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Basics > Vent material > Flashcards

Vent material Flashcards

1
Q
A

restriction

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2
Q
A

airway obstruction

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3
Q
A

fixed obstruction

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4
Q
A

variable intra thoracic obstruction

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5
Q
A

early airflow obstruction

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6
Q
A

variable extra thoracic obstruction

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7
Q
A

normal flow volume loop

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8
Q

spirogram

A
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9
Q

wright respirometer

A
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10
Q

3 types of dead space

A
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11
Q

what is I TIME

A

amount of time spent in inspiration

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12
Q

what is E time

A

amount of time spent in expiration

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13
Q

what is volume

A

the amount of tidal volume a patient recieves

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14
Q

what is pressure

A

measure of impedence to gas flow rate

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15
Q

what is flow

A

measure of rate at which gas is delivered

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16
Q

what is the ideal amount of tidal volume

A

6-8ml/kg of ideal body weight

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17
Q

when do you give lower TVs

A

ARDS or COPD or ASTHMA

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18
Q

what is PIP

A

peak inspiratory pressure
the highest level of pressure aplied to lungs in cm H2O

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19
Q

what is PIP limit

A

40 cmH2O

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20
Q

when can PIP be higher

A

ARDS

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21
Q

what should PIP be in masked or LMA patient

A

20 cmH2O

bc lower esophageal sphincter opens at >20cmH20

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22
Q

what triggers a ventilator to cycle inspiration

A

time
pressure
volume
flow

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23
Q

what is a normal peep level

A

5-8 cm h2o

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24
Q

what conditions require higher peep of 8-12 or 20 cm H2O

A

ARDS

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25
Q

what happens if PEEP exceeds 20 cm H20

A

severe lung damage
barotrauma
subq emphysema
pneumo

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26
Q

slope is a measure of

A

time

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27
Q

slope is how long it takes to reach a set

A

pressure

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28
Q

what is range of slope

A

0-2 seconds

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29
Q

a higher number slope is a more (gradual/steep) slope

A

gradual

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30
Q

what mode is slope important in

A

pressure support

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31
Q

if slope is longer than inspiratory time what is comprimised

A

TV

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32
Q

what is PIP- PEEP

A

delta P

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33
Q

pressure control is

A

preset
delivered Vt changes according to lung compliance
when the patient is spontaneously breathing, as the PIP is fixed, reduces pt discomfort

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34
Q

volume control is

A

volume is preset

delivered PIP varies based on pulm compliance and airway resistance

pt spontaneously breathing, PIP is variable, it will deliver a breath during asynchrony leading to increased work of breathing and discomfort

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35
Q

pressure vs volume waveforms

A
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36
Q

which vent mode provides guaranteed MV and is more comfortable for patients

A

volume control

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37
Q

which vent mode is not optimal for poorly compliant lungs

A

volume

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38
Q

which vent mode provides more support at lower PIP for poorly compliant lungs

A

pressure

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39
Q

which vent mode does not have a guaranteed MV

A

pressure

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40
Q

which vent mode do we use right before extubation

A

pressure support

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41
Q

which vent mode is pressure support but with a BACKUP rate

A

PSV-pro

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42
Q

which vent mode has madatory breaths (synchronized) and pressure support for spontaneous breaths

A

SIMV

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43
Q

what flow is diminished in COPD

A

expiratory
FEV1 is low

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44
Q

normal flow volume loop

A
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45
Q

COPD flow-volume loop

A
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46
Q

how does restrictive lung disease affect volume loop

A

residual volume is low
inspiratory volume (TLC)
FEV1 normal
peak exp flow normal

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47
Q

restrictive flow-volume loop

A
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48
Q

flow volume loop comparison

A
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49
Q

what would cause a pattern of expiratory flow-volume curve to be normal, but have a low inspiratory value

A

upper airway obstruction

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50
Q

what causes upper airway obstruction

A

paralysis of vocal cords
laryngospasms
thuyromegaly
tracheomalacia

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51
Q

what complication obstructs both inspiration and expiration

A

fixed intrathoracic or extrathoracic airway obstuctions
EX. tracheal stenosis, foregn body, neoplasm

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52
Q

what is a cause of post of bradypnea

A

opioid overdose

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53
Q

what is a cause of post op tachypnea

A

pain

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54
Q

as TV decreases, dead space____

A

increases

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55
Q

what must be set in VCV mode

A

TV
RR
I:E ratio

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56
Q

PIP is ____ related to lung compliance

A

inversely

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57
Q

what is set in PCV

A

peak airway pressure
RR
I:E ratio

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58
Q

what must be monitored closely in PCV

A

tidal volume
CO2

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59
Q

what is the amount of gas inspired or expired with each normal breath

A

Tidal Volume (TV)

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60
Q

what is the maximum amount of additional air that can be inspired from the end of a normal inspiration

A

inspiratory reserve volume

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61
Q

what is the maximum volume of additional air that can be expired from the end of a normal expiration

A

expiratory reserve volume

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62
Q

what is the volume of air remaining in the lung after a maximal expiration

A

residual volume

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63
Q

what s the only lung volume which cannot be measured with a spirometer

A

residual volume

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64
Q

what is the volume of air contained in the lungs at the end of a maximal inspiration

A

total lung capacity

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65
Q

what is the sum of the 4 basic lung volumes

A

TLC

IRV+TV+ERV+RV

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66
Q

what is the maximum volume of air that can be forcefully expelled from the lungs following a maximal inspiration

A

vital capacity

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67
Q

what is the sum of inspiratory reserve volume, tidal volume and expiratory reserve volume

A

vital capacity

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68
Q

what is the formula for VC

A

IRV+TV+ERV= TLC-RV

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69
Q

what are some factors that decrease FRC

A

obesity
pregnancy
upright position
supine position
anesthetic induction
neuromuscular blockers
surgical displacement

70
Q

what is the reservoir of oxygen that prevents hypoxemia during apnea

A

functional residual capacity

71
Q

what is the volume of air remaining in the lung at the end of a normal expiration

A

functional residual capacity

72
Q

what is the residual volume plus the expiratory reserve volume

A

FRC

73
Q

what is the fomula for FRC

A

RV + ERV

74
Q

how does GA affect FRC

A

decreases

75
Q

how does obesity affect FRC

A

decreases

76
Q

how does pregnancy affect FRC

A

decreases

77
Q

how is FRC in neonates

A

decreased

78
Q

how does advanced age affect FRC

A

increases

79
Q

how does supine position affect FRC

A

decreased

80
Q

how does lithotomy affect FRC

A

decreases

81
Q

how does trendelenburg affect FRC

A

decreases

82
Q

how does prone affect FRC

A

increases

83
Q

how does sitting affect FRC

A

increases

84
Q

how does lateral position affect FRC

A

no change or increases

85
Q

how does paralysis affect FRC

A

decreases

86
Q

how does inadequate anesthesia affect FRC

A

decreases

87
Q

how does excessive IV fluids affects FRC

A

decreases

88
Q

how does high FI02 affect FRC

A

decreases

89
Q

how does reduced pulmonary compliance affect FRC

A

decreases

90
Q

how does obstructive lung disease affect FRC

A

increased

91
Q

how does PEEP affect FRC

A

increased

92
Q

how do sigh breaths affect FRC

A

increased

93
Q

what is the maximum volume of air that can be inspired from end expiratory position

A

inspired capacity

94
Q

what is the sum of tidal volume and inspiratory reserve volume

A

inspired capacity

95
Q

what is the formula for IC

A

tidal vol + inspiratory reserve volume

96
Q

which lung zone has no blood flow

A

zone 1, pathological zone

97
Q

in what lung zone does pulmonary pressure exceed alveolar pressure. blood flow here is pulmonary artery pressure-alveolar pressure

A

zone 2

98
Q

what lung zone is blood flow proportional to PAP- pulmonary vein pressure

A

zone 3

99
Q

where should Swan be

A

zone 3

100
Q

which zone is present in pulmonary edema

A

zone 4

101
Q

blood flow in zone 4 is PAP- ___________

A

pulmonary interstitial fluid pressure gradient

102
Q

which lung zone is:
PA(alveolar)>Pa>Pv

A

zone 1

103
Q

which lung zone is:
Pa>PA>pv

A

zone 2

104
Q

which lung zone is:
Pa>Pv>PA

A

zone 3

105
Q

which lung zone is:
Pa>Pi (interstitial pressure)> Pv>PA

A

zone 4

106
Q

what is normal Va (alveolar ventilation)

A

4 L/ min

107
Q

what is normal pulmonary capillary perfusion (Q)

A

5 L/min

108
Q

what is normal V/Q ratio

A

0.8

109
Q

what is normal V/Q range

A

0.3-3.0

110
Q

what causes a low V/Q ratio

A

LUNG PROBLEM
shunt
airway obstruction to area

111
Q

what causes a high V/Q ratio

A

BLOOD PROBLEM
deadspace
blood flow problem
pulmonary emoboli

112
Q

low v/q

A
113
Q

high V/Q

A
114
Q

what is the affect of shunt/low V/Q

A

hypoxia

115
Q

what is the affect of deadspace high V/Q

A

hypercapnea
hypoxia

116
Q

shunt

A
117
Q

dead space

A
118
Q

in shunt:
PaO2 is __________
PaCO2 is ___________

A

high
low

119
Q

in pulmonary embolism (dead space):
PAO2 is_________
PACO2 is _________

A

higher
low

120
Q

mapleson circuits

A
121
Q

bain circuit

A
122
Q

at what flow do you not need a CO2 absorber on circuit

A

> 5L

123
Q

where is dead space on a circle cicuit

A

distal to Y piece

124
Q

what gives lungs their elasticity

A

collagen and elastin fibers

125
Q

lungs with low compliance require (less/more) pressure to inflate

A

more

126
Q

what is the elastance formula

A
127
Q

what is compliance formula

A
128
Q

what causes resistance in the lungs

A

tissue resistance and airway resistance

129
Q

what law gives us the formula for resistance

A

poiseuilles law

130
Q

poiseuilles law pressure formula

A
131
Q

what does an increased alfa angle suggest

A

expiratory airway obstruction
-copd, bronchospasm, kinked et tube

132
Q

what can cause increased dead space causing low etco2

A

pulm embolism

133
Q

what does an increased beta angle suggest

A

rebreathing due to faulty inspiration valve
soda lime

134
Q

what needs to be monitored when giving neuromuscular blocking agents

A

neuromuscular function and status

135
Q

what are advantages of side stream sampling

A

lightweight,
less chance of disconnect,
accurate <40 breaths/min,
no dead space

136
Q

what are disadvantages of side stream monitoring

A

water/secretions may clog line,
flexible tube easily obstructed,
inaccurate >40 breath so no peds

137
Q

describe side stream sampling

A

pump in monitor aspirates sample of gas trhough thin/flexible sampling line

138
Q

what monitoring sampling measures gas directly in breathing system

A

mainstream aka non diverting

139
Q

what are advantages of mainstream sampling aka non diverting

A

fast, good fidelity, water and secretions not an issue

140
Q

which sampling method can increase etco2

A

mainstream sampling by increasing dead space

141
Q

what are disadvantages of mainstream sampling aka non diverting

A

heavy in circuit,
increases dead space,
greater opportunity for disconnect,
gas options limited

142
Q

what is the measurement and numerical display of co2 concentrations during respiratory cycle

A

capnography

143
Q

what is a graphic record of co2 concntratino on screen or paper

A

capnography

144
Q

what is the actual waveform genered by capnometer

A

capnogram

145
Q

what may be detected due to abnormalities in capnography

A

airway obstruction

146
Q

what is produced by cells of body during metabolism into circulatory system and then is diffused into lungs

A

CO2

147
Q

what is a better indicator of rosc during resuscitation

A

exhaled CO2

148
Q

what cardiac changes can etco2 aid in detecting

A

decreased cardiac output,
pulmonary embolism,
reduced blood flow to lungs

149
Q

what guides ventilator changes and can give a trend of anesthesia depth

A

CO2

150
Q

what could a sudden increase in co2 represent during code

A

spontaneous cardiac function/output

151
Q

what is difference between etco2 on monitor and blood

A

blood is usually 5 higher than monitor

152
Q

What are some complications that can happen that etco2 can help alert to

A

esophageal intubation,
apnea,
extubation,
disconnection,
ventilator malfunction,
ett partial obstruction,
compliance vs resistance changes,
spontaneous resp w/muscle relaxant use,
poor lma fit,
leaking ett cuff

153
Q

what is phase 1 in capnography (A)

A

inspiratory baseline- 0- low valley

154
Q

what could be a problem if your co2 isn’t reading 0 during phase 1

A

co2 canister needs to be changed out

155
Q

what is phase 2 in capnography and what letters are in it

A

initiating exhale- b- c

156
Q

what is phase 3 in capnography and what letters are in it

A

plateau c-d
no plateau= not reading correctly

157
Q

how is slope of phase 3 increased

A

kink, ventilation perfusion status,

158
Q

what is phase iv in capnography and what letters are in it

A

end tidal point down to zero (inhalation)
d-e

159
Q

what is the letter with the highest co2 number on capnography

A

d- 35-40 torr

160
Q

what could cause no co2 in gas line

A

obstruction, disconnection, esophageal intubation, no blood circulation to lungs

161
Q

what uses each anesthetic gas’s ability to absorb specific frequencies of emr in the infrared spectrum

A

infrared absorption analysis

162
Q

what anesthesia gas monitoring has advantages of being fast, reliable, low cost, multiagent/multigas

A

mass spectrometry

163
Q

what anesthesia gas monitoring has disadvantages of warm up time, space, must be scavenged, and measures only preprogrammed gases

A

mass spectrometry

164
Q

what has a laser that interacts with gas molecule and measures the fraction of energy absorbed at different live wavelengths called scattering

A

raman spectrometry

165
Q

what anesthesia gas monitoring is less accurate with pediatric cases, since they use high carrier gas flow rates and small tidal volumes

A

raman spectrometry

166
Q

what are disadvantages of raman spectrometry

A

costly, less accurate in pediatrics

167
Q

what are advantages of raman spectrometry

A

no scavenging,
accurate,
fast multi-gas/agent

168
Q

what do you need to do with o2 flow sensor (galvanic cell)

A

calibrate to room air, degrade in 30 days

169
Q

what does vaporizer output assess

A

detects incorrect agents
detect vaporizer turned off/empty
provides info on uptake and elim of agent in pt

170
Q

what should baseline be on capnography

A

zero

171
Q

what can interfere with bis

A

shivering, electrocautery, forced air warmer, cardiac pacemaker spikes

172
Q

how does electrocautery interupt bis

A

unipolar cautery overloads bis signal transmission

Basics (7 decks)

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