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120 Cards in this Set
- Front
- Back
what valvular disfunction is represented?
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aortic regurgitation
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what valvular disorder is shown?
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aortic stenosis
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mitral reguritation
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Unidirectional equilibrium of energy from high concentration to low concentration
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Entropy
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C to Kelvin
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C+273
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C to F
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1.8 x C +32
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Four processes of heat loss
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radiation
convection conduction evaporation |
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What is the order of heat loss mechanisms from most to least?
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radiation, convection, conduction, evaporation
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infrared electromagnetic wavelength transfers heat from warm bodies to the less warm environment
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radiation
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the process of creating air currents by heat
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convection
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the transfer of heat from physically touching a less warm object
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conduction
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Heat is lost from when skin becomes moist or when water vapor is lost via ventilation, requires energy
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evaporation
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the process of converting liquids or solids into vapors
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vaporization
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What is the only volatile agent that is heated?
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Desflurane
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All liquids that have high vapor pressures at room temperature
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volatile agents
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As gas molecules escape the liquid, they exert a pressure known as...
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vapor pressure(mm Hg)
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Vapor pressures & boiling points are inversely related
(T/F) |
True
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Vapor pressure of isoflurane
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238mmHg
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Vapor pressure of sevoflurane
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160mmHg
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Vapor pressure of Desflurane
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660mmHg
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Desflurane placed into a vaporizer calibrated for isoflurane would put out a (higher/lower) amt than on the dial
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higher
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studied the relationship of volume and temperature when pressure is held constant
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Charles
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studied the relationship of pressure to volume when temperature is held constant
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Boyle
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studied the relationship of pressure and temperature when volume is held constant
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Gay-Lussac
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The volume of a gas is directly proportional to the number of gas molecules
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avagadro's law
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P1V1=P2V2
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boyle's law
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V1/T1=V2/T2
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Charles law
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as the temperature increases, the volume increases
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charles law
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AS THE PRESSURE INCREASES THE VOLUME DECREASES
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boyle's law
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As the Temperature increases the Pressure will increase
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gay-lussac's law
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universal/combined gas law
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PV=T
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The total pressure of a gaseous mixture is the sum of the partial pressures
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Dalton's law
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List 5 components of kinetic molecular theory
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1.small particles whose volume is negligible compared to the volume of the gas
2.constant random motion 3. no atrractive/repulsive forces 4 collisions are elastic 5.kinetic energy depends on temperature |
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A rapid expansion or compression of a gas without equilibration of energy with the surrounding environment and entails no increase or decrease in a system’s energy
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adiabatic changes
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the attractive/repulsive forces between molecules other than that by taking up volume and/or interaction with other molecules
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van der waal's forces
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gas container becomes warmer when compressed and cooler when expanded
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adiabatic effect
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Rapid expansion causes the temperature to decrease
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joule-thompson effect/energy dilution
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Compressing a gas quickly will intensify the kinetic energy such that the thermal measurement of the gas will be higher
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energy concentration effect
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what forms the triangle for central venous catheterization?
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the clavicle and the medial and lateral heads of the sternoceidomastoid muscles
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what is the mechanical meaning of the a wave on the CVP?
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atrial contraction/systole
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what is the mechanical meaning of the v wave on the CVP?
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passive atrial filling
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what is the mechanical meaning of the c wave on the CVP?
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combination wave, tricuspid closure and bowing back into atria, transmits carotid pulse, begins diastole in aorta and atria and systole in ventricles
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what is the mechanical meaning of the x descent on the CVP?
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descent of the base, ventricular systole
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what is the mechanical meaning of the y descent in the CVP waveform?
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passive ventricular filling, tricuspid valve opens
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what wave is missing from the CVP waveform in tricuspid regurg and why?
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c wave because there is no valve closure in tricuspid regurg
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what wave is missing from the CVP waveform in AFib and why?
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a wave because ther is no atrial contraction in AFib
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What wave is missing from the CVP waveform in complete AV Block?
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waveform is all over the place because there is dyssynchrony between atria and ventricles
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should CVP be used to make clinical decisions regarding fluid management?
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no
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what segment of the ECG represents atrial sytole?
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PR interval
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what segment of the ECG represents ventricular systole?
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QRS interval
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what segment of the ECG represents atrial diastole?
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QRS interval
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what segment of the ECG represents ventricular diastole?
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ST interval
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How does cardioplegia affect the heart?
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it overwhelms the Na/K pump and makes the cells hyperpolarized, unable to depolarize and contract resulting in arrest in diastole phase.
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which leads hould be monitored simultaneously on the ECG and why?
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lead II shows inferior wall ischemia and V5 shows lateral and anterior wall ischemia
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How would a BP cuff being too small affect the BP reading?
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false high
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what is the driving force in arterial pulse genesis?
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intrinsic contractility of the LV
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What are the 3 determinants of opposing force in arterial pulse genesis?
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1. resistence
2. inertia 3. compliance |
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what happens to the arterial pressure waveform as the arterial line placement is moved from subclavian to dorsalis pedis?
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the mean remains the same but the systolic increases and the diastolic decreases
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what happens to the ABP reading with a 1in difference in height of the transducer?
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the reading will change inversely by 2mm Hg
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what is the primary cause of an overdamped ABP waveform?
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air bubbles in the system/tubing
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what happens to the ABP waveform in aortic stenosis?
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loss of dicrotic notch
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what happens to ABP waveform with an increased SVR?
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high riding notch
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what is the difference between pulsus alternans and pulsus paradoxus?
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pulsus paradoxus correlates to respiratory variations(lower with inspiration) and pulsus alternans is an alternation of strong and weak beats, indicative of left ventricular failure
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How does a PAOP of 10, 16, 18, and>20 affect the patient?
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10 is normal, 16 provides a higher cardiac output, 18 causes dyspnea, and >20 causes pulmonary edema
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When are the coronary vessels perfused on the right vs left side?
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Right side is perfused during systole and diastole and left side is perfused during diastole only.
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Where does a NSTMI occur and what happens physiologically?
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This is ischemia to the subendocardium which happens from decreased O2 supply to coronaries(on the epicardium) and the subendocardium requires more O2
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What is the Frank-Starling law?
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greater the volume of blood entering the heart during diastole (end-diastolic volume), the greater the volume of blood ejected during systolic contraction (stroke volume) up to a point at which further increase in volume will not result in any further increase in output
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What is stroke work?
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pressure times volume, area under the curve
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What is stroke volume?
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The difference between isovolumetric relaxation and isovolumetric contraction
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How does exercise affect afterload and contractility?
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Increases both
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How does increased EDV affect SW and SV?
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Increases both
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Which areas of the heart does the RCA supply?
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R atrium, R Ventricle, inferior wall of L ventricle
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What areas of the heart does the PDA supply?
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superior posterior IV septum and the R inferior wall
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LMCA bifurcates into the LAD and the CX, which areas of the heart do these vessels supply?
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LAD=septum and anterior wall
CX=lateral wall |
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What vessle supplies the SA and AV nodes?
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SA= RCA or LAD (60/40)
AV=RCA or CX (90/10) |
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what is the mechanical meaning of the X' descent in the CVP waveform?
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atrial relaxation
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What is a vapor?
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when a liquid and a gas coexist at a certain temperature
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List 3 factors that affect FI(inspired concentration of volatile agent)
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1. FGF
2. circuit volume 3.circuit absorption |
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List 3 factors that affect uptake of volatile agents
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1. solubility
2. partial pressure difference between alveoli and venous blood 3. alveolar blood flow |
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List 3 factors that affect FA(alveolar concentration of volatile agent)
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1. uptake
2. ventilation effect 3. concentration effect |
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How does a higher BGPC(blood gas partition coefficient) affect solubility?
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the higher the BGPC, the more soluble the agent is in the blood
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What is the ventilation effect?
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the greater the alveolar ventilation, the faster the patient achieves anesthesia
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What are the 2 components of the concentration effect?
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1. concentrating effect
2. augmented inflow effect |
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What is the concentrating effect?
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The higher the concentration of gas delivered, the faster anesthesia is achieved because the alveolar concentration will be higher, faster
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What is the augmented inflow effect?
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The gas absorbed into the blood must be replaced in order to keep the same mixture in the alveoli, this increases the concentration further.
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What is the second gas effect?
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When 2 agents of varying onset speeds are administered together, the slower gas is "carried" by the faster gas and anesthetic levels of the slower gas are achieved faster than if it had been given alone.
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What does the oil/gas solubility coefficient mean?
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Indicates the anesthetic potency, higher number means more potent agent.
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What is diffusion hypoxia and how is it treated/prevented?
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When high concentrations of N2O are discontinued, it leaves the body rapidly, diffusing into the alveoli and diluting the oxygen and CO2 in the alveoi. This can be overcome by flushing the lungs with 100% O2 for 3-5min after discontinuing the N2O
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How does CO affect anesthetic speed?
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A higher CO will slow the speed of onset of all anesthetics
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How does obesity affect anesthetic speed?
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minimal change in induction but slower emergence due to deposits of anesthetics in fat
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How is anesthetic speed and delivery different in pediatrics?
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anesthesia is achieved faster because of higher ventilatory rates and vessle rich blood flow despite a higher CO and higher required dose of anesthetics.
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What does a BGPC of 0.42 mean?
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only 0.42 molecule of the anesthetic remains in the blood for every 1 molecule entering the brain
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Place the following agents in order from least to most soluble: Isoflurane, desflurane, nitrous oxide, sevoflurane, halothane
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desflurane, nitrous oxide, sevoflurane, isoflurane, halothane
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Why does N2O have a more rapid rate of rise of alveolar concentration than desflurane despite the higher BGPC of N2O?
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the concentration effect, N2O is delivered at a higher concentration, thus increasing its uptake.
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How will a beta blocker affect the rate of induction?
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more rapid induction
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List 3 factors that affect transfer of agent from blood to tissue
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1. tissue solubility
2. tissue blood flow 3. partial pressure difference between arterial blood and tissue |
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What are the 4 major tissue types and what order do they fill with anesthetics?
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vessel rich, muscle, fat, vessel poor
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How does alveolar blood flow affect uptake?
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increased blood flow decreases anesthetic effect because more agent is moving from the alveoli to the blood
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How does ventilation affect the FA(alveolar concentration) of volatile agent?
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increased ventilation causes increased anesthetic effect
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How does a V/Q mismatch affect anesthetic effects?
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the non-soluble agents will take effect slower
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List the 5 goals of general anesthesia
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1. analgesia
2. amnesia 3. muscle relaxation 4. loss of consciousness 5. homeostasis |
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What is MAC?
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minimum alveolar concentration, amount of agent required to inhibit movement to surgical inscision in 50% of people
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What is the difference between 1, 1.3, and 0.3 MAC?
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1 MAC inhibits movement in 50% people, 1.3 MAC inhibits movement in 95% people, 0.3 MAC is MAC awake
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MAC values are additive in their potency and side effects(true/false)
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false- they are additive in potency but not in side effects
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List 7 factors affecting MAC
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1. temperature
2. age 3. intoxication 4.drugs 5. anemia 6.hypotension 7.pregnancy |
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What is the difference between acute and chronic alcohol intoxication in its effect on MAC?
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higher MAC required with chronic intoxication, lower MAC required for acute intoxication
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What is the difference between acute and chronic amphetamine use in its effect on MAC?
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higher MAC required with acute amphetamine use and lower MAC required for chronic amphetamine use
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Which is more potent, MAC of 6 or MAC of 1.2?
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MAC of 1.2, lower MAC is more potent (lower BGPC is faster effect)
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There is an inverse relationship between MAC and fat solubility(true/false)
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true, lower MAC has greater fat solubility
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List 3 routes of elimination of volatile agent
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1. biotransformation(CYP450)
2. transcutaneous(minimal) 3.exhalation(primary) |
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What are the 4 stages of anesthesia?
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1. analgesia
2. excitement 3. surgical anesthesia 4. medullary depression |
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Why wouldn't you use N2O in a patient with a pneumothorax?
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The N2O will diffuse into the pneumothorax and expand the size/worsen it, also don't use in tympanostomy, bowel surgeries, pneumocephalus
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What does halogenation do to an agent?
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decreases flammability
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What does flourination do to an agent?
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decreases solubility
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What do triflurocarbon groups do to an agent?
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add stability
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What do alkanes do to an agent?
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precipitate arrythmias
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Halothane is metabolized more than any other agent(true/false)
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true
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Which agent can be degraded into compound A and cause fires with dessicated soda lime?
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sevoflurane
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Which agents have a non-pungent odor and thus can be used for inhalation induction?
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sevoflurane and halothane
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Which agents can cause a significant carbon monoxide increase with dessicated baralyme?
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desflurane, sevoflurane, isoflurane
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