A SUMMER Principles of Anesthesia I - EB > Anesthesia Ventilators - Exam 3 > Flashcards

Anesthesia Ventilators - Exam 3 Flashcards

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1
Q

Anesthesia ventilators are designed to provide/augment patient ____ and _____

A

Ventilation, oxygenation

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2
Q

Anesthesia ventilators are on anesthesia workstations and replace the ____

A

reservoir bag

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3
Q

Older ventilators issues:

They provided only _______ ventilation

They couldnt provide high enough ____ pressure

They couldnt provide _____

Their tidal volumes were affected by ____ and _____ ____

They offered only ______ control ventilation

Different _____ were required between adults and peds

A

CMV

Inspiratory

PEEP

FGF and Circuit compliance

Volume control

Bellows

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4
Q

This is an injury resulting from high airway pressures

A

barotrauma

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5
Q

Compliance is the ratio of..

A

change in volume / change in pressure

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6
Q

This is referring to compliance, is this volume controlled or pressure controlled:

Decreases in compliance in breathing system cause a decrease in VT as volume is used to expand the system

A

Volume controlled

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7
Q

This is referring to compliance, is this volume controlled or pressure controlled:
Newer vents alter the volumes delivered to compensate for system compliance

A

Pressure controlled

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8
Q

This term describes when airway pressure is maintained above ambient, commonly used in reference to spontaneous ventilation

A

CPAP

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9
Q

This term describes the maximum pressure during the inspiratory phase time

A

Peak pressure

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10
Q

In older vents, as FGF increased, so did __

How do new vents prevent this?

A

VT

THey have excess FGF diverted during inspiration

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11
Q

This term describes the time during which the lungs are held inflated at a fixed volume / pressure

A

Inspiratory pause time

Inspiratory plateau (?)

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12
Q

This is the deliberate increase in tidal volume for one or more breaths

A

Sigh (think she mispelled on ppt)

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13
Q

What is the I:E ratio?

What is a normal one?

A

Ratio of inspiratory phase time to the expiratory phase time

Normally 1:2

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14
Q

What is Inverse ratio ventilation?

Normal ratio?

A

Inspiratory phase time is longer than expiratory phase time
2:1

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15
Q

This is the sum of all tidal volumes in one minute

A

Minute volume

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16
Q

This is the energy expended by the patient/ventilator to move gas in and out of the lungs

A

work of breathing

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17
Q

This valve allows excess gases to be sent to scavenging system during exhalation

A

Spill valve

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18
Q

This valve opens to allow driving gas to exit the bellows housing

A

Exhaust valve

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19
Q

FGF is a Factor impacting ventilation Explain the terms:
FGF compensation

FGF decoupling

A

Compensation: bellows excursion was altered related to measured inspiratory FGF

Decoupling: diversion of inspiratroy FGF through a valve into a reservoir

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20
Q

Compliance is a factor that can impact ventilation, however new machines alter the ___ based on compliance

You also should do a machine check with the planned ____

A

VT

circuit configuration

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21
Q

7 Components of Bellows Ventilators

A

-Double circuit
-O2, air, or mix
-Controls
-alarms
-pressure-limiting mechanism
-The bellows assembly
-Housing

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22
Q

what is the significance of this component of a bellows ventilator:

Oxygen, air or mix

A

Driving gases

These gases are equal to Vm

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23
Q

what is the significance of this component of a bellows ventilator:

Controls

A

They regulate flow, volume, timing and pressure

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24
Q

On a bellows ventilator, there are alarms. It must have these two types of alarms

A

Must have a low-pressure and high-pressure alarm

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25
The pressure limiting mechanism on a bellows ventilator is important because what happens if the pressure is? Too low Too high
Too low --> insufficient pressure for ventilation Too high --> creates excessive airway pressure
26
What is a good set point for the pressure limiting mechanism for a bellows ventilator?
10 cm H20 above peak pressure with desired vt
27
The bellows housing has a scale on the side for a rough estimate of
VT
28
What drives bellows in a box?
They are pneumatically driven
29
With bellows in a box, the driving gas squeezes gas out of the ___ and into the ___ What two things refill the bellows
bellows, lungs Exhalation and FGF in circuit
30
Is this ascending or descending bellows: Safer Fails to rise if disconnected
Ascending
31
Is this ascending or descending bellows: Rises on inspiration, descends on expiration If disconnected, will descend due to gravity
Descending
32
If i have an improper bellows seating, my ___ will be inadequate
ventilation
33
A hole in bellows is bad because it can lead to
alveolar hyperinflation or barotrauma
34
If there is a hole in the bellows and i am using O2 as my driving gas, what will happen to the patients FiO2?
It will be high
35
If i have a problem with my bellows and the scavenging system is closed, what happens to my waste gases?
They are vented to the room
36
Piston ventilators: Have a ____ driven motor Do they have driving gas? Single or double circuit? Do they use more or less gas, compared to bellows vents? How is the vt altered based on compliance?
Mechanically No single dramatically less Vt NOT altered based on compliance
37
2 problems with piston ventilators
Refills even with disconnection Entrain room air during leaks which dilutes O2 and volatiles
38
Pulmonary waveform pictures
39
This is the most commonly used mode of ventilation
Volume control (assist control)
40
What things are set on volume control assist control?
Vt, RR, I:E ratio
41
Volume control (assist control) may cause excess ____ pressure
inspiratory
42
With pressure control, a preset pressure is quickly achieved during inspiration and then maintained until
exhalation begins
43
What things are set on pressure control?
PIP, RR and I:E ratio
44
Assuming compliance is good, how can you improve Vt in pressure control?
Inspreasing inspiratory flow rate or rise time (if compliance is good)
45
Pressure control ventilation can cause these 2 things we worry about
atelectasis and hypoventilation
46
How is the VT maintained in volume guarantee pressure control?
Adjusting PIP over several breaths
47
What is set on IMV? What is an issue with this type of ventilator mode?
Vt, RR, I:E ratio Breath stacking
48
How does SIMV work? How does it prevent stacking?
Synchronizes the ventilator driven breaths with spontaneous breaths Prevents stacking by sensing airway pressure changes
49
What things are set in SIMV? Can it be used with pressure support?
Vt and minimum respiratory rate Yes
50
In pressure support, _____ sensitivity must be set (5-10 cm)
triggering
51
Why do you need an apnea alarm with pressure support?
No ventilator breaths are initiated
52
What are some solutions to prevent the ventilator from being magnetized and sucked up into the MRI
-MRI compatible machines :O -Keep anesthesia machine in hallway -Machine bolted to the wall -Aluminum tanks or pipeline gas supply
53
What can cause ventilation failure with a ventilator
-DIsconnection from power supply -Extremely high FGF -Fluid. in electronic circuitry -Leaking bellows housing
54
What can cause loss of breathing system gas with a ventilator
-Faiure to occlude spill valve -Leak in sysem -More common in older machines with compensation
55
What are some things that can cause incorrect settings on your vent?
-Bumping into machine -Forgetting to adjust for new case -Not adjusted when pt position changes or pressure changes -Ventilator turned off for x rays then reverts to manufacturer settings
56
Advantages of a ventilators (3)
57
Disadvantages of a ventilator (6)
-Loss of feel -Not all modes on old machines -Hard to clean/fix components -Lack of user-friendliness -Noisy or too quiet -May require a driving gas; expensive
58
WHat are trace gas concentrations?
Concentration of a gas far below that needed for anesthesia or detected by smell
59
How are trace gas concentrations written Give an example: 100% 1%
PPM 100% of a gas is 1,000,000 ppm 1% is 10,000 ppm
60
There are higher trace gas concentrations in these areas
-Pediatric anesthesia -Dental surgeries -Poorly vented PACUs
61
in 1977, the NIOSH released health reccomendations for trace anesthesic gases. Their macimum TWA in ppm are on a chart. GIve the numbers for: Halogenated agent alone Nitrous alone Combo halogenated agent Combo nitrous Dental factilities (nitrous alone)
2 25 0.5 25 50 ## Footnote https://stacks.cdc.gov/view/cdc/19384
62
What things can contaminate the operating room with gases?
63
Old studies that are not supported said that trace gases could lead to these 8 things
64
Scavenging system collects gases from _____ and removes these gases to ___
rquipment used to administer anesthesia or exhaled by patient Removal of these gases outside the work environment
65
These scavenging system is uncommon and involes the disposal tubing from the anesthesia machine being attached to the exhause grill and removed with room air
Passive
66
Where is a passive scavenging system attached?
Room ventilation system
67
Where is an active scavenging system attached?
central vacuum system
68
An active scavenging system must be able to provide high volume around ___L/min
30
69
Active scavenging systems require plenty of ___ outlets and should be close to the ____ machine
suction anesthesia
70
What are 5 ways you can limit the room contamination of trace gases?
-Make the mask fit the patient well -Turn off gas flow (not vaporizer) during intubation -100% wash out at the end of case -Prevent liquid spills -Place anesthesia machine as close to exhause grill (passive system) as possible
71
What are 6 things that can cause a hypoxic inspired gas mixture with your anesthesia machine and/or breathing system?
72
What are 5 things that can cause hypoventilation with your anesthesia machine and/or breathing system?
-Insufficient gas -Obstruction -Leaks -Main machine power off -Breathing system leaks
73
If you notice your machine is hypoventilating your patient due to insufficent gas, what can you do?
switch from pipeline to cyliner replace cylinder
74
What are 3 things that can cause blocked inspiratory/expiratory paths with your anesthesia machine and/or breathing system?
-Mask wrapping -Absorbent wrapping -Get caught occluding elbow connection
75
What are 4 things that can cause hypercapnia with your anesthesia machine and/or breathing system?
76
What are 5 things that can cause anesthestic agent overdose with your anesthesia machine and/or breathing system?
77
What should you do if there is an inadvertent exposure to volatiles i.e. for malignant hyperthermia cases

A SUMMER Principles of Anesthesia I - EB (28 decks)

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