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I&M Final > I&M - Test 1 > Flashcards

I&M - Test 1 Flashcards

1
Q

measured value =

A

true value + (systmatic + random error)

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2
Q

example of a systematic error

A

transducer lower than patient producing higher reading; predictable

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3
Q

example of random errors

A

multiple BP measurements in atrial fibrillation; unpredictable. average repeated reduces these

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4
Q

closeness of agreement between measured and true value

A

accuracy

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5
Q

the degree of consistency

A

precision

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6
Q

ability to maintain precision

A

reproducibility

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7
Q

likelihood an event will be detected

A

sensitivity

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8
Q

normal = no event indicated

A

specificity

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9
Q

accuracy formula

A

(correct / total) x 100

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10
Q

precision formula

A

(measure-mean) / mean

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11
Q

sensitivity formula

A

hits / (hits+misses)

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12
Q

specificity

A

correct rejections / (correct rejections + false alarms)

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13
Q

characteristics of signal

A

each signal has inherent variability. The distinction between normal and adnormal

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14
Q

mechanics of the sensor

A

ability to detect the underlying state of the system

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15
Q

mechanics of the artifact rejection

A

ability to sense degredation in quality of signal and filter out noise

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16
Q

programming by the user

A

adjustable alarm limits can adjust hit to miss and false alarms and correct alarms

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17
Q

% saturation error in pulse ox

A

+/- 3% adults. +/- 4% neonate.

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18
Q

% pulse rate variation

A

+/- 3%

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19
Q

Bland-Altman plot

A

table for comparison of values in standard deviations from baseline

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20
Q

slow, low frequency component of a signal

A

drift

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21
Q

rise time

A

time it takes for instrument to get from 10 to 90% of complete response

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22
Q

frequency response

A

how well the instrument can reproduce the signal being measured

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23
Q

of harmonic waves needed to produce a box like waveform

A

5 to 6

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24
Q

the greater the rate of rise or the original waveform

A

the greater the number of harmonics needed

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25
Q

example of combining harmonics

A

arterial waveform

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26
Q

Dichrotic notch - what does it mean if it’s closer to the beginning of the waveform?

A

closer the reading is to the heart

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27
Q

transient increase in aortic pressure upon closure of aortic valve

A

dichrotic notch

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28
Q

What is the resulting aortic waveform?

A

the mean pressure

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29
Q

Symbol for freqeuncy

A

rounded “w”

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30
Q

Hz =

A

cycles per second (s^-1)

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31
Q

average amplitude of R wave

A

1 mV

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32
Q

digital horizontal and vertical resolution

A

sampling rate, diff btw 2 amplitudes

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33
Q

the higher the upstroke of a wave …

A

the higher the amplification needed to reproduce

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34
Q

Definition of the Nyquist Rate

A

Space sampling frequency must be greater than twice the maximum frequency. f[s] > 2 x f[max]
Ex. We hear at 22000 hz, so it is reproduced at 44000.

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35
Q

ACGME

A

accredation council for graduate medical education

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36
Q

APSF

A

anesthesia patient safety foundation

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37
Q

ACGME - 2 criteria

A

cognitive and psychomotor skills

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38
Q

cognitive ex

A

do i need an a line for this case

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39
Q

psychomotor skills

A

placing an oett tube

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40
Q

ASK goals

A

attitude, skills, knowledge

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41
Q

when you can be damaged from a complete or incomplete circuit

A

complete: standing in water helps complete the circuit, lower impedence, and causes further damage

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42
Q

Macroshock (milliA)

A

defined by 1-6000 mA. Intact skin

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43
Q

1 ma

A

threshold of perception, tingling

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44
Q

5 mA

A

accepted maximal harmless current

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45
Q

10-20 mA “let go” current

A

tetanic contraction of skeletal muscles.

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46
Q

50 mA

A

pain, fainting, mechanical injury

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47
Q

100-300mA

A

ventricular fibrillation

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48
Q

6000 mA

A

defibrillation. sustained ventricular contraction.

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49
Q

Microshock (microA)

A

defined by 10-100 micro Amps, vascular access (catheters), myocardial lead wires

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50
Q

10 uA

A

safe current limit for directly applied cardiac equipment

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51
Q

50 uA

A

max falt condition current for cardiac equipment

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52
Q

100 uA

A

ventricular fibrillation.

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53
Q

nadir point

A

50hz - low point of current in which most people can detect. threshold of sensation

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54
Q

point of “cannot let go” for general population

A

60hz, 8mA

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55
Q

watts =

A

volts x amps. (w~amp^2)

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56
Q

surface area regarding burns

A

large area of contact = no burns. small = burns

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57
Q

Current density =

A

amps / area

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58
Q

properly applied ESU

A

electrical surgical unit. current density at return plate is low

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59
Q

skin burn temperature

A

45 C

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60
Q

completed circuit

A

two contact points

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61
Q

ground prong

A

round, green, longest of the 3

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62
Q

hot

A

shorter thin, black

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63
Q

neutral

A

longer flat, white

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64
Q

which plug has 1 horizontal prong?

A

high current outlets.

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65
Q

hubbellock devices

A

lock into outlet. prevents tripping/disconnection

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66
Q

impedence can lower by a factor of 100 by..

A

operating in a wet environment in nonstandard footwear

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67
Q

Class I electrical outlet:

A

grounded. use of a fuse that melts disconnecting circuit

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68
Q

Class II outlet

A

double insulated

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69
Q

Class III outlet

A

internal power source

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70
Q

Which class at minimum do we use on patients?

A

Class II

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71
Q

three components of electrosurgical system

A

hand held probe, ESU, large dispersive electrode

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72
Q

the return pad of the ESU is not

A

a grounding pad

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73
Q

the right leg lead of an ECG is not

A

a ground

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74
Q

spark frequencies & effect

A

wide variety. might make muscle contract @ low spark freq.

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75
Q

What causes a microshock?

A

Pulmonary artery catheter (V-fib). Central line (A-fib). Risk of electrocution if patient comes in contact with earthed equipment

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76
Q

Capacitive coupling

A

Allows high frequency to be transmitted. electrical frequencies will be detected. Energy coupled from one circuit to another through an electric field

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77
Q

equipment ground wire

A

Protect patient. A break in this wire –> entire electrical current conducted to heart. V-fib (100-300 mA)

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78
Q

earthing point

A

Reference point in which voltages are measured

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79
Q

electrical interference

A

Interference at a demand node pacemaker from an external electromagnetic field.

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80
Q

inductors

A

Transmits low frequencies. Resists changes in electrical current

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81
Q

capacitors

A

Transmit high frequencies, block low. Stores energy in an electric field

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82
Q

isolation transformers

A

1-1 transformer, voltage on secondary side = first side. limits the connection. no direct connection to power source. 1 for each OR. reduces shock by 30%. Converts grounded power to ungrounded power system on secondary side of transformer

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83
Q

line isolation monitor (LIM)

A

Measures how much current is going through each line and ground. alarms if voltage goes to ground. Detects fautly equipement plugged into isolated power system

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84
Q

LIM annunciator

A

electronic signaling device

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85
Q

GFCI

A

Ground fault circuit interrpters. If excessive current goes to ground, it triggers the fault switch. Measures the current in hot and neutral wires

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86
Q

3 things needed for a fire

A

oxygen, heat, fuel (oxidizer, ignition source, fuel)

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87
Q

4 combustible gasses

A

ethers, halo, enflurane, iso

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88
Q

3 combustion supporting gasses

A

O2 N2O Air

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89
Q

combustion squelching gases

A

N2 CO2 He

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90
Q

ignition sources

A

lasers, hot filaments, sparks and arcs, gas compression

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91
Q

difference of conditions needed for explosion vs fire

A

pressure, temperature. 1 bar (200-500 C) vs 25 bar (3000 C) (fire vs explosion)

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92
Q

clinical ignition sources

A

surgeons, esu’s lasers

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93
Q

increases molecular speed to allow a reaction to occur

A

activation energy

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94
Q

Rule of Arrhenius

A

rate is doubled when temp raised by 10 C

95
Q

locations of surgical fires

A

head, neck upper chest (44%), airway (21%)

96
Q

clinical oxidizers

A

anesthesia combustion supporting gases (O2, N2O, Air)

97
Q

clinical fuel sources

A

drapes, prepping agents

98
Q

Clinical recommendation for high risk fire prevention

A

keep O2 levels low as possible

99
Q

APSF

A

Anesthesia Patient Safety Foundation

100
Q

If at risk, is >30% required to maintain oxygen saturation?

A

Yes -> secure with ETT, No-> use delivery service such as blender or common gas outlet to maintain below 30

101
Q

PASS

A

Pull aim squeeze sweep

102
Q

first step if fire in airway

A

remove ETT, stop flow of all airway gases, remove sponges, pour saline into airway

103
Q

type of fire extinguisher

A

CO2

104
Q

oxidizer enriched atmosphere

A

any increase in O2 [ ] above room air level

105
Q

airway fire

A

airway or breathing circuit

106
Q

Types of fires: Class A

A

materials that leave residue in form of ash

107
Q

Types of fires: Class B

A

flammable liquids and gases

108
Q

Types of fires: Class C

A

electrical wiring or equipment (if electricity is cut, becomes one of other classes)

109
Q

Types of fires: Class D

A

potassium, sodium fires. uncommon materials in specialized situation

110
Q

open circuit

A

no path for current to return

111
Q

complete circuit

A

:(

112
Q

beta particle

A

electron

113
Q

alpha particle

A

two neutrons and two protons

114
Q

radiation absorbed by person

A

rad (conventional). Gray (SI)

115
Q

inverse square law

A

E ~ 1/d2; if distance is doubled, the energy density is quartered; radiation

116
Q

GRadiation within the body of a patient

A

alpha and beta absorbed by surrounding tissue. gamma radiation: some escapes the body. Actively dividing cells (tumors cells), are very vulnerable

117
Q

Tissue/organ sensitivity - what is most sensitive

A

gonads, bone marrow

118
Q

ALARA

A

As low as reasonably achievable. Pregnant workers 8-15 weeks

119
Q

x-ray positioning do’s and donts

A

face the source. facing away permits double penetration (heh)

120
Q

simulated absorption

A

photon transfers energy, pushes e- to higher energy orbit

121
Q

spontaneous emission

A

electron spontaneously loses energy = emitted photon

122
Q

stimulated emission

A

incoming photon + electron–>two photons leave the e-

123
Q

lasers

A

deliver more photons to a given area

124
Q

Gaseous lasing medium

A

CO2. HARKEN. He, Ne, Ar, Kr

125
Q

Solid lasing medium

A

YAG

126
Q

Liquid lasing medium

A

Excimer. Do not generate heat. Turn tissue into gas by breaking chemical bonds

127
Q

Helium-neon

A

color: red: 632 wavelength, Aiming beam.

128
Q

most medical lasers

A

CO2, Nd:YAG, argon, KTP; hazardous if viewed directly of diffuse reflection; control measures? YES

129
Q

Excimer, CO2, YAG uses

A

Excimer for shallow, CO2 for medium, YAG for deep; stratum corneum, epidermis, dermis

130
Q

laser hazards

A

plume, perforation, embolism, energy transfer

131
Q

Most common laser injuries

A

perforation of organ/vessel (24%), gas embolism (24%), eye exposure (19%)

132
Q

O2 index of flammability for tracheal tubes

A

polyvinylchloride>silicone>red rubber.

133
Q

Mean time to ignition (tracheal tubes)

A

polyvinylchloride 3.06, silicone not tested, red rubber 33. (sec)

134
Q

Eye protection - laser surgeries

A

patient eyes should be taped then covered with saline soaked knit or metal shield.

135
Q

Lasers requiring color filtered eyewear & their colors

A

Nd:YAG (green). Ar&Kr (amber/orange). KTP:ND:YAG (red)

136
Q

CO2 laser

A

any plastic or glass lens

137
Q

2 ways to offset the baseline from a half-cell potential

A

1) differential input dc amp so that effects of two halfcell potentials are cancelled out.
2) use an ac coupled amplifier (capacitor makes it AC) so that the DC voltage is blocked out

138
Q

Differential amplifier. how it works

A

inverts the input so that the voltage out is zero.

139
Q

DC to AC coupled differential amplifier - key component

A

capacitor changes it from DC to AC

140
Q

what is the most common source of ecg slippage

A

electrode slippage

141
Q

needle electrodes for EEG

A

surface area of needle is the sensory input

142
Q

Clustering of ECG leads in an MRI purpose

A

reduce burns - lowers surface area of open antenna of leads

143
Q

Einthoven dog’s name

A

jimmy

144
Q

monitors of both the patient and anesthesia system

A

Paw Qaq Vt Resp Gas Analyzer

145
Q

Nae for the degree of consistency between repeated measurements

A

precision

146
Q

ASA recommendations for the use of a circuit disconnect monitor

A

continuous

147
Q

audible alarm definitions

A

advisory = 2 beeps “help me. caution = “help me please” 3 beeps. Warning = “oh my god help me” 5 beeps. 3db difference between each

148
Q

Fourier components of a rapidly changing waveform

A

many high frequency components

149
Q

Most sensitive lead for detection of myocardial left ventricular ischemia.

A

V5 @ 75%. V5+V4 = 90. V5+II = 80%. V5,V4,II = 96%

150
Q

TOF and degree of blockade

A

100-95, 0/4. 90, 1/4. 85 2/4. 80 3/4. 70-80 4/4.

151
Q

Amplitude of R wave changes with inspiration

A

increases with inspiration

152
Q

Meaning of resultant vector in Einthoven’s triangle

A

vector component of the depolarizing dipole

153
Q

Most common cause of peri-op arrhythmias

A

bovi?

154
Q

The V4 ECG is located in what position

A

5th intercostal space mid-clavidular

155
Q

Normal surgical depth of field for a BIS

A

40-60

156
Q

TOF and PTC comparison

A

PTC of 10 = 1/4

157
Q

Common type of electrode used for ECG monitoring

A

Ag-AgCl or column tower.

158
Q

Average amplitude of EKG R wave

A

1 mV

159
Q

Sources of common mode interference

A

60 Hz. EKG cord wrapped around power cord, proximity of high current device, high electrode impedence from poor skin contact or faulty wire

160
Q

Position of V2 ECG electrode

A

L sternal border @ 4th intercostal space

161
Q

Most immediate indication of a circuit disconnect

A

bellows collapse

162
Q

Normal QRS complex as displayed in lead III

A

no Q wave.

163
Q

Primary method that skin electrodes make contact with the volume conductor

A

capacitive coupling through pores

164
Q

definition of waves present during v depolarization

A

QRS

165
Q

Cardiac vector axis determination

A

based on depolarizing vector being parallel or perpindicular to waveform and direction of vector

166
Q

American Heart Association recommendations for ECG diagnostic amps -

A

.05 - 100 hz

167
Q

Normal range of the cardiac vector in degrees

A

110-30. transverse 30- -30

168
Q

depolarization offset mV at action potential

A

90 mV

169
Q

functions of an ECG monitor that require the highest frequency range

A

pacemakers

170
Q

dipole theory explanation

A

propagation of depolarization is seen as moving dipole (separation of charges)

171
Q

ECG manifestations of ischemia

A

peaked T waves, ST elevation, Q waves, T wave inversion

172
Q

the augmentation provided by the augmented vector leads

A

50%

173
Q

requirements of ASA standards of ECG monitoring

A

continuous

174
Q

duration of the ST interval

A

0.26 (seconds?)

175
Q

Einthoven’s Law

A

Lead II = Lead I + Lead III

176
Q

most common mechanism that creates artificial ECG monitoring

A

electrode slippage

177
Q

recognition of CS5 lead

A

R Arm at central subclavian, L Arm at V5, Lead I selected

178
Q

Cardiac vector axis determination

A

biphasic = perpendicular. Largest amplitude = parallel

179
Q

interpretation of upward sloping ST segments

A

infarction

180
Q

Definition of isoelectric line of the ECG

A

neutral baseline???

181
Q

dosing of a 20% medication

A

200 mg/ml

182
Q

point of ETCO2 on a capnogram

A

end of alveolar plateau (phase 3) (top right corner of the waveform)

183
Q

definition of specificity

A

correct rejection. how reliable the device is at detecting true abnormal readings

184
Q

definition of an ECG interval

A

from the beginning of one wave to another (vague)

185
Q

the meaning of “continual”

A

repeated

186
Q

the definition of precision

A

degree of consistency between repeated measurements

187
Q

determination of the first harmonic from heart rate

A

?? harmonics are multiples. Ex 5 = 1st = 10, 2nd = 15, 3rd= 20 etc.. via google: determined by the mean heart rate per second

188
Q

the definition of “drift” on a signal reproduction

A

slow, low frequency component of the signal. lower frequency than the signal

189
Q

major ion to cross the cell membrane during initial depolarization

A

Na

190
Q

definition of an aVR lead

A

RA is +, LA, Legs are -

191
Q

relationships of leads in hexaxial reference system

A

? slide 2 in ECG 1???

192
Q

the functions of an ECG monitor that require the highest frequency range

A

pacemaker

193
Q

the r-r interval differences in patients based on gender

A

men (can’t read this) larger weight = decreased HR, & Incr RR

194
Q

placement of anode during NMB

A

closest to heart

195
Q

cartoon forwny face and J point variation

A

normal healthy variation

196
Q

reason for specific placement of ECG electrodes in MRI

A

decrease burn risk and open atennae surface area of electrodes

197
Q

Einthoven’s Triangle

A

I: RA to LA II: RA to LL III: LA to LL

198
Q

Triaxial Reference system

A

Lead I: 0 deg; Lead II: -120 deg; Lead III: -60 deg

199
Q

Standard ECG limb lead positioning should be…

A

outside the cardiac borders.

200
Q

Information obtained from EKG: anatomy

A

infarction, ischemia, hypertrophy

201
Q

Information obtained from an EKG: physiology

A

automaticity, anthythmogenicity, conduction, ischemia, autonomic tone, electrolyte abnormalities, drug toxicity/effect, ejection fraction (?)

202
Q

Name of the vector angling system

A

triaxial reference system

203
Q

monitoring

A

repeated and continuous observations or measurements, assessement

204
Q

ASA standard monitors

A

oxygenation (FiO2) ventilation (ETCO2), circulation (ECG, arterial BP, HR: Q5min) + SPO2, temperature

205
Q

esophageal stethoscope

A

depth ~ 30 cm from lips

206
Q

a graph of gaseous CO2 [ ] as a fx of time

A

capnogram

207
Q

instrument for measuring CO2

A

capnometer

208
Q

practice of measuring

A

capnometry

209
Q

phases of capnogram

A

I: dead space, II: DS/alveolar mix. III: alveolar. IV: inhaled fresh gas

210
Q

ECG

A

Rate, Rhythm, ST segment

211
Q

NIBP

A

width 40% of limb circumference

212
Q

most common type NIBP

A

oscillometric

213
Q

direct arterial pressure requires a?

A

transducer

214
Q

SpO2

A

p is pulse

215
Q

which nerve wraps around humerus

A

radial nerve

216
Q

When is ischemia most easily detected. depol or repol

A

repolarization

217
Q

State angles of aVF:R:L

A

“+90, -150, -30”

218
Q

Area of typical depolarization (ventricular axis)

A

30 to 90

219
Q

explain “left axis deviation” and who can get it

A

greater than minus 30 deviation. more upward from base of left ventricle .pregnancy, laprascopic, ascites. LEFT VENTRICULAR HYPERTROPHY

220
Q

What would cause right axis deviation

A

pulmonary hypertension. Right ventricular hypertrophy

221
Q

V1 location

A

At 4th intercostal space at rt margin of sternum

222
Q

V2 location

A

at 4th intercostal space, at left margin of sternum

223
Q

V3 location

A

midway between sites V2 and V4

224
Q

V4 Location

A

at 5th intercostal space at midclavicular line

225
Q

V5 Location

A

at same level as site of V4 at anterior axillary line

226
Q

V6 location

A

at same level as site of V4 at midaxillary line

227
Q

EASI electrode configuration

A

alternate lead system: upside down “T” configuration. Ground is reference and placed anywhere.

228
Q

Which 2 leads are in the sagittal plane?

A

V2 an aVF

229
Q

which 5 leads are in the frontal plane

A

aVR, aVL, II aVf, III

230
Q

Which leads are in the transverse plane?

A

V1 through V6

231
Q

The cardiac vector is perpendicular to which lead?

A

V2

232
Q

What is the cardiac vector (mean of QRS axis)

A

-45 degrees. (up to the right)

233
Q

What does a biphasic vector represent?

A

the vector is perpendicular to the reference lead

I&M Final (5 decks)

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