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Basics > BASICS Exam 1 > Flashcards

BASICS Exam 1 Flashcards

1
Q

what increases and speeds up burning effects

A

oxygen

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2
Q

what is used in a gas autoclave that cannot tolerate exposure to high temperatures or water vapor

A

ethylene oxide (EtO)

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3
Q

what are examples of intermediate and low level disinfectants

A

chlorine based products
phenols
high percentage alcohols

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4
Q

what must you have before choosing anesthetic technique

A

patient consent

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5
Q

how do propofol and volatile agents decrease blood pressure

A

by decreasing SVR

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6
Q

what population is emergence delirium more common in

A

elderly

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7
Q

what is the biggest fear for providers with lasers

A

eye/retina damage
Igniting fire

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8
Q

why is electrocautery ultra high frequency

A

prevents damage or electrical interference to neuromuscular and cardio-electric system

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9
Q

what megahertz is electrocautery usually set at

A

0.1-0.3mHZ

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10
Q

what happens to electrocautery unit if grounding pad isnt plugged in

A

beeps and wont start

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11
Q

what is caused by 10-20miliamps

A

let go current

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12
Q

what is caused by 100-300 miliamps

A

vfib

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13
Q

what is the temperature conversion formula

A

C=(F-32) x 5/9

F= (C x 1.8) + 32

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14
Q

what is a solute

A

substance that is dissolved, usually a solid (think drug)

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15
Q

what is a solvent

A

The substance that dissolves the solute, usually a liquid

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16
Q

what is a solution

A

solute+solvent

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17
Q

what is the equation for watts

A

watts=volts x amps (vxi) or I^2 xR

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18
Q

what are volts

A

electrical pressure

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19
Q

what monitors isolated power to ensure it is isolated from the ground and alarms when it isnt

A

line isolation monitor

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20
Q

what vital monitoring equipment has the highest incidence of positive test for occult blood

A

ecg cables

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21
Q

what is the preferred skin prep

A

chlorhexidine

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22
Q

what skin prep should not be used in neuraxial procedures due to risk of neurotoxicity

A

chlorhexidine

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23
Q

what monitors both sides of the circuit for equality of current flow and shuts off power if a difference is detected

A

ground fault interrupter

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24
Q

what should not be used on eye, mucous membranes, ears, or genitals

A

chlorhexidine

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25
Q

what skin prep should be used for epidurals and neuraxial procedures

A

povidone iodine

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26
Q

prevention techniques for VAP

A

-HOB 30-40 degrees
-20cm H2O cuff pressure
-avoid PPI or H2 blocker if possible due to risk of acid suppression therapy enhancing bacterial colonization of aerodigestive tract

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27
Q

what case transmission occurs when same patient serves as the source of the pathogen and the host

A

within case transmission

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28
Q

how far can a droplet particle spread

A

3-6 feet

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29
Q

what is the most common complication associated with hospital care

A

hospital associated infection

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30
Q

what is the single most important practice in reducing transmission of infectious diseases

A

hand hygiene

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31
Q

what are examples of airborne diseases

A

measels, TB, varicella, shingles, smallpox

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32
Q

how are bacteria/viruses aerolized

A

sneezing
coughing
tracheal suctioning
bronchoscopy
intubation/extubation

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33
Q

what are diseases with droplet precautions

A

flu
pertussis
mumps
rhinovirus

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34
Q

what is the absence of potentially pathogenic microorganisms

A

asepsis

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35
Q

what are practices to minimize contamination by pathogens and prevent their spread

A

aseptic technique

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36
Q

what is a device that enters sterile tissue or vascular system

A

critical device

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37
Q

what is the absence of all microbial life

A

sterile

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38
Q

what is an animate or inanimate object that carries a pathogen and transmits the pathogen from source to host

A

vector

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39
Q

what are the most common HAI

A

staph
eterococci
enterobacteriaceae

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40
Q

when should you perform hand hygiene

A

before/after patient contact
before aseptic tasks
after exposure to body fluids
after contact with pt surroundings

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41
Q

what kind of device comes in contact with mucous membranes or nonintact skin

A

semi critical device

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42
Q

what is the most common source of pathogen transmitted through contact

A

an infected patient

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43
Q

should you re-use the same syringe on the same patient to draw up a second time from a multi dose vial

A

no

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44
Q

when should you discard a multi use vial

A

when empty or at the end of the procedure

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45
Q

what is an example of a semicritical device

A

laryngoscope

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46
Q

how big is a droplet particle

A

greater than 5micrometers in diameter

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47
Q

what case transmission occurs when infected patient serves as the source of the pathogen spread to other patients

A

between case transmission

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48
Q

what operates by generating high frequency currents passing through tissues and heat is then created by resistance of tissues to current flow

A

electrocautery

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49
Q

what is a small hand held battery operated device using electrical current to heat a metal wire

A

electrocautery

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50
Q

what is the sum of the forces that oppose electron movement in an AC circuit

A

impendance

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51
Q

what shock is delivered to an individual with an external conduit in direct contact with the heart

A

microshock

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52
Q

what does a capacitor have the ability to do

A

store charge

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53
Q

what is the equation for MAP

A

(systolic + (2xdiastolic))/3

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54
Q

how many surgical fires are in the US annually

A

550-650

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55
Q

has there been a decrease in fire risk with advent of halogenated anesthetics

A

no

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56
Q

what is the fire triad

A

oxidizers
ignition/heat
fuel

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57
Q

what are oxidizers

A

oxygen and nitrous oxide

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58
Q

what are sources of fuel

A

drapes
gloves
aerosols
hair
alcohol prep
skin prep
gowns

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59
Q

what is the most common type on on-patient fires

A

head and neck

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60
Q

why are head and neck the most common type on on patient fires

A

open source of oxygen and drapes

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61
Q

is it recommended to run open oxygen during head and face MAC

A

no

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62
Q

what is the most common type of in-patient fires

A

airway

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63
Q

what should be done with ET tube to prevent airway fires

A

use cuffed ET tubes

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64
Q

what should oxygen setting be below to prevent airway/surgical fires if possible

A

25% or less

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65
Q

how long should oxygen be turned off prior to electrocautery

A

1 min

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66
Q

what is the benefit of tenting drapes

A

adding volume underneath to introduce air as a buffer

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67
Q

what can be put in drapes to pull oxygen out

A

suction

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68
Q

how long should alcohol antiseptic be allowed to dry before electrocautery

A

4-5 min

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69
Q

what is special about a laser ETT

A

has 2 cuffs
one filled with methylene blue solution so surgeon knows if he hit the cuff

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70
Q

why can cuffed ETT now be used for pediatrics more often

A

high volume, low pressure cuffs

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71
Q

what are the steps to take during an in patient fire

A

disconnect circuit
turn off gas
do no ventilate
extubate
irrigate with saline
look for left over material
re-establish airway

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72
Q

why should you not ventilate before extubating during a fire

A

do not want to add positive pressure to fire to create blow torch effect

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73
Q

what should be poured down the airway to extinguish the fire

A

normal saline

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74
Q

what should be considered after an airway fire

A

bronchoscopy and ICU

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75
Q

steps to take for an on patient fire

A

turn off all gases,
remove burning material
extinguish fire
assess patient/remove from harm

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76
Q

what is Ohms law

A

V=IR

(volatge= amps x resistance)

it is easier to see that current (the rate at which the electrical charge flows through a circuit) is proportional to voltage (how hard energy is pushed through the circuit) and inversely proportional to resistance (how strongly the circuit resists the movement of electrical charge). To return to the example of the car, pushing with more force is expected to increase the speed of the car, while someone in the driver’s seat pressing the brakes (adding resistance to rolling) is expected to slow the car or require more force to maintain the same speed

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77
Q

what is I in Ohm’s Law

A

amps

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78
Q

what is the r in Ohms law

A

resistance/ohms

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79
Q

what is the v in Ohms law

A

volts

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80
Q

what is another word for amps

A

current
number of electrons flowing through

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81
Q

what is another formula for Ohms law

A

R= V/I

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82
Q

what are electrical diagrams used for

A

schematically represent electrical circuits

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83
Q

when does a circuit exist

A

when charge is able to flow around a closed path

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84
Q

what is an example of a direct current

A

battery

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85
Q

what is a direct current

A

only flows in one direction

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86
Q

what is an alternating current

A

current periodically changes direction

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87
Q

what is an example of an alternating current

A

wall outlet

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88
Q

what is a circuit with only one path that can be taken by the current

A

series circuit

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89
Q

how is voltage in series of batteries calculated

A

add voltage of each battery together

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90
Q

what is equivalent resistances the sum of

A

individual resistances

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91
Q

what doubles in a parallel circuit

A

capacity

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92
Q

is voltage added together in a parallel circuit

A

no

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93
Q

what is an example of a parallel circuit

A

the electrical system in a house

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94
Q

what is an advantage of a parallel circuit

A

you can connect loads that need different currents to the same parallel circuit

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95
Q

why do houses run on parallel circuits

A

not every individual appliance needs to be turned on to complete the circuit

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96
Q

what is not good at conducting electricity

A

insulator

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97
Q

what is good at conducting electricity

A

conductor

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98
Q

what is in the middle of a conductor and an insulator

A

semiconductor

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99
Q

what are semiconductors commonly used in

A

computers

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100
Q

what is a common semiconductor

A

silicon

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101
Q

what are impurities added to semiconductors to control conductivity called

A

doping agents

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102
Q

what is an electrical shock

A

sensation/muscular spasm caused by current passing through body

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103
Q

what prevents a bigger electrical shock in a 3 pronged plug in

A

grounding wire- circular part

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104
Q

does every circuit have potential to shock

A

yes

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105
Q

what is a large current resulting in serious injury or death

A

macroshock

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106
Q

what is a macro shock measured in

A

miliamps

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107
Q

what is a minor current delivered directly to the heart

A

microshock

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108
Q

what can +100 microamps cause through a direct line t heart

A

vfib

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109
Q

what trips and cuts power to avoid electrocution

A

ground fall interrupter

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110
Q

what is a typical limit for a line isolation monitor

A

2-5 miliamps

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111
Q

how many miliamps is needed for human perception

A

1

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112
Q

what monitor determines degree of isolation between 2 power wires and ground wire

A

line isolation wire

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113
Q

what alarms when too much high current is going through the ground wire

A

line isolation monitor

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114
Q

does a line isolation monitor interrupt electricity

A

no

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115
Q

what is placed on the patient to ground the electrical current from electrocautery

A

grounding pad with gel

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116
Q

what might have lower resistance than grounding pad on a patient

A

metal of any kind

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117
Q

what can cause serious burns with grounding pad

A

inadequate contact

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118
Q

what are the types of non ionizing radiation

A

microwave
infrared
visible
UV lights

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119
Q

what is caused by non ionizing radiation

A

sunburns
skin cancer

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120
Q

what type of radiation results in rotation, vibration, or excitation of electrons with atoms

A

non ionizing

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121
Q

is ionizing or non ionizing radiation more destructive

A

ionizing

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122
Q

what type of radiation can break covalent bonds

A

ionizing radiation

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123
Q

what are examples of ionizing radiation

A

gamma rays
xrays
alpha/beta particles

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124
Q

what type of radiation has sufficient energy per photon to remove electrons from atoms

A

ionizing radiation

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125
Q

what type of radiation has lower energy photons that can be absorbed thus increasing internal energy

A

non ionizing

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126
Q

what should you take into account when protecting yourself from radiation

A

time
distance
shielding

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127
Q

what tissues are more rapidly affected by radiation

A

gonads
bone marrow
lungs
thyroid

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128
Q

what is the inverse square law equation

A

Intenssity1/Intensity 2= distance 2/distance 1

intensity= 1/distance ^2

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129
Q

how many rads would you receive at 2 meters if your receive 4 rads per meter

A

rads= 4( 1^2/2^2)=1

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130
Q

what is the optimal minimum distance for radiation

A

6 feet

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131
Q

what creates a fire risk especially in airways

A

lasers

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132
Q

what should be worn by patient and staff during lasers

A

goggles or wet 4x4s

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133
Q

who sets the standards for laser safety

A

ANSI

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134
Q

what technique is the patient completely unaware

A

general

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135
Q

what type of anesthesia is difficult for patients with anxiety, shortness of breath, and sitting still

A

MAC

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136
Q

what are advantages of regional anesthesia

A

quicker recovery
pain free
no narcotics

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137
Q

what is mass

A

the amount of matter in an object

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138
Q

what is the measure of electrical power

A

watts

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139
Q

what law states for every action there is an equal and opposite reaction

A

Newtons 3rd law

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140
Q

how is mass different from weight

A

weight is gravitational force exerted on an object by a much larger object

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141
Q

what is an example of force

A

push or pull of syringe
larger force produces more acceleration

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142
Q

what is another equation for MAP

A

(CO x SVR )+ CVP

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143
Q

what is the force required to move 1g of weight 1 cm per second

A

dyne

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144
Q

what unit is force measured in the body

A

dynes

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145
Q

what is normal SVR

A

900-1200 dynes/sec/cm^-5

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146
Q

what is newtons first law

A

an object at rest or moving at a constant speed in a straight line will continue in that state until acted on by an external force

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147
Q

Newtons 2nd law

A

force = mass x acceleration

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148
Q

what explains the behavior of gases, liquids and solids

A

kinetic molecular theory

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149
Q

does visible light or other electromagnetic radiation have mass

A

no

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150
Q

what is the resistance of an object to acceleration

A

mass

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151
Q

how do you re-arrange newtons 2nd law to calculate mass

A

mass= force/acceleration

mass in kg
force in newtons

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152
Q

what is the force per unit area

A

pressure

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153
Q

what is the equation for pressure

A

force/area

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154
Q

how can pressure be increased

A

increased applied force
decrease area over force is applied

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155
Q

how can pressure be decreased

A

decrease applied force
increase the area over which the force is applied

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156
Q

what is the standard unit for measuring pressure

A

pascal

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157
Q

what is the equation for pascal

A

102g/1sqmeter

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158
Q

what are the anesthesia measures of pressure

A

psi= pounds per square inch
mmHg

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159
Q

do gas molecules have volume

A

no

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160
Q

when do gas molecules exert force on each other

A

when they collide

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161
Q

what does the temperature of a gas depend on

A

average kinetic energy

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162
Q

in kinetic energy, what does more molecules in a system lead to

A

more transfer of energy

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163
Q

what must all calculations involving gas temperatures include

A

Kelvin

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164
Q

what is the formula for celsius to kelvin

A

Kelvin= c+ 273

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165
Q

what is the formula from Fahrenheit to kelvin

A

kelvin= ({f-32}/1.8) + 273

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166
Q

what measures the pressure difference between the pressure exerted by the gas and the atmospheric pressure

A

bourdon gauge

its a type of aneroid gauge

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167
Q

what happens when gas at pressure above atmospheric pressure enters coiled tube

A

tube slightly uncoils, causing pointer to move over a numerical scale

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168
Q

what needs to be exceeded before the bourdon gauge will uncoil

A

atmospheric pressure

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169
Q

what measures absolute or actual pressure

A

barometers

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170
Q

what is the pressure of a system above or below atmospheric pressure

A

gauge pressure

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171
Q

what is the equation for total pressure

A

atmospheric pressure + gauge pressure

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172
Q

what is the formula for gauge pressure

A

absolute pressure - atmospheric pressure

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173
Q

what is the pressure inside a tank at 0 psi

A

atmospheric pressure 14.7 psi

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174
Q

what is quickly affected by temperature change

A

gas

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175
Q

behaviors of gases

A

-no definite boundary
-mix freely with each other though not attracted
-low density
-large spaces between molecules
-readily compressible
-exert pressure equally on all sides

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176
Q

gas diffuses based on ….

A

molecular weight and viscosity

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177
Q

what influences the pressure exerted by gas

A

kinetic energy and number of molecules

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178
Q

do gases move based on osmotic pressure

A

no, move regardless of concentration

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179
Q

how does gas exert pressure on a molecule

A

same on all sides

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180
Q

what are adiabatic changes

A

the rapid expansion or compression of gas without equilibrium of energy with the surrounding environment

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181
Q

rapid gas expansion vs rapid gas compression results in

A

expansion= decrease in temp

compression = increase in tempt

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182
Q

what happens when gas is compressed quickly

A

-intensifies kinetic energy
-does not allow energy to dissipate
-temp rises proportionally to decreased volume

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183
Q

what happens in the energy concentration effect

A

Compressing a gas quickly increases temp

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184
Q

Joule-Thompson effect

A

escape of gas cylinder at high flow causes frost to accumulate on the cylinder outlet

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185
Q

what happens to the energy content of the gas during the Joule-Thompson effect

A

remains constant, temp will change

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186
Q

what are the two adiabatic changes

A

Joule-Thompson effect
energy concentration effect

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187
Q

name the gas pressure units

A

torr
mmHg
atm
pascal

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188
Q

physical properties of gas

A

pressure
volume
temperature
amount in moles (n)

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189
Q

what is the gas and the kinetic theory

A

gas particles are so far apart and moving so fast that their van der waals attractions are unimportant due to limited effect

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190
Q

what is gas always compared to

A

STP, standard temp and pressure

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191
Q

what is standard temp

A

0 degree C
273K

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192
Q

kinetic molecular theory

A

-molecules have no volume
-gas exert no force unless they collide
-gas particle collisions don not decrease the energy in the system
-molecules of gas are in constant random motion
-temp of gas depends on its average kinetic energy

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193
Q

what is standard pressure

A

760 mmHg
1 atm

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194
Q

1 g molecular weight (1 mole) =

A

22.4L in a flexible container

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195
Q

what is avagadros law equations

A

N1/V1=N2/V2

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196
Q

what is avagadros law

A

equal volumes of gases under the same conditions of pressure and temperature contain the same number of molecules

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197
Q

1 mole =

A

6.023x10^23 molecules

aka Avogadros number

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198
Q

avogadros hypothesis

A

one mole of any gas at standard temp(0 C) and standard pressure (1 atm) occupies 22.4L

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199
Q

what are the three variables that characterize an ideal gas behavior

A

absolute pressure
temp
volume

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200
Q

ideal gas law equation

A

PV=nRT

P=pressure
V=volume
n=number of moles
R= 0.0821
T= temp in kelvin

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201
Q

what is the constant number that is the same for all gases

A

0.0821

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202
Q

ideal gas laws demonstrate a relationship between?

A

temp
pressure
volume

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203
Q

what are the ideal gas laws

A

Boyles
Charles
Gay-Lussacs

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204
Q

equation for Boyles Law

A

P1V1=P2V2

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205
Q

what does boyles law state

A

volume increases pressure decreases

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206
Q

give an example of boyles law in anesthesia

A

squeezing the ambu bag increases pressure on bag and decreases volume of the bag

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207
Q

what increases and decreases during inspiration

A

volume increases
intrapulmonary pressure decreases

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208
Q

what increases and decreases during expiration

A

volume decreases
intrapulmonary pressure increases

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209
Q

how long will it take a cylinder to empty with 1100psi and flow of 5L/m

A

tank=50% full
50% of 660=330L

330l/5l/m=66min

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210
Q

how many liters does a full O2 E cylinder hold

A

660L

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211
Q

how much psi is a full O2 e cylinder

A

2000psi

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212
Q

Charles Law equation

A

V1T2=V2T1

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213
Q

what is charles law

A

Volume increase temp increase

volume varies directly with temperature when at constant pressure

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214
Q

give an example of charles law

A

ETT cuff expanding when sterilized in an autoclave

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215
Q

what happens in charles law

A

temp increases gas expands increasing the volume

temp increases volume increases

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216
Q

Gay-Lussacs equation

A

P1/T1=P2/T2

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217
Q

Gay-Lussacs Law

A

at a constant volume, pressure of a gas is proportional to its absolute temperature

as temp increases, pressure increases

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218
Q

give an example of Gay-Lussacs Law

A

tires deflating in the cold and inflates more in the warmth

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219
Q

For each 1 degree of celsius a gas increases, the pressure increases by?

A

1/273

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220
Q

what can cause an oxygen cylinder to explode

A

extreme increase in temp

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221
Q

triangle theory to remembering gas laws

A

Can These Guys Possibly Be Violinists

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222
Q

combined gas law equation

A

P1V1T2=P2V2T1

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223
Q

process of converting solids to liquids or liquids to vapors

A

evaporation

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224
Q

what is vaporization

A

its what happens when further addition of heat beyond boiling point is added to the system

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225
Q

what is boiling point

A

the temperature at which bulk of liquid is converted to vapor

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226
Q

what is vapor pressure a function of?

A

temperature

it will increase vapor pressure of a liquid

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227
Q

what is vapor pressure

A

vapor that accumulates in a closed container

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228
Q

what are the units of standard pressure

A

1 atm
14.7 psi
760 torr
760mmHg
1.013x10^5n/m2 (same as pascals)

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229
Q

when does a liquid reach its boiling point

A

when the vapor pressure equals the external pressure

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230
Q

at 1 atm, when will water boil in degrees celcius

A

100 C

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231
Q

what happens when boiling point increases

A

vapor pressure decreases

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232
Q

when vapor pressure increases

A

boiling point decreases

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233
Q

if atmospheric pressure increases what happens to the boiling point

A

increases

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234
Q

what is saturated vapor pressure

A

the number of molecules returning to liquid phase is equal to the number of molecules converting into gas phase

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235
Q

what is the energy required to boil a liquid

A

heat of vaporization

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236
Q

that is the temperature where vapor pressure of substance equals 1 atm

A

boiling point

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237
Q

what is critical pressure

A

pressure at which a vapor can be forced into a solid state

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238
Q

what is critical temp

A

the temp at and above which vapor of substance cannot be liquified no matter how much pressure is applied

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239
Q

whats the critical temp of nitrous oxide

A

36 c

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240
Q

critical temp of O2

A

-119C

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241
Q

what happens when a liquid reaches it critical temp

A

it turns into a gas

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242
Q

properties of general gas laws

A

-expand easily
-readily compressed
-high velocity
-weak intermolecular forces
-high degree of random motion

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243
Q

What is Daltons Law of partial pressure

A

total pressure = sum of all the partial pressures of the individual gases

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244
Q

what is 1 atm in weight

A

14.7lb/in^2

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245
Q

Grahams Law of Diffusion

A

diffusion of gases through membranes/solutions is inversely proportional to the square root of its molecular weight

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246
Q

Henrys Law

A

solubility in a liquid is directly proportional to pressure

Temp is constant

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247
Q

In Henrys law, what does increasing the partial pressure of a gas above a liquid do

A

increases the amount of gas that dissolves in the liquid

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248
Q

example of Henrys Law

A

increasing FiO2 increases arterial PaO2

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249
Q

what is O2 solubility coefficient

A

0.003ml/dl/mmHg

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250
Q

CO2’s solubility coefficient

A

0.067mL/dL/mmHg

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251
Q

How much O2 is dissolved in arterial blood when PaO2 is 300mg?

A

0.003x300mmHg= 0.9ml O2/100ml blood

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252
Q

how much O2 should be dissolved in arterial blood when FiO2 is 40%

A

40% x 5 = 200mmHg

200mmHgx 0.003= 0.6ml O2/ 100ml blood

can estimate PaO2 if given FiO2 by multiplying 5 by %

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253
Q

how much faster does CO2 dissolve across alveolar capillary membrane

A

20x faster because its 20x more soluble in fluid

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254
Q

what law explains the measurement of functional residual capacity by body plethysmography?

A

Boyles Law

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255
Q

what is an endothermic reaction

A

a reaction that uses energy

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256
Q

does pressure have influence on solubility of solids/liquids

A

NO

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257
Q

what happens to the solubility of gas in a liquid as the temperature increases

A

dissolving decreases aka solubility decreases

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258
Q

why does less gas dissolve in liquid at a higher temperature

A

kinetic energy allows gas molecules to escape from dissolving

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259
Q

what happens to solubility of a gas in a liquid as temperature decreases

A

energy is slowed
more gas dissolves into the liquid

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260
Q

How does hypothermia affect anesthetic gas and the patient

A

slower emergence bc of increased solubility of gas in the blood

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261
Q

What are the 5 factors of fluid permeable through a tissue

A

-concentration gradient
-area of the tissue
-fluid tissue solubility
-membrane thickness
-molecular weight

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262
Q

what is diffusion inversely proportional to

A

molecular weight of gas
membrane thickness

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263
Q

diffusion is directly proportional to

A

pressure gradient (membrane area)
concentration gradient
solubility

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264
Q

what is the second gas effect

A

using N2O with isoflurane speeds the uptake of isoflurane in the blood

explained by Ficks Law, as N2O leaves alveolar sack it decreases the area of the sac and increases diffusion

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265
Q

what is diffusion hypoxia

A

when turning off nitrous oxide, N2O escapes into lungs faster than O2

turn on O2 to correct

266
Q

When do we avoid N2O

A

pneumothorax
bowel obstruction
middle ear/sinus disease

N2O will diffuse and expand in spaces

267
Q

How much more soluble is N2O than nitrogen

A

35x more

diffuses in and out more rapidly

268
Q

what are liquids and gases considered

A

fluids

269
Q

what forces are associated with fluids

A

gravity
pressure
friction

270
Q

how are fluids defined

A

response to stress
-resistant to compression= liquid
-compressible and expandable= gas

271
Q

units for flow rate

A

m^3/s

cubic meters per second

272
Q

what is laminar flow

A

all molecules move in an orderly, parallel path through the tube

273
Q

what kind of flow is in the terminal bronchioles (smallest airways)

A

true luminar flow

274
Q

reynolds equation

A

Re=velocity x density x diameter / viscosity

Re= v x p x d / N
v= velocity
d= large vessel diameter
p=density
n =viscosity

275
Q

turbulent flow

A

chaotic flow with eddie currents

276
Q

Reynolds number <2100 is

A

laminar flow

277
Q

Reynolds number > 4000 is

A

turbulent flow

278
Q

what is turbulent flow determined by

A

density

279
Q

how does flow rate relate to diameter

A

as the diameter of a tube decreases, the speed of the fluid flowing through it increases

280
Q

what kind of gas helps an upper airway obstruction

A

low density gas mix such as helium oxygen
decrease turbulent flow and make it more laminar

281
Q

where does turbulent flow occur in the airway

A

trachea
upper bronchi
upper bronchioles

282
Q

characteristics of turbulent flow

A

increased velocity
increased volume per unit time
increased energy required

283
Q

where does diffusion occur in the lungs

A

terminal and respiratory bronchioles

284
Q

what flow predominates in coughing, phonation, and periods of peak flow

A

turbulent flow

285
Q

Poiseulles Law states

A

velocity of a liquid flowing through a capillary is directly proportional to the pressure of the liquid and the fourth power of the radius of the capillary

velocity of a fluid through a capillary is inversely proportional to the viscosity and the length of capillary

286
Q

what does Poiseulles Law describe and what affects it most

A

laminar flow

radius

287
Q

what 4 things determine volume over time according to Poisuelles Law

A
  1. pressure difference
  2. viscosity
  3. length of tube
  4. radius of tube (to the 4th power)
288
Q

Poisuelle’s equation

A

Q= flow rate

289
Q

an example of Poisuelle’s Law

A

16gauge infuses faster than 22gauge IV

290
Q

what is flow directly proportional to

A

hydrostatic pressure gradient

291
Q

what is flow rate inversely proportional to

A

fluid viscosity
length of tube

292
Q

what is laminar flow determined by

A

viscosity

293
Q

how is flow affected in polycythemic patients vs anemic patients

A

polycythemic have high blood viscosity so flow through vessels is reduced

anemic have decreased blood viscosity=greater flow

294
Q

what are three factors that affect resistance

A

volume of fluid
tube length
internal diameter of tube

295
Q

Bernoullis Theorem

A

pressure of a fluid flowing through a tube is least at the point of greatest constriction and speed is the greatest

the widest portion of is where the pressure is the greatest and speed is least

296
Q

what is the Coanda effect

A

fluid tends to flow in a pattern that follows a curved surface surface after emerging from a constricted area

can create preferential flow in the direction of the curve and drags the other fluid with it

297
Q

clinical example of the coanda effect

A

unequal gas distribution in the lungs past where there is a kink in the equipment

also bronchospasm leads to unequal gas flow distribution

298
Q

Law of Laplace equation

A

T=Pr

t=wall tension
p=pressure
r= radius

299
Q

Law of Laplace definition

A

as structure expands (increases the radius) the tension (force) in the wall increases

tension is proportional to radius

300
Q

clinical example of Law of Laplace

A

aortic aneurysm

the larger the radius the higher the tension and more likely the vessel will rupture
threshold aneurysm 5cm

301
Q

Frank Starling Law

A

the greater the filling the greater the tension in the left ventricle

increase in diastolic volume= increase in stroke volume

302
Q

Law of Laplace equation sphere

A

p=2T/r

p=pressure
t=surface tension
r=radius

303
Q

what is surfactant

A

soapy substance that lowers surface tension in alveoli and prevents laplace law effects

equilibriates surface tension among different sized alveoli and stabilizes alveoli pressures

304
Q

why does pressure within the alveolus not change

A

because tension also increases

305
Q

what is the unit for work and energy

A

Joule

306
Q

what is a joule a combination of

A

newton and the meter

307
Q

what is kinetic energy

A

the energy a mass has by virtue of being in motion

308
Q

ways to prevent heat loss

A

fluid warmers
bair hugger
humidify inspired gas
blankets

309
Q

what is energy

A

the capacity to do work

310
Q

law of energy conservation

A

energy is neither created or destroyed, only converted into other kinds of energy

311
Q

how many joules in one thermochemical calorie

A

4.184 J

312
Q

how many joules in a kilocalorie

A

1000 cal in kilocalorie

so 4184 joules

313
Q

zeroth law of thermodynamics

A

if A and B are the same temp, and A and C are the same temp then B and C will have no heat flow between them

314
Q

1st law of thermodynamics

A

the change in internal energy is equal to the sum of heat that caused energy to leave the system

315
Q

2nd law of thermodynamics

A

heat spontaneously flows from hot body to cold body when two bodies are in thermal contact

316
Q

what is proportional to the average kinetic energy of particles in a sample of gas

A

temperature

317
Q

define heat capacity

A

the amount of heat/energy required to raise of lower temp of an object

318
Q

what is specific heat

A

the heat required to raise the temperature of a unit of mass of a given substance by a given amount

319
Q

define conduction ( in regards to heat)

A

heat transfer via physically touching an object
ex: pt touching OR table

320
Q

define convection

A

heat transferred to moving air molecules
ex: air moving around OR

321
Q

define radiation heat loss

A

heat transfer via infrared electromagnetic wavelength from a warmer to cooler area

322
Q

define evaporation heat loss

A

heat transfer to a liquid causing it to change to a gas

ex: expiration

323
Q

what is cause of most heat loss in OR

A

radiation and convection

324
Q

what is percent transmittance

A

the percentage of light that passes through a sample

325
Q

what does a spectrometer measure

A

the number of photons per second per unit area in the light

326
Q

What 3 factors affect how much light is absorbed in the Lambert-Beers Law

A

-greater concentration of analyte increases chance photon will encounter molecule to interact

-increasing distance the light beam travels increases the chance photon will encounter molecule with which to interact

-absorptivity describes likelihood photon will excite molecule, constant for each substance at given wavelength

327
Q

Lambert Beer’s law describes the function of what

A

pulse oximeter

328
Q

explain how pulse ox works

A

oxy hgb= absorbs infrared lgiht

doxy hgb= absorbs more red light

computer calculates % of oxy hgb based on the ratio of the two light wavelengths received by the detector

329
Q

how many nanometers is red light

A

650

330
Q

what is the color, psi, capacity, and weight of N2O

A

blue
750psi
1590
8.8kg

331
Q

how many nanometers is the infrared diode (oxy)

A

950

332
Q

how many nanometers is the red light diode (deoxy)

A

650

333
Q

how long will 1600 psi O2 last if you deliver at a 2L and 3L

A

1600/2000= 80

80% of 660= 528

528/2L= 264 min
528/3L=176 min

334
Q

what is the service pressure and capacity of oxygen

A

2000 psi
660L

335
Q

what is the service pressure and capacity of nitrous oxide

A

~750 psi
1590L

336
Q

what is the service pressure and capacity of air

A

1900 psi
625L

337
Q

why are surgical patients at risk for positioning injuries

A

insensible to pain
unable to reposition
anesthesia blunts compensatory mechanisms

338
Q

what is inadequate tissue perfusion caused by

A

Poor arterial blood supply and venous drainage

339
Q

what were most common injuries due to positioning by order of frequency

A

ulnar neuropathy
brachial plexus injuries

ulnar have no mechanism of injury

340
Q

what patient population reports/claims more injuries

A

men

341
Q

what is a key in preventing nerve damage

A

thorough preoperative history

342
Q

what are some other ways of preventing nerve damage

A

place patient in position they would tolerate if awake
pad pressure points
head/neck neutral
reassess throughout the case

343
Q

when are nerve injuries more common in regards to length of time

A

surgery greater than 2 hrs

344
Q

what are risk factors for nerve damage in positioning

A

asa>2
obese
low BMI
malnourishment
pre-existing neuropathy

345
Q

what is imperative in pre-existing neuropathies

A

documentation of existing neuropathy

346
Q

what are some conditions associated with pre existing neuropathies

A

HTN
CHF
HYPOtension
tobacco use
DM
ETOH dependency
liver disease
limited joint mobility
carpal tunnel
dough crush syndrome
radiculopathies

347
Q

who should move the patient from stretcher to OR bed

A

the patient

348
Q

what is a common complication in post op often reattributed to positioning and what causes increased risk

A

post op back pain
long duration of surgery
use of muscle relaxants: muscle relaxation and loss of lordosis leads to stretching of ligaments

349
Q

how can you decrease post op back pain

A

position with knees slightly flexed
knees supported with pillow
do not cross feet

350
Q

what do general anesthesia, NMB, and PPV interfere with

A

venous return
arterial tone
autoregulation

351
Q

what position minimizes respiratory compromise but can cause CV compromise

A

sitting

352
Q

what positions interferes with venous return and compromises functional residual capacity

A

lateral and prone

353
Q

what is stretched or compressed causing neurovascular compromise and what can this lead to

A

intraneural vasa nervosum (blood supply to the nerve)

nerve ischemia

354
Q

when is there a higher risk of neurovascular compromise

A

-when nerve has long superficial course between two fixed points
-small focused areas
-longer duration of compression

355
Q

what are small focused areas neurovascular compression occur

A

heels and occiput

pressure is concentrated

356
Q

how long can compression occur before numbness

A

20 minutes average

357
Q

what is neurovascular compromise

A

compression of a nerve between internal structure and rigid objects

358
Q

what can increase the risk of neurovascular compromise

A

tissue edema (potentially from excessive crystalloids)

359
Q

what are major causes of acute peripheral nerve injury

A

damaged axon or myelin sheath causing dysfunctional nerve
-mechanical pressure injury

360
Q

what does external compression first effect in the nerve

A

myelin sheath causing slow conduction
if severe enough from conduction block

361
Q

what is it called when the underlying axon is injured

A

frame conduction block

362
Q

how is nerve damage calculated

A

amount of pressure and amount of time

even high pressure and short time can cause large damage

363
Q

example of a common mechanical compression injury

A

carpal tunnel
tourniquet paralysis
hematoma
cast
prolonged immobilization

364
Q

when does a stretch injury occur

A

connective tissue of nerves stretch 10-20%

this happens before structural damage

365
Q

why are stretch injuries significant in nerves

A

there can be severe lesions disrupting the axon

366
Q

how can you avoid stretch injuries

A

abduct arms <90
gently flex hips and knees
maintain cervical spine neutrality

367
Q

what are pressure points

A

parts of the body that are more prone to developing ischemia

368
Q

give examples of pressure point areas

A

ears
scapula
occiput
elbows
hips
knees
heels

369
Q

has pressure point padding shown to reduce peripheral neuropathy in the OR

A

NO

370
Q

when moving an intubated patient, how should head and neck be positioned

A

neutral to prevent stretch injury

371
Q

how can you prevent ETT migration/extubation

A

disconnect from vent
hold ETT
ALWAYS RECHECK BREATH SOUNDS especially when moving lateral or prone

372
Q

what does supine positioning decrease/ increase

A

decrease FRC
increases preload

373
Q

what is another way to describe V/Q mismatch

A

when closing capacity exceeds FRC -> hypoxemia

374
Q

what is v/q mismatch

A

defect in lung ventilation/perfusion ratio
-lung receives oxygen but no blood, or receives blood but no oxygen
-leads to hypoxemia usually from a blockage

375
Q

who is at increased risk for decreased FRC while supine

A

elderly (higher closing capacity)
obese and pregnant (already have reduced FRC)

376
Q

how do you mitigate decreased FRC while supine

A

peep

377
Q

what other illness can contribute to intolerance of supine positioning

A

CHF
respiratory dysfunction

378
Q

how can supine affect women greater than 20 weeks

A

inferior vena cava/aorta compression by fetus which lowers cardiac output
tilt the table or wedge under right hip

379
Q

what can reduce preload in supine patient

A

obesity
abdominal tumor
pregnancy

380
Q

how does going from standing to supine effect a healthy patient

A

increases venous return and thus increases stroke volume

381
Q

what can happen to occiput if not padded properly

A

pressure alopecia

382
Q

what nerves can be damaged with hyperextension of knee

A

tibial/peroneal

383
Q

when arms are on arm boards, how far can they be abducted

A

less than 90 degrees

384
Q

what are benefits of Trendelenburg position

A

increases venous return/cvp
prevents air embolism
facilitates cannulation of IJ central line

385
Q

negatives to Trendelenburg position

A

decreases FRC and pulmonary compliance
increases facial/laryngeal edema

386
Q

what may be a complication of positioning with ETT

A

caudad (moving to posterior end) movement= endobrachial intubation

387
Q

what does cephalad movement of diaphragm cause when supine

A

decreases in FRC

388
Q

what complications do trendelenburg predispose patient to

A

atelectasis and decreased compliance= may need higher pressure to achieve adequate tidal volume

389
Q

what may result from high peak inspiratory pressures

A

barotrauma

390
Q

what increases risk of brachial plexus injury in trendelenburg

A

shoulder braces- not recommended
-use antislide mat or bean bag

391
Q

what should PIP be kept below in trendelenburg and what is adjusted to achieve this goal

A

40
tidal volume and rate

392
Q

how can trendelenburg exacerbate CHF

A

increases venous return which increases preload

393
Q

what are pros and cons of reverse trendelenburg

A

pro: increases FRC and lung compliance (monitor lung volumes)
cons: hypotension, reduced perfusion pressure to brain

394
Q

how can you assure there is no ulnar nerve compression

A

palpate the ulnar groove
supinate slightly and slightly flex to prevent

395
Q

how can neuropathies arise in positioning

A

compression
ischemia
excessive stretch

396
Q

what position puts most pressure on ulnar nerve

A

pronation

pressure increases as abduction degree increases

397
Q

what can tucking at the arms at the sides lead to if hands are flexed

A

carpal tunnel
-hands should be in neutral position
-maintain thumbs upright

can also lead to ulnar nerve compression

398
Q

what can lead to radial nerve damage

A

improper arm board depth
arm board lower than the table
IV sticks

399
Q

where is radial nerve prone to compression

A

posterior surface of humerus
can also stretch brachial plexus

400
Q

what are signs of radial nerve damage

A

wrist drop
inability to abduct thumb
inability to extend hand/forearm
loss of sensation

401
Q

what is a sign of complete plexus damage

A

entire limb is num and flaccid

402
Q

what are signs of brachial plexus injury

A

shoulder pain
tenderness over supraclavicular area

may be noticed POD1 or several days post op

403
Q

how can brachial plexus injuries be limited

A

limit arm abduction to <90d
avoid external rotation and posterior displacement of arm
head in neutral position or moved toward abducted arm

404
Q

what are the nerve roots injured in brachial paralysis

A

C5 C6 C7

405
Q

what is erbs palsy

A

internal rotation of arm
extension of forearm
pronation of hand

C5-C7 injury

406
Q

which nerve roots are rarely affected in brachial plexus injuries and what happens when they are

A

C8 and T1

Klumpke paralysis=loss of finger flexion
paralysis of hand
horners syndrome

407
Q

when can median nerve injury occur

A

carpal tunnel

408
Q

what is carpal tunnel characterized by

A

inability to abduct thumb
inability to flex distal phalax of 2nd finger
decreased sensation of lateral 3 fingers

409
Q

what nerve is most commonly injured and why

A

ulnar nerve

superficial path along medial epicondyle of humerus

410
Q

what are direct and indirect trauma of ulnar nerve

A

direct: compression against OR table
indirect: nerve is stretched around medial epicondyle

411
Q

signs of ulnar nerve damage

A

decreased sensation of medial 1.5 fingers
decreased ability to grip
inability to adduct thumb
claw hand

412
Q

what are signs of median nerve damage

A

inability to oppose thumb- ape/benediction hand thumb muscle atrophy

413
Q

what are pressure points for the prone position

A

head
ears
eyes
nose
face
penis
testicles
breast
hips
knees
chin
mouth

414
Q

what needs to be prevented with the head/neck in the prone position

A

excessive flexion/extension
2 fingers between neck and chin

415
Q

complications for prone

A

edema
post op vision loss
retinal ischemia from eye pressure
ischemic optic neuropathy-avoid trendelenburg, maintain arterial BP

416
Q

what can be obstructed in prone position

A

external jugular veins

417
Q

what would you give to help secretions while prone

A

robinol 0.2mg, give before case starts

418
Q

how to protect eyes while prone

A

lacrilube and tape
NO PADDING

419
Q

what can happen to the vena cava during prone

A

compression leading to decreased preload
increased surgical bleeding and paravertebral pressure

420
Q

how does prone affect FRC

A

increase it if no pressure on abdomen

421
Q

what is functional residual capacity (FRC)

A

volume of air in lungs after expiration

422
Q

pro and con of kneeling position

A

pro: decreases surgical blood loss for spine surgery

con: increases venous pooling in lower extremities, increases risk of air embolism

423
Q

what is lateral decubitus

A

position that refers to the side of the body which comes into contact with the OR table

424
Q

what can cause hypoxemia in the lateral decubitus position

A

positive pressure

425
Q

what happens in lateral decubitus position with nonspontaneous ventilation

A

perfusion greater in dependent and ventilation greater in independent lung

VQ mismatch

426
Q

what are considerations for removing pressure in lateral decubitus position

A

remove pressure from humerus
palpate radial artery pulse
put axillary roll below axilla to support rib cage

427
Q

what nerves most commonly damaged in lateral decubitus

A

radial and common peroneal nerve

428
Q

how can you protect peroneal nerve and saphenous nerve while in lateral decubitus

A

saphenous: pillow between legs
peroneal: pillow underneath dependent leg

429
Q

what can cause hypotension in beach chair position

A

anesthetic blunts baroreceptor response and may decrease SVR
sit up slowly

430
Q

how much lower is BP in the brain than in the arms

A

15-20mmHg

431
Q

potential complication of beach chair position

A

venous air embolism due to negative pressure at surgical site

432
Q

what is a risk of sitting position

A

air embolism due to entrained air during spontaneous respiration

433
Q

how can you detect venous air embolism

A

capnography
precordial dopplar listening for mill wheel
TEE

434
Q

treatment for venous air embolism

A

flood surgical site with saline
withdraw air from CVP (doesnt usually work)
Left lateral decubitus trendelenburg

435
Q

where do you zero art line to measure brain perfusion

A

tragus

436
Q

conversion factor for brain map vs arm map

A

1cm rise= 0.75 mmHg drop in MAP

so if brain is 20cm higher than arm, 15mmHg drop

437
Q

complications of sitting position

A

blood pooling in lower extremities
decreased vent preload
empty heart
hypotension
decreased end diastolic volume

438
Q

what can happen when epi is mixed in a regional block in sitting

A

epi increases sympathetic tone/myocardial contractility can cause body to reflexively decrease HR and BP

439
Q

complication of lithotomy from central blood volume

A

pulmonary edema

440
Q

most common nerve injury in lithotomy

A

peroneal nerve from candy cane stirrups

footdrop, sensory loss to sole of foot

441
Q

what can lithotomy position exacerbate

A

heart and respiratory disease

442
Q

nerves that can be damaged in lithotomy

A

obturator-adductors
saphenous- medial thigh
femoral- hip flexion/knee extension
lateral femoral cutaneous- anterior lateral thigh
sciatic- any muscle below foot-hamstring

443
Q

what is a rare complication from lithotomy

A

compartment syndrome

444
Q

preop documentation should include

A

neuro deficits
parathesia
neuropathies

445
Q

positioning aspects that need to be documented

A

response to position
padding (location and type)
position changes
people present during positioning
post op neurological function

446
Q

ways to prevent ulnar injuries

A

avoid pressure on postcondylar groove of humerus
keep hand/forearm supinated or neutral

447
Q

ways to prevent brachial plexus injuries

A

-keep axillary roll out of axilla in decubitus position
-ultrasound for IJ placement
-avoid shoulder braces in trendelenburg
-avoid excessive lateral rotation of head
-limit arm abduction to less than 90degrees

448
Q

ways to avoid sciatic/peroneal injuries

A

-minimize time in lithotomy
-avoid excessive pressure on fibular head (peroneal)
-use two people to move both legs in/out of lithotomy
-avoid excess flexion of hips, extension of knees, torsion of lumbar spine

449
Q

incidence of median/radial nerve injuries

A

25% from IV insertion/infiltration
25% from axillary block

450
Q

4 applications for Daltons Law

A

-calculate pressure of an unmeasured gas
-calculate total pressure of a gas mixture
-convert partial pressures into volumes percent
-convert volumes percent into partial pressures

451
Q

which component of the oxygen delivery equation is MOST affected by Henry’s Law

A

PaO2

APEX

452
Q

three applications of Henry’s Law

A

-anesthetic emergence is prolonged in hypothermic patient
-overpressuring the vaporizor
-increase the FiO2 increases the PaO2

453
Q

3 Applications of Fick’s Law

A

-cardiac output calculation
-placental drug transfer
-diffusion hypoxia

454
Q

how does partial pressure affect gas solubility

A

pressure decreases = solubility decreases

pressure increases=solubility increases

455
Q

how does temperature affect gas solubility

A

temp decreases=increases solubility

temp increases= solubility decreases

456
Q

Grahams Law states

A

molecular weight of a gas determines how fast it can diffuse through a membrane

-rate of diffusion of gas is inversely proportional to the square root of the gas’s molecular weight
-smaller molecules diffuse through a membrane faster than larger molecules

457
Q

2 applications of Grahams Law

A

2nd gas effect- using N2O to speed up onset of a volatile anesthetic

high fresh gas flow is turbulent as it passes through the annular space

458
Q

how does knowing the O2 solubility coefficient help us calculate O2 delivery

A

multiplying the PaO2 by the solubility coefficient (0.003mL/dL) allows us to calculate how much oxygen is dissolved in the blood

459
Q

what are two applications of Boyles Law

A

-pneumatic bellows used for positive pressure ventilation
-diaphragm contraction increases tidal volume
-squeezing a bag valve mask
-using bourdon gauge to calculate how much O2 left in a cylinder

460
Q

what is an application of Charles’ Law

A

LMA cuff ruptures when placed in an autoclave

461
Q

What is an application of Gay-Lussac’s Law

A

O2 tank explodes in a hot environment

462
Q

what is the r constant in PV=nrT

A

0.0821 liter-atm/K/mole

463
Q

Ohm’s Law states

A

the current passing through a conductor is directly proportional to the voltage and inversely proportional to the resistance

464
Q

what is viscosity

A

the result of friction from intermolecular forces as a fluid passes through a tube

465
Q

what is viscosity inversely proportional to?

A

temperature

decrease temp= increased viscosity and resistance

increased temp=decreased viscosity and resistance

466
Q

Reynolds number is lowest in which part of the airway?

A

terminal bronchioles

467
Q

which areas of the airway have turbulent air flow

A

glottis
carina
medium-sized airways

468
Q

equation for reynolds number

A

Reynolds #= (density x diameter x velocity) / viscoscity

469
Q

what is laminar flow dependent on

A

gas viscosity

Poiseuilles Law

470
Q

what is turbulent flow dependent on

A

gas density

Grahams Law

471
Q

what gas mixture reduces turbulence and improves gas flow in the setting of bronchospasm

A

Helium/oxygen

Heliox

472
Q

what are two physical principles that applies to the operation of a jet ventilator

A

venturi effect- if the pressure inside the tube falls below atmospheric then air in entrained into the tube

bernoulli- as airflow moves past the point of constriction the pressure at the constriction decreases

473
Q

When applied to the left ventricle, which variables are included in the Law of Laplace?

A

Wall tension
Wall thickness

apex

474
Q

Surface tension of a sphere equation and example

A

Tension= (pressure x radius)/ 2

Ex: alveolus, ventricle, saccular aneurysm

475
Q

Surface tension of a cylinder equation and example

A

Tension= pressure x radius

Ex: blood vessels, aortic aneurysm

476
Q

Pressure is a ____ force

A

Pushing

477
Q

Tension is a _____ force

A

Pulling

478
Q

Laplace equation in reference to heart

A

Wall stress= (ventricular pressure x radius) / ventricular thickness

479
Q

The risk of ionizing radiation exposure to the anesthesia provider is:

A

Inversely proportional to the square of the distance of the source

480
Q

Define specific heat

A

The amount of heat required to increase the temp of 1g of a substance by 1 degree C

481
Q

What is an adiabatic process

A

A process that occurs without gain or loss of energy (heat)

482
Q

Define critical pressure

A

The minimum pressure required to convert a gas to a liquid at its critical temp

483
Q

Define critical temp

A

The highest temperature where a gas can exist as a liquid

484
Q

1 atm = ____ cm H2O

A

Nagelhout says 1020

Apex says 1033

485
Q

Fahrenheit to celcius

A

C= (F-32) x 5/9

486
Q

Celsius to Fahrenheit

A

F= ( C x 1.8) + 32

487
Q

Celsius to kelvin

A

K= C+ 273

488
Q

Kelvin to Celsius

A

C= K-273

489
Q

1 atm =

A

760mmHg
760 torr
1 bar
100 kPa
1033 cmH2O
14.7 lb/in^2

490
Q

1mmHg= ____ cmH20

A

1.36

491
Q

1cmH2O = _____ mmHg

A

0.74

492
Q

What is the vapor pressure of sevo

A

170mmHg

493
Q

What is the vapor pressure of enflurane

A

172mmHg

494
Q

What is the vapor pressure of isoflurane

A

240 mmHg

495
Q

What is the vapor pressure of halothane

A

244 mmHg

496
Q

What is the vapor pressure of desflurane

A

669 mmHg

497
Q

1 psi= ____mmHg

A

54

498
Q

Reynolds number is directly proportional to

A

Fluid velocity
Fluid density
Tube diameter

499
Q

Reynolds number is inversely related to

A

Fluid viscosity

Meaning when flow is turbulent it’s the density not the viscosity that determines the flow

500
Q

Relationship of volume and pressure in boyles law

A

Volume decreases = pressure increases

Constant temp

Inverse relationship

501
Q

Relationship between temperature and volume in charles law

A

Temp increase volume increase

Directly proportional

Constant pressure

502
Q

Relationship of temperature and pressure in Gay Lussacs law

A

Temp increase pressure increase

Directly proportional

Constant volume

503
Q

Forces associated with fluids

A

Gravity
Pressure
Friction

504
Q

Which temperature monitoring site offers the best combination of accuracy and safety over an extended period of time

A

Esophageal

505
Q

5 Laser safety steps

A

-use < 30% FiO2
- do not use N2O
-use laser resistant ETT
-fill cuff with saline
-protect patients eyes by taping closed, covering with saline soaked gauze and using protective glasses specific to laser being used

506
Q

What positions increase cardiac preload

A

Trendelenburg
Lithotomy

507
Q

What positions reduce cardiac preload

A

Reverse trendelenburg
Sitting
Flexed lateral

508
Q

02 flow equation

A

O2 flow= (total flow) x ( FiO2- .21)/ (1-0.21)

509
Q

What electrical system are ORs on

A

most ORs are built with an isolated power system (IPS).

This is an ungrounded power delivery system, also called a floating ground.

510
Q

What is a line isolation monitor

A

The LIM is fundamentally an ohmmeter (resistance meter) between earth ground and each line of the IPS.

It measures the impedance between these two lines and earth ground to assess the extent to which the IPS is isolated

511
Q

National Institute for Occupational Safety and Health (NIOSH) in 1977 recommended exposure limits (RELs)

A

2 ppm for halogenated anesthetic agents (Sevo, Iso, Desflurane) when used alone

0.5 ppm for a halogenated agent and 25 ppm of nitrous oxide when used together

N20 alone = 25ppm
1st trimester exposure inhibits DNA synthesis

512
Q

how is N2O harmful for exposure

A

Nitrous oxide irreversibly inhibits the vitamin B-12 dependent enzyme methionine synthase, which has key roles in the folate and S-adenosyl methionine (SAM) cycles

513
Q

Risks to Pregnancy with WAG

A

NIOSH Study:
-Increased risk of spontaneous abortion and congenital abnormalities in children of women who worked in the operating room
-an increased risk of congenital abnormalities in offspring of unexposed wives of male operating room personnel.

Follow Up Studies: Other job-associated conditions besides exposure to trace anesthetic gases, such as stress, infections, long work hours, shift work, and radiation exposure, may account for many of the adverse reproductive outcomes

514
Q

Proper Work Practices for the Management of Waste Anesthetic Gases

A

-Ensure tight fit of anesthetic mask
-Ensure tight fit of endotracheal tube cuff or laryngeal mask airway
-Ensure absence of leaks in anesthetic machine and tubing
-Use low-flow techniques when appropriate (e.g., during maintenance phase of anesthetic)
-Do not administer inhaled anesthetic until scavenging system is active
-Ensure that anesthetic vaporizer(s) are turned off when anesthetic machine not in use

515
Q

surgical smoke risk in OR

A

Electrocautery smoke can contain mutagenic, carcinogenic, and toxic compounds

“verage plume created in a single day in the OR is equivalent to smoking as many as 30 unfiltered cigarettes.”- AORN

USE N95 or smoke evacuators

516
Q

what are the limits for ionizing radiation

A

Annual limit = 50 mSv

Allowable lifetime limit = 10
mSv X Age in years

Pregnant or lactating worker monthly limit = 5 mSv

517
Q

what does ALARA stand for

A

As Low As Reasonably Achievable

TIME
DISTANCE
SHIELDING

518
Q

what does the Inverse square Law apply to

A

applies to radiation, light, pressure waves and electricity

519
Q

what are some ways to shield from ionizing radiation

A

thyroid shield
lead apron
lead lines glasses

520
Q

what is recommended for anesthesia machine for TB/COVID patients

A

TB/COVID – Must have viral filter on expiratory limb to protect machine from contamination

Recommended airway filter before Y-piece and before ETCO2 sampling

Inspiratory filter only if machine has been contaminated

521
Q

incidence of surgical fires

A

550-650 in US annually

5-10% associcated with serious injury or death

522
Q

what percentage of fires are in patient fires

A

airways 38%

523
Q

surgical fire prevention steps

A

-Reduce O2 concentration to less than 30%
-Do not use open O2 administration sources
-Use of adequate tenting technique with scavenging
-Communicate with surgical team
-Use cuffed/Laser ETT’s
-Pay attention

524
Q

what kind of O2 is flammable

A

FiO2 and FeO2

inspired and expired O2

525
Q

steps for airway fire

A

-Look for early warning signs
-Stop Ventilation, turn off gas, disconnect circuit, do not ventilate, and extubate
-Pour saline into airway to extinguish fire
-Remove any left over materials
-Ventilate patient, re-establish airway
-Assess injury
-Consider bronchoscopy

526
Q

what are some chemical makeups of CO2 absorbent

A

Chemical makeup of the absorbent
Fresh gas flow rates
Minute ventilation
Anesthetic itself

527
Q

what can lead to accelerated degradation of CO2 absorbent

A

High fresh gas flows accelerate the desiccation of absorbent, and this leads to accelerated degradation

Because this is an exothermic process, temperature of the absorbent may increase dramatically

528
Q

what is a risk with CO2 absorbent and volatile anesthetics

A

Exothermic reaction results from interaction of desiccated carbon dioxide absorbent and volatile anesthetics (especially sevoflurane) can produce extremely high temperatures inside of the absorbent canister

Temperature increase may lead to explosion and fire in the canister or anesthetic circuit

529
Q

How To ensure maintenance of adequate hydration in the absorbent?

A

-Change the absorbent regularly
-Turn fresh gas flow down or off on unattended anesthesia machines
-Limit fresh gas flows during anesthesia
-When in doubt about hydration of the absorbent. . . Change it!

530
Q

what is ohms law used for

A

Used to predict that ↑ resistance over constant voltage will ↓ current

For electricity to flow there must be a completed circuit. The ground is a conductor connected to the earth (ground) providing a low resistive alternate route for the electricity to flow in the case of electrical surge.

531
Q

what physiological equation is the ohms law a basis for

A

BP= CO x SVR

Blood pressure is analgous to the voltage (V)
Cardiac output to current (I)
SVR to resistance (R)

532
Q

what are some unintentional sources of electrical shock

A

cardiac pacing wires
invasive monitoring catheters

533
Q

what is a macroshock

A

current large enough to cause injury to the bodys surface

534
Q

what is an electrical shock

A

body contact with two conductive materials at different voltage potentials that complete a circuit

535
Q

how many microamps does it take to stop the heart

A

10 microamps if current bypasses the skin and conducted within the body

536
Q

what are some of the bodys natural resistance to electrical currents

A

dry intact skin

537
Q

what is impedence

A

resistance to current of electricity

538
Q

what helps electrical shock prevention

A

Isolation transformer

GFI or GFCI
Usually not installed in OR’s

Line isolation monitors

539
Q

explain the 1993 National electrical code

A

Requires either GFCI or isolated power systems in wet locations

Isolated power systems are more likely used in ORs, because a GFCI would interrupt power to other equipment (lighting, ventilators, monitors)

540
Q

what is the prime function of a circuit breaker

A

fire prevention

541
Q

describe Isolated Power System (IPS)

A

No direct connection to power supplied to the hospital and isolated from the ground

Electrical potential difference between the energized wire and ground is 120 v in a typical household circuit

Potential difference between either line of an isolated power system and ground is 0 v

Person who is grounded and in contact with a live wire in OR with an isolated power system should suffer no ill effects

542
Q

what is used in wet locations to lessen the possibility of macroshocks

A

GFCIs
Isolated power systems

543
Q

what is a line isolation monitor

A

Assesses the integrity of the isolated power system and alarms when more than 2-5 mA of current flows to ground

544
Q

what are line isolation monitors used to protect from

A

MACRO shocks not micro shocks

545
Q

what are the frequencies of electrosurgery

A

Frequencies 300 kHz to 2 MHz

546
Q

what is unipolar electrocautery

A

One tip to deliver an electric current

Needs a return pad (dispersive electrode) to complete its circuit

Path from the unipolar device to the return pad should never cross the patient’s heart

Placement of the pad should be away from bony prominences and metal objects as well to minimize risks for burns

547
Q

what is bipolar electrocautery

A

Two tips, one to supply the electric current and the other to return the current

Do not require a return pad and are less likely to cause burn or injury away from the local area of use

Especially effective during abdominal surgery as in tube/ovary surgery to prevent possible fatal bowel injury

Prevents widespread tissue coagulation

Part held by surgeon like a forceps with current entering one prong and leaving by the other – no grounding plate required

548
Q

what is the safest approach when AICD and electrocautery used

A

The safest approach is to disable the AICD’s ability to defibrillate.

Each manufacturer uses a magnet to apply modalities to their specific device, so it is safest to consult with the representative before surgery and to interrogate the AICD postoperatively

549
Q

steps to take with an external pacemaker

A

Wrap wires with rubber gloves

Use non-electric OR bed

Avoid sources that might cause external interference with the pacemaker’s function

Do not touch intracardiac leads of any kind unless wearing gloves – especially not while touching a metal surface or piece of equipment

550
Q

Contact precautions

A

Prevents transmission of infectious agents by contact with the patient or environment

551
Q

Droplet precautions

A

Prevents transmission of infectious agents spread by close contact with respiratory secretions

552
Q

Airborne precautions

A

Prevents transmission of infectious agents suspended in the air

Ex: TB, measles, varicella, Covid

553
Q

Venous pressure increases:

A

-hydrostatic pressure -> edema of face, eye and airway

-intracranial htn

554
Q

What 4 body positions are associated with a higher incidence of hemodynamic instability under GA

A

Reverse trendelenburg
Sitting
Flexed lateral
Prone

555
Q

Name 5 common anesthesia techniques that attenuate the body’s compensatory mechanisms for maintaining CV stability in trendelenburg

A

General anesthesia
Neuraxial anesthesia
Positive pressure ventilation
Peep
Muscle relaxants

556
Q

The trendelenburg position (4)

A

Reduces pulmonary compliance

Increases risk of endobronchial intubation

Diaphragm moves cephalad

FRC is resuced

557
Q

How does head down affect the patient

A

Compressed lungs
Impairs function of diaphragm
Decreases pulmonary compliance
Increases peak inspiratory pressure
Decreases total lung volume
Decreases FRC

558
Q

How does head up affect the patient

A

Improves diaphragm function
Lungs expand freely
Increases pulmonary compliance
decreases peak inspiratory pressure
Increases total lung volume
Increases FRC

559
Q

What happens to the endotracheal tube tip during neck flexion

A

Pushes ETT tip towards carina

Increases risk of endobronchial intubation

560
Q

What happens to ETT tip with neck extension?

A

Moves tip towards vocal cords

Increase risk for inadvertent extubation

561
Q

Where could ETT tip settle in trendelenburg

A

Mainstem bronchus

Pushes diaphragm towards ETT increasing risk of endobronchial intubation

562
Q

In a patient with facial edema, what are two ways you can assess airway patency before extubation

A

Perform leak test for air movement around ETT

Visually inspect larynx with DL

563
Q

What type of brachial injury can occur when a bean bag is used for positioning

A

Compression injury

564
Q

A patient is unable to abduct his 5th digit after a prolonged stay in ICU. Which nerve sustained an injury

A

Ulnar nerve

565
Q

Ulnar nerve injury presentation

A

Impaired sensation of the 4th and 5th digits

Inability to abduct or oppose the pinky finger

Chronic injury presents with claw hand

566
Q

What’s the most common nerve injury

A

Ulnar nerve

567
Q

Which nerve is most likely to be injured following a traumatic IV insertion in the AC

A

Median nerve

568
Q

What is the only nerve to pass through the carpal tunnel

A

Median nerve

569
Q

Median nerve injury presents with

A

Reduced sensation over palm

Inability to oppose the thumb

570
Q

What can cause radial nerve injury

A

Excessive BP cycling
Upper extremity tourniquet
External compression of IV pole

571
Q

How does radial nerve injury present

A

Wrist drop
Inability to extend the hand

572
Q

How does a common peroneal nerve injury present

A

Foot drop
Inability to every the foot
Inability to extend toes dorsally

573
Q

Which complications are most commonly associated with the sitting position (2)

A

Midcervical tetraplegia
Paradoxical air embolism

574
Q

In a patient with a mediastinal mass what are 3 things that worsen tracheobronchial compression

A

Supine
Induction of GA
Loss of spontaneous ventilation

575
Q

name the injury

A

Median n

576
Q

name the injury

A

radial nerve injury

577
Q

name the injury

A

ulnar nerve injury

578
Q

what are the most common nerve injuries in the OR

A

ULNAR NERVE 1st
brachial plexus injuries
lumbosacral injuries

579
Q

CPP=

A

CPP= MAP - ICP

580
Q

Normal CPP

A

60-80 mmHg

581
Q

Normal MAP

A

70-100 mmHg

582
Q

Normal ICP

A

7-15 mmHg

583
Q

What nerve root is dark purple area

A

C8

584
Q

What nerve root is the hot pink area

A

C7

585
Q

What nerve root is the light blue

A

C6

586
Q

What nerve root is the yellow

A

T1

587
Q

What nerve root is the dark blue

A

C5

588
Q

what nerve supplies the dark yellow section

A

femoral nerve (anterior cutaneous root)

589
Q

what nerve supplies the light yellow section

A

saphenous nerve

590
Q

what nerve supplies the pink area

A

lateral cutaneous

591
Q

what nerve supplies light blue and dark blue

A

common fibular/peroneal nerve

592
Q

what nerve supplies the green area

A

posterior cutaneous

593
Q

what nerve supplies the purple areas

A

tibial nerve

594
Q

what nerve supplies the red area

A

lateral femoral cutaneous

595
Q

what nerve supplies the dark purple

A

posterior cutaneous

596
Q

what nerve supplies the light purple

A

saphenous

597
Q

what nerve supplies the blue area

A

common peroneal

598
Q

what nerve supplies the brown area

A

tibial nerve

599
Q

where does the femoral nerve supply

A

green area

600
Q

what area does the obturator nerve supply

A

orange area

601
Q

where does the medial cutaneous nerve supply

A

purple areas

602
Q

where does the axillary nerve supply

A

red areas

603
Q

where does the median nerve supply

A

blue areas

604
Q

which nerve supplies the brown area

A

ulnar nerve

605
Q

which area does the radial nerve supply

A

green areas

606
Q

which nerve supplies the musculocutaneous nerve supply

A

yellow areas

607
Q

What are the roots of the musculocutaneous nerve

A

C5 C6 C7

608
Q

axillary nerve roots

A

C5 C6

609
Q

radial nerve roots

A

C5 C6 C7 C8 T1

610
Q

median nerve roots

A

C5 C6 C7 C8 T1

611
Q

ulnar nerve roots

A

C7 C8 T1

612
Q

Risk of compartment syndrome increases with:

A

-hypotension
-advanced age
-obesity
-anemia
-connective tissue disease

613
Q

What kind of injury is compartment syndrome

A

A reperfusion injury

Tissues swell due to reperfusion of an ischemic area

614
Q

Your patient reports decreased sensation over the dorsal surface of the lateral three and one half fingers. Which nerve has been injured

A

Radial nerve

valley

615
Q

After surgery, your patient states they are unable to flex their arm and that they had decreased sensation over the ventral surface of their forearm. Which nerve is injured?

A

Musculocutaneous nerve

616
Q

Weakened skeletal muscle function below the knee is a symptoms of injury to which nerve

A

Sciatic nerve

617
Q

Your patients foot has been in plantar flexion during a very long surgery. What nerve injury is most likely to result from this?

A

Anterior tibial nerve

618
Q

The surgeon places a self-retaining retractor which can cause compression of this nerve against the pelvic brim

A

Femoral nerve

619
Q

What 3 nerves may cause foot drop when injured

A

Sciatic
Common peroneal
Anterior tibial

620
Q

Gases that are more blood soluble will diffuse across a liquid/gas interface such as the alveolar capillary membrane in greater or lesser quantities than a less soluble gas? What law applies?

A

Gases that are more blood soluble diffuse in greater quantities across liquid/gas interfaces, as described by Fick’s law of diffusion

621
Q

Describe the second gas effect. What law applies?

A

When one gas delivered at a high inspired concentration (first gas such as N2O) accelerates the blood uptake of a concurrently administered companion gas (second gas such as isoflurane, halothane, desflurane, sevoflurane, or enflurane), this is the second gas effect. Fick’s law of diffusion explains this phenomenon.

622
Q

What happens to the volume of the cuff of the endotracheal tube when N2O is turned on? Explain this phenomenon. Whose law applies?

A

The cuff will expand. More N2O will diffuse into the cuff from the surface of the trachea than will N2 diffuse from the cuff because N2O is much more soluble in blood than N2. Fick’s law of diffusion applies

623
Q

If you have 500 ml of oxygen at a pressure of 1520 mmHg (two atmospheres) what volume would be present at 760 mm Hg (one atmosphere) if temperature did not change? What law applies?

A

1000 ml.

Halving the pressure to 760 mm Hg while maintaining pressure constant doubles the volume.

Boyle’s law applies.

624
Q

A patient is sitting in a chair and breathing spontaneously. Whose gas law applies?

A

Boyle’s Law.

At constant temperature, the volume of a gas in the lungs varies inversely with intrapulmonary pressure.

When intrapulmonary pressure becomes negative (decreases) intrapulmonary volume increases

625
Q

Whose law explains the operation of a bellows ventilator?

A

boyles law

626
Q

A full E cylinder of oxygen will empty 625–675 liters into the atmosphere. What law applies? Explain.

A

Boyle’s law applies.

Pressure and volume are inversely related, if temperature is constant. A relatively small volume of gas is found at high pressure in the cylinder. When the gas is released into the atmosphere (relatively low pressure), a large volume results.

627
Q

How do you calculate the partial pressure of a gas mixture if you know its percent concentration?

A

Partial pressure = ( % concentration/100) x total pressure

628
Q

What is the partial pressure of nitrogen at one atmosphere? Whose law permits this calculation to be made?

A

N2 is 79% of the atmosphere. Partial pressure of N2 at 1 atm. = 0.79 x 760 = 600 mmHg. Dalton’s law of partial pressure applies

629
Q

Henrys Law is used for what two purposes?

A

Henry’s law is used to calculate:
(1) the amount of oxygen dissolved in blood (O2 dissolved = PO2 x 0.003)
(2) the amount of carbon dioxide dissolved in blood (CO2 dissolved = 0.067 x PCO2).

630
Q

What happens to the temperature of a liquid as vaporization occurs?

A

Since vaporization requires energy, the temperature of a liquid decreases as vaporization proceeds. As the liquid temperature falls, a gradient is established between the liquid and the surrounding environment. Energy flows from the warmer area (surroundings) to the cooler area (liquid)—this flow of thermal energy is called heat. At some point, an equilibrium is reached at which the energy lost (heat) to vaporization is matched by the energy supplied from the surroundings (heat)

631
Q

What is heat of vaporization? What is the latent heat of vaporization?

A

A liquid’s heat of vaporization is the number of calories (a measure of energy) necessary to convert 1 mL liquid into a vapor.

The latent heat of vaporization is more precisely defined as the number of calories required to change 1 g of liquid into vapor without a temperature change.

632
Q

Describe what may happen to vapor pressure if a carrier gas flows through the vaporizer container.

A

As a flow of gas (carrier gas) passes through the vaporizer container, molecules of vapor are carried away. This causes the equilibrium to shift so that more molecules enter the vapor phase. Unless some means of supplying heat is available, the liquid will cool.

As the temperature drops, so does the vapor pressure of the liquid, and the carrier gas will pick up fewer molecules so that there is a decrease in concentration in the gas flowing out of the container.

633
Q

Will saturated vapor pressure change with a change in altitude?

A

Vapor pressure is a function of temperature. Thus, vapor pressure will not change with a change in altitude if the temperature remains constant.

634
Q

A volatile agent is poured into a flask containing 100% oxygen. Explain how to calculate the % volatile agent and the % oxygen above the liquid.

A

% volatile agent = (saturated vapor pressure of volatile agent)/(760) x 100. % oxygen = 100 - % volatile agent.

635
Q

What will happen to the gas concentration delivered to the patient if enflurane or sevoflurane is placed in an isoflurane vaporizer? Why?

A

The delivered concentration of enflurane or sevoflurane will be less than expected by the dial setting because enflurane and sevoflurane have lower vapor pressures than isoflurane.

636
Q

When considering flow through a tube, the gradient in hydrostatic pressure (inflow pressure minus outflow pressure) equals flow times resistance. Mathematically, Pin - Pout = F x R. Whose law describes this relationship?

A

Ohm’s law.

637
Q

How are flow and resistance related?

A

Flow through a tube is inversely proportional to resistance.

For example, if resistance doubles, flow is halved. If resistance is halved, flow is doubled

638
Q

What happens to flow and what happens to resistance when the radius of a tube increases? When radius of a tube decreases?

A

When the radius of a tube increases, resistance to flow decreases and flow increases.

when the radius of a tube decreases, resistance to flow increases and flow decreases

639
Q

Hagen-Poiseuille’s law states that laminar flow is proportional to what two factors? Inversely proportional to what two factors?

A

Flow is directly proportional to:
(1) the pressure drop along the tube;
(2) the fourth power of the radius (r4) of the tube.

Flow is inversely proportional to:
(3) the length of the tube;
(4) the viscosity of the fluid.

640
Q

If the radius of a tube is doubled, how much does laminar flow increase? If the radius of a tube is tripled, how much is laminar flow increased? What law applies?

A

Flow increases 16 times if the radius of a tube is doubled
81 times if the radius is tripled.

Hagen-Pouiseulle’s law describing laminar flow through tubes applies

641
Q

Assuming laminar flow through a tube, how much does flow through a tube decrease if the radius of the tube decreases to one-third of its original value? Whose law applies?

A

If the radius of a tube decreases to one-third of its original size, flow will decrease to 1/81 of its original value. Flow is proportional to the radius to the fourth power (r4). 1/3 x 1/3 x 1/3 x 1/3 = 1/81. Hagen-Poiseuille’s law applies. Note also that if radius is halved, flow is reduced to 1/16th of its original value. If radius is doubled, flow increases 16-fold. If radius is tripled, flow increases 81-fold.

642
Q

If flow through a tube is laminar (streamlined), explain how resistance and flow are changed if radius is: doubled, halved, tripled, or reduced to one-third of its original value.

A

According to Hagen-Poiseuille’s law, when radius is doubled, resistance is decreased to 1/16th of its original value and flow is increased 16-fold; when radius is halved, resistance is increased 16-fold and flow is decreased to 1/16th of its original value; when radius is tripled, resistance is decreased to 1/81 of its original value and flow is increased 81-fold; when radius is decreased to 1/3rd of its original value, resistance is increased 81-fold and flow is decreased to 1/81 of its original value.

643
Q

In order to decrease peak inspiratory pressure, you change the endotracheal tube from a 6.0 to an 8.0. Whose law explains this decreased resistance?

A

Hagen-Poiseuille’s law. The greater the radius of a tube, the lower the resistance.

Peak inspiratory pressure is greater when inflow resistance is higher, and vice versa

644
Q

Is the viscosity of a fluid (gas or liquid) important during laminar or turbulent flow?

A

Viscosity is a determinant of gas flow when flow is laminar. Flow is inversely proportional to viscosity (the greater the viscosity, the lower the flow) when flow is laminar (non-turbulent)

645
Q

Identify three conditions that can change laminar to turbulent flow during anesthetic administration.

A

(1) Gases changing direction (bend in tube of more than 20 degrees)
(2) increased velocity
(3) rough walled (corrugated) tubes.

646
Q

When flow of gas through a nasal cannula is low, flow is determined by what property of the gas? Whose law applies?

A

When flow of a gas through a tube such as a nasal cannula is low, flow is laminar. For laminar flow, the viscosity of the gas is a determinant of flow. This is shown by Poiseuille’s law

647
Q

What property of a gas determines gas flow rate through a variable orifice flow meter at low flow rates?

A

Viscosity.

Flow through a variable orifice flow meter is laminar when flow is low, so flow rate is inversely proportional to viscosity.

648
Q

What property of a gas determines gas flow rate through a variable orifice flow meter at high flow rates?

A

Density.

With high flows, flow through a variable orifice flow meter is turbulent, and flow rate is inversely proportional to gas density.

649
Q

Venturi extended whose work? What observations did Venturi make?

A

Venturi extended Bernoulli’s work on the relationship between the velocity of flow of a fluid and the lateral pressure exerted on the wall of a tube.

650
Q

What principle of physics explains the operation of the high frequency jet ventilator?

A

The Venturi effect explains high frequency jet ventilation. In fact, high frequency jet ventilation is sometimes referred to as jet Venturi ventilation.

651
Q

The Law of Laplace relates tension in the wall of a tissue, the pressure inside the wall, and the radius of the structure. How do radius and tension generally relate to each other?

A

According to the law of Laplace, the tension in the wall of a hollow structure (blood vessel, left ventricle, or normal alveolus) is proportional to the radius.

The greater the radius in a chamber or vessel, the greater the tension in the walls of the chamber or vessel.

T is proportional to P x r, where T is tension, P is pressure, and r is radius.

652
Q

Does a dilated ventricle exert more tension compared with a normal ventricle? What law applies?

A

Yes, a dilated ventricle has greater tension in its wall.

This is the law of Laplace. The greater the radius of a chamber, the greater the tension in the wall.

653
Q

Define and differentiate between macroshock and microshock.

A

Macroshock refers to a large voltage applied to skin or tissue.

Microshock refers to small voltages or currents applied directly to the heart

654
Q

How many microamps are required to cause microshock-induced ventricular fibrillation?

A

A minimum of 50 microamps can cause microshock-induced ventricular fibrillation

655
Q

How many milliamps are required to cause macroshock-induced ventricular fibrillation?

A

100–2,500 milliamps can cause macroshock-induced ventricular fibrillation

656
Q

Is the electrical equipment in the operating room grounded or isolated? Electrical equipment in the operating room is monitored by what?

A

Electrical equipment in the operating room is isolated with isolation transformers.

It is monitored by a line isolation monitor (LIM)

657
Q

What is the function of a line isolation monitor, and how does it work?

A

Line isolation monitors monitor isolation of the transformer in every operating suite. Every operating room has electricity that is isolated from the main power by an isolation transformer.

658
Q

What triggers the alarm of the line isolation monitor?

A

The line isolation monitor alarms if either isolated power line is less than 60,000 ohms or if a fault would draw more than 2 milliamps (mA). Newer LIMs may be set to trigger at 5 mA.

659
Q

What should be done if the alarm of the line isolation monitor goes off?

A

If the LIM alarm goes off, check the gauge to determine if it is a true fault. The other possibility is that too many pieces of electrical equipment have been plugged in and the 2-mA limit has been exceeded.

If the gauge is between 2 and 5 mA, it is probable that too much electrical equipment has been plugged in.
If the gauge reads >5 mA, most likely there is a faulty piece of equipment present in the OR.
The next step is to identify the faulty equipment, which is done by unplugging each piece of equipment until the alarm ceases. If the faulty piece of equipment is not of a life-support nature, it should be removed from the OR. If it is a vital piece of life-support equipment, it can be safely used.

660
Q

Long thoracic nerve injury roots and result in what?

A

C5 C6 C7

Serratus anterior muscle dysfunction with winging of the scapula

Basics (7 decks)

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