CUMULATIVE - Science (10/ppt, hard)
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Questions and Answers

Which act was designed to ensure MD participation in anesthesia for reimbursement?

  • American Association of Nurse Anesthesiology
  • Omnibus Budget Reconciliation Act
  • Medicare Access and CHIP Reauthorization Act (MACRA)
  • Tax Equity and Fiscal Responsibility Act (TEFRA) (correct)

    • Who performed the first public display of inhaled anesthesia with diethyl ether at Massachusetts General Hospital?

  • Karl Köller
  • Alice Magaw
  • William T. G. Morton (correct)
  • Sister Mary Bernard

    • Who demonstrated the use of cocaine as a local anesthetic?

  • Karl Köller (correct)
  • Sister Mary Bernard
  • Alice Magaw
  • William T. G. Morton

    • Who provided anesthesia for the Mayo brothers in Rochester, MN, and was commonly known as the 'Mother of Anesthesia'?

    <p>Alice Magaw</p> Signup and view all the answers

    Who was the first to provide formal training of nurses/physicians at Lakeside Hospital in Cleveland, OH?

    <p>Agatha Hodgins</p> Signup and view all the answers

    Who was the founding President of the National Association of Nurse Anesthetists, which later changed to the American Association of Nurse Anesthetists?

    <p>Agatha Hodgins</p> Signup and view all the answers

    What is a potential cause of hypercapnia in the context of anesthesia?

    <p>Inadequate CO$_2$ removal</p> Signup and view all the answers

    How can hypoxic gas mixture be detected during anesthesia?

    <p>Calibrated OXYGEN ANALYZER</p> Signup and view all the answers

    What should be done in response to pipeline crossover during anesthesia?

    <p>Open oxygen cylinder, DISCONNECT PIPELINE</p> Signup and view all the answers

    What is a potential cause of hyperventilation in the context of anesthesia?

    <p>Ventilator Inappropriate settings</p> Signup and view all the answers

    How can hypercapnia be troubleshooted during anesthesia?

    <p>Assess absorbent function, rule out exhausted absorbent</p> Signup and view all the answers

    What is the typical response to a 'flat' reservoir bag during manual ventilation with a reservoir bag?

    <p>Fill circuit with O2 flush valve</p> Signup and view all the answers

    What is the correct response to pipeline crossover?

    <p>Connect to an auxiliary oxygen source</p> Signup and view all the answers

    What are the potential causes of hypoventilation/hypercapnia?

    <p>Oxygen flush valve overuse</p> Signup and view all the answers

    What is the correct response to inspiratory/expiratory circuit obstruction?

    <p>Disconnect breathing circuit from the patient</p> Signup and view all the answers

    What are the potential causes of excessive airway pressure?

    <p>Tipped vaporizer</p> Signup and view all the answers

    How do the gases arrive to the anesthesia machine?

    <p>Through supply cylinders or pipeline processing</p> Signup and view all the answers

    What is the purpose of the anesthesia machine?

    <p>To prepare and deliver gases to the patient for anesthesia</p> Signup and view all the answers

    How are waste gases disposed of by the anesthesia machine?

    <p>Through the CO2 absorbent disposal system</p> Signup and view all the answers

    What is the purpose of the hanger yokes in the supply cylinder supply?

    <p>To orient cylinders, provide gas-tight seal, and ensure unidirectional flow into the machine</p> Signup and view all the answers

    What is the function of the check valve in the supply pipeline supply?

    <p>Prevents gas leakage from the machine upon disconnect and higher pressure gas backflowing into the pipeline</p> Signup and view all the answers

    What is the purpose of the pressure regulators in the cylinders?

    <p>To regulate the pressure from the cylinder and supply it to the machine at 45 psi</p> Signup and view all the answers

    What is the potential compound produced by the base degradation reaction of sevoflurane with absorbent?

    <p>Fluoromethyl-2,2-difluoro-1-(trifluoromethyl) vinyl</p> Signup and view all the answers

    Which factor does NOT increase the potential for carbon monoxide production from absorbents?

    <p>Low temperature</p> Signup and view all the answers

    What is the purpose of the scavenging system in the operating room?

    <p>Collection and removal of waste anesthetic gas</p> Signup and view all the answers

    Which component of the anesthesia machine is operator-adjustable and provides control of pressure in the circuit during ventilation?

    <p>APL valve</p> Signup and view all the answers

    What is the primary ingredient in the carbon dioxide absorbent granules used in anesthesia machines?

    <p>Ca(OH)2</p> Signup and view all the answers

    Which type of mechanical ventilation consumes less gas and has a fresh gas decoupling mechanism?

    <p>Mechanically-driven piston ventilator</p> Signup and view all the answers

    What is the purpose of the oxygen fail-safe mechanism in the anesthesia machine?

    <p>Prevents or limits delivery of N2O when oxygen pressure falls</p> Signup and view all the answers

    How is the minimum oxygen flow ensured when the anesthesia machine is powered on?

    <p>Always present when the machine is powered on, even with the oxygen flow control valve closed</p> Signup and view all the answers

    What are the safety features of vaporizers in the anesthesia machine designed to prevent?

    <p>Misfilling, tipping, overfilling, and simultaneous agent administration</p> Signup and view all the answers

    Which factor does NOT contribute to the increased incidence of wound infection due to hypothermia?

    <p>Longer PACU stays</p> Signup and view all the answers

    What effect does hypothermia have on the cerebral blood flow?

    <p>Decreased</p> Signup and view all the answers

    What is the impact of hypothermia on platelet production and activity?

    <p>Decreased</p> Signup and view all the answers

    Which warming method is effective at slowing heat loss compared to room temperature fluids, especially important when delivering cold fluids such as blood products?

    <p>Intravenous Fluid Warmer</p> Signup and view all the answers

    What is the primary purpose of the Reflective hat and garments used for maintaining normothermia intraoperatively?

    <p>Lessen heat loss from radiation and convection</p> Signup and view all the answers

    How do Low Fresh Gas Flow Rates contribute to maintaining normothermia intraoperatively?

    <p>Effective at slowing heat loss</p> Signup and view all the answers

    What is the primary function of the Heat and Moisture Exchanger (HME) used intraoperatively?

    <p>Decrease heat loss from respiratory tract</p> Signup and view all the answers

    What is the effect of hypothermia on the hypoxic drive?

    <p>Decreased</p> Signup and view all the answers

    What is the impact of hypothermia on the oxygen-hemoglobin dissociation curve?

    <p>Left shift</p> Signup and view all the answers

    What is the primary purpose of the BAIR Hugger used for maintaining normothermia intraoperatively?

    <p>Pulls ambient air into unit, warms and exits through specialized blanket</p> Signup and view all the answers

    According to Boyle's Law, if the pressure of a gas is doubled while the temperature remains constant, what happens to the volume of the gas?

    <p>It is halved</p> Signup and view all the answers

    If the temperature of a gas is increased while the pressure remains constant, according to Charles' Law, what happens to the volume of the gas?

    <p>It increases</p> Signup and view all the answers

    In which state of matter do molecules move linearly, with attractive forces between molecules being less than their kinetic energy?

    <p>Gas</p> Signup and view all the answers

    What is the mathematical representation of Boyle's Law?

    <p>$P_1V_1 = P_2V_2$</p> Signup and view all the answers

    What is the universal gas law equation that combines Boyle's, Charles', and Avogadro's laws?

    <p>$PV = nRT$</p> Signup and view all the answers

    What is the equation representing Van der Waal's Equation?

    <p>$(P + \frac{n^2a}{V^2})(\frac{V}{n-b}) = RT$</p> Signup and view all the answers

    What is the equation for Charles' Law?

    <p>$\frac{V1}{T1} = \frac{V2}{T2}$</p> Signup and view all the answers

    What is the equation for Gay-Lussac's Law?

    <p>$\frac{P1}{T1} = \frac{P2}{T2}$</p> Signup and view all the answers

    What is the equation for the Universal Gas Law?

    <p>$PV = nRT$</p> Signup and view all the answers

    What is Avogadro's Number?

    <p>6.02 x 10^23</p> Signup and view all the answers

    What is the relationship between luminous intensity of light and distance in an absorbing medium?

    <p>It decreases exponentially with distance</p> Signup and view all the answers

    What is the primary purpose of a pulse oximeter probe?

    <p>To differentiate pulsatile arterial signal from nonpulsatile signals and tissue</p> Signup and view all the answers

    What is the key risk associated with pulse oximetry monitoring?

    <p>Prone to artifacts and delayed measurements</p> Signup and view all the answers

    What does plethysmographic analysis primarily aim to differentiate?

    <p>Pulsatile arterial signal from nonpulsatile signals and tissue</p> Signup and view all the answers

    What is the relationship between absorptivity and solution concentration?

    <p>They are directly proportional</p> Signup and view all the answers

    What is the relationship between oxygen saturation (SaO2) and arterial oxygen tension (PaO2) according to the oxyhemoglobin dissociation curve?

    <p>SaO2 90% = 60 PaO2, SaO2 of 70% = 40 PaO2</p> Signup and view all the answers

    How is the calculation of SpO2 done in pulse oximetry based on the Beer-Lambert Law?

    <p>Using spectrophotometry and plethysmography to measure optical properties and changes in volume</p> Signup and view all the answers

    What does the Beer-Lambert Law describe in the context of pulse oximetry?

    <p>Calculation of SpO2 using an algorithm derived from the Beer-Lambert Law</p> Signup and view all the answers

    What determines the wavelength of light in a laser?

    <p>The amount of energy released when the electron drops to a lower orbit</p> Signup and view all the answers

    What is the acronym 'Laser' stand for?

    <p>Light Amplification by Stimulated Emission of Radiation</p> Signup and view all the answers

    What is the primary function of the resonant chamber in a laser?

    <p>To contain the laser medium</p> Signup and view all the answers

    Which type of laser medium is represented by the acronym 'CO2'?

    <p>Gas</p> Signup and view all the answers

    What property describes the light emitted by a laser?

    <p>Monochromatic and coherent</p> Signup and view all the answers

    Which type of laser is solid with a crystalline structure and emits near-infrared wavelength?

    <p>KTP laser</p> Signup and view all the answers

    Which laser is exclusively used for retinal and LASIK surgery?

    <p>Excimer laser</p> Signup and view all the answers

    What is the primary benefit of laser surgery?

    <p>Reduced tissue reaction</p> Signup and view all the answers

    Which laser type provides efficient tissue vaporization due to water absorption at far-infrared wavelength?

    <p>CO2 laser</p> Signup and view all the answers

    What is the purpose of the secondary light beam used in the operating room when the laser is not in use?

    <p>To assist aiming</p> Signup and view all the answers

    What is the equation representing Ohm's Law?

    <p>$V = I \times R$</p> Signup and view all the answers

    What is the measure of opposition in an electrical circuit?

    <p>Resistance</p> Signup and view all the answers

    What does Coulomb's Law describe?

    <p>The electrostatic attraction or repulsion between charges</p> Signup and view all the answers

    What is the equation representing the heat produced by the Electrosurgery Unit (ESU) when operating in coagulation mode?

    <p>$Heat Produced = \frac{Current^2}{Area}$</p> Signup and view all the answers

    What type of current does the Bipolar Electrosurgery Unit (ESU) use?

    <p>Low voltage, interrupted, high density current</p> Signup and view all the answers

    What is the recommended last resort to reduce electromagnetic interference when the use of a bipolar ESU is not feasible?

    <p>Short, intermittent, and irregular monopolar bursts at lowest energy setting possible</p> Signup and view all the answers

    Where should the dispersion pad be positioned to minimize the risk of electrical burn to alternate sites?

    <p>Away from implants and devices</p> Signup and view all the answers

    What type of circuit utilizes an isolation transformer for galvanic isolation?

    <p>Ungrounded circuit</p> Signup and view all the answers

    What factor determines whether a given flow will be laminar or turbulent according to Reynolds Number?

    <p>Velocity</p> Signup and view all the answers

    According to Poiseuille's Law, what happens to flow if the length of the tube is halved?

    <p>Doubles</p> Signup and view all the answers

    In Bernoulli's Principle, what happens to the pressure as the velocity of flow increases?

    <p>Decreases</p> Signup and view all the answers

    What property of a fluid resists flow and is represented by the symbol η?

    <p>Viscosity</p> Signup and view all the answers

    What is the SI unit for flow rate, representing the volume of a fluid passing a point per unit of time?

    <p>Cubic meters per second</p> Signup and view all the answers

    In fluid mechanics, which type of flow is characterized by all molecules traveling in a parallel path within the tube?

    <p>Laminar flow</p> Signup and view all the answers

    Which factor determines whether a given flow will be laminar or turbulent according to Reynolds Number?

    <p>Fluid density</p> Signup and view all the answers

    What is the critical Reynolds Number value that determines the point at which laminar flow becomes turbulent?

    <p>2000</p> Signup and view all the answers

    What type of flow is characterized by all molecules traveling in a parallel path within the tube?

    <p>Laminar flow</p> Signup and view all the answers

    What is the SI unit for flow rate, representing the volume of a fluid passing a point per unit of time?

    <p>Cubic meters per second (m^3/s)</p> Signup and view all the answers

    What is the relationship between flow (F) and the radius (r) in Hagen-Poiseuille's Law for laminar flow?

    <p>Flow (F) is exponentially proportional to the Radius (r)</p> Signup and view all the answers

    What does Pascal's Principle state?

    <p>Pressure applied to a confined fluid is transmitted unchanged throughout the entire system.</p> Signup and view all the answers

    In the context of Law of Laplace for a sphere, what happens to wall tension with an increased radius?

    <p>Wall tension increases</p> Signup and view all the answers

    What is the relationship between fluid pathways and internal pressure in the Law of Laplace for a cylinder?

    <p>Fluid pathways are dependent on internal pressure</p> Signup and view all the answers

    What is the additional component described in the context of the Law of Laplace for a sphere, apart from increased pressure and wall tension?

    <p>Afterload</p> Signup and view all the answers

    What is the primary function of surfactant in alveoli?

    <p>To break surface tension and ensure equal distribution of water molecules</p> Signup and view all the answers

    In a healthy alveolus with constant pressure, what happens to tension if the radius decreases?

    <p>Tension decreases due to the concentration of surfactant</p> Signup and view all the answers

    What is the equation for potential energy?

    <p>$PE = m \cdot g \cdot h$</p> Signup and view all the answers

    What is the standard unit of pressure?

    <p>Pascal (Pa)</p> Signup and view all the answers

    What is the equation representing work?

    <p>$Work = F \cdot d$</p> Signup and view all the answers

    What does the Law of Energy Conservation state?

    <p>Energy is constant and can be converted but not destroyed/created</p> Signup and view all the answers

    What is the equation for force?

    <p>$F = m \cdot a$</p> Signup and view all the answers

    What is the equation representing Newton's SECOND Law?

    <p>$F = ma$</p> Signup and view all the answers

    What is the primary unit of measurement for volume in the International System of Units?

    <p>Liters (l)</p> Signup and view all the answers

    According to Newton's FIRST Law, an object in motion will tend to stay in motion unless acted upon by another, outside force. This concept is also known as:

    <p>Law of Inertia</p> Signup and view all the answers

    What is the amount of energy required to change an object from a state of rest to a state of motion known as?

    <p>Work</p> Signup and view all the answers

    Which equation represents the relationship between force, mass, and acceleration?

    <p>$F = ma$</p> Signup and view all the answers

    Which method is commonly used to measure oxygen concentration in anesthesia practice?

    <p>Polarographic Electrode (Clark Electrode)</p> Signup and view all the answers

    What is the primary principle used to determine the mixture of gases in gas analysis?

    <p>Dalton’s Law of partial pressures</p> Signup and view all the answers

    Which type of sensor allows oxygen to pass through a semipermeable membrane and then dissolves it into an electrolyte solution?

    <p>Galvanic (fuel cell) sensor</p> Signup and view all the answers

    In capnography, what does the EtCO2 waveform phase III correspond to?

    <p>Alveolar plateau</p> Signup and view all the answers

    What factor does NOT increase the arterial-alveolar gradient in capnography?

    <p>Increased perfusion of lung apices</p> Signup and view all the answers

    What does EtCO2 underestimates PaCO2 by approximately 25mmHg in general anesthesia due to?

    <p>Presence of dead space</p> Signup and view all the answers

    What is the most common method for measuring CO2 pressures over time in capnography?

    <p>Infrared Analysis</p> Signup and view all the answers

    Which gas analysis technique uses oxidative-reductive reactions and has a limited shelf life?

    <p>Piezoelectric gas analysis</p> Signup and view all the answers

    How do Clark electrodes measure oxygen levels?

    <p>By reducing oxygen to hydroxyl ions at the cathode</p> Signup and view all the answers

    Which gas analysis technique separates gases based on mass-to-charge ratio and provides volume percent?

    <p>Mass spectrometry</p> Signup and view all the answers

    What is the SI unit for temperature?

    <p>Kelvin (K)</p> Signup and view all the answers

    Which phase of matter has no definite shape or volume and is highly compressible?

    <p>Gas</p> Signup and view all the answers

    What is the composition of matter that cannot be broken down into smaller substances?

    <p>Element</p> Signup and view all the answers

    Which equation represents the heat required to convert 1 mole of liquid to vapor at the normal boiling point?

    <p>$q = n riangle H_{ovap}$</p> Signup and view all the answers

    What is the primary function of a mole in chemistry?

    <p>To provide a practical unit for counting atoms by mass</p> Signup and view all the answers

    According to Dalton's atomic theory, what is a molecule?

    <p>A tightly bound combination of atoms</p> Signup and view all the answers

    What is the maximum number of electrons that can occupy the third shell of an atom, according to the Bohr model?

    <p>18</p> Signup and view all the answers

    Which group of elements tends to accept electrons when reacting with metals and share electrons when reacting with other nonmetals?

    <p>Halogens</p> Signup and view all the answers

    What is the primary purpose of the octet rule of electron filling?

    <p>To make atoms most stable by achieving a filled or empty outer layer of electrons</p> Signup and view all the answers

    Which type of elements tend to give up electrons in chemical reactions and are good conductors of electricity?

    <p>Alkaline metals</p> Signup and view all the answers

    What largely defines the chemical and physical properties of an organic compound?

    <p>Functional groups</p> Signup and view all the answers

    What type of bond has the shortest bond length?

    <p>Triple bond</p> Signup and view all the answers

    Which functional group is characteristic of carbohydrates?

    <p>Alcohols</p> Signup and view all the answers

    What are the physical properties of alkanes?

    <p>Non-polar molecules, insoluble in water</p> Signup and view all the answers

    What is the purpose of classifying organic compounds based on functional groups?

    <p>To define their chemical and physical properties</p> Signup and view all the answers

    Which functional group is characterized by at least one C=C double bond and can undergo hydrogenation to produce alkanes?

    <p>Alkenes</p> Signup and view all the answers

    What is the parent chain naming rule in U.P.A.C. for organic compounds?

    <p>Naming the longest chain as the parent</p> Signup and view all the answers

    What is the common name for benzene when added to another compound?

    <p>Phenyl group</p> Signup and view all the answers

    What type of organic compound contains one or more halogen atoms and is common in anesthetic agents?

    <p>Organo-halogen compounds</p> Signup and view all the answers

    Which functional group is derived from ammonia and has high boiling points and solubility in water due to nitrogen's electronegativity?

    <p>Amines</p> Signup and view all the answers

    Which of the following is a characteristic of monosaccharides?

    <p>They consist of a single sugar unit</p> Signup and view all the answers

    What is the primary function of structural polysaccharides?

    <p>Provide protective walls or lubricative coating to cells</p> Signup and view all the answers

    What is the defining characteristic of enantiomers?

    <p>They must contain at least one asymmetric carbon</p> Signup and view all the answers

    What is the primary biological purpose of lipids?

    <p>Cell membranes</p> Signup and view all the answers

    What is the role of chiral centers in the formation of enantiomers?

    <p>They allow for the formation of mirror pair of enantiomers</p> Signup and view all the answers

    What is the general formula for fatty acids?

    <p>CH$_3$(CH$_2$)$_n$COOH</p> Signup and view all the answers

    What is the most abundant and important lipid, essential for plasma membranes and the precursor to steroid hormones and bile acids?

    <p>Cholesterol</p> Signup and view all the answers

    What type of acids are involved in smooth muscle contraction and modulation of the immune response, occurring primarily in leukocytes?

    <p>Leukotrienes</p> Signup and view all the answers

    What are proteins polymers of?

    <p>Amino acids</p> Signup and view all the answers

    What do nucleic acids form through base pairing?

    <p>Double helix</p> Signup and view all the answers

    What is the mathematical representation of Molarity (M)?

    <p>M = \frac{moles ext{ of solute}}{liters ext{ of solution}}</p> Signup and view all the answers

    What is the primary difference between Molarity (M) and Molality (m)?

    <p>Molarity is the moles of solute per liter of solution, while Molality is the moles of solute per kilogram of solvent</p> Signup and view all the answers

    What does the term 'Percent by weight to volume (% w/v)' represent?

    <p>grams of solute per 100 ml of solution</p> Signup and view all the answers

    What is the mathematical representation of Molality (m)?

    <p>m = \frac{moles ext{ of solute}}{kilograms ext{ of solution}}</p> Signup and view all the answers

    In pharmacology, when a drug is expressed as percent by weight volume, what does it always represent?

    <p>grams of solute per 100 ml of solution</p> Signup and view all the answers

    What is the definition of Henry’s Law?

    <p>Solubility is directly proportional to the partial pressure of the gas and inversely proportional to temperature</p> Signup and view all the answers

    What does the dissociation constant (pKa) measure?

    <p>The pH at which 50% of solute is ionized and 50% is non-ionized</p> Signup and view all the answers

    What do blood:gas partition coefficients indicate?

    <p>Solubility and potency of inhaled anesthetics</p> Signup and view all the answers

    What is the primary measurement of gas solubility in a liquid?

    <p>Partition coefficient</p> Signup and view all the answers

    How do inhaled anesthetics equilibrate in tissue compartments?

    <p>Based on partial pressures</p> Signup and view all the answers

    Which factor is directly proportional to the rate of diffusion according to Fick's Law?

    <p>Tissue area/membrane area</p> Signup and view all the answers

    What property is inversely proportional to the rate of diffusion according to Fick's Law?

    <p>Membrane thickness</p> Signup and view all the answers

    Which gas demonstrates high diffusibility across membranes and has low blood:gas partition coefficient?

    <p>Nitrous Oxide (N2O)</p> Signup and view all the answers

    What process involves molecules of a solvent passing through a semipermeable membrane from a less concentrated solution into a more concentrated one?

    <p>Osmosis</p> Signup and view all the answers

    What is the primary factor contributing to physiologic osmotic pressure in capillaries?

    <p>Oncotic pressure</p> Signup and view all the answers

    What is the equation representing Fick's Law of diffusion?

    <p>$Diffusion = DP \times (\frac{area}{thickness}) \times (\frac{solubility_{gas}}{molecular weight_{gas}})$</p> Signup and view all the answers

    What factor does the diffusion constant (D) decrease with?

    <p>Increasing molecular mass</p> Signup and view all the answers

    According to Graham's Law, what is the relationship between the rate of diffusion of a gas and its molecular weight?

    <p>Inversely proportional</p> Signup and view all the answers

    What does Osmotic Pressure depend on?

    <p>Molecular Weight</p> Signup and view all the answers

    What is the primary driving force for diffusion?

    <p>Concentration Gradient</p> Signup and view all the answers

    What is the primary concern regarding drug incompatibility mentioned in the text?

    <p>Ionization/acid-base reactions</p> Signup and view all the answers

    Which pH range indicates that 50% of a drug is ionized and 50% is non-ionized?

    <p>$pH = pKa$</p> Signup and view all the answers

    Which anesthetic drug is mentioned as a weak acid with a pKa of 7.4?

    <p>Thiopental</p> Signup and view all the answers

    What is the inherent behavior of ionized drugs?

    <p>Increased water solubility</p> Signup and view all the answers

    What is the primary impact of altering the pH of a drug solution?

    <p>Changes in drug stability and water solubility</p> Signup and view all the answers

    What does the Henderson-Hasselbach equation measure?

    <p>The pH of a solution containing a weak acid and its conjugate base</p> Signup and view all the answers

    What is the primary concern regarding drug incompatibility in anesthesia?

    <p>Ionization (pKa) / acid-base reactions</p> Signup and view all the answers

    What does the pKa of a drug indicate?

    <p>The tendency of the drug to donate or accept protons</p> Signup and view all the answers

    How do local anesthetics cross cell membranes and reach receptors?

    <p>By passive diffusion through lipid membranes</p> Signup and view all the answers

    What is the significance of ion trapping in anesthesia?

    <p>It allows for trapping of drugs in different pH environments</p> Signup and view all the answers

    Which factor causes a leftward shift in the Oxy-Hgb Dissociation curve?

    <p>Increased affinity of O2 to Hgb</p> Signup and view all the answers

    What represents the amount of acid or alkali that must be added to 1L of blood to return the sample to a pH of 7.40 while maintaining the PaCO2 at 40mmHg?

    <p>Base Excess</p> Signup and view all the answers

    What is the traditional calculation method for Base Excess (BE)?

    <p>Van Slyke equation</p> Signup and view all the answers

    In a study by Chawla et al, what would have been wrong 33-58% of the time if BD or anion gap had been used as the sole criterion rather than serum lactate concentration?

    <p>Resuscitation decisions</p> Signup and view all the answers

    When is bicarb administration prescribed?

    <p>During emergency scenarios</p> Signup and view all the answers

    What are the paradoxical effects of IV NaHCO3 administration?

    <p>Both A and B</p> Signup and view all the answers

    What does Base Excess (BE) of > +2 suggest?

    <p>Metabolic alkalosis</p> Signup and view all the answers

    What does Base Excess (BE) of < -2 suggest?

    <p>Metabolic acidosis</p> Signup and view all the answers

    What is the equation for calculating the amount of NaHCO3 to be administered?

    <p>$NaHCO3 mEq/L = Wt(kg) x 0.3(24mEq/L – actual HCO3-)$</p> Signup and view all the answers

    What is the primary limitation of using Base Excess (BE) for resuscitation decisions?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Anesthesia Machine Components and Safety Features

    • Anesthesia machine supplies fresh gas to flowmeter, powers oxygen flush mechanism, activates fail-safe mechanisms, activates low-pressure alarms, and compresses bellows of mechanical ventilators
    • Regulation of oxygen pressure involves cylinder regulators, second-stage regulators, and flow-control valves/flowmeters for oxygen cylinders and pipelines
    • Second-stage oxygen regulator receives oxygen at intermediate pressure, regulates it, and maintains consistent pressure to flowmeter
    • Oxygen flush valve is used to quickly fill breathing circuit with oxygen and can cause barotrauma if activated during inspiratory cycle
    • Oxygen fail-safe mechanism prevents or limits delivery of N2O when oxygen pressure falls
    • Ventilator drive gas is pressurized with 100% oxygen, and modern machines convert to air in case of oxygen pressure failure
    • Flowmeter assembly precisely controls and measures fresh gas flow using glass tapered tube or electronic flowmeters with digital displays
    • Flowmeter safety features include visual and tactile distinctions for oxygen control knob, physical arrangement of flowtubes, and hypoxic guard/proportioning systems
    • Minimum oxygen flow is always present when the machine is powered on, even with the oxygen flow control valve closed
    • Vaporizers allow capture and measured delivery of vapor above liquid volatile anesthetic and have safety features to prevent misfilling, tipping, overfilling, and simultaneous agent administration
    • Hazards associated with vaporizers include intermittent back pressure, which can be minimized by a check valve and construction of smaller vaporizing chambers
    • Gas/patient interaction is controlled and monitored through the various components and safety features of the anesthesia machine, ensuring the safe delivery of anesthesia to patients

    Gas Laws and Anesthesia Practice

    • Charles' Law states that volume is directly proportional to temperature, with pressure constant, represented by the equation V1 / T1 = V2 / T2.
    • Gay-Lussac's Law states that pressure is directly proportional to temperature, with volume constant, represented by the equation P1 / T1 = P2 / T2.
    • Avogadro's Number describes the relationship between the amount of a gas and its volume, stating that equal volumes of all gases at the same temperature and pressure contain an equal number of particles, and one mole of a gas at STP occupies a volume of 22.4L.
    • The Universal Gas Law is represented by the equation PV = nRT, where P = pressure, V = volume, n = number of moles, R = constant, and T = temperature.
    • Van der Waal's Equation accounts for the volume of actual molecules and intermolecular forces, represented by the equation (P + n^2a / V^2)(V / n-b) = RT, with a as a measure of attraction between molecules and b as the volume excluded by a mole of particles.
    • Adiabatic changes involve altering the state of a gas without allowing the exchange of heat energy with its surroundings, leading to energy concentration and dilution effects.
    • Dalton's Law of Partial Pressures states that the total pressure exerted by a mixture of gases is the sum of their individual partial pressures, allowing for the calculation of the partial pressure of a gas if the percent concentration is known.
    • Ideal Gas Law Problems can be solved by identifying what is given, what is asked, labeling appropriately, identifying which law applies, and converting temperature to Kelvin before performing the necessary calculations.
    • Anesthesia practice involves applying gas laws to scenarios such as calculating the volume of gases in cylinders, understanding the behavior of gases used for anesthesia, and explaining hypoxia at high altitudes.
    • Resources for further study of gas laws in anesthesia practice include "Basic Physics and Measurement in Anesthesia" by Davis & Kenny, "Physics for Anesthesiologists" by Pisano, and "Casey.crow@tcu."
    • The text provides a comprehensive overview of gas laws, their applications in anesthesia practice, and the relevant equations and principles, making it a valuable resource for anesthesiologists and students.
    • Understanding gas laws is crucial for anesthesia practice as it enables the accurate calculation of gas volumes, pressures, and behaviors in various clinical scenarios, contributing to patient safety and effective anesthetic management.

    Pulse Oximetry and Plethysmography: Key Points

    • Absorptivity is proportional to solution concentration
    • Luminance is proportional to the cosine of the angle with the normal
    • Luminous intensity of light decreases exponentially with distance in an absorbing medium
    • Pulse oximeter probe contains two light-emitting diodes (LED) in red and near-infrared bands
    • Plethysmographic analysis differentiates pulsatile arterial signal from nonpulsatile signals and tissue
    • Risk-benefit analysis of pulse oximetry: non-invasive, continuous monitoring, but prone to artifacts and delayed measurements
    • Reduced false alarms and hemoglobin species affect light absorption
    • Artifacts and inaccuracies in pulse oximetry readings
    • Physiological derangements affecting oxygenation
    • Improving standards in plethysmography and anesthesia care
    • Cerebral oximetry using near-infrared spectroscopy to monitor regional tissue oxygen saturation
    • Additional resources for anesthesia equipment and standards for nurse anesthesia practice

    Understanding Electrical Flow and Injury in Medical Settings

    • Electrical flow in materials is influenced by resistance, voltage, and amperes, with conductors permitting the flow and insulators opposing it.
    • Electrical flow can be delivered as direct current (DC) or alternating current (AC), with AC having periodically reversed polarity.
    • AC electricity is delivered at set frequencies measured in hertz, with voltage and current waveforms forming a sinusoidal pattern.
    • Electrical power is measured by the equation P=VxI, indicating the rate at which work is performed and converting into other forms of energy like heat, light, or motion.
    • A typical electrical circuit comprises hot and neutral leads, with a ground lead connecting to the device's chassis to return leaked energy to Earth for dissipation.
    • There are two types of circuits: grounded and ungrounded, with the latter utilizing an isolation transformer for galvanic isolation.
    • Line Isolation Monitors (LIM) measure resistance created by leakage and unintentional grounding of lines, calibrated to display amperes and alarming at >5 mA.
    • Electrical shock occurs when a person completes an electrical circuit, with risks in the operating room due to the presence of electricity and equipment.
    • Macroshock refers to large amounts of current conducted through the patient's skin and tissues, with varying effects based on current intensity.
    • Factors determining the degree of electrical injury include the amount of current, resistance encountered, voltage, current pathway, duration of contact, and type of current.
    • The three major mechanisms of electrical-induced injury are electroporation, conversion of electrical energy into thermal energy, and mechanical injury from falls or muscle contraction.
    • Ohm's Law is applied to calculate resistance, with skin impedance not being constant and varying based on moisture and cannulation, affecting the amount of current delivered.

    Medical Gas Analysis Techniques

    • Galvanic sensors use oxidative-reductive reactions and have limited shelf life
    • Clark electrodes measure oxygen levels by reducing oxygen to hydroxyl ions at the cathode
    • Paramagnetic analyzers measure oxygen levels using the paramagnetic property of oxygen
    • Fluorescence quenching measures oxygen concentration by analyzing emitted photons
    • Colorimetric sensors detect carbon dioxide by changing color due to altered pH levels
    • Severinghaus PCO2 electrodes measure CO2 concentration based on pH-sensitive glass electrodes
    • Gas analysis includes organic and inorganic gases and is based on the Beer-Lambert Law
    • Mass spectrometry separates gases based on mass-to-charge ratio and provides volume percent
    • Infrared analysis measures gas absorption of infrared light to determine partial pressure
    • Raman spectroscopy uses alterations in wavelength frequency to measure gas characteristics
    • Piezoelectric gas analysis uses crystals that oscillate from the application of an electrical current
    • Advantages and disadvantages of each technique are outlined, including accuracy, portability, and limitations

    Organic Chemistry: Functional Groups and Hydrocarbons

    • U.P.A.C. rules for naming organic compounds include naming the longest chain as the parent, naming substituents in alphabetical order, using multipliers for identical substituents, and numbering the parent chain.
    • Alkanes are hydrocarbons with a hydrogen atom removed, represented by “R-” in chemical formulas, and named by replacing “-ane” with “-yl”.
    • Alkenes, also known as olefins, are characterized by at least one C=C double bond and can undergo hydrogenation to produce alkanes.
    • Alkynes are characterized by at least one C≡C triple bond and are rare in pharmacology applications.
    • Geometric isomerism exists in alkenes due to rigid bonds, while alkanes can rotate about all bonds and alkynes have linear rigid bonds with no geometric isomers.
    • Aromatics, such as benzene, have a stable arrangement and are frequently used in pharmacology, with benzene being called a phenyl group when added to another compound.
    • Organo-halogen compounds contain one or more halogen atoms and are common in anesthetic agents, such as chloroform and halothane.
    • Replacing one hydrogen atom on water with an organic group produces alcohols, while replacing both hydrogen atoms with organic groups produces ethers.
    • Amines are organic bases derived from ammonia, with nitrogen being very electronegative, resulting in high boiling points and solubility in water.
    • Carbonyl groups, including aldehydes, ketones, carboxylic acids, esters, and amides, are common in chemistry and have specific characteristics and functions.
    • Understanding of carbon chains involves describing their bonds and shapes, functional group composition, and the relationship between halogens and hydrocarbons.
    • Differentiating between alkanes, alkenes, alkynes, and aromatics, understanding geometric isomerism, and defining and describing alcohols, ethers, amines, and carbonyl groups are essential in organic chemistry.

    Lipids, Proteins, Nucleic Acids, and Metabolic Pathways Overview

    • Fatty acids are long-chained monocarboxylic acids with the general formula CH3(CH2)nCOOH, ranging in size from C12-C24, and can be saturated or polyunsaturated.
    • Eicosanoids are derivatives of arachidonic acid, some of which are essential fatty acids, and include significant groups such as prostaglandins, leukotrienes, and thromboxanes.
    • Prostaglandins have diverse biological functions, including smooth muscle stimulation, regulation of steroid production, and mediation of inflammatory responses.
    • Thromboxanes promote clotting and platelet aggregation and are direct metabolites of prostaglandins.
    • Leukotrienes are involved in smooth muscle contraction and modulation of the immune response, occurring primarily in leukocytes.
    • Cholesterol is the most abundant and important lipid, essential for plasma membranes and the precursor to steroid hormones and bile acids.
    • Glycerophospholipids, also known as phosphoglycerides, are found in plant and animal cell membranes, containing glycerol, two fatty acids, and one phosphate ester.
    • Sphingolipids contain sphingosine, an amino alcohol glycerol, and are predominant in cell membranes.
    • Proteins are polymers of amino acids joined by peptide bonds, with polypeptide chains ranging in length from only 20 amino acids.
    • Amino acids contain amine and carboxyl groups, with naturally occurring amino acids existing as L-isomers.
    • Peptide bonds result from a condensation reaction between the carboxyl group of one amino acid and the amino group of the second, leading to the polymerization of amino acids.
    • Nucleic acids, including DNA and RNA, are composed of nucleosides and nucleotides, with DNA forming a double helix through base pairing and RNA using ribose as the sugar component.

    Pharmacologic Implications of Ionic Solutions and Gas Solubility

    • Solutions are expressed in percentages, with 1 gram of solute per ml of solution
    • Equivalent weight is the gram weight of a substance that will combine or replace 1 gram of hydrogen
    • Colloids are large molecules balanced between precipitation and suspension by intermolecular forces
    • Ionic solutions involve atoms and/or molecules in ionized form, with dissociation into ionic atoms in water
    • Dissociation constant (pKa) is the pH at which 50% of solute is ionized and 50% is non-ionized
    • Gas solubility is measured by partial pressure, reflecting the force to move into a solution
    • Inhaled anesthetics equilibrate based on partial pressures in tissue compartments, not concentration
    • Henry’s Law defines solubility as directly proportional to the partial pressure of the gas and inversely proportional to temperature
    • Blood:gas partition coefficients define the size of the physiologic blood container
    • Higher blood:gas partition coefficients indicate higher solubility and potency
    • Different types of coefficients (Bunsen, Ostwald, partition) measure gas solubility in a liquid
    • The blood:gas partition coefficient affects the pharmacokinetics of inhaled anesthetics

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    Test your knowledge on organic chemistry focusing on functional groups such as alkenes, alkynes, aromatics, alcohols, ethers, amines, and carbonyl groups. Understand naming conventions, isomerism, and properties of different organic compounds.

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