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Equipment & Monitoring Flashcards

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1
Q

What components are present in the high pressure system of the AGM? What is the gas pressure?

A

-Hanger Yoke
-Yoke block w/check valves
-Cylinder Pressure Gauge
-Cylinder pressure regulators
Gas pressure = cylinder pressure

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2
Q

What components are present in the intermediate pressure system of the AGM? What is the gas pressure?

A

-Pipeline inlets
-Pressure gauges
-Ventilator power inlet
-Oxygen pressure failure system
-Oxygen second-stage regulator
-Oxygen flush valve
-Flowmeter valve

Gas pressure = 50 PSI (pipeline) and 45 PSI (cylinder)

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3
Q

What are the components of the low pressure system?

A

Flowmeters
Vaporizers
Check valves (if present)
CGO

Gas pressure = slightly above atmospheric pressure

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4
Q

What are the 5 tasks of oxygen in the AGM?

A

-O2 pressure failure alarm
-O2 pressure failure device (failsafe)
-O2 flowmeter
-O2 flush valve
-Drives the ventilator

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5
Q

What are the maximum pressures and volumes for cylinders?

A

Air = 1,900 PSI and 625 L
Oxygen = 1,900 PSI and 660 L
Nitrous Oxide = 745 PSI and 1590L (20.7 lb when full, 14.1 lb when empty)

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6
Q

List 3 safety relief devices that prevent a cylinder form exploding when the ambient temperature increases

A

-Never expose to temps > 130F (57C)

  1. Fusible Wood’s plug that melts at high temperatures
  2. Frangible disk that ruptures under pressure
  3. Valve that opens at elevated pressures
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7
Q

Give 4 examples of how the hypoxia prevention safety device (proportioning device) can allow for a hypoxic mixture

A
  1. Pipeline crossover
  2. Leak distal to flowmeter valves
  3. Admin of a 3rd gas
  4. Defective mechanic or pneumatic components
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8
Q

Oxygen pressure failure device

A

-Failsafe
-Shuts off nitrous when oxygen drops below 20 PSI

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9
Q

Describe the structure and function of the flowmeters

A

Variable orifice constant flow
-The annular space is the space between the indicator float and the side wall of the flow tube. It is narrowest at base, and widest at the top

-Base = laminar flow (Poiseulle) based on viscosity
-Top = turbulent flow (Graham) based on density

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10
Q

An AGM uses FGF coupling .. how do you determine total TV that will be delivered to patient

A
  1. Convert FGF to mL/m
  2. Multiple mL/m x I:E ratio
  3. Calculate MVe
  4. Add MVe plus the #2
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11
Q

When using a ventilator that couples FGF to TV, what types of ventilator changes will impact the Tv delivered to the patient

A

Vt increases with: decreased RR, increased I:E ratio (1:1), increased FGF, increased bellows height

Vt decreases with: increased RR, decreased I:E ratio (1:2), decreased FGF, decreased bellows height

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12
Q

What does the oxygen analyzer measure, and where is it located?

A

Monitors oxygen concentration and is the only device downstream of the flowmeters that can detect a hypoxic mixture.

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13
Q

Oxygen flush valve

A

35 - 75 LPM
50 PSI

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14
Q

Describe the function of the ventilator spill valve in relation to using the O2 flush valve

A

The spill valve is closed during inspiration so if you press the oxygen flush valve during inspiration … the patient is at high risk for barotrauma

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15
Q

What is desiccation

A

Water is required to facilitate the reaction of carbon dioxide with CO2 absorbent. The granules are hydrated to 13 - 20% by weight. When the absorbent is devoid of water, it is desiccated.

It produces carbon monoxide des > iso > sevo and compound a with sevo

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16
Q

What are the OSHA recommendations regarding inhalation anesthetic exposure

A

Halogenated agents alone < 2 ppm
Nitrous oxide alone < 25 ppm
HA + NO < 0.5 and 25 ppm

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17
Q

Which mapleson circuit is most efficient for spontaneous ventilation? Which one for controlled Ventilation?

A

Spontaneous
A > DFE > CB

CMV

DFE > BC > A

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18
Q

What conditions decrease pulmonary compliance? How does this affect the peak pressure and plateau pressure?

A

D/t decreased static compliance (PIP and PP increase)

-endobronchial intubation
-pulmonary edema
-pleural effusion
-tension pneumothorax
-atelectasis
-chest wall trauma
-abd. insufflation
-ascites
-t-burg

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19
Q

What conditions increase pulmonary resistance? PP vs PIP

A

D/t reduction in dynamic compliance (PIP increases, PP unchanged)

-kinked ETT
-ETT cuff herniation
-Bronchospasm
-Secretions
-Airway compression
-Foreign body aspiration

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20
Q

Describe the four phases of normal capnograph

A

1 = exhalation of anatomic dead space
2 = exhalation of anatomic dead space and alveolar gas
3 = exhalation of alveolar gas
4 = inspiration of fresh gas that does not contain CO2

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21
Q

Describe the significance of the alpha and beta angles on the capnograph

A

Alpha = resistance. airflow obstruction. COPD, bronchospasm, kinked ETT
Beta = increased with some breathing

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22
Q

Pulse oximeter basics

A

Beer Lamber Law
660 nm (deoxyHgb)
940 nm (oxyHgb)

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23
Q

What conditions impair the reliability of pulse oximeter

A

Vasoconstriction, hypothermia, reynaud’s
carboxyhgb (absorbs 660nm same degree as oxygenated Hgb)
metHgb (absorbs 660 and 940 equally)
methylene blue, indocyanine green, indigo carmine
CPB, LVAD

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24
Q

What affects the accuracy of the NIBP cuff

A

Length = 80%
Width = 40%

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25
Falsely increased BP
BP cuff too small BP cuff too loose Below level of the heart
26
Falsely decreased BP
BP is too large Deflated too rapidly Above level of the heart
27
How does the site of measurement affect BP monitoring
As the pulse moves from the aortic root toward the periphery, the systolic pressure increases, the diastolic pressure decreases, and the pulse pressure widens. MAP remains constant throughout the arterial tree *At aortic root, SBP is the lowest, DBP is the highest, PP is the most narrow *At dorsalis pedis, SBP is the highest, DBP is the lowest, PP is the most wide
28
How does the arm position affect NIBP?
Located above the heart, BP reading will be falsely decreased Located below the heart, BP reading will be falsely increased *For every 10 cm, BP changes by 7.4 mmHg *For every inch, BP changes by 2 mmHg
29
Systolic BP = what on an a-line
Peak of waveform Diastolic = trough
30
Contractility on an a-line is measured by? Stroke volume?
Upstroke SV = AUC
31
Damping and interpretation of the high pressure flush test
High pressure flush helps us determine this when we observe oscillations that result -Optimally dampened = 1 oscillation -Under dampened = Lots of oscillations (SBP overestimated, DBP underestimated) -Over dampened = No oscillations (SBP underestimated, DBP overestimated) d/t air bubble, clot, low flush bag pressure
32
How do you determine the appropriate distance to thread a central line
1. Distance from site of entry to vena cava 2. Distance from VC junction to where catheter tip should be placed 3. Add them together
33
Insertion site to the vena cava
Subclavian = 10 cm IJ right = 15 cm IJ left = 20 cm Femoral = 40 Median basilic rt, lt (40,50)
34
VC --> Catheter tip
Right atrium = 0 - 10 cm RV = 10 - 15 cm PA = 15 - 30 cm PAOP = 25 - 35 cm
35
Discuss the 3 waves, 2 descents on CVP tracing
a = RA contraction c = tricuspid valve elevation into RA (after QRS) x = downward movement of contracting RV (ST) v = RA passive filling (T wave) y = RA empties through tricuspid valve
36
when do you lose an a wave on the cvp
a fibb, v-pacing w/underlying asystole
37
what causes an increased a wave on cvp
stenosis MI chronic lung dx = RVH av dissociation junctional rythm PVCs
38
What causes a large v wave on cvp
tricuspid regurg increase in intravascular volume rv papillary muscle ischemia
39
where should the tip of the PAC locate
west zone 3 part > p venous> p alveolus
40
equation for mixed venous oxygen saturation
sao2 - vo2/ (q * 1.34 * hgb * 10)
41
What are the 12 leads
Bipolar (3) I - III Limb (3) avr, avl, avf Precordial (6) v1-v6
42
Name the region of the heart & leads
II, III, avf = inferior, RCA I, avL, v5, v6 = lateral, circumflex v1 - v4 = LAD V1 & V2 (septum) V3 & V4 (anterior)
43
right axis deviation
anything with the lungs
44
left axis deviation
chronic HTN LBBB As AI MR
45
Class IA, IB, IC antiarrythmics
Na Channel Blockers IA = quinidine, procainamide, disopyramide *moderate depression of 0, prolongs phase 3 repolarization* IB = Lidocaine, Phenytoin *shortened phase 3 repol* IC = flecainaide, propaferone *strong depression of phase 0*
46
Class II antiarythmics
BB - slows phase 4 depolarization in the SA node
47
Class III antiarythmics
K Channel BLockers Amio, Bretyium Prolongs phase 3 repolarization (prolongs QT) increases effective refractory period
48
Class IV antiarrythmics
Ca Ch Blockers Decreasing conduction velocity through AV node Verapamil, Diltiazem
49
EKG findings w/WPW
Delta wave d/t ventricular preexcitation Short PR interval < 0.12 seconds Wide QRS Possible T wave inversion
50
What conditions increase the risk of torsades de pointed?
POINTES P = phenothiazines O = Other meds (methoadone, droperidol, amio) I = ICH N = No known cause E = electrolytes ... low K, Ca, Mg S = syndromes (romano-ward, timothy)
51
Five indications for cardiac pacemaker insertion
Symptomatic diseases of impulse formation (SA node disease) Symptomatic diseases of impulse conduction (AV node disease) Long QT syndrome Dilated CM Hypertrophic obstructive cardiomyopathy
52
Pacemaker identification code
1 = chamber paced 2 = chamber sensed 3 = response to sensed event 4 = programmability 5 = can peace multiple sites
53
What conditions increase the risk of failure to capture?
Potassium high or low Low CO2 (intracellular K+ shift) Hypothermia MI fibrotic tissue around pacing leads
54
Cerebral oximetry utilizes NIRS
-CBV = 1 part arterial to 3 parts venous, 75% of the blood in the brain is on the venous side of circulation -NIRS cannot detect pulsatile blood flow, it is primarily a measure of venous oxyhemoglobin saturation and oxygen extraction -greater than 25% change in baseline = reduction in cerebral oxygenation
55
Beta waves
high frequency low voltage awake mental stimulation or light anesthesia
56
Alpha waves
awake, but restful state
57
Theta
GA and normal sleep with kids
58
Delta
GA, deep sleep, brain ischemia or injury
59
Burst suppresion
GA, hypothermia, CBP, cerebral ischemia
60
GA and brain waves
increased beta wave theta, delta waves predominate during GA deep GA produces burst suppression 1.5 - 2 MAC = complete suppression
61
name 2 drugs that reduce the reliability of the BIS value
nitrous oxide (increaases the amplitude of high-frequency activity and reduces the amplitude of low frequency activity) ketamine increases high frequency amplitude
62
Macro vs micro shock
Macro = large current, external surface of the body. Skin offers high resistance so it takes a larger current to induce ventricular fibrillation Micro = small current, directly to myocardium
63
Thresholds for macro/micro shock
Macro 1 mA = perception 5 mA = harmless threshold 10 - 20 mA = let go current 50 mA = LOC 100 mA = vfibb Micro 10 microamps = max allowable in OR 100 microamps = vfibb
64
What is the role of the line isolation monitor?
Assesses the integrity of the ungrounded power system in the OR. Tells you how much current could flow through you if a second fault occurs *Alarms when 2 - 5 mA is detected* Unplug your last equipment you plugged in if it alarms!!

APEX (18 decks)

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