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120 Cards in this Set

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