out the
provisions of OSHA?

Answer 4

The Occupational Health and Safety Act (OSHA) created two separate executive-branch agencies to carry out the provisions of the act: ( 1) the National
Institute of Safety and Health (NIOSH), an agency with the Centers for DiseaseControl and Prevention under the Department of Health and Human Services,
and OSHA. under the Department ofLabor.

Question 5

What is the capacity (L) and pressure of a full (E) cylinder?

Answer 5

660L , psi of 1900

Question 6

What is the capacity (L) and pressure (psig) of a full H cylinder of oxygen (02)?

Answer 6

full H cylinder of oxygen (02) has a capacity of 6,900 L under a pressure of2,200 psi.

Question 7

What is the capacity (L) and pressure (psig) of a full E cylinder of nitrous oxide (N20)?

Answer 7

A full E cylinder of nitrous oxide {N 20) has a capacity of 1590 L under a pressure of 745 psi.

Question 8

What is the capacity (L) and pressure psig) of a full H cylinder of nitrous oxide (N20)?

Answer 8

A full H cylinder of nitrous oxide {N20) has a capacity of 15,800 L under a pressure of 745 psi

Question 9

Nitrous oxide {N20) is stored as a liquid in cylinders, as you know. What does the gauge pressure of745 psi actually represent?

Answer 9

Since nitrous oxide {N20) is stored as a liquid, the cylinder pressure of 745 psi represents the vapor pressure of liquid nitrous oxide at room temperature

Question 10

What is the capacity (L) and pressure {psig) of a full E cylinder of air?

Answer 10

A full E cylinder of air has a capacity of 625 L under a pressure of 1900 psi.

Question 11

What is the capacity (L) and pressure ( psig) of a full H cylinder of air?

Answer 11

A full H cylinder of air has a capacity of 6,550 L under a pressure of 2,200 psi.

Question 12

Because the pressure on a nitrous oxide cylinder remains relatively constant (745 psi) as long as there is liquid nitrous oxide in the cylinder, what is the only way to know the amount of liquid in the cylinder of nitrous oxide?

Answer 12

In a cylinder containing a liquefied gas, the pressure depends on the vapor pressure of the liquid-weight must be used to determine the amount of liquid in cylinders that store liquefied gas

Question 13

What is the weight of an empty E cylinder?

Answer 13

An empty E cylinder weighs 14 pounds.

Question 14

The gauge on an E cylinder of nitrous oxide reads 740 psi. Explain the significance of this pressure reading.

Answer 14

Since nitrous oxide is stored as a liquid, the nitrous oxide cylinder pressure gauge remains at 745 psi until the liquid is gone; at this point, the cylinder is more than three-quarters empty. After all the liquid nitrous oxide is
gone, the pressure rapidly declines until the cylinder is exhausted

Question 15

What volume of anesthetic vapor is produced by 1 milliliter of volatile anesthetic liquid?

Answer 15

One milliliter of liquid volatile anesthetic produces - 200 milliliters of anesthetic vapor at 20 °C and 1 atmosphere

Question 16

Describe synchronized intermittent mandatory ventilation (SIMV).

Answer 16

Synchronized intermittent mandatory ventilation (SIMV) is a refinement of intermittent mandatory ventilation (IMV} in which the intermittent mandatory breaths are delivered in synchrony with, and triggered by, the
patient’s spontaneous efforts.

Question 17

SIMV can be used for

Answer 17

full to partial support of ventilation and helps to prevent “fighting the ventilator~ and “breath stacking”

Question 18

Is synchronized intermittent mandatory ventilation (SIMV) used in pressure or volume mode? What aspect of ventilation is detected to trigger synchronization
with the patient’s ventilatory effort?

Answer 18

Synchronized intermittent mandatory ventilation (SIMV} may be used in either pressure- or volume-cycled mode. A trigger window controls the amount of time during each expiratory cycle that the ventilator is sensitive to spontaneous breaths, by sensing negative (subatmospheric) pressure generated by the patient’s diaphragm.

Question 19

Where is positive end-expiratory pressure (PEEP) applied in the anesthesia circuit?

Answer 19

positive end-expiratory pressure (PEEP) valve must be placed in the expiratory side of the breathing system.

Question 20

What does the ASTM standard require of disposable PEEP valves?

Answer 20

The ASTM standard requires that a PEEP valve be marked with an arrow indicating proper direction of gas flow or the words inlet and outlet or both.

Question 21

These generally have a more depressant effect on evoked potentials than equipotent doses of intravenous agents. . .

Answer 21

Inhalational agents, including nitrous oxide,

Question 22

Combinations of drugs generally produce

Answer 22

additive effects on MEPs

Question 23

2 medications Attenuate the amplitude of virtually all evoked potential modalities but do not obliterate them

Answer 23

Propofol and thiopental

Question 24

Have negligible effects on the recording of all evoked potentials

Answer 24

Opioids and benzodiazepines

Question 25

Have been reported to enhance the quality of signals in patients with weak baseline somatosensory evoked potential (SSEP) signals.

Answer 25

Ketamine and etomidate

Question 26

In general, cortical evoked potentials with long latency involving multiple synapses are e.
Mnemonic:

Answer 26

exquisitely sensitive to the influence of anesthetic while
short latency brainstem and spinal components are resistant to anesthetic
influenc

Question 27

Can be recorded under any anesthetic technique,

Answer 27

BAEP

Question 28

Are very sensitive to anesthetic agents.(MEPs)

Answer 28

whereas VEP and SSEP

Question 29

Mnemonic MEPs

Answer 29

Visual are Very, Somatosensory are Somewhat, and Brainstem are Barely sensitive

Question 30

Research has validated that use of a single ECG lead for ischemic monitoring in patients with documented CAD is

Answer 30

is inadequate; monitoring with multiple leads enhances patient safety.

Question 31

ECG monitoring system is currently the standard for monitoring patients with suspected myocardial ischemia.

Answer 31

A 5-cable (S-lead)

Question 32

Describe the placement of the 5 electrodes in the S-cable system.

Answer 32

LA, RA, LL, and RL placed at their corresponding monitoring locations allow any of the six
bipolar limb leads (I, II, III, aVR, aVL, and a VF) to be obtained, and a fifth chest electrode can be placed in any of the standard precordial V1 to V6 locations

Question 33

Describe the proper placement of RA, LA, LL, and RL electrodes according to the Mason-Likar lead position scheme

Answer 33

Proper placement of the RA electrode is over the outer right clavicle and of the LA electrode is over the outer left clavicle. The LL electrode is placed near the left iliac crest or midway between the costal margin and left iliac
crest along the anterior axillary line. The RL electrode may be placed at any convenient location on the body

Question 34

Which unipolar lead in the 5-lead monitoring system is preferred when arrhythmias are anticipated? Which unipolar leads are preferred for monitoring ischemia?

Answer 34

In the 5-lead system, VI is preferred for special arrhythmia monitoring, whereas V3 to V5 are the preferred leads for monitoring ischemia.

Question 35

A patient has an arterial line in the right arm and a blood pressure cuff on the left arm; the left arm is 20 cm higher than the right arm. If the blood pressure from
the arterial line is 120/80, what is the pressure from the cuff on the left arm? (Assume the a·line has been properly calibrated to the phlebostatic axis.)

Answer 35

The blood pressure from the cuff on the left arm is 105/65. For each 10 cm of vertical height above or below the level of the heart, 7.5 mm-Hg should be subtracted from or added to, respectively, the blood pressure readings (for every inch, subtract or add 1.80 mm-Hg). Since the left arm is above the arterial line in the right arm, the pressure adjustment must be
sub-tracted from the readings

Question 36

What and where is the phlebostatic axis?

Answer 36

The phlebostatic axis approximates the position of the right atrium. In the supine position, the phlebostatic axis is the fourth intercostal space, midanteroposterior level (not midaxillary line); for the right lateral decubitus
position, at fourth intercostal space midsternum; for the left lateral decubitus position, at fourth intercostal space at the left parasternal border

Question 37

What advantage does C02 monitoring have over pulse oximetry or vital sign monitoring?

Answer 37

Carbon dioxide monitoring detects acute, complete airway obstruction and extubation more rapidly than pulse oximetry or vital sign monitoring

Question 38

What issues may increase the Beta angle of the C02 waveform?

Answer 38

The~ angle of the C02 waveform is increased with rebreathing, malfunctioning inspiratory valves, and with prolonged response time compared to respiratory cycle time, especially in children.

Question 39

What Decrease the beta angle

Answer 39

The beta angle will be decreased if the slope of phase III is decreased.

Question 40

Why might low or poor perfusion states interfere with accurate pulse oximeter readings?

Answer 40

Pulse oximeters require adequate pulsations to distinguish light absorbed from arterial blood from venous blood and tissue light - this process is
called plethysmographic analysis. Therefore, pulse oximeter readings may be unreliable or unavailable if there is loss or diminution of peripheral pulse.

Question 41

List two factors that lead to falsely high pulse oximeter readings (SP02 > Sa01).

Answer 41

Carboxyhemoglobin (CO poisoning) and methemoglobin-when the true Sa02 < 85% - lead to falsely high pulse oximeter readings

Question 42

Explain how the presence of methemoglobin can lead to both falsely high and falsely low pulse oximeter readings.

Answer 42

Methemoglobin absorbs a significant amount of light at both 660 and 940 nm and thus the pulse oximeter detects equal amount of oxy- and deoxyhemoglobin
which results in a reading of 8O% to 85%. In other words, in the presence of significant methemoglobinemia the pulse oximeter reading
is essentially “fixed” at 80% to 85%. Therefore, when the true Sa02 is less than 85%, the reading is falsely high and the obverse is true as well.

Question 43

List 5 factors the generally have no significant
effect on pulse oximeter readings
(SP02 = Sa02).

Answer 43

(1) polycythemia; (2) skin pigmentation; (3) alternate

hemoglobins, specifically HbF, HbS, HbH, and sulfHb; ( 4) red henna dye; and, (S) jaundice.