Mechanical Ventilation Quiz

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Questions and Answers

What is the primary function of Positive End-Expiratory Pressure (PEEP) in mechanical ventilation?

  • To synchronize ventilator breaths with patient's breathing pattern and minimize fatigue.
  • To increase lung compliance and decrease barotrauma risk.
  • To increase tidal volume delivered and improve oxygenation.
  • To maintain open small airways and decrease preload. (correct)

Which ventilation mode uses a constant flow rate to deliver a set tidal volume?

  • Pressure-Control Ventilation (PCV)
  • Volume Control (VC) (correct)
  • Synchronized Intermittent Mandatory Ventilation (SIMV)
  • Pressure-Support Ventilation (PSV)

What is the primary advantage of Pressure-Control Ventilation (PCV) over Volume Control (VC)?

  • It delivers a guaranteed tidal volume, minimizing the risk of hypoventilation.
  • It allows for spontaneous breathing and facilitates weaning from mechanical ventilation.
  • It reduces inspiratory pressures and minimizes the risk of barotrauma. (correct)
  • It is synchronized with patient's breathing pattern and minimizes ventilator dyssynchrony.

Which ventilation mode is best suited for patients who require mechanical ventilation but can also breathe spontaneously?

<p>Synchronized Intermittent Mandatory Ventilation (SIMV) (B)</p> Signup and view all the answers

What is the primary disadvantage of synchronized Intermittent Mandatory Ventilation (SIMV)?

<p>It can be poorly tolerated by patients with fatigue or chest wall abnormalities. (A)</p> Signup and view all the answers

Which ventilation mode is most commonly used intraoperatively?

<p>Pressure-Control Ventilation with Volume Guarantee (PCV-VG) (C)</p> Signup and view all the answers

What is the primary concern associated with the use of Pressure-Support Ventilation (PSV)?

<p>It is not suitable for patients with unstable respiratory status. (D)</p> Signup and view all the answers

Which of the following is NOT a clinical manifestation of Auto-PEEP?

<p>Increased end-tidal carbon dioxide levels. (B)</p> Signup and view all the answers

What is the primary goal of pre-operative assessment?

<p>To identify and quantify potential concerns to adapt anesthetic management. (B)</p> Signup and view all the answers

Which of the following is NOT a factor considered when planning a patient's post-operative disposition?

<p>The patient's insurance coverage. (A)</p> Signup and view all the answers

In the context of pre-operative assessment, what does "optimizing" the patient refer to?

<p>Improving the patient's overall health and fitness for surgery. (B)</p> Signup and view all the answers

Which of the following is an example of a pre-operative investigation that may be ordered to assess a patient's condition?

<p>All of the above. (D)</p> Signup and view all the answers

According to Choosing Wisely Canada, pre-operative testing is considered beneficial in the following scenario?

<p>For patients with a known history of heart disease. (A)</p> Signup and view all the answers

What is the purpose of adapting the anesthetic technique during the perioperative period?

<p>To ensure the patient remains stable and safe throughout the procedure. (B)</p> Signup and view all the answers

What are the primary goals of advanced care planning in the pre-operative setting?

<p>To ensure that the patient's wishes are respected in the event of a medical crisis. (D)</p> Signup and view all the answers

What is the main purpose of the pre-operative airway exam?

<p>To identify potential airway concerns and complications. (D)</p> Signup and view all the answers

What is the primary objective of a pre-operative anesthetic assessment?

<p>To identify potential complications that could arise during surgery and to optimize patient care. (C)</p> Signup and view all the answers

What is NOT a component of the immediate pre-operative assessment?

<p>Patient's preferred music genre (A)</p> Signup and view all the answers

Which of the following is NOT mentioned as a key component of a pre-operative assessment for patients with severe obesity?

<p>Ensure early mobilization post-op to reduce DVT risk (B)</p> Signup and view all the answers

Which of the following conditions is NOT explicitly mentioned as a potential pre-existing condition that should be considered in a pre-operative assessment?

<p>Hypertension (A)</p> Signup and view all the answers

What is the definition of PACU handover?

<p>The process of transferring a patient from the operating room to the recovery room. (B)</p> Signup and view all the answers

What is the name for the condition that occurs when a patient's body experiences a rapid and uncontrolled increase in temperature, muscle rigidity, and metabolic rate?

<p>Malignant hyperthermia (C)</p> Signup and view all the answers

What is the primary role of the individual listed as 'Illustrator'?

<p>Providing medical illustrations for the content. (D)</p> Signup and view all the answers

Which of the following is NOT mentioned as a contributor to the content?

<p>Daniel Cordovani (C)</p> Signup and view all the answers

The text mentions "CAS standard monitoring guidelines". What does CAS stand for?

<p>Canadian Anesthesia Society (B)</p> Signup and view all the answers

What is the definition of Auto-PEEP in the context of anesthesia?

<p>A condition where the patient's lungs become hyperinflated due to airway obstruction. (D)</p> Signup and view all the answers

Which of the following is NOT a condition or procedure listed under 'Airway management, intubation, and emergencies'?

<p>Electrocardiogram (ECG) monitoring (A)</p> Signup and view all the answers

What is NOT a sign or symptom of hypoxemia?

<p>Hypertension (A)</p> Signup and view all the answers

What is NOT a criterion for extubation?

<p>Ability to follow commands (D)</p> Signup and view all the answers

Which of the following is NOT a complication or emergency that can occur during airway management?

<p>Hemorrhage (B)</p> Signup and view all the answers

What is the meaning of the acronym 'SOAP-IM'?

<p>Supplies, Oxygen, Airway, Positioning, Instruments, Medications (B)</p> Signup and view all the answers

What is NOT a blood therapy or related definition listed in the text?

<p>Thrombin (C)</p> Signup and view all the answers

Which of the following is NOT a complication or emergency that can arise during fluid management?

<p>Hypoxia (B)</p> Signup and view all the answers

What is the primary goal when managing intraoperative blood pressure?

<p>Maintain blood pressure within 20% of preoperative levels (B)</p> Signup and view all the answers

Which of the following could be a sign of hypervolemia?

<p>Pitting edema (C)</p> Signup and view all the answers

What MAP (Mean Arterial Pressure) threshold is generally required for organ perfusion?

<p>MAP &gt; 65 (C)</p> Signup and view all the answers

Which condition is a cause of widened pulse pressure?

<p>Aortic regurgitation (C)</p> Signup and view all the answers

In which situation should early intubation be considered?

<p>Patients with airway burns (C)</p> Signup and view all the answers

Which of the following is NOT an indication for a CBC before major surgery?

<p>Patient with a history of diabetes (C)</p> Signup and view all the answers

In the Mallampati classification, which structure can be visualized at Class 2?

<p>Faucial pillars and soft palate (B)</p> Signup and view all the answers

What AHI value signifies a diagnosis of obstructive sleep apnea without other symptoms or comorbidities?

<p>≥15/hr (D)</p> Signup and view all the answers

Which of the following is a risk factor for obstructive sleep apnea according to the STOP-BANG criteria?

<p>BMI over 35 (B)</p> Signup and view all the answers

What is one of the physiological changes associated with severe obesity (BMI ≥35)?

<p>Increased metabolic rate (C)</p> Signup and view all the answers

Which complication is NOT associated with obesity hypoventilation syndrome?

<p>Pulmonary edema (C)</p> Signup and view all the answers

What preoperative management technique is advised for patients at high risk for obstructive sleep apnea?

<p>Opioid-sparing multimodal techniques (B)</p> Signup and view all the answers

Which of the following devices should patients with obstructive sleep apnea bring for their preoperative care?

<p>CPAP/BiPAP machine (C)</p> Signup and view all the answers

What is the primary goal in the prevention of bronchospasm during surgery?

<p>Ensure adequate anesthesia (C)</p> Signup and view all the answers

Which of the following is NOT a sign or symptom of bronchospasm?

<p>Stridor (C)</p> Signup and view all the answers

What management strategy is effective in treating laryngospasm?

<p>Suctioning secretions (A), Manual bag ventilation (D)</p> Signup and view all the answers

Which risk factor is associated with an increased chance of laryngospasm?

<p>Recent upper respiratory tract infection (B)</p> Signup and view all the answers

What is a common complication of bronchospasm?

<p>Auto-PEEP (C)</p> Signup and view all the answers

Which measure is considered an ineffective treatment for suspected infection in bronchospasm management?

<p>Empiric antibiotics (D)</p> Signup and view all the answers

In the context of status asthmaticus, which treatment is typically used?

<p>Systemic corticosteroids (B)</p> Signup and view all the answers

Which of the following agents has bronchodilatory properties that may aid during anesthesia?

<p>Ketamine (D)</p> Signup and view all the answers

Flashcards

CBC Indications

Conditions requiring complete blood count (CBC) before surgery.

Mallampati Classification

Classification for predicting airway difficulties based on oral structures observed.

Obstructive Sleep Apnea (OSA)

Cessation or reduction of breathing during sleep; measured by AHI.

STOP-BANG

A screening tool for identifying risk factors for OSA based on 8 criteria.

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Severe Obesity Definition

Characterized by a Body Mass Index (BMI) of 35 or higher.

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OSA Complications

Potential issues arising from OSA include pulmonary hypertension and cognitive impairment.

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Pre-operative Management for OSA

Strategies include using CPAP, supplemental oxygen, and positioning to prevent apnea.

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Physiological Changes in Severe Obesity

Increased cardiac output and oxygen demand, affecting respiratory function.

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Hypervolemia Causes

Conditions like AKI/CKD, cirrhosis, CHF, urinary tract obstruction cause hypervolemia.

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Signs of Hypervolemia

Symptoms include pitting edema, stigmata of liver disease, ascites, and crackles.

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Intraoperative BP Management

Maintain BP within 20% of preoperative levels, considering MAP >65.

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MAP Calculation

Mean Arterial Pressure (MAP) is calculated as MAP ≈ 2/3 DBP + 1/3 SBP.

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Pulse Pressure Importance

Normal pulse pressure is ≈ 40; widened (>40) or narrowed (<8) can indicate issues.

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Pre-operative assessment

Evaluation process to optimize patient health before surgery.

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Blood therapy

Administration of blood components to manage deficiency.

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Intraoperative hypotension

Low blood pressure occurring during surgery.

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Anaphylaxis

Severe allergic reaction potentially triggered by anesthesia agents.

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Supraglottic airway

Device placed above the vocal cords to secure airway.

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Fluid management

Overall strategy for maintaining hydration and blood volume during surgery.

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Spinal anesthetic

Type of regional anesthesia involving injection into the spinal fluid.

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Epidural analgesia

Pain relief method through injection in the epidural space.

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Post-operative nausea/vomiting

Common side effects that can occur after surgery.

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Midazolam

Benzodiazepine used for sedation and anxiety relief.

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Vasoactive drugs

Medications that affect blood vessel tone and blood pressure.

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Reversal agents

Drugs used to counteract the effects of anesthetics and neuromuscular blockers.

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Pain management ladder

Stepwise approach to managing pain using various medications.

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Prevention of Bronchospasm

Strategies to avoid bronchospasm, including medication and anesthesia management.

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Bronchospasm

Reversible involuntary contraction of smooth muscle in bronchi leading to narrowed airways.

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Signs of Bronchospasm

Symptoms include low O2, high airway pressures, and wheezing.

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Complications of Bronchospasm

Breath stacking leading to auto-PEEP and decreased blood pressure.

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Laryngospasm

Partial or complete airway obstruction caused by the larynx closing reflexively.

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Signs of Laryngospasm

Symptoms include low O2, stridor, and the use of accessory muscles to breathe.

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Status Asthmaticus

Severe asthma attack unresponsive to short-acting beta agonists (SABAs).

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Management of Bronchospasm

Utilize 100% FiO2 and nebulized SABA; deepen anesthetic if needed.

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Positive End-Expiratory Pressure (PEEP)

Maintains small airway patency at end of exhalation; affects preload and intracranial pressure.

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Volume Control (VC)

Ventilation setting where tidal volume (VT) and respiratory rate (RR) are set for consistent delivery.

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Pressure-Control Ventilation (PCV)

Machine delivers a set inspiratory pressure and RR for a specified time, affecting tidal volume.

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Pressure Control Ventilation with Volume Guarantee (PCV-VG)

Delivers set tidal volume at minimum pressure, adjusting breath by breath for ventilation needs.

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Synchronized Intermittent Mandatory Ventilation (SIMV)

Ventilator synchronizes with patient’s breaths, providing support between patient-triggered breaths.

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Pressure-Support Ventilation (PSV)

Supports patient-triggered breaths with set pressure; does not initiate breaths unless needed.

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AUTO-PEEP/Dynamic Hyperinflation

Occurs when lungs don't fully deflate, causing air-trapping and affecting ventilation efficiency.

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Signs of AUTO-PEEP

Signs include non-zero expiratory flow, decreased blood pressure, low SpO2 and ETCO2, wheezing.

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Malignant Hyperthermia

A life-threatening condition triggered by certain anesthetics leading to hypermetabolism.

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Pseudocholinesterase Deficiency

A genetic condition causing prolonged paralysis post-anesthesia due to slow drug breakdown.

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Obesity Comorbidities

Three common conditions often seen in obese patients include diabetes, hypertension, and sleep apnea.

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OSA Impact on Surgery

Obstructive Sleep Apnea can prolong recovery and increase complications post-operatively.

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Hypoglycemic Therapy Adjustment

Perioperative adjustments to diabetes medications may be necessary to prevent hypoglycemia.

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Pre-Anesthetic Airway Exam

A clinical assessment evaluating factors that affect airway management during anesthesia.

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ASA Classification

A system that classifies patients based on their physical status prior to anesthesia.

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Study Notes

Anesthesia: A Clerkship Pocket Guide

  • This is a practical, peer-reviewed resource for anesthesia clerkship learners.
  • It's designed for a background level of knowledge and experience.
  • The resource covers McMaster core anesthesia clerkship learning objectives and Essential Clinical Encounters (ECEs).
  • It provides a comprehensive overview of anesthesia pharmacology, drug indications, mechanisms of action, considerations for usage, and effects.
  • The Pocket Guide is intended to be used in conjunction with practical experience in the operating room.
  • It does not aim to replace experiential learning or structured training.
  • This resource is intended for review of core topics and concepts, not a complete reference source.
  • The resource acknowledges the rapidly changing nature of medicine and human error.
  • The document was generously supported by WRC Research at McMaster University.
  • Publication date: 2020-2021

Contributors

  • The document includes a list of authors, section reviewers, and senior reviewers who contributed to the book.

Table of Contents

  • The table of contents lists the various topics covered in the pocket guide, providing an overview of the key subject areas studied.

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