anesthesia tech – Flashcards
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causes of a decrease in circuit pressure
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circuit leak or patient disconnected
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what does "PISS" stand for?
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Pin Index safety system
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What does "DISS" stand for?
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Diameter Index safety system
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If co2 is high, then why?
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soda sorb is dry
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during spontaneous ventilatioin, what should we do to the APL valve?
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open all the way, APL valve is at 0.
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what occurs if APL valve is closed and patient is spontaneously breathing?
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the circuit pressure decreases *
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Patient is on mechanical ventilation, what is the best monitor to detect a leak in the bellow?
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oxygen analyzer
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In lithotomy position, how are the legs lifted?
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simultaneously
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if the patient is in beach chair position, what are they at an increase risk of?
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increase risk of venous air embolism
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a patient is in the trendelenberg position, how is the position
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the head is position down
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a patient is in the reverse trendelenberg position, how is the head position?
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the head is position up
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what is the usual position for thoracotomy and splenectomy?
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lateral decubitus
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for nephrectomy, which position is desire for a subaracnoid block?
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modified lateral decubitus
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the heart has how many chambers
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four chambers
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right side of the heart receives what kind of blood?
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deoxygenated blood
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left side of the heart receives what kind of blood?
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oxygenated blood
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which chamber of the heart does the blood go through to the rest of the body?
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left ventricle
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which valve is in between the right atrium and the right ventricle?
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tricuspid valve
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which valve is in between the left atrium and the left ventricle?
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mitral valve
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deoxygenated blood leads to the lung through which valve?
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pulmonic valve
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what are the 3 main valves of the heart
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pulmonic valve, tricuspid valve and mitral valve
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cvp catheter is inserted at which two entry point of the body?
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subclavian and internal jugular
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the tip of the cvp catheter sits at which chamber of the heart?
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right atrium
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why do we use a cvp catheter?
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to measure preload of the heart
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what is afterload of the heart?
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it is blood leaving the heart to the rest of the body
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what are complication of cvp?
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infection, arterial puncture, pneumothorax, venous air embolism
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what is the most common complication of a subclavian cvp?
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pneumothorax
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what is the most common area of placement for an arterial line?
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radial artery
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which of the following is an artery?
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radial artery
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what are the reason for the placement of an arterial line?
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pressure measurement and ABGs
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where is does the transducer have to be level at?
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phlebostatic axis
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an air bubble in the syringe can decrease your o2 saturation and affect the concentration of o2
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true
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what is a normal pH for an arterial blood gas?
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7.35-7.45
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what is the normal range for o2 saturation?
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80-100%
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what is the normal range for co2?
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35-45mmHg
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what is the normal metabolic bicarb level?
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22-28
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which condition is define as having a pH less than 7.35 with a paco2 greater than 45mmHg?
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respiratory acidosis
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what are steps to drawing up blood gas?
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put on gloves, label it, tap out air bubbles
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when handling a blood gas, what is one thing we do not do?
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* DO NOT COOL IT*
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when using chloroprep, what do we do?
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we wipe in a circular motion from the center outward
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when putting in a PA Catheter, is the package sterile?
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YES!!
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room air consists of which two primary gases?
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oxygen and nitrogen
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what percentage is nitrogen to oxygen in room air?
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nitrogen is 79%, oxygen is 21%
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what is the mmHg value of oxygen in room air
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159mmHg
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at the alveoli and capillary level what occurs?
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gas exchange
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while under anesthesia, what can occur with the alveoli?
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they can collapse and gas exchange cannot occur
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what does the term atelectasis mean?
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collapsed alveoli
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how do we initially treat atelectasis?
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dial in PEEP to increase oxygen saturation of the blood
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what does PEEP stand for?
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positive end expiratory pressure
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what does PEEP do to the patient stability?
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increase oxygen saturation of the blood
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on a laryngoscope, what does the mac blade do?
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indirectly lifts the epiglottis and sits in the vallecula
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what is the purpose of the miller blade?
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to directly lift the epiglottis
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a device use for nasal intubation to place an et tube into the trachea is what?
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magil forceps
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which patient do we normally use LMA on?
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pediatric and short cases
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what are contraindication to LMA use?
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patient with GERD and trauma
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LMA is ideally use for patient because?
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it cannot be push down into the trachea or pass the esophagus because of it's size and shape
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what is the purpose of DLT?
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is facilitates one lung ventilation
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what does ANSI stands for?
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american national standard institute
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what does ANSI do?
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regulates the equipments
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what is the ANSI standard for oral airway?
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length
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what is the correct measurement for an et tube in OD?
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15mm OD
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Et Tube measures by what?
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diameter
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what is the purpose of the pilot balloon?
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indicated whether the cuff of the et tube is properly inflated
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what is the purpose of the cuff?
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so the patient can be properly ventilated and the et tube doesn't move
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the et tube has what kind of tip?
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bevel tip
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which are consider to be an intubation oral airway?
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ovasapian and williams
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how are nasal trumpet measure?
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french size
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What is the condition known as malignant hyperthermia?
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A genetic disease.
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What happens during malignant hyperthermia?
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Heart rate increase, tachypnea, and muscle rigidity.
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2.5 mg/kg of dantrolene is normally administered for?
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The treatment of malignant hyperthermia.
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How many lab tubes should we have on the cart for malignant hyperthermia?
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Minimum of 5.
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What do you do when MH occurs?
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You remove the agents, flush the machine, and replace the sodasorb cannister.
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What type of drugs are ideal for an MH patient?
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TIVA, barbituates, and narcotics.
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How can a fire occur in the OR?
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Oxygen + fuel.
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What do you do if the ET tube catches on fire?
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Take out the tube, have a safety kit ready, save the circuit if it isnt damaged, switch to a laser tube, and check for swelling and confirm with the ENT person.
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What should you do when you have an accidental needle stick?
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You clean the area, report to the supervisor, report to employee health, check the patient history, blood tests for patient and yourself, see if there is any further development.
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How do you protect yourself in the OR?
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Wash your hands, put on a mask, put on gloves.
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What do you do when radiation is being used in a room?
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Minimize your exposure time, put on a lead apron, or stand behind the anesthesia machine.
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How many miligrams of drug x do you need when you have a 500 ml bag of solution to make a 2mg/ml IV bag?
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1000 mg of drug x
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How much a patient weigh in lbs if they weigh 70 kg?
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154 lbs
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Drug x has a concentration of 20 mg/ml. You have a 10 cc vial of drug x. How many mg of drug x do you have?
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200 mg
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If Rocuronium has a concentration of 10mg/ml, we need to have 7mg of rocuronium. How many cc's need to be drawn up?
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0.7cc of rocuronium.
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What is another name for Rocuronium?
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Zemuron
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What is another name for Atracurium?
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Tracrium
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What is another name for Pancuronium?
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Pavulon
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What is another name for Vecuronium?
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Norcuron.
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What is another name for Cisatracurium?
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Nimbex.
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What is another name for Succinylcholine?
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Anectine
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Which muscle relaxant is a depolarizer?
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Succinylcholine/Anectine
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Which muscle relaxant is powder based?
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Vecuronium/Norcuron
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What is the reversal agent for fentanyl?
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Narcan
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Which drug increases heart rate?
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Atropine
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The next case is going to be general anesthesia, what is going to be used?
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Propofol, Vecuronium, ET Tube
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What medication is commonly given as an IV infusion?
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Propofol
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What drugs are given during RSI?
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*Succinylcholine and Pentothal
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What is the common use for mannitol?
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It reduces swelling of the brain during neurological procedures.
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Desflurane has to be ________ before use.
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Heated
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Benzocaine is a local anesthetic used for what?
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Topical use and numbing of the mucosa lining.
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Which leads are the best to monitor the left ventricular inferior lateral wall of the heart?
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Leads II and V5
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A patient has a left MI of their heart. Which lead is best monitored to check the heart?
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Leads II and V5
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How do we verify ET tube placement?
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Bilateral breath sounds, condensation, ETCO2, and pulse ox
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ET tube placement is verified. Which monitor is not usually used to verify placement?
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EKG
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Which two ways are the most accurate to measure internal core temperature?
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PA catheter and esophageal temp. probe
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What is the heart doing if ST elevation is observed?
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MI is occuring
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What is the heart doing if ST depression is observed?
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It has ischemia
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Which place of measurement is the least accurate to assess core temperature?
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The skin
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What happens if a BP cuff that is too big is put on a patient?
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False low reading
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What happens if a BP cuff is too small and is put on a patient?
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False high reading
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MI is detected by?
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EKG monitor.
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What causes a false low reading on a pulse ox monitor?
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Patient was given benzocaine, methyline blue, or indigo carmine.
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Pulse ox measures 02 saturation where?
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In the arteries
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Pulse Ox measures what?
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Arterial 02 saturation.
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What is the minimum time to process equipment in gluteraldehyde?
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20 minutes
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What kind of solution is considered to be a colloid?
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Albumin
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What kind of solution is considered a crystalloid?
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NS
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What % of NS is isotonic?
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0.9%
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What % of NS is hypotonic?
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0.45%
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What % of NS is hypertonic?
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3.0%
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During emergency fluid resuscitation, what do we need to have?
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PRBCs, level I rapid infusion device, large bore IV, NS, and CVP Kit with introducer and guide wire.
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What does a CVP Kit contain?
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Guide wire, introducer, dialator, blade, sterile drape, needle and sutures
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What do we bring with a rapid infusion device?
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Y-Tubing, blood filter, normal saline, pressure bag, and increase the height of the IV pole, and dont bring a 22G catheter!
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For IV starts, where should we begin?
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Start in the hand and work your way up
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If an IV is started in the antecubital space, what is at risk for the patient?
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Increase risk of medial nerve damage
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What is the normal temperature of fluid warmer?
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35-40 Degrees Celcius
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Which tubing is the best for pediatrics?
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Buretrol
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What happens when the IV pump alarms "OCCLUSION!!!"?
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The substance is too viscous
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What does HRSA stand for?
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Hospital Borne Infection
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What do you do before sterilizing the blades?
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Decontaminate them
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What items can we autoclave?
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Bougie and blades
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What can be used if sterilization is required?
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Steam & Periceatic Acid
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What is considered to be a sterile package?
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CVP, PA Catheter, and Arterial Line Packages
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Sterile ET tube is used on a surgical field during a trach procedure.
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True
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RSI indications are for what patients?
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Pregnant women and trauma patients
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What supplies are needed if the patient cannot be ventilated?
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Tracheostomy Kit, Cricothyrotomy Kit, and Jet Ventilator
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What is the most effective way to warm a patient in the OR?
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Convective Warming Device (Bair Hugger)
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Where does the distal tip of the Combitube go?
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In the esophagus
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The patient has an obstruction at the epiglottis, a jet ventilator is being used. What else can we use?
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Tracheostomy or Cricothyrotomy Kit
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A 3.5 in 22G Spinal Needle is used for what?
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Regional Anesthesia
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What is a sub-arachnoid block?
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Spinal Block
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What supplies are needed for regional anesthesia?
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20ml Marcaine, propofol, 02 mask, B-Bevel Needle(Short Blunt)
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An 02 E cylinder is full. How many PSI does it have?
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2000 PSI
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How can you identify if nitrous oxide is full?
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It remains as 750 PSI even if partially full
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An 02 cylinder has 1000 PSI and is running at 10l/min. How long with it last? Constant is 0.3/60min
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30 minutes
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How many PSI is the hospital pipeline?
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50 PSI
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The 02 flow meters have what unique properties?
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It is fluted and larger in size and always on the right side.
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A inhalational agent changes from a liquid to a vapor due to what?
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Because it is Temperature Dependant
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What does the sodasorb do?
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Gets rid of co2 from the patient
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Which area of the circuit is the best place for sampling co2?
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The elbow connector
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The ETCO2 is low. Why?
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The sample line has a leak
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What does the anesthesia machine have to prevent back flow of gases into the machine?
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Check Valves
