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ANPR 535 Equipment & Technology > Test 3 aka Final > Flashcards

Test 3 aka Final Flashcards

1
Q

• Identify four standard monitors for the intubated patient undergoing general anesthesia

A
  1. Oxygenation- oxygen analyzer, pulse ox
  2. Ventilation- capnography, ETCO2
  3. Circulation- ECG, BP q5min
  4. Body Temp- should be READILY AVAILABLE
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2
Q

• Describe the role of the oxygen analyzer in avoiding a hypoxic mixture of gases

A

located in the inspired limb and is calibrated to RA 21%; measures downstream from flowmeters

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3
Q

• Identify the single monitor which provides the most clinical information

A

pulse oximetry

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4
Q

• List wavelengths of oxygenated and deoxygenated blood and describe how this

generates pulse oximeter readings

A

Oxygenated- 960 nm (katrins notes say 990)

Deoxygenated- 660 nm

Differ in their absorption of red and infrared light; change in light absorption when passing through vascular bed during arterial pulsation is the basis for oximetric readings

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5
Q

List three clinical scenarios which may result in decreased oxygen saturation

A

V/Q mismatch, disconnect, inadequate MV, misplaced ET tube, diffusion abnormality

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6
Q

List eight locations which may be used to monitor oxygen saturation

A

finger, nose, earlobe, forehead, lip, tongue, cheek (couldn’t find an eighth one)

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7
Q

List eight factors affecting pulse oximeter accuracy

A

electrocautery, motion/venous pulsations, ambient light/radiant warmers, nail polish/acrylic nails, low perfusion, CO/Methemoglobin, methylene blue(false low), hypothermia, tourniquet, IABP/CPB

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8
Q

• Identify monitoring standards for accuracy, signal adequacy and mandatory alarms (in reference to saturation)

A

Accuracy b/t 70-100% mandatory alarm for sat <85% (must be stated if accurate below 65%), indication for signal inadequacy, indication if lag time for data, indication if affected by motion

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9
Q

• List four uses for pulse oximetry besides measuring oxygen saturation

A

Estimate of SBP, monitoring peripheral circulation, locating arteries, warning of fluid extravasation

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10
Q

• Identify the most commonly used technology used for anesthesia gas monitoring

A

Infrared analysis

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11
Q

• Describe how infrared technology works in relation to measuring anesthesia gas concentration

A

Based on the principle that gases with 2 or more dissimilar atoms have specific infrared light absorption; the amount of IR light absorbed is proportional to the concentration of the absorbing molecules; gas concentration may be determined by comparing IR light absorption to known standard

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12
Q

• Compare and contrast limitations of non- diverting and diverting gas monitors

A

Nondiverting- “mainstream”, sensor located directly in gas stream, more accurate, no gas removed, must be placed close to patient (cumbersome), expensive

Diverting- requires water trap for condensation, accuracy decreases with increasing RR and longer sampling lines, requires TV 150 ml, must be beyond HME, particulate matter may clog line, if FGF high may have dilution, larger gradient but less cumbersome

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13
Q

• List four limitations of IR technology

A

Gas interference, oxygen may interfere with CO2 accuracy, overlap of CO2 and nitrous IR peaks, mixture of agents causes erroneous readings, interference from water vapors

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14
Q

• Discuss accuracy standards for capnometry

A

CO2 reading will be within 12% of the actual value or 4 mmHg, manufacturer must disclose any interference by inhalation anesthetics,

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15
Q

• Describe mandatory alarms for capnometry

A

capnometer must have a high CO2 alarm for both inspired and exhaled CO2, mandatory alarm for low exhaled CO2

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16
Q

List four factors associated with a decrease in ETCO

2

A

hyperventilation, respiratory obstruction, poor mask/LMA fit, malposition of ETT, embolism/hypoperfusion, diffusion issue, cardiac arrest

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17
Q

List four critical clinical events detectable by gas analysis

A

machine malfunction, disconnect, vaporizer malfunction, circuit leaks, ETT cuff leak, hypoventilation, MH, Airway obstruction, Air embolism, circuit hypoxia

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18
Q

List four sources of heat loss during anesthesia

A

Radiation, evaporation, convection, conduction

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19
Q

Identify four deleterious effects associated with hypothermia during anesthesia

A

shivering, decreased metabolism of drugs, prolonged emergence, increased bleeding, N/V, poor wound healing

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20
Q

Identify five clinical scenarios associated with a higher risk of hypothermia

A

elderly/neonates/peds, burn patients, pts with spinal cord injuries, open abdomen/chest, cold room

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21
Q

Identify the most effective method of keeping the patient warm

A

Increase ambient temperature

22
Q

Identify the BIS range associated with a surgical plane of anesthesia

A

BIS 40-60

23
Q

List four potential monitoring sites for nerve stimulators

A

Ulnar nerve (most sensitive), median nerve, tibial nerve, posterior tibial nerve, peroneal nerve, facial nerve, mandibular nerve

24
Q

• Compare and contrast nerve stimulator monitoring for depolarizing and nondepolarizing

muscle relaxants

A

Nondepolarizing- decreased twitch height, fade during tetany, fade during TOF, T4/T1 <0.7, post-tetanic potentiation, absence of fasciculations, antagonism of block by Achase
inhibitors, augmentation by NDMR

No slide on depolarizing*

25
Q

List five clinical signs of neuromuscular function

A

head lift, leg lift (kids), grip strength, max inspiratory force, vital capacity, tidal volume

26
Q

List three disadvantages of using a face mask for general anesthesia vs. LMA

A

Ties up hands, higher FGF, access difficult during certain procedures, more desat vs. LMA, higher work of breathing

27
Q

• Identify four complications from the use of a face mask

A

Pressure necrosis, nerve injury, gastric inflation, pollution

28
Q

• Identify four methods of inserting LMA’s

A

Pull up on chin and advance, insert upside down, insert stylet into LMA, press LMA against hard palate with index finger

29
Q

• Identify two differences between an LMA classic and an intubating LMA

A

LMA classic has a black line that runs longitudinally and 2 vertical bars to keep epiglottis from obstructing tube. Intubating LMA has short curved stainless steel shaft and single moveable epiglottic elevator bar

30
Q

• List three complications of LMA insertion

A

Aspiration, gastric distention, larygnospasm

31
Q

• List three advantages of LMA vs ET tube

A

Ease of insertion, less invasive, less laryngospasm and bronchospasm

32
Q

• List three advantages of ET tube vs. LMA

A

Less risk of aspiration, can be used in prone or jackknife positions, can ventilate with higher pressures if necessary

33
Q

• List two unconventional handle configurations and describe their use in specific populations

A

Short handle better for obese and large breasts/chests, small handle better for pediatrics bc it doesn’t obscure view

34
Q

• List four uses of fiberoptic bronchoscopes (FOB)

A

Intubation, confirm placement of ETT or double lumen ETT, clear secretions, bronch

with lavage for aspiration

35
Q

• List four disadvantages or limitations of FOB

A

Expensive/fragile, difficult or impossible with certain pts (blood, secretions, hypoxemia), gastric distension with oxygen insufflation, largyngeal trauma

36
Q

• List four structures at risk of damage from direct laryngoscopy

A

Lips, tongue, palate, hypopharynx, larynx, esophagus, tmj dislocation

37
Q

• Identify the importance of sizing of RAE ET tubes in regard to the preformed bend

A

Size determines location of bend

38
Q

• Identify the role of embedded ET tubes in maintaining ventilation

A

Spiral embedded tubes (anode, reinforced, armored) to prevent compression or kinking

39
Q

• Identify differences between a Microlaryngeal

tube and a conventional ET tube

A

Microlaryngeal tube has larger cuff and body for narrow airways

40
Q

• Discuss the physical characteristics of the laser

ET tube

A

Laser shield tube made from silicone with inner aluminum wrap (cuff filled with blue indicator instead of air)

41
Q

• List four complications of endotracheal intubation

A

Trauma, esophageal intubation, inadvertent bronchial intubation, aspiration, vocal cord dysfunction

42
Q

• Describe how determination is made of what

size FOB to use for a specific ET tube and size

A

outside diameter of the bronchoscope must obviously be less than inner diameter of ETT

43
Q

-Identify the type of oral airway used for awake

fiberoptic intubation using the oral approach

A

Use ovassapian airway and pull tongue

44
Q

• Identify the main advantage of using a nasal

approach for awake FOB

A

has the most direct path to the glottis

45
Q

• Identify the power source for a McGrath VL

A

Single 1.5V AA battery

46
Q

• List two limitations of a McGrath VL

A

Small screen, potential fogging

47
Q

• List two potential advantages of a CMAC VL over a McGrath VL

A

A D-blade (difficult airway blade is available for a CMAC), still images and video images can be recorded

48
Q

List two limitations of a CMAC VL

A

Cleaning takes time, high profile and may be difficult to use in patients with a small mouth opening or fixed flexion of the neck

49
Q

• Identify a potential advantage of Glidescope VL over McGrath and CMAC VL

A

Anti-fogging technology that automatically warms the glass covering

50
Q

• List two limitations of a Glidescope VL

A

Less portable, expensive

ANPR 535 Equipment & Technology (5 decks)

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