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Intro To principles Of Anesthesia > Exam 2 Fall2 2023 > Flashcards

Exam 2 Fall2 2023 Flashcards

1
Q

What are examples of decreased pulmonary compliance?

A

Pneumothorax, pulmonary embolism, insufflation of the abdomen, Trendelenburg, tense, muscles, bronco construction 

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2
Q

What are two causes of increased PIP with unchanged plateau pressures

A

Increased inspiratory, gas flow
Increased airway resistance - kinked ETT, secretions, foreign body, aspiration, bronchospasm, airway compression, ETT cuff herniation 

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3
Q

On a flow loop, what direction would a spontaneous breath travel

A

Clockwise

The loop will also begin left of the Y access due to the initial negative pressure

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4
Q

True or false peep increases compliance?

A

True

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5
Q

Name contraindications to peep?

A

Tension pneumothorax
Hypovolemic shock
Bronco, plural fistula
High intracranial pressure
Right ventricular failure

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6
Q

What can detect early changes in breathing?

A

Listening with precordial or esophageal stethoscope

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7
Q

 what is the goal minute ventilation?

A

5 to 7 mL per kilogram, ideal body weight

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8
Q

How much lower should ETco2 be than PaCo2 in normal heart and lungs?

A

ETco2 should be 2-5 mmHg lower than PaCo2 in normal heart and lungs

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9
Q

On end tidal capnography, what does point D represent

A

End tidal CO2 that shows up on monitor

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10
Q

Describe phase, 1 of end tidal capnography

A

Includes points a and b
Exhalation of anatomic dead space

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11
Q

Describe phase 2 of end tidal capnography

A

Includes points, b and c
Exhalation of anatomic dead space and alveolar gas

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12
Q

Describe phase 3 of end tidal Capnography

A

Includes points, C and D
Exhalation of alveolar gas

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13
Q

Describe phase 4 of end tidal capnography

A

Includes points D and E
Inspiration of fresh gas that does not contain carbon dioxide

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14
Q

The alpha angle is measured where and what is the normal angle degree?

A

Measured at point C
Normal equals 100 to 110°

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15
Q

What are causes of increased alpha angle?

A

Expiratory airflow obstruction
COPD, bronco spasm, kinked ETT

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16
Q

Where is Beta angle measured and what is the normal angle degree?

A

Measured at point D
Normal angle is 90°

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17
Q

What are causes of increased beta angle?

A

Rebreathing
Faulty inspiratory valve

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18
Q

What is the formula for determining time left in a cylinder gas cylinder

A

Total tank capacity divided by total tank pressure multiplied by remaining given pressure equals liters left in tank. May need to divide this by liters per minute to get minutes remaining.

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19
Q

What is the color service pressure and capacity of an oxygen tank?

A

Oxygen tanks are green service pressure is 1900 psi, capacity, 660 L

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20
Q

What is the color service pressure and capacity of nitrous oxide cylinder?

A

Nitrous oxide is blue service pressure is 750 psi tank capacity is 1600 L

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21
Q

What is the cylinder color service pressure and capacity of a cylinder of air?

A

Cylinder color is yellow service pressure is 1900 psi cylinder capacity is 625 L

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22
Q

Name the five tasks of oxygen within the gas machine

A

1 flows to the fresh gas flow meter
2 powers, the oxygen flush
3 activates, failsafe mechanism
4 activates, oxygen, low pressure alarm
5 compresses the bellows of mechanical ventilators

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23
Q

What is the outside diameter of the common gas outlet? And what is the pressure delivered at the outlet?

A

Outer diameter is 22 mm pressure delivered at the outlet is 5-8 PSI

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24
Q

What is the most fragile part of the anesthesia machine?

A

Flow meters

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25
Q

Flow control valves regulate the amount of flow into what type of flow tube

A

Thorpe

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26
Q

Flow meters are located downstream from all safety devices and alarms, except

A

The oxygen analyzer

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27
Q

The flush valve is required by standard to deliver how many liters per minute

A

35 to 75 L per minute

28
Q

If flush valve is required to fill breathing circuit with oxygen, what phase of ventilation should this be down to prevent bot trauma?

A

Expiratory phase

29
Q

The flush valve delivers what quantity of O2 per minute

A

35 to 75 L per minute

30
Q

In the hypoxic guard, considering nitrous, oxygen and oxygen, what is the minimum oxygen, concentration and ratio

A

Minimum of, 23 to 25% oxygen three to one ratio

31
Q

There’s only one system that determines that oxygen is present what is it?

A

Inspired oxygen analysis

32
Q

What are the two types of sensors in current use?

A

Electro, chemical, galvanic, fuel cell and paramagnetic analyzer

33
Q

The tech six is heated to what degree Celsius producing a vapor pressure of approximately 1500 mmHg

A

Heated to 39°C

34
Q

The low pressure systems consist of

A

Includes the vaporizer, common gas, outlet, manifold, check valves. Low pressure is 16 psi and is the pressure after the second stage regulator. It begins at the flow meter and ends at the common gas outlet.

35
Q

Intermediate pressure begins and ends where

A

Begins at the pipeline ends at flow meter valves

36
Q

High-pressure begins and ends where

A

Begins at the cylinder, ends at the cylinder regulator

37
Q

What does low pressure leak test evaluate

A

Integrity of the machine from flow control valves to the common gas outlet

38
Q

Barrel trauma risk increases when plateau pressure exceeds

A

35 cm/H20

39
Q

Define plateau, pressure and when it is measured

A

The pressure in the small airways and LØVË after target title volume is delivered. It is measured during inspiration pause, and there is no airflow so airway resistance does not affect plateau pressure.

40
Q

Increased peak, inspiratory, pressure and increased. Plateau pressure is a result of decreased compliance, causes of decreased compliance.

A

Endo bronchial intubation
Pulmonary edema
Pleural effusion
Tension pneumothorax
Atelectasis
Chest wall
Abdominal insufflation
Ascites
Trendelenburg position
In adequate muscle relaxation

41
Q

Increased positive inspiratory pressure with no change in plateau pressure can result from resistance has increased, or inspiratory. Flow rate has increased what are examples of increased resistance

A

Kinked and endotracheal tube
Endotracheal tube, cough, herniation
Bronco spasm -think of white bronco OJ resistance
Bronchial secretions
Compression of the airway
Foreign body aspiration

42
Q

On capnography an increased, alpha angle suggests what

A

Expiratory airway obstruction

43
Q

In capnography an increased beta angle, suggest what

A

Rebreathing due to a faulty inspiratory valve

44
Q

What are the two methods of carbon dioxide analysis?

A

Mainstream in line
Sidestream diverting

45
Q

At what point in the cap graph is entitle carbon dioxide measured

A

Point D, which is the beta angle and beginning of inspiration

46
Q

On the cap graph phase 1 which is point A to point B what is happening?

A

Exhalation of an anatomic dead space

47
Q

On the cap Graff phase 2, which is represented by points B to see what is happening

A

Exhalation of anatomic, dead space, and alveolar gases

48
Q

On the cap graph phase 3, which is also points C an D what is happening?

A

This is exhalation of LVL our gas, and also were entitled CO2 measurement takes place

49
Q

On the cap graph phase 4, which is also points D and E what is happening?

A

Inspiration of fresh gas that does not contain carbon dioxide. This is also where beta angle is.

50
Q

What is normal angle of the alpha angle at point C

A

100 to 110° an increase suggest obstruction

51
Q

Where is the beta angle measured?

A

Point D

52
Q

The beta angle is normally a 90° angle. What does an increased angle suggest?

A

Rebreathing typically from a faulty inspiratory valve

53
Q

On the capnography, how will airflow obstruction look and water examples of what caused this

A

Prolonged up, stroke with increased alpha angle
COPD, bronco spasm, kinked, ETT

54
Q

What are causes of cardiac oscillations on capnography?

A

Caused by the heart beating against the lungs, more common and children, because they heart is close to the lungs

55
Q

What does cure rare cleft capnography look like and what causes this?

A

Normal alphabet angles, with a slight indentation just before the beta angle from spontaneous breaths during mechanical ventilation, suggest inadequate muscle relaxant reversal, or a lack of synchronization between intercostal muscles and diaphragm

56
Q

On capnography, what does low entitle CO2 appear like and water causes

A

Plateau phase as well below normal caused by hyper ventilation, decreased carbon dioxide production or increased LVL, our dead space, examples, light, anesthesia, metabolic, acidosis, hypothermia, hypotension, pulmonary embolism

57
Q

What does elevated entitle CO2 with normal plateau look like on capnography and what are examples or cause?

A

Be sure to look at baseline. It returns to zero so it is not considered rebreathing. It’s either caused by increased carbon dioxide production or decreased LVL ventilation causes are MH, sepsis, fever, hyperthyroidism, hypo, ventilation, narcotics.

58
Q

On capnography inspired carbon dioxide what does it look like and what are causes?

A

Look at the baseline it does not return to zero. This is rebreathing carbon dioxide causes exhausted, absorbent, incompetent expiratory valve hole in the inner tube of vein in adequate Mapleton circuit or rebreathing, under drapes of a patient not intubated.

59
Q

On the cap ground, what does incompetent inspiratory valve look like?

A

It looks more like a ski hill on expiration. There’s a widened beta angle part of the exhale breath. Re-enters the respiratory limb.

60
Q

On capnography, what does a leak in sample line during positive pressure ventilation look like

A

Normal with a knob at the end right before inspiration, positive pressure during inspiration pushes the CO2 rich gas through the sample line, which results in the peak

61
Q

On capnography explained by phasic expiratory plateau what does this look like what causes it?

A

There is a big valley in the middle. It’s caused after a single lung transplant valve or gas from the transplanted long and the disease long have different time constants there are two peaks one for each lung

62
Q

Name three causes of increased entitle CO2

A

Increased CO2 production and delivery to the lungs, such as MH thyrotoxicosis and tourniquet removal
Decreased LVL ventilation, such as CNS, depressant drugs, COPD, residual, neuromuscular, blockade
Equipment malfunction, CO2, absorbent, exhaustion, unit, directional valve, malfunction, increase dead space

63
Q

What are causes of decreased entitle CO2?

A

Decreased CO2 production and delivery to the lungs, hypothermia, decreased cardiac output, VQ mismatch, pulmonary embolus

Inadequate anesthesia
Equipment, malfunction, esophageal, intubation, poor seal with an LMA, sample line leak

64
Q

What is the best Mapleton circuit for spontaneous ventilation and what is the worst?

A

Best is a worst is B all dogs bite

65
Q

What is the best and worst Mapleton circuits for controlled ventilation

A

Best is D and worst is a don’t be arrogant

Intro To principles Of Anesthesia (2 decks)

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