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Equpiment 1 > Final > Flashcards

Final Flashcards

1
Q

___________ is delivered into the space bw bellows and housing

A

Driving gas

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2
Q

______________ mandate high pressure limit, as well as low pressure and minute ventilation alarm

A

Alarm standards

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3
Q

With ________ ventilators have very precise tidal volumes

A

Piston

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4
Q

Actual bellows (plastic housing) should be sterilized with

A

Ethylene oxide or steam sterilization

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5
Q

Mode of ventilation:
Reaches preset pressure but achieves a target volume

Volume achieved depends on compliance and resistance

Pressure constant during inspiratory cycle

Flow decreases as pressure in lung decreases

Increased mean airway pressures

Improves recruitment

A

Pressure control ventilation

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6
Q

Established vaporizer standards

A

ASTM

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7
Q

3 advantages of open breathing circuits

A

Low resistance
Low pollution
Easy
Relatively cheap

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8
Q

Volume fluctuates depending on how much flow required to reach target pressure

A

Pressure control ventilation

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9
Q

Optimizing ventilation during volume control ventilation use

A

Reverse I:E ratio

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10
Q

3 characteristics of closed system

A

No waste of oxygen
Retains heat and humidity
Less pollution

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11
Q

PEEP greater than 5 results in

A

Decreased venous return and hypotension

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12
Q

The amount of calories required to convert 1 gm of liquid to vapor without temperature change in the remaining liquid

A

Heat of vaporization

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13
Q

Bellows of ventilator are housed in a ______ and inside the bellows is connected to the breathing system

A

Pressure chamber

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14
Q

In VC ventilation changes in compliance or resistance are reflected in

A

Changes in PIP

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15
Q

Pressure control ventilation difference in normal lung compliance and poor lung compliance?

A

Peak flow remains same but total flow fluctuates

Volume fluctuates depending on flow required to reach target pressure

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16
Q

Chemical reaction bw CO2 and soda lime

A

Water reacts with CO2 to produce carbonic acid (H2CO3) and heat

H2CO3 reacts with base in soda lime to form bicarbonate, water, and heat

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17
Q

Modern machines __________ ______ ventilator when bag/ventilator switch is switched

A

Automatically activate

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18
Q

Basic characteristics of CO2 absorbent

A

Do not support bacterial growth
Gas tends to travel along periphery
Each last 20-30 hours

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19
Q

Disadvantages of NRB

A

Require high FGF resulting in pollution and economic waste
Inspired heat and humidity low r/t higher FGF
Requires frequent adjustment of FGF
Not suitable for pt with MH hx due to inability to increase FGF enough to blow off CO2

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20
Q

3 uses of reservoir bag

A

Provides a means for delivering positive pressure
Allows use of lower FGF
Protects pt from excessive pressure in breathing circuit

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21
Q

Electrical (piston) ventilator

Tidal volume

A

More precise

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22
Q

Electrical (piston) ventilators

By eliminating need for a drive gas_______

A

Stable flow can be provided

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23
Q

Increased empty space results in

A

Longer diffusion times

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24
Q

Advantages of circle system

A 
Economical
- expired gases reused
- minimize FGF and anesthetic agent
Humidifies inspired gas
Preserves heat and pt temperature
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25
Q

Desflurane is heated to __________and overpressurized to ________

A

39C

1300 mmHg

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26
Q

Compared to newer vaporizers (tec6,7,etc.) the Tec 5 vaporizers require FGF close to _______ and are more affected by

A

FGF close to 5 lpm

More affected by pumping

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27
Q

Reversing I:E ratio on VC ventilation results in

A

Alveolar recruitment improved by prolonging inspiratory period

Slow alveoli recruited

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28
Q

Most popular non-rebreathing circuit is the ______

Why?

A

Mapelson D

Excess gas scavenging is easy and most efficient during controlled ventilation

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29
Q

Double circuit ventilators

1 circuit contains _____
The other contains _____

A

Patient gas

Other drive gas

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30
Q

Risks of PEEP

A

Potential for barotrauma
May decrease venous return and BP

May worsen VQ with OLV

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31
Q

Ventilator can deliver gas by generating specified _____ or________

Must be

A

Volume or pressure

Individualized

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32
Q

Three characteristics of modern vaporizers

A
  1. Agent-specificity
  2. Temperature compensation
  3. Flow over
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33
Q

Disadvantages of rebreathing systems

A 
Complex
Less portable
Opportunities for disconnect
Unidirectional valves may malfunction
Increased dead space
Increased empty space
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34
Q

2 fx of APL valve

A

Control pressure in breathing circuit

Releases gas to scavenging system

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35
Q

Causes of decreased pulmonary compliance

A 
CHF
Trandelenburg
Pleural effusion
Abdominal packing/insufflation
Obesity
Tension pneumo
Endobronchial intubation
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36
Q

Must be careful when switching between modes to ______________

A

Assess compliance changes

PIP and/or TV may be inappropriate

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37
Q

_________ ventilators less accurate especially with non-compliant lungs

A

Bellows ventilators

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38
Q

Safety feature that allows only one vaporizer on at a time

A

Vaporizer interlock

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39
Q

The double circuit separates

A

Breathing system from driving gas

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40
Q

Which mode of ventilation?

Preset TV administered, independent of pt effort

Flow rate is fixed at constant value during inspiration

Changes in compliance or resistance are reflected in changes in PIP

A

Volume control ventilation

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41
Q

Lower compliance translates into ___________ for same pressure setting

A

Lower TV

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42
Q

Basic operating premise of variable bypass vaporizers states that FDF enters the vaporizer and splits into carrier gas (_________) and bypass gas (_________)

A

Carrier gas <20%

Bypass gas 80%

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43
Q

Ventilator in circle system takes place of

A

Reservoir bag in ventilation

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44
Q

Use of backup or SIMV rate part of this mode

A

PSV Pro

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45
Q

_____________may be tipped as long as in the ______setting

A

Vapor 2000

As long as in the “T” setting

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46
Q

Modern ventilators/machines ________ tidal volume regardless of FGF by separating FGF from TV

A

Compensate

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47
Q

To avoid hypercarbia with increased deadspace minute ventilation ____________

A

Must increase

Alveolar ventilation = VE-VD

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48
Q

Benefits of PEEP

A 
Increase compliance
Recruits alveoli
Decreases VQ mismatch
Increases TV above closing volume
Redistribution of extravascular water
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49
Q

Pressure fluctuates depending on lung compliance and resistance?
(Mode of ventilation)

A

Volume control ventilation

50
Q

3 causes of increased PIP

A

Increased TV

Decreased pulmonary compliance

Increased airway resistance

51
Q

Advantages of semiclosed system

A

Conveys excess gas to scavenging system
Humidification
Low FGF

52
Q

With traditional ventilators

Tidal volume is affected by

A

FGF

Increased FGF decreased TV

53
Q

Disadvantages of pressure control ventilation

A

Tidal volume fluctuates with change in resistance

Increasing RR decreases inspiratory time and decreases TV

PEEP decreases TV

54
Q

Increasing __________________ between gas and liquid in a vaporizer increases efficiency of vaporization

A

Increasing contact area

55
Q

Power source and drive mechanism for gas-driven bellows

A

Double circuit

Driving gas O2 or room air

56
Q

4 common features of non-rebreathing circuits

A

Low resistance
Less deadspace/empty space
Lack of unidirectional valves
Lack of CO2 absorption

57
Q

Soda Lime Canister

  • moisture content
  • granule size
A

14-19% water

4-8 mesh size of granules

58
Q

Advantages of closed system

A

No pollution
Cheap
Retains heat and humidity

59
Q

If wrong agent is used what should you do?

A
  • discard vaporizer contents

- run 5lpm oxygen until no agent detected (about 2 minutes)

60
Q

Electronic control of the Aladdin cassette is where?

A

Inside the anesthesia machine

61
Q

Mode of ventilation

Lowest possible pressure used to generate set TV

If target volume exceeded, the pressure for subsequent breaths is lower

A

SIMV with PRVC

62
Q

Mode of ventilation

Designed to augment patients spontaneous breaths with positive pressure in response to pt initiated breathes

Support may be pressure or flow initiated

Support usually pressure based

A

Pressure support ventilation

63
Q

Higher FGF is associated with ______________ and the higher the FGF the _________ gas concentration in circuit will resemble that of common gas outlet

A

Less rebreathing

More

64
Q

2 effects of rebreathing

A

Heat and moisture retention

Altered inspired CO2 and agent concentrations

65
Q

Causes of increased airway resistance

A

Kinked ETT
Airway compression
Bronchospasm
Secretions/foreign body

66
Q

Bellows assembly:
Hanging, inverted
Compressed upward during inspiration
Leak causes RA to enter the bellow

A

Descending

67
Q

2 advantages of pressure control ventilation

A

Decelerating inspiratory phase allows recruitment of slow alveoli

Gas delivered to less compliant alveoli

68
Q

Basic configuration of circle system

A

Location of ventilator/bag- on expiratory limb before CO2 absorbent
FGF- after CO2 absorbent on inspiratory limb
CO2 absorbent- after reservoir bag before FGF inlet

69
Q

Advantages of semi-closed system

A 
Easy modification
Maintains heat
Keeps pollution down
Easy ventilation
Cheap
70
Q

Mode of ventilation: calculated pressure required to deliver the volume control target (based on compliance calculated from the first test breath)

A

SIMV with PVRC

71
Q

3 reasons for decline of NRB

A

Modern efficient ventilators
Conservation of heat with rebreathing circuits
Waste gas management

72
Q

Mode of ventilation:

Delivers a set volume at a set flow rate with pressure dependent on compliance and resistance

Flow constant throughout inspiratory cycle. (Square waveform)

Pressure increases throughout inspiratory cycle

Pressure waveform resembles shark fin

A

Volume control ventilation

73
Q

Disadvantages to electrical (piston) ventilators

A

Lack of conventional bellows

No audible excursion of bellows

Limited ability to adapt to non-rebreathing circuit

74
Q

Reversing I:E ration in VC may be problematic in

A

Obstructive lung disease with “stacking”

75
Q

Mode of ventilation

Synchronizes ventilator delivered breaths with pt spontaneous breaths

Mandatory breaths occur at intervals with constant flow and preset volume

Minimum minute ventilation must be selected

A

SIMV

Synchronized intermittent mandatory ventilation

76
Q

Any breathing circuit creates ___________ to gas flow and ___________ work of breathing patient under anesthesia should____________

A

Resistance
Increases
Always be assisted

77
Q

4 factors potentially affecting vaporizer output

A
  1. FGF
  2. Temperature
  3. Carrier gas composition
  4. Ambient pressure
78
Q

Classification of modern ventilators (4)

A

Power source and drive mechanism

Cycling mechanism

Modes

Bellows classification

79
Q

Vaporizer output is _____________ over a wide range of flows

A

Relatively constant

80
Q

Power source and drive mechanism for piston ventilator

A

Electric motor

81
Q

Amsorb canisters

  • moisture content
  • granule size
A

14.5%water

4-8 mesh size

82
Q

Optimizing ventilation using longer I:E ratio

A

Allows compensation for flow related collapse

Medium airways stay open longer

FRC potentially improved through recruitment

83
Q

Good for alveolar collapse, bad lungs, morbidly obese,

A

Pressure controlled ventilation

84
Q

When bellows are compressed ________ and _____ are closed

A

Spill valve and exhaust valve

85
Q

The ________ modification to the Mapelson involves placement of FGF through expired gases to heat inspired gases

A

Bain

86
Q

High, medium, low priority ventilator alarms based on

A

Immediate action need

87
Q

2 breathing circuit hazards

Component of machine check that verifies intact circuit

A
  • circuit disconnection
  • leaks

Inflating and insure ability to hold positive pressure

88
Q

Clinical signs of CO2 canister exhaustion

A 
Rise in HR (later fall)
Increased RR
Respiratory acidosis
Dysrhythmia
S/S SNS activation (flushed, sweating)
Increased bleeding 
Increased ETCO2
89
Q

Electrical (piston) ventilator

Reservoir bag is ______ from breathing system

A

Not isolated

90
Q

Function of expiratory valve

A

Closes to prevent rebreathing of exhaled gas that still contains CO2

91
Q

3 uses of pressure gauge

A

Measure circuit pressure bw inspiratory and expiratory valves

92
Q

Which mode of ventilation?

Ventilator generates pressure to set level and maintains flow

Decelerating inspiratory flow allows alveolar recruitment

TV may fluctuate with changes in resistance and compliance

A

pressure control ventilation

93
Q

The ______________ of two flows depends on ratio of resistances to their flow

A

Splitting ratio

94
Q

Advantages of NRB include

A 
Inexpensive, rugged
Variations in MV affect ETCO2 less
Resistance usually very low
Less drag on mask or ETT
Changes in fresh gas concentration result in rapid changes
No CO or compound A
95
Q

3 methods of increasing contact area between gas and liquid in a vaporizer

A

Baffles
Spiral tracks
Wicks

96
Q

Electrical (piston) ventilator

During ________ the bag is isolated from breathing system and _____________________

A

Inspiration

Collects FGF from breathing system

97
Q

Volume control ventilation difference bw normal lung compliance and poor lunch ocmpliance

A

Pressure fluctuates depending on lung compliance/ resistance

98
Q

The quantity of heat required to raise the temperature of one gram (1ml)of a substance by 1 degree Celcius

A

Specific heat

99
Q

Three factors that may affect delivered tidal volume when using a ventilator

A

FGF

Compliance and compression volumes

Leaks

100
Q

Modern vaporizers are accurate over

A

A wide range of temperatures and fresh gas flows

101
Q

A measure of the volatility of the liquid anesthetic in the carrier gas

A

SVP

102
Q

In PC ventilation ________ may fluctuate with changes in resistance and compliance

A

Tidal volume

103
Q

2 factors affecting resistance

A

Width and length of tubing

104
Q

__________ may occur in bellows assembly despite proper breathing circuit function

A

Leaks

105
Q

Common signs of CO2 canister exhaustion

A

CO2 in inspiratory limb
Indicator color change
Increased canister temp

106
Q

Attach __________ to elbow of circuit and set TV and rate, watch for __________ and __________

Maintenance and testing of ventilation

A

Reservoir bag

Return of volume and appropriate rate

107
Q

Dynamic compliance in COPD

At __________ dynamic compliance is same as static compliance

At rates greater than ______ compliance decreases due to smaller airway resistance

A

Low breathing frequencies

15

108
Q

Bellows assembly: standing, floating
Compressed downward during inspiration
Leaks cause collapse to bottom

A

Ascending

109
Q

Measurement units for airway pressure

A

cmH20

kPa

110
Q

Splitting ratio is determined by what

A

Concentration dial

111
Q

Higher compliance translates into ______ for same pressure setting

PV ventilation

A

Higher TV

112
Q

Vaporizer standards include 4

A
  1. FGF limits (15lpm)
  2. Unidirectional rotation for concentration increase
  3. Concentration calibration of vaporizers
  4. Temperature/pressure effects
113
Q

4 hazards associated with vaporizers

A
  1. Wrong agent
  2. Tippin
  3. Overfilling
  4. Empty vaporizer
114
Q

Bellows reexpand as ______ and _______ flow into it

A

Breathing system gases and FGF

115
Q

3 advantages of rebreathing

A

Cost reduction
Increased warmth and humidity of inspired gases
Decrease OR contamination

116
Q

Driving gas from ventilator is expelled through

A

The exhaust valve

117
Q

Bellows are compressed by _____________ so gas flows into the breathing system

A

Drive gas

118
Q

Major disadvantage to descending bellows

A

Inability to visually detect leak

119
Q

Describes the affect on vaporizer output from intermittently fluctuating pressures in breathing system

A

Pumping effect

120
Q

Excess circuit gas is vented into the scavenging system through the

A

Spill valve

121
Q

Characteristics of semi open system

A

Excess gas released into air
No humidification
Requires high FGF (1.5 X MV)

122
Q

4 safety features of vaporizers

A
  1. Agent specific keyed fillers
  2. Secured vaporizers
  3. Counterclockwise rotation of dial for increase in %
  4. Interlocks

Equpiment 1 (2 decks)

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