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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
Why should a spontaneously breathing person under anesthesia on a vent always be assisted?
Any breathing circuit creates resistance to gas flow and increases work of breathing.
26
What is higher FGF associated with?
Less rebreathing, the higher the FGF the more the gas in the circuit will resemble that at the common gas outlet.
27
Advantages of rebreathing
cost reduction, increased warmth and humidity of inspired gases, and decreased OR contamination
28
semi-closed circuit features
O2 delivery exceeds consumption and excess gases constantly eliminated through APL valve
29
Semi-closed circuit compared to closed circuit advantages and disadvantages
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
differences between semi-closed and semi-open
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
List two settings which require manual adjustment during the use of SIMV and why they are necessary
Minimum minute ventilation and Pressure Support for assisted ventilation of spontaneous breaths
32
Compare SIMV and PSV (differences between the 2 modes, which is best used for an LMA)
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
List 3 advantages of PEEP
Increases lung compliance and recruits alveoli, increases functional residual capacity, increases tidal volume above closing volume
34
List 3 disadvantages of PEEP
Potential for barotrauma, may decrease venous return and blood pressure, may worsen V/Q with OLV
35
Identify the typical minimum tidal volume with modern ventilators
10mL
36
Identify the standard delivery pressure of oxygen during jet ventilation
15-30 PSI
37
List 3 complications of jet ventilation
Barotrauma, gastric distention, ball-valve distention from tumor
38
Identify the government agency that regulates trace gases
OSHA
39
Identify the typical capacity of waste gas disposal in an anesthesia machine
10-15 liters
40
List 4 practices that minimize exposure to anesthesia gas
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
List 4 sources of hypercapnia during anesthesia
Hypoventilation, rebreathing, inadequate FGF, excessive dead space
42
List 5 sources of accidental excessive airway pressure during anesthesia
High inflow, low outflow, ventilator spill valve malfunction, obstruction in scavenging system, misconnected oxygen tubing, unintentional PEEP
43
List 5 sources of inadvertent anesthetic agent overdose or underdose
Tipped vaporizer, incorrect agent, vaporizer interlock failure, improper vaporizer installation, vaporizer inadvertently turned on
44
List 4 maneuvers employed for MH history
Remove all vaporizer from machine, remove soda lime canisters, remove circuit, flush circuit/machine for 30 min
45
List 4 protective features of modern anesthesia machines
Fewer user accessible connections, more accurate tidal volume, advanced ventilation features, automated checkout systems
46
Identify how excess drive gas and circuit gas from the ventilator is expelled
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
Differentiate between modern ventilators based on power source and drive mechanism
- 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
List three factors that may affect the delivered tidal volume when using a ventilator
FGF, compliance and compression volumes, leaks
49
Define fresh gas decoupling
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
List three standard alarms on modern ventilators
high priority requires IMMEDIATE attention medium priority requires prompt attention low priority alarms are for operator awareness
51
List five criteria activating a ventilator alarm
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
List five causes of increased peak inspiratory pressure
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
List two disadvantages to using descending ventilator bellows
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
List two advantages and disadvantages associated with an electronic (piston) ventilator
advantages- precise tidal volume, no drive gas required | disadvantages- initially expensive, can't visualize bellows, no audible excursion of bellows
55
Identify a risk involved with switching ventilator modes during an anesthetic
assess compliance change, PIP or VT may be too high or low depending on insufflation, etc.
56
Identify the most commonly used mode of ventilation and why it is used
volume control. simple and fixed, doesn't change based on insufflation, etc.
57
Define volume control ventilation (flow pattern, effect of compliance and resistance)
airway pressure linear but angled, tidal linear, alveolar pressure linear, flow rate constant (box)
58
Define pressure control ventilation (flow pattern, effect of compliance and resistance)
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
Identify advantages and disadvantages to the use of pressure controlled ventilation (PCV)
advantages- recruit slow alveoli, opens less compliant alveoli disadvantages- tidal fluctuates, increases in rate decrease inspiratory time and lowers tidal, peep decreases tidal
60
Identify two patient populations that may benefit from PCV
lung injury, obese, one lung ventilation
61
Describe the potential effects of I:E manipulation on patients with lung disease
- 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
2 factors affecting resistance
Width and length of tubing
63
A pt under anesthesia should always be assisted in some way bc the circuit creates?
Resistance or increase work for the spontaneous breather
64
Advantages of rebreathing include?
Cost reduction Increased warmth Increased humidity Dec OR contamination
65
Higher fgf is associated with what two things?
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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