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ANPR 535 Equipment & Technology > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Effects of rebreathing include

A

heat and moisture retention, altered inspired carbon dioxide and agent concentrations

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2
Q

Factors affecting rebreathing include

A

FGF, apparatus dead space (from Y to alveoli), breathing system design (open, closed, semi), and empty space (circuit, canister, reservoir bag, ventilator)

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3
Q

To avoid hypercarbia with increased dead space

A

minute ventilation must increase (alveolar ventilation=VE-VD)

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4
Q

Common features of non-rebreathing circuits include

A

low resistance, less dead space/empty space, lack of unidirectional valves and lack of CO2 absorption

Dead space = patient
Empty space = equipment

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5
Q

Most popular non-rebreathing circuit is the

A

Mapleson D as excess gas scavenging is easy and most efficient during controlled ventilation

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6
Q

The Bain modification to the Mapleson involves

A

placement of the FGF through the expired gases to heat inspired gases

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7
Q

List advantages of NRB

A

inexpensive, rugged, excellent positive pressure ventilation, less dead space, in Bain system the inspiratory limb is heated by exhaled gases, low resistance, lightweight, changes in FGF result in rapid changes, no CO2 or compound A

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8
Q

List disadvantages of NRB

A

High FGF required (1.5x minute ventilation) with resultant pollution and economic waste, inspired heat and humidity low, requires frequent adjustment in FGF, not suitable for patient with MH (cannot increase FGF enough to blow off CO2)

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9
Q

Reasons for decline of NRB include

A

modern efficient ventilators, conservation of heat with rebreathing circuits and waste gas management

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10
Q

List advantages of circle systems

A

economical (expired O2 and vaporized agent recirculated and reused, FGF and agent use minimized), humidifies inspired gas, preserves heat

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11
Q

List disadvantages of circle systems

A

complex, less portable, opportunities for disconnect, unidirectional valves may malfunction, increased dead space, increased “empty space” (longer diffusion time)

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12
Q

Describe the basic configuration of the circle system in regard to location of the ventilator/bag, FGF and carbon dioxide absorbent

A

fresh gas inlet, inspiratory limb one way valve, inspiratory tubing, patient Y piece, expiratory tubing, expiratory limb one way valve, reservoir bag, APL valve, CO2 absorbent

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13
Q

List two functions of the APL valve

A

user adjustable valve that releases gases to a scavenging system, used to control pressure in the breathing system

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14
Q

Describe basic characteristics of carbon dioxide absorbents

A

Gas tends to travel along periphery of canister and inlet. Does not support bacterial growth. Each canister should last 20-30 hours. 55% granules, 45% air space. Smaller granules absorb more but dust and cake so usually a mix of large and small granules packaged.

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15
Q

Identify moisture content and granule size of common carbon dioxide absorbents

A

14-19% moisture, essential for CO2 absorption.

Granule size 4-8 mesh

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16
Q

Describe the chemical reaction involving CO2 and soda lime

A
  1. CO2 + H2O = H2CO2 (and heat)
  2. H2CO3 + 2 NaOH = Na2CO3 + CO + 2 H20 (and heat)
  3. Na2CO3 + CaCO3 + 2 NaOH
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17
Q

List common clinical signs of CO2 canister exhaustion

A

Rise in HR, then fall. Increased RR, respiratory acidosis, dysrhythmias, SNS activation (flushed, sweating), increased bleeding, increased ETCO2.

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18
Q

Describe the function of the expiratory valve on the circuit

A

closes to prevent rebreathing of exhaled gas that contains CO2

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19
Q

Identify measurement units for airway pressure

A

kPa or cmH2O

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20
Q

List three uses of the pressure gauge

A

measure circuit pressure between inspiratory and expiratory valves
high pressures reflect change in compliance or resistance
low pressures reflect circuit leak
pressure higher than 20 cmH2O opens the esophageal sphincter (mask induction or mask anesthetic)

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21
Q

List three uses of the reservoir bag

A

means for delivering positive pressure, monitor spontaneous ventilations, allows use of low FGF, protects patient from excessive pressure in breathing circuit

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22
Q

List three characteristics of a closed system

A

O2 supply = metabolic consumption, no waste of O2, should be used with close attention to FiO2 and no nitrous, extremely economical for FGF and volatile, retains heat and humidity, less pollution.

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23
Q

List three breathing circuit hazards and a component of machine check that verifies an intact circuit

A

circuit disconnection, leaks,

to detect leaks and disconnects, perform positive pressure check.

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24
Q

Two factors affecting resistance

A

length and width of tubing

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25
Q

Why should a spontaneously breathing person under anesthesia on a vent always be assisted?

A

Any breathing circuit creates resistance to gas flow and increases work of breathing.

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26
Q

What is higher FGF associated with?

A

Less rebreathing, the higher the FGF the more the gas in the circuit will resemble that at the common gas outlet.

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27
Q

Advantages of rebreathing

A

cost reduction, increased warmth and humidity of inspired gases, and decreased OR contamination

28
Q

semi-closed circuit features

A

O2 delivery exceeds consumption and excess gases constantly eliminated through APL valve

29
Q

Semi-closed circuit compared to closed circuit advantages and disadvantages

A

advantages of semi-closed over closed: safe and more rapid change in anesthesia concentration
disadvantages of semi-closed over closed: less economical, heat loss, more pollution

30
Q

differences between semi-closed and semi-open

A

semi-closed: conveys excess gas to scavenging system, humidification, low FGF
semi-open: excess gas released to air, no humidification, high FGF (1.5x minute ventilation)

31
Q

List two settings which require manual adjustment during the use of SIMV and why they are necessary

A

Minimum minute ventilation and Pressure Support for assisted ventilation of spontaneous breaths

32
Q

Compare SIMV and PSV (differences between the 2 modes, which is best used for an LMA)

A

SIMV-delivered breaths with pt’s spontaneous breaths, mandatory breaths occur at intervals. PSV-best for an LMA. Designed to augment patient’s spontaneous breaths by supplying positive pressure in response to patient-
initiated breaths

33
Q

List 3 advantages of PEEP

A

Increases lung compliance and recruits alveoli, increases functional residual capacity, increases tidal volume above closing volume

34
Q

List 3 disadvantages of PEEP

A

Potential for barotrauma, may decrease venous return and blood pressure, may worsen V/Q with OLV

35
Q

Identify the typical minimum tidal volume with modern ventilators

A

10mL

36
Q

Identify the standard delivery pressure of oxygen during jet ventilation

A

15-30 PSI

37
Q

List 3 complications of jet ventilation

A

Barotrauma, gastric distention, ball-valve distention from tumor

38
Q

Identify the government agency that regulates trace gases

A

OSHA

39
Q

Identify the typical capacity of waste gas disposal in an anesthesia machine

A

10-15 liters

40
Q

List 4 practices that minimize exposure to anesthesia gas

A

Avoid unnecessary disconnects of circuit, avoid turning any agent on until face mask is on patient, administer 100% oxygen prior to removing airway device, install key-filled vaporizers whenever possible

41
Q

List 4 sources of hypercapnia during anesthesia

A

Hypoventilation, rebreathing, inadequate FGF, excessive dead space

42
Q

List 5 sources of accidental excessive airway pressure during anesthesia

A

High inflow, low outflow, ventilator spill valve malfunction, obstruction in scavenging system, misconnected oxygen tubing, unintentional PEEP

43
Q

List 5 sources of inadvertent anesthetic agent overdose or underdose

A

Tipped vaporizer, incorrect agent, vaporizer interlock failure, improper vaporizer installation, vaporizer inadvertently turned on

44
Q

List 4 maneuvers employed for MH history

A

Remove all vaporizer from machine, remove soda lime canisters, remove circuit, flush circuit/machine for 30 min

45
Q

List 4 protective features of modern anesthesia machines

A

Fewer user accessible connections, more accurate tidal volume, advanced ventilation features, automated checkout systems

46
Q

Identify how excess drive gas and circuit gas from the ventilator is expelled

A

Drive gas is vented to atmosphere through the exhaust valve (or to the scavenging
system in the modern OR)
Circuit gas is vented to the scavenging
system through the spill valve (pop off valve)

47
Q

Differentiate between modern ventilators based on power source and drive mechanism

A
  • gas-driven bellows have a double circuit, one with drive gas, one with patient gas
  • piston ventilator driven by an electric motor, uses less gas and very precise
48
Q

List three factors that may affect the delivered tidal volume when using a ventilator

A

FGF, compliance and compression volumes, leaks

49
Q

Define fresh gas decoupling

A

During inspiration a decoupling valve closes off to inlet so no FGF can enter and affect TV. Because you would not want FGF of 7 L to make your TV go up. It separates the two. Modern machines have this decoupling valve which is effective but to some extent FGF does affect TV

50
Q

List three standard alarms on modern ventilators

A

high priority requires IMMEDIATE attention
medium priority requires prompt attention
low priority alarms are for operator awareness

51
Q

List five criteria activating a ventilator alarm

A
  1. high peak pressure (above 40)
  2. pressure less than threshold for >15 seconds
  3. continuous high pressure
  4. apnea/disconnect alarm
  5. reverse flow (incompetent expiratory limb valve, sticky unidirectional valve d/t blood or frothy airway)
  6. high rate
  7. low tidal or minute ventilation
52
Q

List five causes of increased peak inspiratory pressure

A
  1. increased tidal
  2. decreased compliance (d/t CHF, trendelenburg, pleural effusion, abdominal insufflation, obesity, tension pneumo, endobronchial intubation)
  3. increased airway resistance (d/t kinked tube, bronchospasm, secretions, foreign body)
53
Q

List two disadvantages to using descending ventilator bellows

A

you cannot tell if there is a leak in the circuit because the bellows sink to the bottom no matter what, and you could lose your tidal volume but be oblivious to the fact

54
Q

List two advantages and disadvantages associated with an electronic (piston) ventilator

A

advantages- precise tidal volume, no drive gas required

disadvantages- initially expensive, can’t visualize bellows, no audible excursion of bellows

55
Q

Identify a risk involved with switching ventilator modes during an anesthetic

A

assess compliance change, PIP or VT may be too high or low depending on insufflation, etc.

56
Q

Identify the most commonly used mode of ventilation and why it is used

A

volume control. simple and fixed, doesn’t change based on insufflation, etc.

57
Q

Define volume control ventilation (flow pattern, effect of compliance and resistance)

A

airway pressure linear but angled, tidal linear, alveolar pressure linear, flow rate constant (box)

58
Q

Define pressure control ventilation (flow pattern, effect of compliance and resistance)

A

airway pressure box shaped or constant (maximal from time 0 until plateau), tidal gradual curved up, alveolar pressure gradual curved up, flow rate gradual downward as alveolar pressure and tidal plateau

59
Q

Identify advantages and disadvantages to the use of pressure controlled ventilation (PCV)

A

advantages- recruit slow alveoli, opens less compliant alveoli
disadvantages- tidal fluctuates, increases in rate decrease inspiratory time and lowers tidal, peep decreases tidal

60
Q

Identify two patient populations that may benefit from PCV

A

lung injury, obese, one lung ventilation

61
Q

Describe the potential effects of I:E manipulation on patients with lung disease

A
  • reverse I:E (2:1) improves alveolar recruitment

- long I:E (1:3 or 1:4) good for COPD, compensates for flow related collapse, FRC improved, airways stay open longer

62
Q

2 factors affecting resistance

A

Width and length of tubing

63
Q

A pt under anesthesia should always be assisted in some way bc the circuit creates?

A

Resistance or increase work for the spontaneous breather

64
Q

Advantages of rebreathing include?

A

Cost reduction
Increased warmth
Increased humidity
Dec OR contamination

65
Q

Higher fgf is associated with what two things?

A

Less rebreathing

The higher the fgf the more the concentration will resemble the common gas outlet

ANPR 535 Equipment & Technology (5 decks)

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