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APEX > Unit 6 > Flashcards

Unit 6 Flashcards

1
Q

High pressure system

A 
Begins at cylinder, ends at cylinder regulators
Hanger yoke
Yoke block with check valves
Cylinder pressure gauge
Cylinder pressure regulators
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2
Q

Intermediate pressure

A 
Begins at pipeline, ends at flowmeter valves
Pipeline inlets
Pressure gauges
Oxygen pressure failure device
Oxygen 2nd stage regulator
Oxygen flush valve
Ventilator power inlet
Flowmeter valves
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3
Q

Low pressure

A 
Begins at flowmeter tubes, ends at common gas outlet
Flowmeter tubes (Thorpe tubes)
Vaporizers
Check valve
Common gas outlet
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4
Q

Low pressure leak test

A

(Negative pressure test)
Assess from flow meter valves to common gas outlet
Atttach bulb to common gas outlet and creat negative pressure
Fail=blurb inflates within 10 seconds
NO FGF and vent off
Vaporizers off first and then repeated with each vaporizer on
Best way to test a vaporizer leak

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5
Q

High pressure leak test

A

Closing APL valve and pressuring to 30cm/H2O
Pressure should remain constant
No check valve- checks entire breathing circuit and low pressure system
Check valve- checks breathing circuit and low pressure system, NOT between check valve and low pressure system

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6
Q

5 task of oxygen

A 
O2 pressure failure alarm
O2 pressure failure device (Failsafe)
O2 flowmeter
O2 flush valve
Ventilator drive gas
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7
Q

Air PISS

A

1,5

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8
Q

Oxygen PISS

A

2,5

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9
Q

Nitrous oxide PISS

A

3,5

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10
Q

Cylinder colors

A

Standard in US, NOT in WHO
Air= black and white (yellow in US)
Oxygen= white
Nitrous= blue

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11
Q

Air tank

A

1900 psi

625 L

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12
Q

Oxygen tank

A

1900 psi

660 L

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13
Q

Nitrous oxide

A 
745 psi
1590 L
Wt full 20.7 lb
Wt empty 14.1 lb
Psi changes when its 3/4 empty, 400 L left (Barish says 250)
Change when psi falls below 745
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14
Q

Fire triad

A

Oxidizer, fuel, igniter

Oiling cylinder valve increases fire risk-only need a heat source

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15
Q

American society for testing and materials

A

Anesthesia machine components

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16
Q

DOT

A

Standards for gas cylinders

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17
Q

FDA

A

Checkout procedures

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18
Q

OSHA

A

Occupational exposure for volatiles

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19
Q

Oxygen pressure fail safe

A

Protects against low O2 pressure in machine
Not actually failsafe- crossover can cause hypoxic mixture
Intermediate pressure system
2 components 1. When less than 28-30 psi 2. Reduces and stops nitrous flow when O2 pipeline less than 20 psi
Spring pressure that closes- O2 only thing that goes straight through
Disconnect O2 pipeline with N2O on and watch N2O flowmeter

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20
Q

Hypoxia prevention safety device

A

Prevents a hypoxic mixture with flow valves
Limits N2O flow to 3 times O2 flow (N2O max is 75%)
Can’t prevent hypoxic mixtures:
O2 pipeline crossover
Leaks distal to flow meter
3rd gas administration
Defective mechanic/pneumatic components

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21
Q

Annular space

A

Area between float and side wall of flowmeter

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22
Q

Internal diameter

A

Narrowest at base and widens along ascent

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23
Q

Floats read at top

A

Skirted, plum bomb, non rotating

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24
Q

Read in the middle

A

Ball

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25
Q

Reynolds number

A

(Density x diameter x velocity)/viscosity

Re<2000= laminar flow (dependent on gas viscosity)
Re > 4000= turbulent flow (depending on gas density)
2000-4000= transitional flow

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26
Q

calculating FiO2

A

(Air flow rate x 21) + (O2 flow rate x 100)/ total flow rate

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27
Q

Vt with fresh gas coupling

A

Vt set on ventilator + FGF during inspiration - volume lost to compliance

  1. Convert fresh gas flow from L/min to mL/min
  2. Multiple by FGF by the percentage of time in inspiration (1:2 IE= 33.33%)
  3. Divide 2 by RR.
  4. Add set Vt to 3.

Most new ventilators decouple so this does not apply

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28
Q

Compliance

A

Change in volume/ change in pressure
Elastic properties of lungs and chest wall
Dynamic- during air movement, measure of resistance and tendency of lungs to collapse
Static- when no airflow, measure of lungs tendency to collapse

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29
Q

Volume lost to circuit

A

Circuit compliance x peak pressure

Some of Vt used to expand circuit

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30
Q

Splitting ratio

A

Amount of FGF is directed towards the liquid anesthetic

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31
Q

1 mL of liquid anesthetic

A

Produces about 200 mL of anesthetic vapor

FGF entering chamber is 100% saturated

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32
Q

Latent heat of vaporization

A

of calories needed to convert 1g of liquid into vapor without a change in temp

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33
Q

Temp compensating

A

Heat carried away by vaporized molecues= anesthetic agent cooling
Decreases vapor pressure and vaporizer output
Temp compensating valve adjusts ratio of vaporizing chamber flow to bypass flow and guarantees constant vaporizer output with variable temps

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34
Q

Pumping effect

A

Gas that has already left vaporizer to go back through

Normally due to PEEP with low FGF, low concentration, low anesthetic in chamber

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35
Q

ML of liquid anesthetic used per hour

A

Vol% x FGF in L/min x 3

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36
Q

Desflurane vaporizer

A

Injects des into FGF
Heated to 39 C and 2 atmospheres
Does NOT compensate for changes in elevation
Higher altitude= partial pressure is lower
Lower altitude= partial pressure is higher

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37
Q

Calculating vaporizer output at elevation

A

Required dial setting= (normal dial setting x 760)/ambient pressure (mmHg)

Higher altitude= higher setting
Lower altitude= lower setting

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38
Q

Fuel cell vs paramagnetic

A

Fuel cell- calibrated daily, components must be replaced over time
Paramagnetic- self calibration, magnetic attraction

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39
Q

Oxygen analyzer

A

Monitors O2 concentration
Detects pipeline crossover
Detects leak most common=disconnect, 2nd most common= CO2 canister

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40
Q

Oxygen consumption for average adult

A

250 mL/min

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41
Q

O2 flush valve

A

35-75 mL/min
50 psi pressure (pipeline pressure)
Dont press during inspiration- ventilator spill valve is closed

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42
Q

Spill valve

A

Circuit pressure 2-4 cm H2O sends expired gas to scavenger

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43
Q

Inspiratory pressure limiter

A

Circuit pressure above certain level= gas ventilated to scavenger
Like APL that impacts ventilators

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44
Q

Piston vent

A

Uses electric motor to generate positive pressure
Will not consume tank O2 in event of pipeline failure- no O2 as driving gas
Positive pressure relief valve- opens at 75 +/- 5 cm H2O
Negative pressure relief valve- opens at -8 cm H2O, entrains room air leading to O2 and anesthetic agent dilution
Fresh gas decoupling= no Vt change with FGF, RR, or I:E

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45
Q

VCV

A

Preset vT
Ins pressure varies with compliance changes
Inspiratory flow constant

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46
Q

PCV

A

Preset insp pressure
VT and inspiratory flow vary
Increased resistance or decreased compliance=Vt problems
Decelerating flow pattern

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47
Q

Ethyl violet

A

Changes to purple at pH less than 10.3

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48
Q

reaction of CO2 with soda lime

A

CO2 + H2O = H2CO3 (carbonic acid)
H2CO3 + 2 NaOH = Na2CO3 + 2 H2O + heat
Na2CO3 + Ca(OH)2 = CaCO3 (calcium carbonate) + 2 NaOH (sodium hydroxide)

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49
Q

Best granule size

A

4-8 mesh

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50
Q

Calcium hydroxide lime (Amsorb)

A

CO2 + H2O= H2CO3
H2CO3 + Ca(OH)2 = CaCO3 + 2H2O + energy(heat)

No CO and very title compound A
Lower fire risk
Less absorbent capacity

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51
Q

Absorbent capacities

A

Soda lime 26L of CO2 per 100 g

Calcium hydroxide lime 10.6 L per 100g

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52
Q

OSHA recommendations for anesthetic gas

A

N2O < 25 ppm
Halogenated agents < 2ppm
Halogenated agents with N2O < 0.5 ppm and 25 ppm

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53
Q

Expiratory valve failing

A

Beta angle wider during inspiratory phase

Baseline doesn’t return to 0

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54
Q

Mapleson A

A

Bag after FGF hanging down
Best for spontaneous ventilation
Requires 20 L/min FGF for controlled ventilation

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55
Q

Mapleson D

A

Reservoir, APL, FGF

Bain= modified version

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56
Q

Mapleson B

A

Reservoir, FGF, APL (corigated and longer tubing)

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57
Q

Mapleson C

A

Reservoir, FGF, APL (Short)

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58
Q

Mapleson E

A

Ayers T piece

No APL or reservoir bag

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59
Q

Mapleson F

A

Jackson Rees

APL, reservoir, FGF

60
Q

Mapleson with SV

A

A > DFE > CB

61
Q

Mapleson controlled ventilation

A

DFE> BC> A

62
Q

FGF to prevent rebreathing

A

2.5x patients minute ventilation

63
Q

Bain system

A

Modified mapleson D
FGF enters inner tubing and exhaled goes through corrugated tubing
Good for spontaneous and controlled
Pethick test- occlude elbow and patient end, close APL, fill circuit with O2 flush, remove occultism at elbow while flushing
Patent inner tubing =collapsing reservoir bag due to Venturi

64
Q

Resistance

A

(Airway pressure- alveolar pressure)/ FGF

65
Q

Peak inspiratory pressure (PIP)

A

Maximum pressure during inspiration

Dynamic compliance= tidal volume/ (PIP-PEEP)

66
Q

Plateau pressure (PP)

A

Pressure in smal airways and alveoli after tital volume is delivered
During inspiratory pause
Barotrauma risk increased with pressure > 35 cm/H2O
Static compliance= tidal volume/ (plateau pressure- PEEP)

67
Q

normal static compliance

A

Adult 35-100 mL/cmH2O

Child > 15 mL/cmH2O

68
Q

PIP and PP changes

A

Increased PIP and PP= compliance decreased or tidal volume increased
Increased PIP with no change in PP= increased resistance or increased inspiratory flow rate

69
Q

CO2 waveform

A

A= start of flat phase
Phase 1= flat phase
Alpha angle- measured at point C, normally 100-110 degrees, increased= expiratory airflow obstruction
Beta angle- measure at point D, should be 90 degrees, increased in some rebreathing scenarios

70
Q

CO2 analysis methods

A

Mainstream (in line)- attached to ETT, faster response time, increases dead space

Sidestream (diverting)- outside of airway, slower response time due to pumping air away, need a water trap

71
Q

Beer lambert law

A

Intensity of light transmitted through a solution (blood) and a solute (hemoglobin)
Pulse oximetry

72
Q

Pulse ox wavelengths

A

2 of them

  1. Red light (660 nm)- absorbed by deoxyhemoglobin (higher in venous blood)
  2. Near infrared light (940 nm)- absorbed by oxyhemoglobin (higher in arterial blood)
73
Q

SpO2

A

Oxygenated hgb/ (oxygenated hgb + deoxygenated hgb) X 100%

74
Q

Light changes through pulse ox cycle

A

Trough- greater amount of venous blood
Peak- greater amount of arterial blood
Pulse ox calculates absorption ratio on continuous basis

75
Q

SpO2 response time

A 
Fast= ear, nose, tongue, esophagus, forehead
Middle= finger
Slow= toe
76
Q

SPO2 and PaO2

A

SPO2 90%= PaO2 60 mmHg
80%= 50 mmHg
70%= 40 mmHg

77
Q

Oxyhemoglobin dissociation curve

A

Left= increase infinity
Decrease temp, 23 DPG, CO2 H+
Increase pH, HgbMet, HgbCO, HgbF

78
Q

What does pulse pressure monitor

A

Hemoglobin saturation
Heart rate
Fluid responsiveness (PP variation)
Perfusion- ex: R side for innominate artery in mediastinoscopy

79
Q

Pulse ox error margin

A

2-3% between 70 and 100%

3% between 50-70%

80
Q

Methemoglobin

A

Absorbs 660 and 940 equally
Absorption ration areas at 85%
Underestimates if > 85%
Overestimates if < 85%

81
Q

Carbohemoglobin

A

Absorbs 660- same as O2Hgb

Overestimates SpO2

82
Q

Factors that impact pulse ox

A 
Dyes
Nail polish- blue, black, green
Non pulsatile flow
Motion artifact
Cautery
Pulsatile venous flow- tricuspid regurg
83
Q

Things that dont impact pulse ox

A 
Hemoglobin S
Hemoglobin F
Jaundice
Flouorescein
Polycythemia
Acrylic nails
84
Q

Infrared spectrophotometry

A

Most common exhaled gas analysis method
Each gas absorbs different wavelength of infrared light
Greater conc of gas absorbs more infrared light so light intensity back to sensor is less
Can not measure O2

85
Q

Mass spectrometry

A

Puts electrons in gas sample creating ion fragments
Particles become charge and are identified based on mass
May be used for more than one patient at once

86
Q

Raman scatter spectrometry

A

Argon laser used to produce photons that collide with gas molecules
Scatter of photons measured to identify gas and concentration

87
Q

Piezoelectric crystals

A

Incorporates alipid layer on the crystal
Responds to individual gases as they make contact and get absorbed
Can’t identify more than one gas at once

88
Q

BP cuff distance change

A

Every 10 cm= BP change by 7.4 mmHg

Every inch= BP change by 2 mmHg

89
Q

A line waveform

A 
SBP= peak of waveform
DBP= trough of waveform
PP= Peak - trough
Contractility= upstroke
SV= area under curve
Closure of aortic valve= dicrotic notch
90
Q

ABP waveform flush test

A

Optimally damped- baseline after 1 oscillation
Under damped- baseline after several oscillation= SBP overestimated, DBP underestimated, MAP accurate
Over damped- baseline with no oscillations= SBP underestimated, DBP overestimated, MAP accurate, causes- air bubble/ clot or low bag pressure

91
Q

Insertion to Vena cava/RA junction

A 
Subclavian 10 cm
Right IJ 15 cm
Left IJ 20 cm
Femoral 40cm
R median basilic 40cm
L median basilic 50 cm
92
Q

Vena cava/ RA junction to Cather tip

A

RA 0-10 cm
RV 10-15 cm
PA 15-30 cm
PAOP 25-35 cm

93
Q

Central line complications

A

L IJ= added risk of puncturing thoracic duct (chylothorax)
Dysrhythmias= most common complication
Infection rate increases after 3 days
No PAC with LBB- can cause RBB= complete heart block

94
Q

A wave CVP

A

RA contraction

Just after P wave

95
Q

C wave CVP

A 
RV contraction (bulging tricuspid valve in RA)
Just after QRS complex
96
Q

X descent CVP

A

RA relaxation

ST segment

97
Q

V wave CVP

A

Passive filling of RA

Just after T wave begins (ventricular repol)

98
Q

Y descent (CVP)

A

RA empties through open tricuspid valve

After T wave ends

99
Q

Phlebostatic axis

A

4th intercostal space mode anteroposterio level

100
Q

Where should CVP be measured?

A

End expiration

Not impacted by intrathoracic pressure there

101
Q

Normal CVP

A

Adult 1-10 mmHg

Low= low intravascular volume
High= hypervolemia, decreased ventricular compliance, increased thoracic pressure
102
Q

CVP is a function of

A

Intravascular volume
Venous tone
RV compliance

Assume RV and LV output = and that RAP reflects LVEDP

103
Q

RVP

A

Systolic pressure increases
Diastolic= CVP
15-30/0-8

104
Q

PAP

A

Systolic= same
Diastolic rises
Dicrotic notch formed
15-30/5-15

105
Q

PAOP

A 
5-15
Or wedge pressure
CVP of left heart
A wave= left atrial systole
C wave= mitral valve elevation into LA during LV systole
V wave= passive left atrial filing
106
Q

zone of lung for tip of PA cath

A

Zone III
Most accurate estimation of LVEDP
Dependent region

107
Q

Clues PA tip isn’t in zone 3

A

PAOP > PAEDP
Nonphaseic PAOP tracing
Inability to aspirate from distal port when ballon wedged

108
Q

Thermodilution

A

Injected through proximal port of PA cath
Stewart Hamilton equation plots temp change vs time
AUC inversely proportional to CO
high CO= small AUC
Low CO= large AUC

109
Q

Influencing themodilution CO measurements

A

Underestimates- injecting too much or too cold fluid
Overestimates- injecting too little or too hot fluid, wedge PAC, thrombus on tip
Unable to predict- shunt, tricuspid regurg

110
Q

Mixed venous oxygen saturation

A 
SvO2= SaO2- (VO2/(Q x 1.34 x Hgb x 10))
Normal= 65-75%
VO2= oxygen consumption
SaO2= loading of hemoglobin in arterial blood

Need a PA cath to get blood from SVC, IVC, and coronary sinus together

111
Q

Filling during insp and expiration

A

Inspiration- positive pressure augments LV and increases SV
Expiration- LV filling decreases and reduces SV

Hypovolemia= greater SVV

112
Q

Preload responsiveness

A

200-250 mL fluid bolus improves SV > 10%

Measurement usually 13-15%

113
Q

anterior internodal tract

A

Bachman bundle

Extends into LA

114
Q

Middle internodal tract

A

Wenckeback tract

115
Q

Posterior internodal tract

A

Thorel tract

116
Q

Cardiac conduction velocities

A

SA and AV nodes= 0.02- 0.1 m/sec (slow)
His bundle, bundle branches, and purkinje= 1-4 m/sec (fast)
Myocardial muscle cells= 0.3-1 m/sec (intermediate)

Function of- resting potential, amplitude of AP, rate of change in potential during phase 0

117
Q

Vector of depolarization

A

Positive deflection- vector travels towards from + electrode
Negative deflection- vector travels away from + electrode
Biphasic deflection- vector travels perpendicular to + electrode

118
Q

Bipolar leads

A

I- lateral, CxA
II- inferior, RCA
III- inferior, RCA

119
Q

Limb leads

A

AVR

AVL
Lateral
CxA

aVF
Inferior
RCA

120
Q

Precocial leads

A 
V1- septum, LAD
V2- septum, LAD
V3- anterior, LAD
V4- anterior, LAD
V5- lateral, CxA
V6- lateral, CxA
121
Q

Axis deviation

A

Use lead 1 and aVF
+ and += normal (between -30 and +90)
- and -= extreme R

Leads are Reaching towards each other(I down and aVF up)= R (greater than 90)
Leads are Leaving each other (I up and aVF down)= L (less than -30)

122
Q

Vector direction with hypertrophy and MI

A

Hypertrophy- towards it (more to depolarize)

MI- away from it (has to move around it)

123
Q

Bainbridge reflex

A

Causes sinus arrhythmia
increased venous return stretches RA and SA node causing increase HR
Inhalation= increased venous return

124
Q

Sinus Brady treatment

A

Atropine- can have paradoxical Brady
Transcutaneous pacing
Glucagon- B blocker of Ca blocker overdose, increases cAMP, 50-70 mcg/kg q 3-5 min, 2-10 mg/hr infusions

125
Q

Brigade syndrome

A

Na ion channelopathy in heart
Most common sudden nocturnal death from Vtach or fib
Common in SE Asian males
EKG- RBBB, ST segment elevation in precordial leads
ICD or pad placement in surgery

126
Q

2nd degree heart block type I

A

Mobitz I, Wenckebach
PR interval longer with each cycle and last P wave doe snot conduct
Give atropine if symptomatic

127
Q

2nd degree heart block

A

Mobitz II
Some P’s conduct, others don’t
Usually 2:1 or 3:1 ratio
High risk of conversation to complete

128
Q

3rd degree heart block

A

Atria and ventricles have separate rates

Complete dissociation

129
Q

Class 1 antiarhythmic

A

Na+ channel blockers
1A- quinidine, procainamide, disopyramide
Phase 0 dep, prolonged phase 3 repol

1B- lidocaine, phenytoin
Phase 0 dep, shortened phase 3 repol

1C- flea indie, propafenone
Strong phase 0 dep

130
Q

Class 2 antiarhythmics

A

Beta blockers

Slows phase 4 depol in SA node

131
Q

Class 3 antiarhythmics

A

K+ channel blockers
Amiodarone, bretylium
Prolongs phase 3 repolarization
Increased effective refractory period

132
Q

Phase 4 antiarhythmics

A

Ca Channel blockers
Verapamil, dilt
Decreased conduction velocity through AV node

133
Q

Adenosine

A

Endogenous nucleoside that slows conduction through AV node
Causes K to move into cell (hyperpolarized) and reduces action potential duration
Rapid plasma metabolism
SVT and WPW, NOT a fib, a flut, or Vtach
Can cause brnochospasm

134
Q

WPW syndrome

A

Most common pre excitation syndrome
Direct accessory conduction pathway (Kent’s bundle) that bypasses AV node
EKG- delta wave, short PR interval, wide QRS, possible T wave inversion
A fib- give procainamide

135
Q

Tachycardia with WPW

A

AV nodal reentry tachycardia (AVNRT)

136
Q

Orthodromic AVNRT

A

More common
Atrium to AV node to ventricle to accessory pathway to atrium
Narrow QRS
Block conduction at the AV node to increase AV node pathway

137
Q

Antidromic AVNRT

A

Rare
Atrium to accessory pathway to ventricle to AV node to atrium
Wide ARS
Block accessory pathway- procainamide, amiodarone, cardiversion
Do NOT give agents that increaseAV refractory, favors accessory pathway, can induce V fib
Avoid- adenosine, dig, dilt and verapamil, beta blockers, lidocaine
More dangerous- gatekeeper function of AV node bypassed

138
Q

Drugs that are safe for all AVNRT

A

Amiodarone

Cardiversion

139
Q

Definitive treatment of WPW

A

Radio frequency ablation
LA pathway
Thermal injury to LA and esophagus
Monitor esophageal temp

140
Q

Tornadoes de Pointes

A

Polymorphic v tach causes by delay in ventricular repolarization (phase 3)
Associate with a long QT
Men > .45 sec
Women > 0.47 sec
Can be caused by R on T phenomenon
Treatment- mag, cardiac pacing
Prevention- avoid SNS stim, beta blockers

141
Q

Tornadoes mnemonic

A 
POINTES
Phenothiazines
Other meds- methadone, droperidol, haldol, zofran, halogenated agents, amiodarone, quinidine
Intracranial bleed
No known cause
Type I antiarhythmics
Electrolyte disturbances- low K, low Ca, low Mg
Syndromes- Romano ward, Timothy
142
Q

Pacemaker designation

A 
1- paced
2- sensed
3- response
4- programmability
5- pacemaker can pass multiple sites
143
Q

Magnet

A

Pacemaker- usually converts to asynchronous, best answer is to consult manufacturer
ICD- suspends ICD and prevent shock
Pacemaker and ICD- suspends ICD and prevents shock, NO pacemaker effect

144
Q

Conditions that make myocardium more resistant to depol

A 
May fail to capture
K disturbance
Hypocapnia
Hypothermia
MI
Fibrotic tissue around pacing leads
Antiarhythmics meds
145
Q

Cerebral oximetry

A

Measures venous O2 sat
Detects regional O2
Can’t measure pulsatile flow- detect venous oxyhemoglobin saturation and extraction
> 25% change from baseline suggests reduced oxygenation

146
Q

EEG waves

A

Beta- high frequency, low voltage, awake or light anesthesia
Alpha- medium frequency, awake but restful with eyes closed
Theta- general anesthesia and children sleeping
Delta- low frequency, GA, deep sleep, and brain injury

APEX (6 decks)

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