Equipment Flashcards

Question

21.1 Of the following, the device that delivers the greatest flow when using 'Level 1® Fast Flow Fluid Warmer' rapid fluid infuser system is a (list of intravascular catheters) a. 6.5 Fr sheath b. 8.5 Fr Multilumen line c. 8.5 Fr Swan Ganz Sheath d. Multilumen something 14G cannula (50mm?) e. Peripheral RICC line, 8.5 Fr

Answer 1

e. Peripheral RICC line, 8.5 Fr

Answer 2

a) TXA Hyperfibrinolysis https://derangedphysiology.com/main/required-reading/haematology-and-oncology/Chapter%201.2.0.1/intepretation-abnormal-rotem-data

Answer 3

b. 0.4 BJA: Monitoring of neuromuscular block https://academic.oup.com/bjaed/article/6/1/7/347026 When neuromuscular monitoring is used, visual or tactile evaluation of the degree of neuromuscular block is unreliable. Even experienced anaesthetists are unable to detect fade when the TOF ratio is >0.4. It is now thought that significant residual curarization is still present if the TOF ratio is <0.97 (not 0.7 as previously suggested8).

Answer 4

B) fentanyl Drugs which have the least impact on SSEPs 1. Ketamine 2. Opioids 3. Dexmedetomidine Article in Anaesthesiology https://pubs.asahq.org/anesthesiology/article/99/3/716/40407/Pharmacologic-and-Physiologic-Influences-Affecting o SSEPs = small amplitude potentials measured over the sensory cortex or via epidural electrodes from stimuli applied to the posterior tibial nerves. SSEPs are transmitted via the posterior columns of the spinal cord in the territory of the posterior spinal arteries which supply the posterior 1/3 of the cord. As they are low amplitude they are affected by basal muscle tremor and the signal-to-noise ratio is improved by increasing the depth of muscle relaxation. Their use is not significantly affected by therapeutic concentrations of anaesthetic vapours o MEPs = series of short-duration constant current stimuli of 300-700 V applied to the motor cortex and measured via needle electrodes inserted into tibialis anterior, abductor halluces and vastus medialis muscles along with selected small muscles of the hands for reference. MEPs rely on corticospinal tract integrity which lies in the territory of the anterior spinal artery. MEPs therefore complement SSEPs in their assessment of spinal cord function. MEPs are large amplitude potentials and are incompatible with profound muscle relaxation. Neuromuscular blocking agents are therefore best avoided or given by infusion and dose optomised with discussion with the technicians (or just give remi). o All anaesthetic vapours reduce MEP amplitude in a dose-dependent manner, and more than 0.5 MAC are not compatible with reliable monitoring. Thus Propofol TIVA is preferred. * Remifentanil is commonly used due to low context sensitive half life and negligible effect on intraop evoked responses

Answer 5

Nitrous oxide Halothane & isoflurane cause catalytic destruction of ozone, but halothane hardly used and isoflurane has short atmospheric lifetime. Desflurane + sevoflurane don’t cause ozone depletion.

Answer 6

b) Pulmonary oedema B-lines >Vertical echogenic short path reverberation artefacts originating at the pleural line and extending to the deepest part of the ultrasound image. >They interrupt any horizontal A-lines. >Occasional B-lines are considered normal. >More than 3 B-lines in any single view is considered pathological. >Where there are numerous B-lines in close proximity they become confluent. >B-lines move with lung movement. >They are caused by ultrasound energy reverberating in a fluid filled focus that is surrounded by air. These foci may be interstitial or alveolar. >Cardiogenic and noncardiogenic oedema may have very similar appearances. >Interstitial thickening due to fibrosis or lymphangitis can also create the sonographic appearance of diffuse B-lines.

Answer 7

NIM tube: Neural Integrity Monitor Electromyogram Tracheal Tube

Answer 8

Oscillations in the tube will be diminished

Answer 9

b. AR https://litfl.com/oesophageal-doppler/

Answer 10

Arndt bronchial blocker - use with SLT - 9fr, loop around scope for positioning - suction to deflate lung

Answer 11

a) Normal lungs M-mode image demonstrating seashore sign seen with normal lung sliding.

Answer 12

a) Smaller bolus smaller total dose Marsh = more, Schnider = sparing Marsh based on mass alone = MMA Schnider includes senescence, sex = SSS

Answer 13

c) Wipe with detergent Laryngoscope handles: -non-critical devices -should be cleaned with detergent and water between each patient use. -If contaminated with blood, they should be washed and disinfected. Laryngoscope blades: -considered critical equipment because they may penetrate skin or mucous membranes, require sterilisation. Bougies: -Re-use of these items has been associated with cross-infection. -It is preferable that alternative single-use intubation aids are employed when possible Face Masks: -In contact with intact skin, these items are frequently contaminated by secretions -considered semi-critical, requiring cleaning and thermal disinfection

Answer 14

Dabigatran definitely, almost entirely renal clearance Warfarin no Rivaroxaban no Clopidogrel yes (renal excretion) Apixaban yes

Answer 15

Size 7.0 The Tube The endotracheal tube has a length and diameter. The endotracheal tubes size (“give me a 6.0 tube”) refers to its internal diameter in millimeters (mm). The ETT will typically list both the inner diameter and outer diameter on the tube (for example, a 6.0 endotracheal tube will list both the internal diameter, ID 6.0, and outer diameter, OD 8.8).

Answer 16

c) non-tunneled CVL UTD: In a systematic review that included 200 studies, the risk of catheter-related blood stream infection per 1000 catheter-days and varied by types of intravascular catheter were as follows [38]: ●Peripherally inserted central catheters (PICCs) – 1.1 (95% CI 0.9-1.3) ●Cuffed and tunneled central venous catheters – 1.6 (95% CI 1.5-1.7) ●Noncuffed central venous catheters *Nonmedicated and tunneled – 1.7 (95% CI 1.2-2.3) *Nonmedicated and nontunneled – 2.7 (95% CI 2.6-2.9) However, there was no adjustment for severity of illness. Therefore, a particular type of catheter could be associated with an increased risk of infection if it was preferentially used in more severely ill or vulnerable patients.

Answer 17

d. Use lower frequency probe

Answer 18

b) Desflurane Atmospheric heat absorbed by a substance compared with CO2 is its GWP GWP CO2 = 1 GWP N20 = 265 (atmospheric lifetime of 114yrs) GWP sevo = 130 (atmospheric lifetime of 1.1yrs) GWP desflurane = 2540 (atmospheric lifetime of 14yrs)

Answer 19

B - prevention of electrocution. BJA Education https://academic.oup.com/bjaed/article/11/6/224/263710

Answer 20

b. serum separating tube (gold top tube or red) Potassium EDTA (purple) -> FBC sodium citrate (blue) -> clotting screen/Rotem sodium oxalate (green) -> heavy metals (lead copper zinc)

Answer 21

C) Onsite oxygen liquid evaporator (VIE) VIE Pros and Cons Pros - Cheapest option for oxygen delivery and storage - Storing oxygen as a liquid is much more efficient than as a gas - Does not require power Cons - Set-up costs are expensive - Requires a back-up setup - Will waste large volumes of oxygen if not being used continuously - Fire and explosion risk

Answer 22

e. VOO >Asynchronous mode most often the result of magnet application. In a ventricular PPM, this means VOO >However, various sources recommend against use of magnet for PPM management due to inconsistent effects on different devices Equipment in Anaesthesia and Critical Care: > The use of a magnet as a solution for pacemaker problems, either in theatre or otherwise is not recommended. >The application of a magnet to the pacemaker can have unpredictable results, from causing it to change to a back-up mode such as VOO, to reverting to factory settings, to performing various self-tests, to switching off entirely.

Answer 23

e) ensure leads securely attached https://journals.lww.com/nursing/Citation/2006/11000/Cables_and_electrodes_can_burn_patients_during_MRI.12.aspx#:~:text=The%20radiofrequency%20fields%20that%20occur,enough%20to%20require%20plastic%20surgery. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.187256#d1e281

Answer 24

70-80ml/ kg/ min Controlled ventilation https://www.frca.co.uk/article.aspx?articleid=100141 A fresh gas flow of only 70 ml/kg is required to produce normocarbia. Bain and Spoerel have recommended the following: 2 L/min fresh gas flow in patients <10 kg 3.5 L/min fresh gas flow in patients 10-50 kg 70 ml/kg fresh gas flow in patients >60 kg The recommended tidal volume is 10 ml/kg and respiratory rate is 12-16 breaths/minute.

Answer 25

B. Programability ? Multi-site pacing?

Answer 26

bottle A = fluid trap or collection bottle, can be independently emptied and allows accurate record of drainage amount - first tube connecting drain to drainage bottles must be wide to decreased resistance - volume capacity of this tube should exceed ½ of patient’s maximum inspiratory volume (otherwise H2O may enter chest) bottle B = underwater seal drain, maintained at a predetermined level whilst still allowing for drainage of pleural fluid (if bubbling continuously -> bronchopleural fistula) - volume of H2O in bottle B should exceed ½ patient’s maximum inspiratory volume to prevent indrawing of air during inspiration bottle C = manometer or pressure-regulating bottle allows suction to be attached and should bubble continuously - The maximum negative pressure (in cm H2O) generated by suction equals to the distance (in cm) the vent tube is below the water line (this can be adjusted) -The negative pressure generated by the vent tube is independent of the amount of pleural drainage that is collected in the trap bottle - If suction is turned off then tubing must be unplugged -> so air can escape into atmosphere

Answer 27

E. The colour depends on the angle you hold the probe at Radiopaedia article: change of wording may change the answer to the question

Answer 28

C. Increased minute ventilation Cerebral blood flow Cardiac output Acid–base status Major haemorrhage Arterial inflow/venous outflow obstruction Oxygen content Haemoglobin concentration Haemoglobin saturation Pulmonary function Inspired oxygen concentration Inspired oxygen concentration

Answer 29

b) Central retinal occlusion SE's from HBOT: - progressive myopia (reversible) - seizures - hypoglycaemia - sinus bradycardia from stimulation of vagal activity bassociated with hyperbaric pressures

Answer 30

Fibrinolysis In APTEM, coagulation is also activated as in EXTEM. By the addition of aprotinin or tranexamic acid in the reagent, fibrinolytic processes are inhibited in vitro. The comparison of EXTEM and APTEM allows for a rapid detection of fibrinolysis. Furthermore, APTEM enables the estimation if an antifibrinolytic therapy alone normalises the coagulation or if additional measures have to be taken (e.g. administration of fibrinogen).

Answer 31

c Quincke Needles for spinal anesthesia or lumbar puncture can be classified according to the needle tip. Cutting-tip, or Quincke, needles have sharp, cutting tips, with the hole at the end of the needle. Whitacre and Sprotte needles are two types of pencil point, or noncutting tip needles. They have a closed tip shaped like a pencil, with the hole on the side of the needle near the tip. Pencil point needles are designed to minimize leak of cerebrospinal fluid after puncture and reduce the chance of postdural puncture headache.

Answer 32

C 3L/min LVOT area x VTI = SV 3cm2 x 10cm = 30ml SV x HR = CO 30 x 100 = 3000

Answer 33

b) fibrinogen concentrate bleeding and low fib = concentrate not bleding and low = cryo

Answer 34

e) Reversible hypermetropia

Answer 35

B. 200 nanometers (0.2 micrometres)

Answer 36

0.05-0.1mA Source: LITFL Macro is 100mA

Answer 37

f) Increased SVR

Answer 38

e) 6-13 MHz Atlas of Ultrasound-Guided Procedures in Interventional Pain Management, 13 (2011) The wavelength and frequency of US are inversely related, i.e., ultrasound of high frequency has a short wavelength and vice versa. US waves have frequencies that exceed the upper limit for audible human hearing, i.e., greater than 20 kHz.3 High-frequency ultrasound waves (short wavelength) generate images of high axial resolution. Increasing the number of waves of compression and rarefaction for a given distance can more accurately discriminate between two separate structures along the axial plane of wave propagation. However, high-frequency waves are more attenuated than lower frequency waves for a given distance; thus, they are suitable for imaging mainly superficial structures.5 Conversely, low-frequency waves (long wavelength) offer images of lower resolution but can penetrate to deeper structures due to a lower degree of attenuation. For this reason, it is best to use high-frequency transducers (up to 10–15 MHz range) to image superficial structures (such as for stellate ganglion blocks) and low-frequency transducers (typically 2–5 MHz) for imaging the lumbar neuraxial structures that are deep in most adults.

Answer 39

d) ECG ECG – have AVAILABLE for every anaesthetised patient. Should be used for patients undergoing general and major regional anaesthesia AS CLINICALLY INDICATED. Oxygen analyser – continuous operation for every patient when anaesthesia breathing system in use. Pulse oximeter – use for every patient undergoing general anaesthesia or sedation. Carbon dioxide monitor – use for every patient undergoing general anaesthesia, and have immediately available for sedation cases. ET Volatile – should be in use for every patient undergoing general anaesthesia from an anaesthesia delivery system where inhalational anaesthetic agents are delivered.

Answer 40

c. Two sets of pads, <1 second apart For DSED, to avoid possible defibrillator damage caused by shocks applied at the same instant, a short delay (<1 second) between shocks was created by having a single paramedic depress the “shock button” on each defibrillator in rapid sequence (anterior–lateral followed by anterior–posterior) Among patients with refractory ventricular fibrillation, survival to hospital discharge occurred more frequently among those who received DSED or VC defibrillation than among those who received standard defibrillation. https://www.nejm.org/doi/full/10.1056/NEJMoa2207304

Answer 41

a) Smaller bolus smaller total dose

Answer 42

D. Cerebral Abscess HBOT Indications: - Indications are related to need for enhanced Pressure or oOxygenation and treatment of infection: Pressure - air or gas embolism - Decompression sickness Oxygenation: - arterial insufficiencies (central retinal artery occlusion, enhancement of healing in wound problems) - Carbon monoxide poisoning - Compromised grafts and flaps - Acute traumatic ischaemia - Delayed radiation injuries - Sudden sensorineural hearing loss - Severe Anaemia - Thermal burns Infection: - Clostridium myonecrosis (gas gangrene) - Intracranial abscess - Necrotising soft tissue infections - Refractory osteomyelitis Absolute Contraindications to HBOT: - untreated PTx - Premature Infants - Bleomycin - Disulfiram (antabuse) - Cisplatin Relative contraindications: - Pregnancy - Asthma - Thoracic Surgery - Emphysema with CO2 retention - upper respiratory tract infections - History of middle ear surgery or disorder - History of seizures - Fevers - Congenital spherocytosis - Optic neuritis

Answer 43

c) gas trapping Specific features of increased airway resistance seen here are: High peak airway pressure, but a normal plateau pressure Slow return of the flow-time curve to baseline The flow-time curve does not reach baseline (indicating that emptying is incomplete)

Answer 44

Answer: 3%. (5%/240) x 160 Principle: If Vaporizer specific for agent with low SVP (Enflurane or Sevoflurane) is misplaced with an agent that has high SVP (halothane or isoflurane) then actual output concentration will be greater than the concentration indicated by dial. (inverse is also true) Administration of sevoflurane using other agent-specific vaporizers: The current study investigated the concentration of sevoflurane that could be achieved when sevoflurane was administered using standard agent-specific halothane, isoflurane, and enflurane vaporizers. An artificial lung analog model was made by attaching the 3-L reservoir bag to the 15-mm end of the anesthesia circle system. The lung analog was attached and ventilated with oxygen and air at flow rates of 2 L/min each (total gas flow = 4 L/min), a tidal volume of 800 mL, a rate of 10 breaths/min, and an inspiratory-to-expiratory ratio of 1:2. The vaporizer was filled with sevoflurane and the dial turned to 1%. After a 10-minute equilibration period, the concentration of sevoflurane was measured. The vaporizer concentration was increased in 1% increments, and after a 10-minute equilibration, the sevoflurane concentration was recorded. The dial was increased from 1% to 5% for the halothane and isoflurane vaporizer and from 1% to 7% for the enflurane vaporizer. Each study was repeated five times at each incremental increase of 1% for each of the three vaporizers. The series of studies were repeated using a total gas flow of 8 L/min (oxygen 4 and air 4) instead of 4 L/min (oxygen 2 and air 2). Using the halothane or isoflurane vaporizers at the 5% setting, the maximum sevoflurane concentrations achieved were 3.0% and 3.1%, respectively. The sevoflurane concentration was a maximum of 6% using the enflurane vaporizer set at 7%. The sevoflurane concentration decreased significantly when using any of the three vaporizers at all concentrations when the gas flow was increased from 4 to 8 L/min. The current study demonstrates that clinically useful concentrations of sevoflurane can be achieved with the administration of sevoflurane through an enflurane vaporizer. Although this is not routinely recommended, in specific circumstances it may allow the use of sevoflurane in third-world countries if sevoflurane vaporizers are not available and the use of sevoflurane is clinically necessary.

Answer 45

C: 120ml/min An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO. - humeral flow rates were significantly faster using a pressure bag (153 mL/min) compared with humeral those achieved without pressure bag (84 mL/min) - tibial flow rates to be significantly faster using a pressure bag (165 mL/min) compared with those achieved without a pressure bag (73 mL/min)

Answer 46

B. 30 min P1x V1= P2xV2 150bar x 2l = 1bar x Unknown Volume 150 x 2/1= Unknown Volume 300L = unknown volume 300/10l/min = 30mins

Answer 47

e) Low resistance

Answer 48

c) Cryo Cryo or TXA, TXA first line treatment however patient has low fibrinogen and requires fibrinogen replacement.

Answer 49

C) Obstructive Pattern https://thoracickey.com/ventilator-graphics/ Image 9.6

Answer 50

C. Increased minute ventilation Cerebral blood flow Cardiac output Acid–base status Major haemorrhage Arterial inflow/venous outflow obstruction Oxygen content Haemoglobin concentration Haemoglobin saturation Pulmonary function Inspired oxygen concentration Inspired oxygen concentration

Answer 51

Increased alpha and slow delta power During general anaesthesia with sevoflurane, the EEG shows increased α (8–12 Hz) and slow-δ oscillation power.9 This dynamic also closely approximates the EEG of general anaesthesia with propofol.9 Alpha oscillations are likely to originate from a mechanism similar to that proposed for the β oscillations. An increase in GABAA decay time and conductance results in cortical α oscillations and enhanced rebound spiking of thalamic relay cells, strengthening the intrinsic α oscillatory dynamic of the thalamus. The net result is reciprocal thalamic–cortical α oscillation coupling.13 Mechanisms to explain the slow-δ oscillations are being investigated. However, slow-δ oscillations may be associated with an alternation between ‘on’ states, in which neurones are able to fire, and ‘off’ states, in which neurones are silent.9 Different from propofol, sevoflurane general anaesthesia is also associated with increased frontal θ (4–8 Hz) oscillation power.1,9 The increase in θ oscillation power creates a distinctive pattern of distributed EEG power from the slow-δ oscillation through to the α oscillation range. At an end-tidal sevoflurane concentration of 1.1%, the EEG shows increased slow-δ (0.1–4 Hz) and β (13–33 Hz) oscillations BJA Ed

Answer 52

Size 7.0 The Tube The endotracheal tube has a length and diameter. The endotracheal tubes size (“give me a 6.0 tube”) refers to its internal diameter in millimeters (mm). The ETT will typically list both the inner diameter and outer diameter on the tube (for example, a 6.0 endotracheal tube will list both the internal diameter, ID 6.0, and outer diameter, OD 8.8).

Answer 53

Depth of tube in water in bottle 3

Answer 54

All People Kick My Cat Atm> PSI > KPA > mmHg > cmH2O 1ATM = 14.69 PSI = 101.325 kPa = 760mmHg = 1033 cmH20

Answer 55

b) 2 ATM https://academic.oup.com/bjaed/article/7/1/2/509371 **A typical parameter-set for HFJV via a subglottic catheter is DP, 2 atm; f, 150 min−1; Fio2, 1.0; I-time, 50%. ** Driving pressure 1-2 atm (250-500ml/s) RR 8-10 Automated jet ventilator – typical starting jet pressure for an adult is 1.5 bar (~1.5 atm). Manual jet ventilators deliver up to 3.5-4 bar.

Answer 56

c) Larger bolus lower infusion rate https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.13345 https://journals.lww.com/anesthesia-analgesia/fulltext/2014/06000/a_general_purpose_pharmacokinetic_model_for.12.aspx

Answer 57

Neonates. Eleveld designed for a wide patient pop, but not neonates.

Answer 58

CarboxyHb - Probe cannot differentiate between HbO and COHb The others cause false readings

Answer 59

d) CT British Heart Rhythm Societies guidelines

Answer 60

A. Reduced RR BJA HFNOT It has been demonstrated that patients with acute hypoxaemic respiratory failure experience improved comfort and tolerance with HFNOT compared with humidified oxygen via a facemask, and traditional non-invasive ventilation masks. Subjective feelings of dyspnoea AND RESPRIATORY RATES are REDUCED as is airway dryness.

Equipment Flashcards

(91 cards)