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Instrumentation and Monitors > Summer Final Exam > Flashcards

Summer Final Exam Flashcards

1
Q

Highest Occurence of recall

A

General surgery

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2
Q

Diagnostic criteria for PTSD

A

Both: a)person witnessed, experienced or was confronted with an event or events that involved actual or threatened death or serious injury or threat to physical integrity of self or others b) the person’s response involved intense fear, helplessness or horror

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3
Q

Of 26 patients with awareness in study ___ had no post-op sequelae

A

8

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4
Q

Percent of recall due to faulty anesthetic technique

A

70%

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5
Q

Percent of recall due to failure to check equipment

A

20%

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6
Q

Goals of satisfactory anesthetic

A

1) Adequate perfusion of all organ systems 2) unresponsive to noxious stimuli 3)no awareness or recall of events during procedure

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7
Q

Cortical Phenomenon

A

Consciousness (controlled by hypnotics)

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8
Q

Poor indicators of consciousness

A

Subcortical phenomenon: movement (cord reflex), hemodynamic response (brain stem)

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9
Q

Depth of anesthesia can be defined

A

by suppression of clinically relevant responses to noxious stimuli

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10
Q

Analgesic

A

Agent that relieves pain w/o loss of consciousness

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11
Q

Amnestic

A

agent that results in loss of memory of an event or time period

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12
Q

Hypnotic

A

an agent that produces drowsiness and acts to induce sleep or sleep like state

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13
Q

Sedative

A

an agent that allays excitement and produces a calm state

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14
Q

Muscle relaxant

A

an agent which blocks the transmission of nervous impulses to skeletal muscle, rendering patient paralyzed and unable to breathe or move

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15
Q

Tranquilizer

A

agent that quiets or calms patient w/o affecting clarity of consciousness

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16
Q

Anxiolytic

A

agent that relieves apprehension and fear, relief from anxiety

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17
Q

Most commonly used measurements for monitoring anesthetic depth

A

HR and BP

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18
Q

Explicit Knowledge

A

easily recalled and explained

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19
Q

Implicit knowledge

A

cannot consciously recall, influences our behavior

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20
Q

Tracheal intubation is about ___ as stimulating as skin inscision

A

twice

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21
Q

Most anesthesiologists rely on ___ to assess anesthetic depth

A

their clinical experience and the dose of anesthetic

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22
Q

Isolated arm method

A

Blood pressure cuff inflated high, patient is relaxed and anesthetized. Patient is told to squeeze. Some patients respond even though all other signs would indicate anesthetic depth

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23
Q

MAC that we typically use

A

ED50

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24
Q

Doses minimally larger than ED50

A

prevent movement

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25
Q

concentration response relation for inhaled anesthetics is steep

A

So, ED95 differed minimally from ED50

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26
Q

MAC is mediated at subcortical levels so..

A

Because the cortex is more sensitive MAC is at a higher concentration than is really needed. The concentration of anesthetic needed to cause unconsciousness is much lower

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27
Q

Factors that increase mac

A

Hyperthermia, hyperthyroidism, alcoholism, acute administration of dextroamphetamine, young age

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28
Q

No effect on MAC

A

duration of anesthesia, sex, metabolic acid-base status, hyper/hypocapnia, isovolemic anemia, HTN

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29
Q

Redheads require ___ more anesthesia on average than brunettes

A

20%

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30
Q

Work practices

A

Vigilance, fatigue management, seeking advice

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31
Q

For the intraoperative phase

A

Scan equipment regularly during each case, take care to avoid wrong drug admin., give adequate hypnotic drug where possible, minimize use of muscle relaxants, respond rapidly to suspected inadequate anesthesia, modulate OR behavior, consider using EEG based monitor

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32
Q

BIS

A

Bispectral Index system
Differential amplifier measures potential difference between electrodes 2 and 3. Electrode 1 is the ground (reference). Electrode 4 is used in noise reduction.

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33
Q

EEG

A

represents cortical electrical activity, continuous, responsive, noninvasive indicator of cerebral fxn

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34
Q

BIS XP

A

sensor with additional electrode (#4), electrosurgery resistant, enhanced detection of near suppression

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35
Q

Density Spectral Array (DSA)

A

graphical representation of EEG frequency differences between the 2 hemispheres

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36
Q

Derivation of BIS

A

30, 1 second epochs of frontal EEG, empirical technique is statistical multivariate regression, uses Entropy

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37
Q

Burst suppression ratio

A

extent of electrical silence (0 active 100 silent)

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38
Q

Relative alpha/beta ratio

A

8-13 Hz energy/ 13-30 Hz energy

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39
Q

Bicoherence of EEG

A

degree of phase coupling between individual waves

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40
Q

BIS range

A

0 to 100. 0 is unconscious, 100 is fully awake

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41
Q

SQI (signal quality index)

A

ranges from 0-100%. This is the % of good epochs in the last 60 that could be used for calculation of the BIS.

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42
Q

EMG

A

electrical power in the 70-110 Hz range (given in dB with trend and bar graph)

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43
Q

SR (suppression ratio)

A

% of epochs in past 63 seconds in which EEG signal is considered suppressed

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44
Q

SEF (Spectral edge frequency)

A

the frequency at which 95% of total power lies below and 5% lies above

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45
Q

BIS responds more ___ to an emergence than spectral edge frequency

A

rapidly

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46
Q

EMG signals

A

tend to increase BIS number artifactually

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47
Q

Hypothermia and ischemia

A

appear identical to deep sedation and decrease BIS number

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48
Q

BIS responds better to

A

Halogenated agents and propofol than to N2O and Ketamine

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49
Q

Prevention of implicit memory at BIS of

A

84-91

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50
Q

Awareness estimate

A

0.2-0.4% for elective and emergency surgery

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51
Q

BIS does NOT

A

predict movement or hemodynamic response

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52
Q

BIS index is designed

A

to measure the effect of hypnotic anesthetic drugs.

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53
Q

When patients move during surgery with a BIS below 60,

A

additional analgesia may suppress further movement

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54
Q

In BIS movement trials,

A

Small opioid doses DID blunt surgical responses, and large hypnotic doses DID NOT eliminate surgical responses

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55
Q

Hypothesis from BIS movement trials

A

Movement/autonomic responses correlate with analgesia and EEG changes correlate with hypnosis/consciousness

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56
Q

BIS must be used

A

in conjunction with traditional vital sign monitoring

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57
Q

Entropy

A

describes irregularity, complexity or unpredictability characteristics of a signal

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58
Q

When the patient is awake,

A

EEG is highly irregular and the amt of entropy is very high. As the pt goes into deeper planes of anesthesia, EEG will have a more regular pattern of wave forms which brings down entropy

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59
Q

State Entropy

A

cortical, steady and robust

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60
Q

Response Entropy

A

muscle, fast reacting

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61
Q

PSI

A

Patient State Index. 25-50 optimal hypnotic state for general anesthesia

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62
Q

Entropy range of 40-60

A

Clinically meaningful anesthesia with low probability of consciousness

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63
Q

For control-a-flo: Maintain vertical distance of ___ or greater from container fluid level to venipuncture device

A

75 cm (30”)

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64
Q

Infusion pump types

A

Peristaltic (rotary or linear), cassette, elastomeric reservoir, syringe

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65
Q

Cerulean blue clamp pump (linear peristaltic?)

A

+/- 5% accuracy

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66
Q

Bard Infus O.R.

A

Infusion: linear rate +/- 3% accuracy, Bolus: linear displacement +/-3%

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67
Q

In syringe infusor, a 20 cc syringe will give ___ that of a 60 cc syringe

A

half

68
Q

BET scheme

A

Bolus, Eliminated (continuous infusion to replace drug eliminated), Transferred (exponentially declining infusion to replace drug transferred out of plasma to other body compartments)

69
Q

PCA (patient controlled analgesia) advantages

A

patient autonomy, rapid relief of pain, analgesia/dosage tailored to patient’s requirements with patient able to balance analgesia and side effects

70
Q

Key Points to PCA system

A

route of admin, type of admin, ease of programming, ease of priming, power source, safety, security, portability, display, printout

71
Q

Who painted 3 ages of woman?

A

Gustav Klimt

72
Q

Blood volume of mother at term

A

35% increase

73
Q

Plasma volume of mother at term

A

45% increase

74
Q

Erythrocyte volume of mother at term

A

20% increase

75
Q

Blood platelets of mother at term

A

unchanged

76
Q

A non-pregnant woman should have a hematocrit of about 40% but because plasma volume ____ more than RBCs ____, HCT at term is about ___.

A

increase, increase, 35%

77
Q

Minute ventilation at term

A

+50%

78
Q

Alveolar ventilation at term

A

+70%

79
Q

Tidal volume at term

A

+40%

80
Q

Respiratory rate at term

A

+15%

81
Q

Closing volume, arterial pH, Vital capacity, inspiratory lung capacity, and total lung capacity at term

A

unchanged

82
Q

Arterial PO2 at term

A

+10 mmHg

83
Q

Arterial PCO2 at term

A

-10 mmHg

84
Q

Airway resistance at term

A

-36%

85
Q

FRC, Expiratory reserve volume and residual volume at term

A

-20%

86
Q

Oxygen consumption at term

A

+20%

87
Q

Normal fetal heart rate

A

120-160 beats per minute

88
Q

NST

A

non stress test-FHR and movement monitored over 15-60 minute period. We want to see variability and accelerations= negative NST

89
Q

CST

A

contraction stress test, FHR monitored over 10 minutes w/ 3 contractions: induced vs non-induced. We want to see variability and accelerations=negative CST

90
Q

BPP

A

biophysical profile: Fetal breathing, body movements, tone, heart rate reactivity and amniotic fluid volume

91
Q

Fetal Oxygen Sat

A

Monitored by fetal scalp probe: SpO2 < 30% is concerning

92
Q

Normal fetal scalp blood gases

A

pH=7.25-7.35 (mean umbilical artery pH=7.26), SaO2=30-50%, PO2=18-22mmHg, PaCO=40-50 mmHg

93
Q

High apgar score

A

correlates to near normal pH (64.4%?)

94
Q

Ways to measure fetal HR

A

fetal electrode, doppler ultrasound transducer, external abdominal ECG, phonocardiogram

95
Q

Classes of HR variability

A

No FHR variability-range undetectable, Reduced FHR variability-range 0-15 bpm

96
Q

tocograph

A

graphs fetal HR compared with fetal contractions

97
Q

Sign of normal fetal oxygenation

A

accelerations with contractions

98
Q

Bad deceleration patterns

A

Head compression- early deceleration (usually progresses to late deceleration), uteroplacental insufficiency-late deceleration (also indicates Hypoxia), umbilical cord compression- variable deceleration (indicating transient asphyxial myocardial failure w/ lack of HR variability indicating decreased cerebral oxygenation)

99
Q

APGAR Score

A

Activity, Pulse, Grimace(reflect irritability), Appearance (Skin color), Respiration

100
Q

WIKI

A

What I know is

101
Q

Bedside point of care(POC) testing- Mandated by joint commission on accreditation of healthcare organizations

A

must be coordinated by department of pathology

102
Q

Advantages of POC testing

A

enhanced decision making, improved clinical outcomes, reduced turnaround time, increased patient satisfaction, reduced length of stay

103
Q

Locations where point of care testing options are helpful

A

Emergency room, ICU, Coronary care unit, obstetric suites, neonatal intensive care unit, burn unit, trauma room, OR

104
Q

Potential testing options in OR

A

Blood sugar, H/H, coag,platelet function,creatinine kinase, troponin t, arterial blood gas, electrolytes, calcium, magnesium

105
Q

Potential testing options in PACU

A

Blood sugar, H/H, coag,platelet function,creatinine kinase, troponin t, arterial blood gas, electrolytes, calcium

106
Q

Potential testing options in ICU/CCU

A

Blood sugar, H/H, coag,platelet function,creatinine kinase, troponin t, arterial blood gas, electrolytes, calcium, magnesium, bacteriologic POCT

107
Q

Issues influencing the introduction of Point of Care testing

A

Personnel and training, quality control, Proficiency testing( frequency, methodology), calibration verification, certification and inspection, records and documentation, integration with central laboratory

108
Q

Disadvantages of POC testing

A

innacuracy, difficult controls and calibrations, training requirements

109
Q

Chief uses of POC testing

A

Blood glucose analyses, blood gas analyses, critical electrolytes, H/H, coagulation, myocardial markers, urinalysis, pregnancy

110
Q

CGB in Istat tests for:

A

Na, K, Ca, Glu, H/H, pH, PCO2, PO2, TCO2, HCO3, Base excess, sO2

111
Q

Analyzers

A

evaluate blood permanently withdrawn from the patient (takes blood away, doesn’t give it back)

112
Q

Monitors

A

Evaluate blood constituents by means of a probe exposed to circulating blood (looks at blood but gives it back)

113
Q

Electroconvulsive therapy requires

A

Hypnotic, NMB, airway/bite block

114
Q

Amount of fluid needed to drop patient temp by 1 degree C

A

4 liters

115
Q

2 main problems with MRI facilities

A

high fixed magnetic field strength always present, high power pulsed radio frequency fields used during scanning

116
Q

MRI scanner strength

A

1.5-4 Tesla, 10000 Gauss= 1 Tesla, Earth’s magnetic field is 0.5 to 1 Gauss.

117
Q

MRI hazards

A

Projectile effect, twisting, burns, image artifacts, device malfunction

118
Q

ECG in MRI

A

burn risk- Proper for is to have 4 electrodes placed over heart

119
Q

Leads V5 and V6

A

maximize QRS and minimize artifact

120
Q

Capnography in MRI

A

Artificially high inspired and low exhaled CO2 if line length is long and sample flow rate is low

121
Q

Temperature monitoring in MRI

A

should be limited to liquid crystal strips, thermistors in orifices present a burn risk

122
Q

Metal in MRI

A

must be non-ferrous (such as aluminum). Steel will get pulled in.

123
Q

Heat dissipation can be measured by

A

Heated wire anemometer (has hot wire made of platinum or tungsten. One wire measures flow and the other wire determines effects of various gases during no flow)

124
Q

Pressure gradient is measured by

A

Pneumotachometer

125
Q

Calibration in a thorpe tube

A

should be read from the top of the float

126
Q

Cerebral O2 consumption

A

3.5 ml/100g/min

127
Q

CBF

A

50ml/100g/min

128
Q

Respirometer locations

A

upstream or downstream of unidirectional valve

129
Q

Flow volume loop moved down and right

A

decrease in compliance

130
Q

Open flow volume loop

A

indicates gas leak either from deflated ett cuff or poorly seated lma

131
Q

Nafion

A

H2O absorbing

132
Q

When atmosphere surrounding patient’s deadspace

A

CO2 levels of inspired and expired air increase

133
Q

Stethoscopy

A

non-invasive assessment of heart and lung sounds

134
Q

Types of Stethoscopy

A

monaural, binaural, precordial, pretracheal, esophageal, doppler

135
Q

Esophageal stethoscope should be placed

A

Around 30cm

136
Q

R wave envelope

A

Inspiration increases R-wave amplitude.

137
Q

Skin temperature contributes about ____ to control

A

20%

138
Q

Interthreshold range in humans

A

0.2 degrees celsius

139
Q

Cold receptors:non-cold receptors

A

10:1

140
Q

Thermal sensors

A

hypothalamus, skin, deep body tissue receptors

141
Q

BMR loss

A

Radiation- 65%, Convection-25%, Evaporation-10%, Conduction-negligible

142
Q

After 1 hour of anesthesia, core temp

A

decreased 1.6 degrees celsius

143
Q

The temperature in the esophagus may vary up to

A

4 degrees celsius

144
Q

Esophagus temp probe

A

38-42 cm from incisors

145
Q

Cooling and rewarming

A

occurred more rapidly in esophagus. Rewarming also occurred more rapidly in the nasopharynx

146
Q

Wakefulness (eeg)

A

desynchrony

147
Q

sleep (EEG)

A

synchrony

148
Q

Ways to monitor brain fxn

A

EEG (processed-spectral edge, power spectrum), MEP (cortical), SEP (VEP, BAEP,SSEP), Wakeup

149
Q

Rolandic Fissure

A

C3,CZ, C4

150
Q

Montage

A

electrodes used during monitoring

151
Q

Delta

A

<4 Hz, deep anesthesia

152
Q

Theta

A

4-7 Hz light sleep, light anesthesia

153
Q

Alpha

A

8-12 Hz

154
Q

Beta

A

> 12Hz Mental activity, sedation, light anesthesia

155
Q

Abnormal EEG

A

CBF <20-25 ml/100g/min

156
Q

Cellular survival threatened

A

CBF < 12ml/100g/min

157
Q

Deep anesthesia and Ischemia

A

produce same EEG pattern

158
Q

Burst suppression of EEG

A

used during aneurysm clipping

159
Q

Amount of total energy consumed in brain by neurons during depol and repol

A

Half

160
Q

Increased EEG frequency

A

Hyperoxia, Initial Hypoxia, Small dose barbiturates, 30-70% N2O, Inhalational agents <1 mac

161
Q

Decreased EEG frequency, increased amplitude

A

Mild Hypoxia,Inhaled agents >1 mac

162
Q

Decreased EEG freq, decreased amplitude

A

Marked Hypoxia

163
Q

EEG electrical silence

A

Severe Hypoxia

164
Q

BSR

A

Burst suppression ratio-eeg derived variable, % of time in EEG sample that waveform is isoelectric

165
Q

Variables for EEG changes during anesthesia

A

Mean, median, spectral edge

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