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Flashcards in Equipment Class Deck (53):
1

Relative contraindications for Manual Vent. for General anesthesia?

Full stomach or Rx for aspiration

Facial trauma

Anticipated/known difficult airway

1

What are these & why use?

Ring, Adair, Elwin (RAE) ETTs

For nasal intubations

2

What benefit does Miller offer over MAC?

Floppy epiglottis

(but you have to have total control of tongue)

2

How many receptors are blocked when you loose the 3rd Twitch?

85 % of receptors blocked

3

What is Electromyography (EMG)?

-  Based on measurement of muscle compound action potential that occurs with muscle membrane depolarization (electrical not mechanical)

- used at UIHC - uses small amp (20 mv) w/ 100-350 volts

- JUST SHOWS MEMBRANE DEPOLARIZATION - not contraction, either on or off. 

4

Image result for self-inflating manual resuscitator bag

Self Inflating mask

4

What is a Train of four ratio measuring?

Amplitude of 4th twitch/ amp of 1st twitch

 

When TOF >70-80% = 20% receptors arent blocked and normal muscle contraction should occur

5

What does Pre-Oxygenation do?

Fills FRC (approx. 2.5 Litres)

6

What is Post tetanic Count (PTC)? 

-  50 Hz tetanic stimulation for 5 sec; wait 3 sec; then supramaximal stimulus at 1 Hz

- If 5-7 responses are detectable after tetanic stimulation, return of TOF response is imminent.

6

TOF Less than .90 is associated w/?

Functional impairments of the pharynx & lower esophagus

Increasing aspiration and Post op complications

7

How many receptors are blocked when you loose the 4th Twitch?

75-80% blocked post synaptically

8


APSF
Prevention
 Focus: Avoiding preventable injury by 7 necessary components?

1. Reliable delivery of Oxygen at any concentration up to 100%

2. Reliable means of positive pressure ventilation (PPV)

3. Backup vent.

4. Controlled release of PPV

5. Anesthetic Vapor delivery - if part of plan

6. Adequate Suctioning

7. Conform to standards of monitoring - ACLS/PALS

9

What is FRC?

FRC: Lung volume at end of normal exhalation. 

FRC, the elastic recoil forces of the lungs and chest wall are equal but opposite and there is no exertion by the diaphragm or other respiratory muscles

9

How many receptors are blocked when you loose the 2nd Twitch?

90%

10

Who may benefit from a Oral airway?

- Edentulous 
patients



- Down 
syndrome 
and
 pediatric 
patients 
with
 large
 tongues


- Sleep
 apnea 
patients


- Never 
really 
hurts 
to 
place 
one
 (be
careful
 with 
loose 
teeth)


- Make
 sure 
patient 
is 
deep 
enough

11

How to treat Laryngospasm?

Forward displacement of the jaw and apply positive pressure with 100% oxygen

• Severe spasm may require small doses of succinylcholine (0.1 to 1 mg/kg) and re-intuba&on. – May be given intramuscularly or by sublingual injection.

• Laryngospasm will eventually cease as hypercarbia and hypoxia develop.

12

Flow inflating Bag Mask

13

Gas can ONLY exit from an ______ if no other leaks exists in a vent. circuit.

APL valve - adjustable pressure Limit or "pop off" valve

14

What has to be present to get a TOF ratio?

4 twitches

15

What is Mechanomyography?

Classic gold standard 

Uses Add Pol. Based on isometric measurements of muscle force

17

Manual Ventilation Peak pressure upper limit?

20 cm H2O

18

How many receptors are blocked when you loose the 1st(aka ALL) Twitches on a TOF?

98-100% blocked

20

What kind of blade is this?

MAC blade

22

Laryngospasm is controlled by which nerve?

superior laryngeal nerve

23

“gold standard” for anticipated difficult airway

Flexible Fiberoptic Laryngoscopes (Bronchoscopes) 

24

What is accleromyography?

New gold standard 

- Uses force = Mass * acceleration

muscle force is directly proportional to muscle acceleration

***have to use adduct. Pollicis ==> extremity cant be immobile***

25

What kind of blade are these?

Miller

26

Optimal position for intubation

Ramped, sniffed position

28

What TOF ratio is considered adequate reversal?

At least .8 (.90 is better)

29

How to pick a ETT for pediatric patients?

– ID ~ Age divided by 4 + 4

– Compare diameter of ETT to pinky size

– Depth = ~ ETT size x 3 (4.0 X 3 = 12cm deep)

30

Pressure (BP) = ______ X ________

 Flow ( CO= HR X SV)

Resistance (SVR & PVR)

31

How is Oxygen Content of blood measured? 

(Hemoglobin X Saturation % X 1.34) + (PaO2 X 0.003)

32

MAP = _______ X ________

CO (SV * HR) x SVR

33

3 Factors that control Stroke Volume?

Preload

Afterload

Contractility

34

Best Indicator of Tissue perfusion?

 MAP

35

Pulse Pressure = ???

Systolic pressure - diastolic

(Reflects diff. in volume ejected from LV into arterial vessels and the volume already there)

36

Causes for Wide PP variation?

Sepsis

Atherosclerosis

37

Difference between manual BP measurements and Automated?

Automated measures MAP from MAX oscilation amp. and deduces systolic and diastolic 

(Diastolic P is the most unreliable measure w/ automatic)

MANUAL - uses Korotkov sounds to measure SBP & DBP

38

What happens when SBP is less than 80 w/ NIBP cuff? 

MAP is often overestimated

39

BP Cuff length and Width? 

Length = 80% circumference of arm

Width = 40% arm circumference

40

Reasons for Inserting Art line?

– Hemodynamic instability or predicted instability.

– Surgical procedure with antcipated significant blood loss or fluid shifts

– Monitoring of induced hypotension

– Monitoring response to vasoactive drugs

– NIBP is not feasible (burns, obese, shock)

– Repeated blood sampling 

41

What happens to Art lines as the are placed more distally?

greater distance from aortic arch = Higher SBP & greater variability

42

What always remains constant in dampened and hyperressonant Art line waveforms? 

MAP & DBP

43

a - atrial contraction, absent in a fib, larger in tricuspid stenosis, pulmonary stenosis and pulmonary HTN

• c – due to bulging of tricuspid valve into RA

• x - atrial relaxation

• v - rise in arterial P before tricuspid valve opens

• y - atrial emptying as blood enters ventricle 

44

Pulse Pressure variation level responsive to fluid?

Above 13

45

Fluid responsive Systolic Pressure Variation?

Above 10

46

How to deflate balloon during PA cath check?

Always deflate passively

47

Normal PA pressures & Wedge Pressures?

S - 15-30 mmHg

D - 5-15 mmHg

Wedge (PACWP) - 4-14 mmHg (true LV preload)

48

Lead II Covers? 

Lead V5 covers?

2 - Inferior portion of the heart supplied by the RCA

5 - Bulk of LV supplied by LAD 

(2 most common used leads in OR)

49

What major vessel is missed w/ just lead 2 & 5?

Circumflex artery - lead 1

50

Impedance Pnuemography?

Measures movement of the chest electrodes.

51

Difference in light absorbance between oxyHb & DeoxyHB?

OXY - absorbs more infrared Light (940nm) than red light

DEOXY (REDuced) - absorbs mre red light (660nm) than infrared light

52

If Saturation is at 85% regaurdless of changes in oxygen? 

Think - Methemoglobin - (benzocaine & Meth