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Apex Review > Anesthesia machine 6 > Flashcards

Anesthesia machine 6 Flashcards

1
Q

Continuous positive airway pressure is when

A

a continuous amount of pressure is applied to the breathing circuit throughout the respiratory cycle

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2
Q

CPAP has two benefits:

A

it augment’s the patient’s spontaneous breath and it reduces airway collapse during expiration

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3
Q

What is biphasic positive airway pressure (BiPAP)?

A

two levels of pressure are set
P1= inspiratory positive airway pressure (think pressure support for a spontaneous breath)
P2= expiratory positive airway pressure (think CPAP during exhalation)
the patient receives one pressure during inhalation and a different pressure during exhalation

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4
Q

BIPAP is useful for

A

the patient with COPD or when CPAP isn’t quite enough

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5
Q

Airway pressure release ventilation can be used for

A

spontaneous ventilation
like BiPAP but there is a high level of CPAP throughout most of the respiratory cycle
-the high level of pressure is released at preset intervals to facilitate exhalation

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6
Q

Airway pressure release ventilation is useful in patients with

A

ARDS

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7
Q

What is inverse ratio ventilatioN?

A

the respiratory cycle is divided into inhalation and exhalation and the I:E ratio determines how much time is spent in each part

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8
Q

IRV reverses

A

the typical ratio (most modes have longer exhalation than inhalation) and allocates more time to inspiration

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9
Q

IRV requires

A

a paralyzed and sedated patient (no spontaneous ventilation)

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10
Q

IRV has a risk of

A

dynamic hyperinflation (auto-peep or breath stacking)

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11
Q

IRV is useful in the patients

A

with a small FRC or in the patient with ARDs

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12
Q

What is high frequency ventilation?

A

delivers a tidal volume below anatomic dead space in conjunction with a very high respiratory rate

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13
Q

High frequency ventilation allows gas transport by a combination of

A

molecular diffusion
coaxial flow
high-velocity flow

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14
Q

Types of high-frequency ventilation icnlude

A

high-frequency oscillation, high-frequency jet ventilation, and high-frequency percussive ventilation

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15
Q

At what pH does the ethyl violet change to purple?
a. 7.5
b. 8.6
c. 10.3
d. 12.1

A

c. 10.3

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16
Q

Carbon dioxide absorbents remove

A

exhaled carbon dioxide from the breathing circuit

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17
Q

Without carbon dioxide absorption,

A

closed and semi-closed anesthesia circuits would not be possible

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18
Q

The size of the absorbent granule must strike a balance between

A

surface area (absorptive capacity) and airflow resistance (work of breathing)

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19
Q

The best balance of absorbent granule is achieved when _________ are used

A

4-8 mesh granules

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20
Q

The two major problems that can occur with carbon dioxide absorbents include:

A

exhaustion- it’s no longer able to neutralize carbon dioxide
desiccation- it’s too dry

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21
Q

An indicator dye (such as ethyl violet) turns purple when

A

soda lime is exhausted; there’s no color change to signify dessication

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22
Q

Desiccated soda lime increases the production of

A

carbon monoxide in the presence of halogenated agents (desflurane> isoflurane> sevoflurane) and compound A in the presence of sevoflurane

23
Q

Methods to reduce carbon monoxide and compound A production include

A

use a low FGF
turn off the FGF between cases
change all absorbent canisters at one time
change the canisters when the indicator dye signals exhaustion
change the canisters if you’re unsure about the level of hydration

24
Q

__________ in soda lime is a strongly alkaline compound that’s irritating to skin and mucous membranes.

A

Sodium hydroxide

25
Q

The addition of _________ to soda lime provides hardness and minimizes dust production

A

silica

26
Q

What is the reaction of CO2 with soda lime?

A
  1. Carbon dioxide + water–> carbonic acid
  2. carbonic acid + 2 sodium hydroxide–> sodium carbonate + 2 water+ heat
  3. Sodium carbonate + calcium hydroxide–> calcium carbonate + 2 sodium hydroxide
27
Q

The best indicator of expired soda lime is the

A

presence of inspired Co2 in the breathing circuit

28
Q

If you’re not able to replace a CO2 absorbent right away, you should

A

increase your fresh gas flows

29
Q

Carbon monoxide can cause

A

carboxyhemoglobinemia

30
Q

When compared to soda lime, what factor is increased with the use of calcium hydroxide lime?
a. carbon monoxide
b. frequency of replacement
c. CO2 absorption capacity
d. fire risk

A

b. frequency of replacement

31
Q

Benefits of calcium hydroxide lime include

A

no carbon monoxide production
very little or no compound A production
lower risk of fire when compared to soda lime

32
Q

Drawbacks of calcium hydroxide lime include

A

lower CO2 absorption capacity
requires more frequent replacement
higher cost

33
Q

Calcium hydroxide lime does not contain ________ such as sodium hydroxide or potassium hydroxide

A

strong bases

34
Q

What is the calcium hydroxide lime equation?

A
  1. carbon dioxide + water–> carbonic acid
  2. carbonic acid + 2 calcium hydroxide–> calcium carbonate + 2 water + heat
35
Q

While a patient is ventilating spontaneously with an endotracheal tube, you notice that a fresh gas flow of 10L/min is required to fill the breathing bag and determine that the scavenger is malfunction. Which statement must be true?
a. the negative pressure relief valve has failed
b. the positive pressure relief valve has failed
c. there is an open scavenging system
d. there is a passive scavenging system

A

a. the negative pressure relief valve has failed

36
Q

The scavenger removes

A

excess gas from the breathing circuit and minimizes environmental exposure to waste anesthetic gas

37
Q

The scavenger system has five components:

A
  1. gas collection assembly
  2. transfer tubing
  3. interface (open or closed)
  4. gas disposal tubing
  5. gas disposal system
38
Q

The scavenger can be

A

active or passive

39
Q

During spontaneous ventilation, the __________controls the amount of gas that remains in the circuit and the amount that is released to the scavenger

A

APL valve

40
Q

During mechanical ventilation, the ___________ determines the amount of gas that remains in the circuit and the amount that is released to the scavenger.

A

ventilator spill valve

41
Q

The most critical component of the scavenger is the

A

interface

42
Q

Removal of too much gas would create __________________, while removal of too little gas could increase the risk of _________

A

negative pressure in the circuit; barotrauma

43
Q

To maintain a constant pressure inside the breathing circuit, the scavenger must only remove

A

an amount of gas equal to fresh gas flow minus the volume of gas lost due to the patient’s oxygen consumption

44
Q

The gas collecting assembly

A

collects waste gas from the breathing circuit

45
Q

The gas collecting assembly is located at

A

the APL valve and the ventilator spill valve

46
Q

Transfer tubing directs

A

collected gas to the interface

47
Q

With an open system too much suction

A

entrains room air into the scavenger

48
Q

With an open system, too little suction

A

vents scavenged gas into the operating room

49
Q

An open system has a higher risk of

A

exposing OR personnel to waste gas

50
Q

An open system removes the risk of

A

barotrauma or removal of fresh gas from the breathing circuit

51
Q

An open system is open to

A

the atmosphere

52
Q

An open system can only be used

A

with active systems (a system that is connected to suction)

53
Q

A closed system communicates to the

A

atmosphere with pressure valves

Apex Review (224 decks)

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