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614 General Principles Of Anesthesia > Week 6- Anesthesia Monitoring, Vents, & Vent Modes > Flashcards

Week 6- Anesthesia Monitoring, Vents, & Vent Modes Flashcards

1
Q

what does tubing the goose mean? and why is it a problem?

A

intubating the esophagus

can cause vomiting– may need to place OG

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2
Q

increased airway resistance would cause what to the alpha angle of ETCO2

A

increased alpha angle

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3
Q

a incompetent inspiratory valve will cause what change to the ETCO2

A

altered beta angle (not as steep)

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4
Q

if the ETCOs waveform does not return to baseline, what should you think is the cause

A

desiccated CO2 absorbant

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5
Q

a curare cleft in the ETCO2 waveform could signify:

A

pt is not fully paralyzed or sedated

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6
Q

what are cardiac oscillations signify on ETCO2 and what should you do about them

A

detection of the heart beating by the lung

nothing, it is benign

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7
Q

typical ETCO2 waveform appearance of a person with COPD

A

shark fin look

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8
Q

what should you set the I:E ratio of someone with COPD and why

A

1:3

long expiratory time allows for longer exhalation

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9
Q

4 possible causes of exponential decrease in ETCO2

A
  • cardiopulmonary arrest
  • PE
  • sudden hypotension/ massive blood loss
  • cardiopulmonary bypass
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10
Q

what would an air leak cause a ETCO2 waveform to look like

A

stairs

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11
Q

NIBP should be ______% greater than the diameter of the limb and cover _________ of upper arm or thigh

undersized cuffs will give falsely ______ readings and oversized cuffs will give falsely __________ readings

A

20
2/3

high
low

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12
Q

the more peripheral the NIBP is, it will result in _______ systolic and _________ diastolic

A

higher, lower

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13
Q

the desired reference point for NIBP

A

aortic root

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14
Q

for every 4 inches (10cm) in height from the aortic root, the NIBP will differ by about ________ mmHg

A

7.5

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15
Q

what type of cuff is an NIBP and why

A

an oscillometric cuff because it measures changes in pressure as pressure becomes less and less

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16
Q

what causes korotkoff sounds

A

volatile blood flow, which can cause vibrations against the artery walls

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17
Q

MAP is the point at which the __________ are maximal

A

oscillations

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18
Q

standard of care: NIBP measure at least every ______ minutes

A

5

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19
Q

contraindications for NIBP (4)

A
  • traumatic injury (from repeat NIBP, bone frx, or fistula/PICC)
  • axillary lymph node dissection (could cause limb edema from repeat vascular occlusion)
  • iatrogenic injury from prolonged use
  • radial nerve injury
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20
Q

Determines adequacy of ulnar collateral flow and integrity of radial artery

When should color return

A

Allen’s test

<5-6 sec for return of pink color

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21
Q

T or F: ulnar artery is preferred location for Aline placement

A

F - radial artery is preferred. ulnar is much smaller

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22
Q

aline flush is pressurized to ~ _____ mmHg

zero point of aline

A

300

phlebostatic axis, 4th intercostal space (right atrium) 5 cm posterior to the sternal border

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23
Q

can zero a line transducer at what point to determine cerebral pressure/circle of willis

A

mid ear in seated position

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24
Q

peak of aline waveform is equivalent to …

bottom of aline waveform is equivalent to ….

A

systolic pressure

diastolic pressure

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25
Q

what does the dicrotic notch on aline waveform represent

A

closure of AV valves

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26
Q

an overdamped aline waveform will yield __________ oscillations while an underdamped aline waveform will yield ____________ oscillations

A

< 1.5

> 2

** normal= accurate BP 1.5- 2 oscillations

** overdamped= falsely low BP

** underdamped= falsely high BP

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27
Q

systolic waveform variation can signify the ____________ of patient

A

hydration status

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28
Q

some complications from A-line placement

A
  • thrombosis
  • hematoma
  • bleeding
  • vasospasm
  • air embolism
  • necrosis/ischemia
  • nerve damage
  • infection
  • intra-arterial drug injection
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29
Q

the Slope of upstroke of aline waveform provides information on patient’s hemodynamic status, what does is represent

A

myocardial contractility

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30
Q

Slurred/delayed stroke of an Aline waveform is indicative of

A

increased afterload

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31
Q

CVP refers to hydrostatic pressure generated by the blood within either the _________ or the ___________ at a point adjacent to the right atrium

A

right atrium

great veins of the thorax

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32
Q

on the CVP waveform: what does the a represent

A

atrial contraction

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33
Q

on the CVP waveform: what does the c represent

A

tricuspid valve elevation of right atrium

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34
Q

on the CVP waveform: what does the x represent

A

downward slope of contracting right ventricle

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35
Q

on the CVP waveform: what does the V represent

A

back pressure wave from blood filing right atrium

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36
Q

on the CVP waveform: what does the y represent

A

tricuspid valve opens in early ventricular diastole

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37
Q

Waves order on the CVP waveform

A

a > c > x > v > y

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38
Q

the waveform of a CVP correlate to the flow and contractions states of the ________

A

Right atrium

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39
Q

main complication of placing a central line

A

pneumothroax

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40
Q

what can a-fib do to a CVP waveform

A

loss of a wave
prominent c wave

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41
Q

what can AV dissociation do to a CVP waveform

A

cannon a wave

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42
Q

what can tricuspid regurgitation do to a CVP waveform

A

tall systolic c-v wave and loss of x descent

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43
Q

what can tricuspid stenosis do to a CVP waveform

A

tall a wave and attetnuation of y descent

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44
Q

what can pericardial constriction do to a CVP waveform

A

tall a and v waves, steep x and y descents (M or W configuration)

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45
Q

what can cardiac tamponade do to a CVP waveform

A

dominant x descent and attenuated y descent

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46
Q

Standard variables measured with the PA catheter

A
  • CVP/right atrial pressure, RV pressure, PA pressure and PAWP/left atrial
  • CO
  • Mixed venous oxygen saturation
  • Core body temperature
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47
Q

CO =

SVR =

EF =

MAP =

A

CO = SV X HR

SVR= (MAP-CVP)/CO

EF = SV/EDV

MAP = (SBP + 2DBP)/3

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48
Q

T or F: Most rhythm disturbances can be detected and diagnosed with a 5-lead ECG

A

F - 3 lead ECG

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49
Q

Cardiac ischemia is best detected by monitoring with a 5-lead ECG and using both lead ___ and lead _____ (up to ___% sensitivity)

A

II

V5

80%

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50
Q

what happens to ST segment when there is supply-demand mismatch

A

ST-segment depression

** most common form of post-op ischemia (demand ischemia)

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51
Q

placement of a white lead on 5 lead EKG

A

RA

52
Q

the periphery can be up to ___ degrees cooler than the core

A

3

53
Q

Patients can exhibit a passive decrease of _________ degrees Celsius during anesthesia

A

1 to 4

54
Q

t or f: neuraxial blocks can cause vasoconstriction

A

F- causes vasodilation

55
Q

during general anesthesia, why is there an initial decrease in temperature (4 examples)

A
  • prepping/draping
  • redistribution of body heat d/t anesthesia-induced vasodilation
  • vasoconstriction impaired by anesthetics
  • muscle relaxants reduce heat protection–> prevents shivering
56
Q

4 types of heat loss in OR

A
  • radiation **
  • conduction
  • evaporation
  • convection
57
Q

up to 60% of heat loss in or is from

A

radiation heat loss

58
Q

second most significant route for intraoperative heat loss

A

convective (30%)

59
Q

what can you use to prevent heat loss in OR

A

baer hugger and/or warm fluids

60
Q

attributes to the latent heat of vaporization of water from open body cavities and respiratory tract

A

evaporative heat loss ~ 8-10%

61
Q

heat loss that occurs from direct contact of body tissues or fluids to a colder material

A

conductive ~ 5%

62
Q

some major consequences of hypothermia in OR

A
  • wound infection
  • adverse cardiac events
  • coagulopathy
  • introp blood loss
  • increased DOA of NMBD/muscle relaxants
  • shivering
  • increase PACU stay
  • increased hospital stay
63
Q

hyperthermia is a rise in body temperature of __ degrees celcius/HR

A

2

64
Q

usual cause of hyperthermia in OR

A
  • sepsis
  • overheating d/t active warming
  • MH or other syndromes
65
Q

T or F: the site of temperature monitoring intraoperatively depends on the Procedure, type of anesthesia used, and the reason for the temperature monitoring

A

T

66
Q

Gold Standard for measuring core temperature is the

A

pulmonary arterial blood`

67
Q

Optimal position for the esophageal temperature sensor in an adult is the distal third of the esophagus to

A

decrease the cooling by respiratory gases in the trachea

68
Q

T or F: Skin temperatures reflect central/core perfusion

A

F- Skin temperatures reflect peripheral perfusion rather than core body temperature

69
Q

A battery-powered stimulator delivers a small electric current to a superficial nerve, usually the ulnar. Activity stimulated by the four consecutive impulses is assessed by watching or feeling for associated muscle movement.

A

TOF

70
Q

T or F: Adequate muscle relaxation exists when 3 of 4 twitches are present

A

F - adequate when 2 of 4 present

71
Q

Good intubating conditions exist when __ of 4 twitches remain

A

1

72
Q

what is the TOF ratio

A

Comparing of T4 (4th twitch of the TOF) to T1

73
Q

if you are reversing someone from paralysis and you get 4 full twitches, what % of receptors can still be blocked

A

75%

74
Q

strong correlation with rate of larynx recovery

A

corrugator supercilli

75
Q

50-100 Hz stimulus for 1-5 seconds

A

tetanic stimulation

76
Q

two short burst of 50 HZ tetanic stimulation separated by 750 msec

A

double-burst

77
Q

50 Hz tetany for 5 seconds followed by TOF starting 3 seconds later

A

post tetanic stimulation

78
Q

processeselectroencephalographic signals to obtain a value, which reflects the LOC of the patient.

A

BIS monitor

79
Q

A value of __represents the absence of brain activity, and ___ represents the awake state

BIS values between ___ to ____ represent adequategeneral anesthesia for a surgery

Values less than ___ represent a deep hypnotic state.

A

0 & 100

40 & 60

40

80
Q

BIS monitor is unreliable with what two anesthetics

A

ketamine and N2O

81
Q

limitations of BIS monitors (5)

A
  • anesthetic agents
  • age
  • hypothermia
  • neuro impairment
  • medical device interference
82
Q

modern anesthesia delivery systems are typically _________

A

semi-closed

83
Q

T or F: Anesthesia vents are more complex than ICU vents

A

F

84
Q

what is one of the main differences between an ICU vent and an anesthesia vent

A

anesthesia vent can deliver inhalational agents

85
Q

Deliver precise volumes or pressures to support the patient’s breathing, and they often have advanced monitoring

A

Anesthesia ventilators

86
Q

T or F: ICU vents are semiclosed systems

A

F- they are open systems

87
Q

In an ICU ventilator gases are recirculated. (T/F)

A

False - no gases recirculated

88
Q

High gas flows used in an elaborate gas-warming and humidification
(anesthesia or ICU ventilator?)

A

ICU ventilator

89
Q

T or F: Anesthesia vents are able to remove CO2 and conserve potent inhalational agents

A

T

90
Q

T or F: Anesthesia vents are highly customizable

A

F - ICU vents are highly customizable

91
Q

3 modes of an anesthesia ventilator

A
  • spontaneous
  • volume control
  • pressure control
92
Q

in V/Q mismatching, what causes deadspace

A

ventilation without adequate perfusion

93
Q

in V/Q mismatching, what causes shunts

A

perrfusion without ventilation

** deoxygenated blood bypasses alveoli and mixes oxygenated blood, resulting in decreased arterial oxygen Ventilator assumes the work of breathing.

94
Q

lungs have to overcome _______ & _________

A

compliance and resistence

95
Q

compliance has to do with the __________ of the lungs

A

elasticity

96
Q

what initiates a breath

A

trigger mechanism

97
Q

the trigger mechanism is the transition from ______ to _______ and begins in the ___________ phase

A

expiration to inspiration

inspiratory

98
Q

3 main trigger methods

A
  • time-trigger
  • pressure-trigger
  • flow-trigger
99
Q

guarantees a minute volume and decreased work of breathing, but which is less comfortable

A

time-triggering

100
Q

gives the patient more control over the initiation of a breath, but which can also be uncomfortable

A

pressure-triggering

101
Q

trigger that occurs when vent detects a drop in flow

A

flow-triggering

102
Q

refers to the variable a ventilator uses to end inspiration

A

cycling mechanism

103
Q

typical methods of ventilator breath cycling mechanism (4)

A

-pressure-cycled
- volume-cycled
- time-cycled
- flow-cycled

104
Q

in what type of patients is a time-cycled mechanism used

A

sedated or paralyzes patients

** typical of mandatory modes

105
Q

what cycling mechanism is mainly used for spontaneously breathing patients and is typical of spontaneous modes

A

flow-cycled

106
Q

the variable a ventilator uses to end inspiration

A

cycling

107
Q

PEEP can be changed in all vent modes except?

A

Spontaneous

108
Q

the ventilator measures the cycling mechanism variable during the _________ phase

A

inspiratory

** When the set parameter for this variable is achieved, the ventilator opens the expiratory valve, and expiration may begin.

109
Q

the cycling mechanism changes from ______ to _______ and trigger mechanism changes from ________ to __________

A

inspiration to expiration

expiration to inspiration (initiates a breath)

110
Q

in Volume controlled CMV; tidal volume (Vt) is controlled and independent of changes in

A

lung mechanics

** Vt manually to avoid atelectasis

111
Q

two things you can control when using the volume control ventilator setting

A
  • tidal volume and RR

**Rate adjusted manually for reasonable EtCO2 while monitoring PIP.

112
Q

T or F: in volume control vent setting, PIP stays the same at <40 cmH2O

A

F: PIP varies and should be kept as low as possible (< 40 cmH2O)

113
Q

threshold for potential barotrauma

A

40 cmH2O

114
Q

in volume control, a set number of breaths/min are ______-cycled and __________-triggered

A

time-cycled

machine-triggered

115
Q

t or f: Expiratory flow is constant in the volume control vent setting

A

F - Inspiratory flow is constant

116
Q

T or F: you can add PEEP to most volume control vent modes

A

T

117
Q

another name for volume control vent setting

A

CMV (vanilla)

** most commonly used

118
Q

pressure control vent setting controls (3)

A
  • PIP
  • PEEP
  • Frequency (f)
119
Q

in pressure control vent setting, tidal volume varies with changes in

A

compliance, patient effort, and resistance

120
Q

why does flow vary high at first in pressure-control mode?

A

to produce set PIP early

**it is less later in inspiration to maintain the set pressure through the inspiratory time (Ti).

121
Q

pressure control is known as a decelerating flow (or ramp) pattern, which is thought to be beneficial in (2)

A
  • gas exchange
  • V/Q matching
122
Q

pressure support vent (PSV) mode- pressure support should be adjusted tidal volumes of

A

6-8 mL/kg

123
Q

in pressure support ventilation, what should you set the pressure at start

A

10-12 cmH2O

124
Q

T or f: some vents require a spontaneously breathing patient for pressure support ventilation (PSV) because there is no mandatory minimum RR

A

T

** great for when about to wake up patient. It’s a good indicator that pt. is starting to recover from paralysis.

125
Q

why is PEEP ordinarily used with PSV

A

to help recruit alveoli

126
Q

PSV senses a patients _______ effort (volume or flow) and delivers PSV while it is present

A

inspiratory

127
Q

useful to support Ventilation and control arterial CO2 for spontaneously breathing patients during maintenance and emergence

A

PSV - pressure support ventilation

614 General Principles Of Anesthesia (14 decks)

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