Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen Exam 2 > Ventilator > Flashcards

Ventilator Flashcards

1
Q

the first ventilators used ____ pressure. They were called _____

A

negative
the iron lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The iron lung was developed to save victims of respiratory failure due to

A

polio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

in positive pressure ventilation, the only connection between the patient and the machine is the _____

A

endotracheal tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

why we call them “agents” and not “gasses?”

A

administered as vapor, not gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Vapor

A

a solution in liquid form dissipates or evaporates and releases molecules into the air around it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Vapor pressure

A

pressure exerted by a gas above a liquid in a sealed container

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Strong intramolecular forces = _____ vapor pressure

A

lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Weak intramolecular forces = ____ vapor pressure

A

higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Water has ___ vapor pressure

A

lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

We can smell liquids that have (lower/higher) vapor pressure

A

higher
ie: acetone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

(low/high) vapor pressure liquids easily give up their molecules to evaporation

A

high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anesthetic agents have (lo/hi) vapor pressure.

A

high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Highest vapor pressure amongst anes. agents

A

Desflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

We pressurize the agent ____ to ___ atm and heat it to ____ C

A

Des
2
40C (Barash: 39C)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

principle of fluid dynamics that pulls the vapor molecules off the canisters and into the circuit

A

Bernoulli’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Venturi Effect

A

The entrainment of fluid (gas or liquid) due to the drop in pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bernoulli’s principle states that…

A

An increase in the speed of a fluid occurs simultaneously with a decrease in pressure or a decrease in the fluid’s potential energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Venturi effect in the machine

A

(a drop in pressure will entrain gas/liquid)

-fresh gas flows over the top of the canister
-creates a - pressure grdnt
-pulls vapor up and out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

why do we reach MAC faster if you turn your flows up at the beginning of the case?

A

Venturi effect

neg. pressure in vaporizer pulls vapor up and out of canisters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MAC of Desflurane

A

6.6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

most lipid insoluble of all the agents

A

Desflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

lipid insoluble volatile agents

A

-body trying to push it back out through the lungs
-force it in by high inspired %

(why Desflurane the quickest on and quickest off)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

quickest on and quickest off volatile agent

A

Des

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

populations is Desflurane good for

A

Quick cases
obese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which patients is Desflurane bad for?

A

Long cases
reactive airways (asthma, smokers)
tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Desflurane settings

A

flows max: 1L/min
inspired percentage high: 12%+

will reach MAC in same time as Higher % and flows, minus the SEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Sevoflurane MAC

A

1.8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Most to least lipid sol

A

Iso
sevo
Des

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

least pungent of the agents

A

Sevo

“Sevo smells bessst”

“smell the sevo, it’s great!”

Sevo, sweetie

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

agent of choice for inhalational inductions

A

Sevo
b/c she smell gewd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Flow requirements for ____ are 2L/min due to risk of forming _____

A

Sevo
Compound A

“sevo serving us compound A”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

populations is Sevoflurane good for?

A

Reactive airways
case that requires high flows (bronchs)
LMA (not paralyzed = higher risk of bronchospasm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

most lipid soluble of the agents

A

Isoflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

(soluble/insoluble) agents take the longest to go on and to come off

A

soluble

Higher b:g = slower
Iso (highest b:g) is slowest

(remember, when talking about agents, “in/soluble” means water/blood solubility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What happens to insoluble agents in the body?

A

body sequesters it in the fat and then rereleases it into the plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

MAC of Isoflurane

A

1.17%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What cases is Isoflurane most suited for

A

remain intubated and ICU admit
lasts longer = anesthesia “for the road”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

most neuroprotective of the agents

A

Iso

I so save your brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

All agents reduce ___, which is good for the brain, but reduce ___ , which is bad for the brain

A

cerebral metabolic rate
cerebral blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What makes Iso more neuroprotective?

A

reduces Cereb metab rate more & blood flow less

(all agents:
reduce CMR= good
reduce CBF = bad)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When to use Iso

A

hemorrhagic stroke
head trauma w/ crani for hematoma evac

and other pts that always go direct to ICU on vent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

basic components of air

A

21% oxygen
78% nitrogen
and other stuff we dc about rn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

inspiring 75% oxygen & four 4.5 % Desflurane
where’s the rest?

A

We’re giving air (78% Nitrogen)
remaining % = nitrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

inspired and expired gasses here are measured in

A

%s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Flows are measured in

A

L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Six percent of 0.5 liters is the same DOSE as ___ percent of 2 liters

A

six

same percentage, just takes less amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

low-flow anesthesia allows us to use less agent at ____

A

steady state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which is more expensive?
TIVA
inhaled agents

A

TIVA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Which is worse for the environment?
low flow anesthesia
TIVA

A

low flow anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

primary benefit to low-flow delivery

A

economic

(earth, you’re second I guess lol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

primary downside of low flow anesthesia

A

changing dose takes longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How to best change dose in low-flow anesthesia

A

temporarily raise your flows
or
inspired % really high or really low

after desired MAC is reached, put settings back how they were

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

etCO2 capnography
normal range

A

30-40

NOT 35-45; thats PCO2 (PaCO2) on ABGs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

capnography is measured in

A

pressure mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

_____ is about 5 points higher than ____

A

PaCO2 (listed as PCO2 on ABG)
>
etCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

T/F
The gap in PCO2 (PaCO2) and etCO2 is due to dead space, especially from the vent circuit.

A

False
gap exits b/c gases use differences in partial pressures to diffuse (gas exchange)

etCO2 sensor on circuit so close to mouth that dead space is not a significant contributor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

T/F
the vent circuit contributes greatly to dead space, which increases the gap between PCO2 and etCO2

A

False
etCO2 sensor on circuit so close to mouth that dead space is not a significant contributor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

T/F
PACO2 measures CO2 in the arteries

A

False
PACO2 = Alveoli
PaCO2 = arteries

(“Al” both tall; “ar” both short)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

PCO2 NR

A

35-45

(etCO2 30-40)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

T/F
PCO2 and etCO2 are interchangeable.

A

FALSE
PCO2 = PaCO2 =arterial CO2

etCO2 = expired CO2

60
Q

Our etCO2 is 32. What would we expect the PCO2 to be?

A

37

etCO2 is usually 5 points lower than PCO2

61
Q

T/F
PCO2 = PACO2

A

False
PCO2 a.k.a. PaCO2 = arterial
PACO2 = alveolar

62
Q

respiratory alkalosis in a long case

A

kidneys compensate: excrete bicarb
in PACU: metabolic acidosis
compensate by hyperventilating
(hard to do with opioids they’ve been sedated with)

63
Q

T/F
Dead space can increase gap between PaCO2 and etCO2.

A

True
but
not the reason it exists

64
Q

When speaking on gas diffusion, we describe it in terms of _____

A

partial pressures!!!

65
Q

The partial pressure gradient is

A

~5 mmHg

66
Q

T/F
CO2 crosses alv. Mem using active transport.

A

False
passive transport/diffusion

67
Q

How thick is the alv. memb?

A

0.3 micrometers

68
Q

Passive transport is also called

A

diffusion

69
Q

T/F
Gas exchange occurs when there is an equilibrium.

A

False
without a sloping gradient, molecules don’t move

70
Q

Gases move from areas of higher to lower _____

A

partial pressures

not concentration thats for solids dissolved in liquids

71
Q

Fick’s Law of Diffusion

A
72
Q

directly controls pH

A

CO2

73
Q

In pH management, what parameter is easiest for us to control?

A

CO2

74
Q

T/F
CO2 is a base.

A

False
its an acid

75
Q

Abnormal pHs mostly result in

A

acidosis

76
Q

T/F
Pts lose more blood at an acidic pH than at normal pH.

A

True
clotting cascade slows down

77
Q

In acidosis, K moves (into/out of) the cell.

A

acidosis:
K out
H in

78
Q

How does acidosis lead to hypovolemic shock?

A

flaccid peripheral vasculature
SVR drops
BP drops

79
Q

How do shock and acidosis work together to make things 100x worse? lol

A

Acidosis: flaccid vasculature, SVR & BP drop

shock!

Shock: anaerob. respir8n = lactic acid

worsened acidosis

80
Q

Normal etcO2 but pt is still trying to breathe

A

respiratorily compensate for metabolic acidosis
maybe d/t
early hypovol shock (blood loss/inadequate fluid resuscitation)

81
Q

inspired CO2 should always be

A

zero

82
Q

inspired CO2 above 0 means…

A

CO2 absorbent needs to be changed

83
Q

T/F
Using low-flow anesthesia will require more frequent changing of CO2 absorbent

A

True
slower air is more likely to go thru channels in the crystals & wont absorb as well

84
Q

Channeling

A

-preferential passage through absorber via pathways of low resistance.

-decreased efficacy
-bypass absorbent granules

85
Q

Total flows should never be less than….

A

volume of inspiratory limb

86
Q

Volume is measured in

A

mL

87
Q

Volume waveform measures (inspired/expired) tidal volume.

A

expired

88
Q

delta VT

A

difference between VT and VT-INSP

89
Q

delta VT is also known as

A

your leak

90
Q

T/F
O2 absorbed = CO2 expelled

A

O2 absorbed > CO2 expelled

91
Q

troubleshooting a leak (delta VT)

A

check:
cuff pressure
circuit connections (CO2 sampling line)

92
Q

An ETT cuff must be ____ to protect against aspiration.

A

patent

93
Q

calculation for minute ventilation

A

RR x Vt = total volume/minute

94
Q

Minute ventilation
definition

A
95
Q

Minute ventilation is measured in

A

volume/min

L/min

96
Q

circuit disconnects or vent failures can present early as…

A

a big leak

97
Q

Circuit disconnect

A

break in the system that delivers ventilation and drugs to the patient

98
Q

accidental extubation can present as a

A

Circuit disconnect

99
Q

ETT occlusion will show a _____ alarm
A disconnect will be a ____ alarm

A

high pressure
leak

100
Q

You are manually ventilating your pt as you had to disconnect them d/t a leak. Help is on the way. During this time you should administer ____.

A

propofol
(pt is not receiving any IA at this time)

101
Q

new to anesthesia, who dis?

A

pressure waveform

102
Q

pressure waveform measures …(3)

A

3 pressures:
peak, plateau, and PEEP

103
Q

pressure waveform measures in which units?

A

cm H20

104
Q

2 modes of ventilation

A

volume and pressure

105
Q

Volume mode

A

choose volume (mL) & rate

delivers volume regardless of pressure

can set a max pressure

106
Q

normal PEEP (healthy lungs)

A

0
lungs return to atmospheric pressure on end expiration

107
Q

pressure mode

A

set a pressure (cm H2O) & rate

delivers pressure regardless of volume

no max volume setting!
must monitor the pressure yourself

“pressure mode increases the pressure on the CRNA”

108
Q

Which mode does not allow a max limit for the other parameter?
Volume
pressure

A

pressure
cannot set max volume

“pressure mode increases the pressure on the CRNA”

109
Q

volume auto flow

A

type of volume mode

machine calculates pressure needed to deliver the set volume (for each breath)

accounts for pt’s compliance

consistent vol w/ minimal peak prsr

110
Q

(volume autoflow mode)
On the pressure waveform, __ & __ are the same.

A

peak and plateau

111
Q

T/F
the same pressure can deliver variable volumes

A

True
(ie before and after insufflating belly)

112
Q

if a small amount of pressure results in a large change in volume

A

high/good compliance

113
Q

lot of pressure to result in just a small expansion of lung volume

A

low /poor compliance

114
Q

Which is more common?
obstructive
restrictive

A

obstructive

115
Q

pure obstructive

A

✅ compliance

❌how fast the gases can move through the airways

116
Q

always worse on expiration

A

obstructive

117
Q

examples of obstructive problems

A

Dz: COPD, OSA, asthma

Fxnl: bronchospasm, laryngospasm, obstruction

118
Q

How obstructive issues change breathing?

A

slower, deeper breaths
reduced RR
reduces air lost to dead space

119
Q

Dead space calc

A

2cc/kg/breath

or 150 cc/breath for adults

120
Q

When do we see this?

A

obstructive capnography (“shark fin”)
asthma, COPD

breathing too fast and your VT is too low

121
Q

T/F
Obstructive patients need PEEP from the ventilator.

A

False
have pathologically high auto PEEP
don’t add more

122
Q

we usually add _____ of PEEP on the vent to prevent atelectasis

A

2-3
do not add any PEEP to obstructive Dz (ie: COPD)

123
Q

restrictive processes call for (higher/low/no) PEEP

A

higher

124
Q

Restrictive disease is anything that reduces

A

compliance

no obstruction to slow gases

125
Q

examples of restrictive disorders

A

PnA
ARDS
MV w/ pulmonary failure

126
Q

DO NOT hand-ventilate these patients during transport

A

restrictive Dz

keeps tighter control of their settings

127
Q

Changing vent on pt with high PEEP & restrictive Dz

A

(PEEP 10-15)
when disconnecting,
inflate & clamp
unclamp when on new vent

prevents fluid buildup in RHF and pulm edema pts

128
Q

Abdominal insufflation
Pregnancy
Trendelenburg position

are examples of…

A

functionally restrictive
Extrinsic Pulmonary Disease

129
Q

restrictive Dz treatment

A

✅ air flow –> increase RR
✅ no significant dead space

reduce Vt (don’t force volume)
PEEP! (so alveoli dont shut –> atelectasis)

130
Q

do not use auto flow for pts with…

A

severe restrictive (ARDS, Pna)

use pressure mode for this instead

131
Q

T/F
emphysema is both restrictive and obstructive.

A

True
what fun lol

132
Q

what’s happening?

A

Patient trying to breathe over the vent

133
Q

What’s happening?

A

obstruction

134
Q

What do you do when this appears?

A

elevated baseline = change CO2 absorber

135
Q

Whats happening?

A
136
Q

whats happening?

A
137
Q

You noticed this waveform, and recognize it as _______. The first step is to _____ and then ____.

A

esophageal intubation
pull ETT & intubate trachea
decompress stomach w/ OGT

138
Q

You notice this waveform. Your first step is to _____. If that is working normally, you must ____.

A

check the CO2 sampling line
replace water trap

139
Q

A defective water trap can also give you a false low ____.

A

etCO2

140
Q

how long do water traps last?

A

4 weeks

141
Q

We would to increase expiratory time for _____ diseases, but decrease it for ____ diseases.

A

increase E time = obstructive (COPD)

decrease E time = restrictive (ARDS, PnA)

142
Q

compliance equation

A

change in pleural pressure

143
Q

We should use ______ mode in pts with restrictive processes

A

pressure mode (keep their alveoli open; need PEEP)

DO NOT USE volume autoflow

144
Q

Volume autoflow is indicated for ____ processes

A

obstructive

obstructive: use slower, deeper breaths (volume; NO extra peep)

145
Q

T/F
Volume autoflow is good for normal, healthy lungs.

A

True

146
Q

Volume autoflow can be seen as…

A

a gentler version of normal volume mode

147
Q

(restrictive mode)
What to do and what NOT to do

A

needs: pressure! (PEEP to keep alveoli open)

do not give: volume

Gen Exam 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions