Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles of Anesthesia 1 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

where is precordial stethoscope placed

A

4th intercostal space and LEFT sternal border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

is Vt based on IDEAL body weight

A

yes (6-8ml/kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

low BLOOD O2

A

hypoxEMIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

low TISSUE oxygen

A

hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

oxygen consumption

A

VO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

oxygen delivery

A

DO2
(DO2 tissue is MORE important than DO2 lung)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

 Low inspired oxygen (FiO2)
 Hypoventilation
 V/Q mismatch leading to shunt
 Diffusion limitations

A

HYPOXEMIC hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Not enough Hgb hypoxia

A

ANEMIC hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Decreased release of O2

A

AFFINITY hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Not enough cardiac output

A

CIRCULATORY hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cell won’t accept the delivery of the O2

A

HISTIOCYSTIC/O2 utilization hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when are you more likely to illustrate cyanosis

A

with HIGH hgb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

does an increase in CO2 cause decrease in O2

A

YES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If SpO2 is near 100% then increasing FiO2 will have ________ effect on DO2

A

little effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the wavelengths for pulse ox

A

660nm
940nm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what cause false LOW pulse ox readings

A

Excessive motion
Blue nail polish
Anemia (low Hgb concentration)
SpO2 < 60%
Improper fitting probe
MetHgb similar to Hgb; if SaO2 (actual oxygen saturation) GREATER than > 85% then SpO2 will show low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what causes dramatically LOW pulse ox

A

IV methylene blue dye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what causes falsely HIGH pulse ox

A

Ambient fluorescent light
Carbon monoxide poisoning
MetHgb similar to Hgb; if SaO2 (actual oxygen saturation) LESS than < 85% then SpO2 will show high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is most accurate spo2 location

A

cheek

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

decreased CO2

A

Hyperventilation: too much elimination
Hypotension
Decreased CO
R to L pulmonary shunt
Hypothyroidism
Hypothermia
Paralysis, motionless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

examples of obstructive issues

A

COPD, bronchospasm, asthma, cystic fibrosis

looks like a “sharks fin”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the issue with capnography for non-intubated patients

A

no plateau phase, not accurate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the measurement for STATIC lung compliance

A

plateau pressure (end inhalation prior to exhalation)

ALWAYS lower than peak pressure

MORE accurate than dynamic compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

STATIC lung compliance:
Indicates compliance ___________ resistance

A

Indicates compliance WITHOUT resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Measures lung compliance + airway resistance

A

DYNAMIC lung compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the measurement for DYNAMIC lung compliance

A

peak pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pip – plateau pressure =

A

resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

increased PiP withOUT plateau pressure increase?

A

issues with the tube, secretions, foreign body

increased inspiratory gas flow rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Effort INdependent

Most objective measurement of airway resistance for medium airways

Most sensitive indicator of obstructive disease

Normal: 4-5L/sec

A

Forced Expiratory Flow (FEF) between 25% and 75% of exhaled breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Spirometry measures lung _________, __________, and _______

A

lung volumes, capacities, and flows

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

o Helps identify airway resistance
o Normal: at least 80% of vital capacity

A

Forced Expiratory Volume over one second (FEV1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

o Declines with age
o Normal: at least 80%

A

Forced Expiratory Volume/Forced Vital Capacity (FVC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Forced expiratory volume 40%

A

obstructive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

forced expiratory volume 90%

A

restrictive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

forced expiratory volume 80%

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

difficulty getting air OUT of the lungs

A

obstructive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

difficulty getting air INTO the lungs

A

restrictive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Enlarged TLC, RV, FRC
Reduced ERV

A

obstructive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

FEV1/FVC ratio preserved
Reduced TLC, FRC, RV, FVC & FEV1

A

restrictive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

loop looks like upside down ice cream cone*

A

NORMAL (FLOW volume loop)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

smaller, normal FLOW volume loop shape

A

restrictive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q
  • Shape is caved in which indicates expiratory obstruction
  • Lung volumes are larger
  • Flows are reduced
  • FLATTER, LESS ROUND shape as air flow is impeded
A

obstructive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Analyzing shapes and steepness

Indicator of lung compliance (distensibility)

Yields info regarding leaks, lung over-inflation and obstruction

A

PRESSURE volume loops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

pressure volume loop:

during mechanical/positive pressure ventilation

A

COUNTER-clockwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

pressure volume loop:

during spontaneous ventilation

A

CLOCKWISE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

pressure volume loop:

Higher pressure moves loop farther ______

A

RIGHT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

pressure volume loop:

Flatter slope = ______________ compliance

A

DECREASED compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

pressure volume loop:

Steeper slope = _____________ compliance

A

INCREASED compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

flow volume loop:

moves in ______________ direction

A

clockwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

2 examples of fixed obstruction

A

tumor, tracheal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Expiration and inspiration constant

A

fixed obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

inspiration: airway narrows
expiration: opens
(milkshake!)

A

EXTRAthoracic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

inspiration: opens airway
expiration: narrows

A

INTRAthoracic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

example of restrictive disease

A

pulmonary fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

electrolytes:

hyperreflexia
hypotension after induction
ataxia
seizures

A

HYPERnatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

electrolytes:

decreased reflexes
seizures
lethargy

A

HYPOnatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

electrolytes:

too rapid a correction leads to demyelination of pontine neurons*

associated with 3% hypertonic saline

A

central pontine myelinolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

electrolytes:

prolonged PR interval
peaked T wave

A

HYPERkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

electrolytes:

Avoid HYPOventilation (acidosis)
for every 10-mmHg change in EtCO2 the ___+ changes 0.5 mEq

A

potassium
hyperkalemia dont hypoventilate!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

electrolytes:

high U waves
flattened or inverted T waves
low ST segment
digoxin toxicity

A

HYPOkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

electrolytes:

avoid HYPERventilation (alkalosis) with ________________

A

HYPOkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

electrolytes:

DECREASED reflexes
lethargy
confusion

(breast cancer + hyperparathyroidism)

A

HYPERcalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

electrolytes:

INCREASED reflexes
tetany, twitching, tingling lips and fingers
laryngospasm

A

HYPOcalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

electrolytes:

associated with alkalosis, hypoparathyroid

A

HYPOcalcemia
(avoid hyperventilation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

electrolytes:

relaxes muscles

A

HYPERmagnesia + HYPOmagnesia
use nerve stimulator always!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

electrolytes:

lethargy
(preeclampsia)

A

HYPERmagnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

electrolytes:

Poor GI absorption, dialysis, ETOH

A

HYPOmagnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

drugs that cause HYPOkalemia

A

-beta adrenergic agonists
-catecholamines (epi, norepi)
-insulin
-loop diuretics
-thiazide diuretics
-aminoglycosides
-mineralcorticoids (aldosterone)
-AT II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

drugs that cause HYPERkalemia

A

-NSAIDS
-Sch
-digoxin
-ACE inhibitors
-beta blockers
-potassium sparing diuretics
-AT II blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

SV / (divided by) end diastolic volume

A

EF
(normal is 55% or greater)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

normal SVO2

A

70-80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

calcium = ___________ potential

A

threshold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

potassium = _____________ potential

A

resting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what impacts SVO2 (4)

A

o Oxygen consumption (VO2)
o Hemoglobin level (Hgb)
o Cardiac Output (CO)
o Arterial oxygen saturation (starting) (SaO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

SVO2 varies ___________ with VO2 (oxygen consumption)

A

inversely!
as VO2 increases, SVO2 decreases

(all the others are directly related)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

decreased SvO2

A
  • Increased VO2 (fever, hyperthermia)
  • Decreased Hgb (anemia, hemolysis)
  • Decreased SaO2
  • Decreased CO (ex: MI, CHF, hypovolemic states)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

increased SvO2

A
  • Decreased VO2 (cyanide toxicity, carbon monoxide poisoning, hypothermia, sepsis)
  • Increased Hgb (volume depleted)
  • Increased SaO2
  • Increased CO (burns, inotropic drugs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

CBF = ____–____ ml/100 gm/min = ISOELECTRIC EEG (internal cell)

A

15-20 ml/100 gm/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

CBF < ____ ml/100 gm/min = ↓ cell integrity =

A

<10 = irreversible injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

CBF < ____ ml/100 gm/min = __________ of EEG

A

< 25 = slowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Cerebral perfusion pressure < ___ torr

A

<50 CPP= changes in EEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

cerebral perfusion pressure < ___ torr

A

<25 CPP = irreversible damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

torr =

A

pressure (associated with CPP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

anesthesia= _______________ changes

A

anesthesia= symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

ischemia= ________ and ______________ changes

A

focal and Asymmetric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Fast activity, alert, eyes open, concentrating, anxious or busy thinking

A

beta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Normal, resting, relaxed, awake adults

A

alpha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Slow activity, considered abnormal in awake adults; subcortical lesions and encephalopathy

Normal in young children

A

theta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

slowest, subcortical lesions and encephalopathy, hydrocephalus

Normal in babies

A

delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

SLOWEST frequency and highest amplitude

A

delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

FASTEST frequency and lowest amplitude

A

beta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

accentuate frequency, then decrease it

A

Barbiturates and Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

slow frequency, increase amplitude (delta)

A

opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

both frequency and amplitude are attenuated (slowed)

A

inhalation anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

flat line EEG associated with anesthesia

indicative of decreased metabolic oxygen demands and neuroprotective qualities

(good thing!)

A

isoelectric state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Conscious recall or remembering exact events of previous experiences

A

explicit memory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Movement and ability to respond to commands without specific conscious recall of events (“awareness without recall”)

A

implicit (unconscious) memory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Also known as “recall”
consciousness (explicit memory) under general anesthesia with subsequent RECALL of the experienced events

A

awareness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Paralysis of un-anesthetized patients occurring when patients are given NMBs prior to anesthesia (out of sequence, mislabeling)

A

awake paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

surgeries with the highest risk of recall?

A

trauma&raquo_space;> cardiac surgery&raquo_space; c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

to be a part of anesthesia awareness registry, you must experience _________ recall during general anesthesia

A

explicit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

true or false
NO signs are reliable indicators of “light” anesthesia

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

what are the drugs that can mask signs of awareness during surgery

A
  • 1st: NMBs
  • Blockage of physiological responses
    o Amphetamines
    o Beta blockers
    o Calcium channel blockers
  • High levels of vitamin C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

to have NO awareness during surgery:

volatile anesthetic at > ____ MAC

A

> .7
(.5-.7)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

5 questions used to assess awareness event:

A

What was the last thing you remember before you went to sleep?

What is the first thing you remember after your operation?

Can you remember anything in between?

Can you remember if you had any dreams during your procedure?

What was the worst thing about your procedure?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Burst suppression: EEG _______ to random burst of electrical activity

A

EEG SLOWS to random burst of electrical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

4 benefits of BIS monitoring

A

Reduction of PONV

Utilization of less drug to achieve a hypnotic state (save money)

Rapid emergence and recovery from general anesthesia (more efficient)

Improved quality of recovery, reduced PACU length of stay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

when is BIS required*

A

TIVA (use of propofol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

when is BIS indicated

A

Hemodynamically sensitive patients (trauma, elderly, etc.)

ECT (monitoring of sub-clinical seizure activity)

TIVA (use of propofol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

BIS**

recall

A

> 70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

BIS**

general anesthesia

A

40-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

BIS**

burst suppression

A

20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

BIS**

flat line EEG (good neuro protection + reduced demand for oxygen)

A

0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

true or false

Do NOT rely on just a single monitor to test awareness

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what can alter BIS value (7)

A

Hypothermia
shivering
warming blankets
head trauma
patient positioning
unipolar cautery
ketamine + nitrous (can INCREASE BIS value)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what does a Signal Quality Indicator (SQI) of 100 indicate

A

optimal, “perfect” signal, believe the BIS number

117
Q

Electrical signals produced in response to various stimuli by the CNS

Neuronal pathway dysfunction can be identified

A

evoked potentials

118
Q

Analysis of raw EEG data to derive a formula-driven numerical value indicative of LOC

A

BIS

119
Q

Evoked potentials:

An INCREASE in latency: occurs _____ often (more time between spikes)

A

increase in latency = occurs LESS often

120
Q

evoked potentials
described by (3)

A

latency
amplitude
site of stimulus

121
Q

evoked potentials
Somatosensory (SSEP)

A

Afferent signaling = dorsal

Brainstem Auditory: clicking sounds send auditory nerve signal (CN #8)

122
Q

evoked potentials
Motor (MEP)

A

Generally inaccurate, less utilized

Giving so much anesthetic to keep patient from moving without NMBs

Efferent signaling = ventral (corticospinal tracts)

123
Q

evoked potentials

true or false
You CANNOT use NMBs with MEPs

A

true
it interferes with signal

124
Q

four types of evoked potentials

A

Somatosensory
motor
auditory
visual

125
Q

evoked potentials

IV anesthetics affect SSEP ______ than < inhaled anesthetics

A

IV anesthetics affect SSEP LESSSSSSS than inhaled

inhaled&raquo_space; bigger impact than IV

126
Q

Volatile anesthetics produce an _________ in SSEP latency and ___________ in amplitude (slow spikes, less tall)

A

increase in latency
decrease in amplitude

127
Q

Etomidate and Ketamine __________ SSEP amplitude

A

increase amplitude

128
Q

Nitrous ____________ SSEP amplitude

A

decreases amplitude

129
Q

Reductions in blood flow ____________ SSEP

A

decrease

130
Q

Opioids have ____ ________ on SSEP amplitude

A

no effect

131
Q

cerebral oximetry looks at ____ __________, _________ blood flow

A

NON-pulsatile
venous blood flow

132
Q

when should you attach a patient to cerebral oximetry

A

BEFORE giving oxygen (so you have a baseline)

133
Q

cerebral oximetry

Regional sat < ____% or changes > ____% of baseline indicate possible reduction in cerebral oxygen

A

regional < 40%
>25% baseline

134
Q

If cerebral oximetry goes down, increase the ETCO2 to >_____ mmHg by hypoventilating the patient**

A

> 40

hypoventilation (acidosis)
causes cerebral vasodilation

135
Q

Guedel’s Stages of Anesthesia

analyzes ____, ________, and __________ used for respiration

A

rate, rhythm, and muscles used

136
Q

Guedel’s Stages of Anesthesia:

Analgesia and Disorientation (in pre-op holding)

A

stage 1

137
Q

Guedel’s Stages of Anesthesia*

“Ether eye signs”: gaze becomes disconjugate

A

stage 2

138
Q

Guedel’s Stages of Anesthesia*

Laryngospasm, HYPERreflexia,
delirium, agitation, excitement, irregular breathing, apnea, thrashing

A

stage 2

139
Q

Guedel’s Stages of Anesthesia

Occurs during both induction + emergence (worst during EMERGENCE)

A

stage 2

140
Q

Guedel’s Stages of Anesthesia:

EYELID reflex eliminated
Regular respirations + normal muscle tone

A

Plane 1, stage 3

141
Q

Guedel’s Stages of Anesthesia:

LARYNGEAL reflex eliminated (no gag, intubate)
Volume reduced + rate increased

A

plane 2, stage 3 (ideal stage)

142
Q

Guedel’s Stages of Anesthesia:

CARINAL reflex eliminated
onset of intercostal muscle paralysis

A

plane 3, stage 3 (ideal stage)

143
Q

Guedel’s Stages of Anesthesia:

INTERCOSTAL paralysis complete (respirations eliminated)

A

plane 4, stage 3

144
Q

Guedel’s Stages of Anesthesia:

Medullary paralysis (moribund)
Progressive cardiovascular collapse (way too deep)

A

stage 4

145
Q

Guedel’s Stages of Anesthesia:

ideal stages

A

plane 2 and plane 3 (of stage 3)

146
Q

Tissue stress is directly related to ____ and applied __________

A

Vt + pressure

147
Q

anesthesia leads to
_____________ FRC, compliance, and muscle tone and
_____________ resistance

A

decreased FRC, compliance, muscle tone

increased resistance

148
Q

Causes of Ventilator-Induced Injury:

Overdistention (volume) of alveoli

A

VOLUtrauma

149
Q

Causes of Ventilator-Induced Injury:

Excessive pulmonary pressures

A

BAROtrauma

150
Q

Causes of Ventilator-Induced Injury:

Repeated opening and collapse of atelectatic lung units (derecruitment)

A

ATELECtrauma

151
Q

Causes of Ventilator-Induced Injury:

Inflammatory mediator release into alveoli and surrounding bronchiole spaces
(can be caused by the atelectrauma, volutrauma, barotrauma)

A

BIOtrauma

152
Q

what is the range for mild/permissive hypercarbia (to protect the lungs)

A

pCO2 40-45 mmHg

153
Q

Compliance is __________ at the ______________ of inspiration*

A

compliance is GREATER at the BEGINNING of inspiration
(think of a balloon)

154
Q

Beginning of inspiration=_____ pressure=high compliance=_____ flow

A

low pressure=high flow

155
Q

Vt / plateau pressure – PEEP**

A

compliance

156
Q

Increased airway resistance contributes to a ____________ in dynamic compliance*

A

decrease in DYNAMIC compliance

157
Q

Decreased COMPLIANCE = increased plateau pressure = increased _________ pressure*

A

driving pressure

158
Q

Increased resistance = ____________ peak pressure*

A

increased PiP

159
Q

Pplat (plateau pressure) – PEEP**

A

driving pressure

160
Q

The LOWER the driving pressure, the ___________ the pulmonary compliance
(this is a good thing)

A

greater the compliance

161
Q

increase in PEEP = ___________ in driving pressure

A

decrease in driving pressure!

162
Q

increase in fresh gas flow = ____________ in Vt, MV, and PiPs

A

increase!
*unless using a ventilator compensator

163
Q

Disconnect= immediately falls flat*
Small leak= gradually descends*

A

ascending/standing bellows

164
Q

disconnect=still filled*

ascend during inspiration
descend during expiration

less safe

A

descending/hanging bellows

165
Q

initial ventilator settings:

RR: ___-___ bpm

Vt: ___-___ ml/kg ideal body weight

PiP: < ____ cmH2O

Driving pressures: < ___ cmH2O

PEEP: ___-___ (2-3 from bellows weight)

FiO2: ___-___%

I:E Ratio: __:__

A

RR: 8-12 bpm

Vt: 6-8 ml/kg ideal body weight

PiP: < 30 cmH2O

Driving pressures: < 15 cmH2O

PEEP: 4-5 (2-3 from bellows weight)

FiO2: 40-50%

I:E Ratio: 1:2

166
Q

what is the SAFEST way to increase MV

A

increase in RR

167
Q

what is the most EFFICIENT way to increase MV

A

increase in Vt

168
Q

Vt – _________ ____________ = what is delivered to the patient

A

Circuit Compliance

  • Historically: around 100ml
  • Present day: around 35-40ml
169
Q

What is the PAO2 in a patient who is breathing room air and pCO2 is 80 mmHg?

A
  • Lower (around 40-50 mmHg)
170
Q

The “higher” the I:E ratio, the _____________ the inspiratory time=________ driving pressure**

A

the higher I:E, the GREATER the inspiratory time, the LOWER the driving pressure

171
Q

Longer expiratory phase=____________ in ETCO2

A

reduction

172
Q

Increase in respiratory rate=____________ pressure and flow

A

increase

173
Q

Increase in inspiratory flow=___________ in I:E ratio

A

decrease

174
Q

If you are using pressure control ventilation and compliance changes from low to high how will volume change?

A

volume will increase

175
Q

ventilator modes:

Most common
Rate can change
Constant flow
PiP/pressure will vary
Barotrauma can occur

A

VOLUME controlled ventilation

176
Q

ventilator modes:

Indication
Patients with no respiratory effort

A

Volume control

177
Q

ventilator modes:

Indications
LMA, emphysema, neonates, children
Low lung compliance
Laparoscopy, pregnancy, children, ARDS, obesity

A

pressure control

178
Q

ventilator modes:

Vt can vary
Varying/decelerating flow
Mandatory rate and inspiration time
Inspiratory times are longer

A

pressure control

179
Q

ventilator modes:

Caution: changes in compliance or resistance can dramatically affect Vt delivery!

You can go from Vt 200ml to 1400ml very quickly with a chance in compliance

A

pressure control

180
Q

ventilator modes:

decelerating flow waveform

A

pressure control

181
Q

ventilator modes:

constant flow waveform

A

volume control
pressure control with volume guarantee

182
Q

ventilator modes:

Best option!
Ventilator attempts to guarantee a set volume in PCV
Lung safety is improved

A

pressure control with VG

183
Q

ventilator modes:

Pressure support (5-10 cmH20) will overcome the negative inspiratory pressure resistance due to ETT, circuit, filters, etc.

Only inspiratory pressure and breath trigger are set

RR is determined by patient

Amount of inspiratory flow can be programed for sensitivity:
* 200ml/min trigger for sicker patients
* 2000ml/min for patients that are doing well

A

pressure support ventilation

184
Q

ventilator modes:

Indications
Spontaneous breathing support to increase comfort
Decreased work of breathing

A

pressure support ventilation

185
Q

ventilator modes:

Synchronizes the patient’s efforts with ventilator

Senses negative pressure inside the chest cavity created by diaphragm

Ventilator knows the patient initiated a patient driven breath

If patient does not inspire within trigger synchronization window waiting time, ventilator then will deliver a breath

A

synchronized intermittent mandatory ventilation (SIMV)

186
Q

ventilator modes:

Patient breath does NOT compete with ventilator
“Backup” ventilation to maintain normocarbia

A

SIMV

187
Q

Vt and flow are _________ dependent

A

volume

188
Q

PiP, plateau pressure are __________ dependent

A

pressure

189
Q

increase in auto-PEEP = __________ pressure and a ____________ volume

A

increased pressure, decreased volume

190
Q

What artery is the SA node fed by?

A

Right coronary artery
(if affected, will lead to a heart block)

191
Q

Can be from electrolytes or abnormality

Non-pacemaker cells

QRS and T look the same

A

ectopic site/foci

192
Q

what is ventricular THRESHOLD potential

A

-70 mV

193
Q

SODIUM ENTERS the cell to make it more positive; 30 mV

A

phase 0

194
Q

potassium exits the cell

A

phase 1, phase 2, phase 3

195
Q

calcium enters slowly, facilitating prolonged conduction;
potassium still exits the cell

A

phase 2

196
Q

RESTING membrane potential: _____mV

A

-90

phase 4

197
Q

what is DEPOLARIZATION ____ mV

A

30 mV

198
Q

A picture between 2 electrodes
(one + and one -)

A

lead

199
Q

Electricity flowing toward a positive lead is viewed as an __________ line

A

upward

200
Q

leads:
Between the R arm, L arm, and L leg

A

BIPOLAR LIMB leads

201
Q

leads:
Between a limb lead and a reference point (AV node)

A

unipolar AUGMENTED leads

202
Q

leads:
Between a chest lead and a reference point (AV node)

A

unipolar PRECORDIAL leads

203
Q

leads:

I, II, III

A

bipolar (limb)

204
Q

leads:

o aVR (looks right)
o aVL (looks left)
o aVF (looks to the foot)

A

unipolar (AUGMENTED)

205
Q

leads:

V1, V2, V3, V4, V5, V6

A

unipolar (PRECORDIAL)

206
Q

Einthoven’s Triangle*

right arm is always ____

A

negative –

207
Q

Einthoven’s Triangle*

left arm is both ___ and ___

A

+ and -

208
Q

Einthoven’s Triangle*

left leg is always ____

A

+

209
Q

looks from right arm to left arm

A

lead I

210
Q

looks from right arm to left leg

A

lead II

211
Q

looks from left arm to left leg

A

lead III

212
Q

modified chest leads uses lead ____

A

lead III

213
Q

What lead is the most commonly monitored*

A

lead II

214
Q

Looks for:

Presence and location of MI, axis deviation, chamber enlargement

A

DIAGNOSTIC monitoring

215
Q

Explains HR, regularity, rhythm, conduction patterns

A

ROUTINE monitoring

216
Q

4th ICS, RIGHT sternal border

A

V1

217
Q

4th ICS, LEFT sternal border

A

V2

218
Q

5th ICS, mid-clavicular line

A

V4

219
Q

5th ICS, mid-axillary line

A

V6

220
Q

Small box: ____ seconds

A

.04 seconds

221
Q

large box: ___ seconds

A

.2

222
Q

Small box: ___ mV (__ mm)

A

.1 mV = 1 mm

223
Q

large box: ___ mV (__ mm)

A

.5 mV = 5 mm

224
Q

2 large boxes: __ mV (___ mm)

A

1 mV= 10 mm

225
Q

EKG:
standard calibration is ____ mm or ___ mV

A

10 mm or 1 mV (2 large boxes)

226
Q

EKG

More sensitivity allows greater reception, but may __________ artifact

A

increase artifact (so be careful)

227
Q

EKG
filter mode

A

sharp

228
Q

EKG
monitor mode

A

blurry/fuzzy

229
Q

what are the 5 parts of interpretation

A

rate
regularity
p waves
PR interval
QRS complex

230
Q

PR interval should be less than ____ seconds

A

< .2 seconds (1 big box)

231
Q

QRS complex should be less than ___ seconds (less than ___ small boxes)

A

< .12
< 3 small boxes

232
Q

p wave ____–____ seconds
< ____ mm in height

A

.06-.1 seconds
<2.5 mm in height

233
Q

EKG

Intervals=______ throughout all leads
Picture/tracing=____________ for the leads

A

intervals=same
picture/tracing=different

234
Q

Dysrhythmias originate in the SA node

A

sinus

235
Q

sinus tachy is 100 to _____ bpm

A

150

236
Q

Dysrhythmias originate in the ATRIA

A

atrial/SUPRAventricular rhythms

237
Q

Dysrhythmias originate in the AV node

A

junctional

238
Q

Inherent/junctional/junctional escape rate
____–____ bpm

A

40-60

239
Q

Accelerated junctional ___–___ bpm

A

60-100

240
Q

junctional tachy >____

A

> 100

241
Q

SVT >____

A

> 150

242
Q

ALL ventricular rhythms have a _____ complex QRS

A

wide complex

243
Q

what is another name for idioventricular rhythm

A

ventricular escape rhythm
agonal rhythm

244
Q

___ or more beats = “run of VT”

A

> 3 or more

245
Q

idioventricular/ventricular escape/agonal
is ________ rhythm with ____ P waves

A

regular rhythm
NO p waves

246
Q

true or false
with bigeminy PVCs, rate by 60-100, but mechanical rate can be 30-50

A

true

247
Q

which heart block has a irregular R-R interval

A

2nd degree type 1 (wenkebach)

(p-p is still constant, but PR interval changes!)

248
Q

which heart block has regular p-p, regular pr interval, regular QRS

but multiple p waves per QRS complex?

A

2nd degree type 2 (classical)

249
Q

which heart block has a variable PR interval, regular p-p, regular r-r

A

third degree/complete

250
Q

pacers:

position I

A

chamber paced (what the action is)

251
Q

pacers:

position II

A

chamber sensed

252
Q

pacers:

position III

A

response

253
Q

pacers:

position IV

A

modulation (speeding up or slowing down)

254
Q

pacers:

position V

A

antitachyarrhythmia functions

255
Q

true or false
ventricular paced is ALWAYS a wide complex

A

true

256
Q

how can you tell the difference between hyperkalemia and an MI

A

it will be in all leads
look at patient age

257
Q

which lead can cause false ST elevation

A

red

258
Q

RIGHT axis deviation = ____________ movement

A

clockwise

259
Q

LEFT axis deviation = _______________ movement

A

counterclockwise

260
Q

axis deviation:
Infarct: deviates ______

A

AWAY

Electricity does not like dead tissue!

261
Q

axis deviation:
Hypertrophy: deviates ___________ the muscle

A

TOWARD

262
Q

axis deviation:

obesity and pregnancy

A

LEFT shift

263
Q

axis deviation:

Thin/OSA

A

RIGHT shift

264
Q

true or false
Bundle branch block always have a WIDE complex QRS

A

true

265
Q

Bundle branch block:

R-R is found in V1 or V2

A

RIGHT

“right=up”

266
Q

Bundle branch block:

Deep Q wave is in V1 or V2
R-R is found in V5 or V6

A

LEFT

“left=down”

267
Q

Bundle branch block:

can be confused with an MI

A

LEFT BBB

It may give a false positive for Q wave/infarction, and may also give a false positive on ST change

268
Q

EKG:

REVERSIBLE category

A

ischemia

269
Q

EKG:

tissue compromise

A

injury

270
Q

EKG:

irreversible, tissue death

A

infarction

271
Q

EKG:

tall/peaked T waves
or
inverted/symmetrical T waves

ST depression

A

ischemia

272
Q

EKG:

ST elevation (with troponin release)

A

injury

273
Q

EKG:

Q wave formation
(>.04 seconds, >1/3 height of the R wave)

A

infarction

274
Q

what is a pathological Q wave
>___ seconds
>___ height of R wave

A

> .04 seconds
1/3 height of R wave

275
Q

Sub-ENDOcardial = Non-Q wave MI

A

– Less than 1/2 of endocardial wall infarcted
– T wave changes peaked/inverted
– ST depression/elevation, no Q wave

276
Q

what is another term for subendocardial/non-q wave MI

A

NSTEMI

277
Q

transmural = sub-EPI cardial = Q wave MI

A

– More than 1/2 of wall infarcted
– T wave inversion
– ST elevation
– Q wave

278
Q

what is another term for transmural = sub-EPI cardial = Q wave MI

A

STEMI

279
Q

true or false
for diagnostics, there must be an ST elevation in 2 or more leads

A

true

280
Q

what is the overall best lead for detecting ISCHEMIA*

A

V5

281
Q

what is the best combo for leads*

A

Lead V4 + V5: best combo (but usually not allowed)

so use: Lead II + V5!!!!

282
Q

what is the best lead for detecting atrial dysrhythmias

A

lead II

283
Q

what leads is hypertrophy detected in

A

all V leads

284
Q

atrial hypertrophy:

NOTCHED (mcdonalds hump) p wave

BIPHASIC p wave

WIDENED p wave

A

LEFT atrial hypertrophy

285
Q

atrial hypertrophy:

afib and MITRAL regurgitation

A

LEFT atrial hypertrophy

286
Q

atrial hypertrophy:

TALL/PEAKED p wave

A

RIGHT atrial hypertrophy

287
Q

atrial hypertrophy:

OSA and tricuspid regurgitation

A

RIGHT atrial hypertrophy

288
Q

left ventricular hypertrophy:

S wave (in V1 or V2)
+
R wave (in V5 or V6)
=
>____ mm

look for OVERLAP throughout the V leads

A

> 35 mm

289
Q

what is an easy way to determine a long QT interval

A

if it is greater than HALF the distance of an R-R

Principles of Anesthesia 1 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions