Term
| Which medical gases support combustion |
|
Definition
| "Helium, Oxygen, Air, Nitrous oxide, Nitric oxide, Heliox (He/O2), CO2, " |
|
|
Term
| Which gases are nonflammable |
|
Definition
| "nitrogen (N), Helium (He), Carbon dioxide, O2, Air, NO, Heliox (He/O2), CO2" |
|
|
Term
| How is water content removed from medical air |
|
Definition
|
|
Term
| What is DOTC and ICC folowed by on the shoulder of a compressed gas cylinder |
|
Definition
| (Interstate commerce commission) followed by cylinder classification such as 3A or 3AA and normal filling pressure in pounds per square inch |
|
|
Term
| What is below DOT and ICC on the shoulder of a compressed gas cylinder |
|
Definition
| "letter size of the cylinder (E, G, etc)" |
|
|
Term
| WHat is on the third line below DOT and ICC on the shoulder of a compressed gas cylinder |
|
Definition
| mark of ownership followed by stamp or mark identifying inspecting authority |
|
|
Term
| WHat is on the opposite side of a compressed gas cylinder |
|
Definition
| an abbreviation indicating the method of cylinder manufacture and information regarding the original safety test and dates of all subsequent tests |
|
|
Term
| "What does the notation ""EE"" followed by a # indicate on the shoulder of a compressed gas cylinder" |
|
Definition
| the elastic expansion of the cylinder in cubic centimeters under test conditions |
|
|
Term
| What does an asterik next to the test date on the shoulder of a compressed gas cylinder indicate |
|
Definition
| DOT approval for 10-year testing |
|
|
Term
| what does a plus sign next to the test date on the shoulder of a compressed gas cylinder indicate |
|
Definition
| the cylinder is approved for filling to 10% above its service pressure |
|
|
Term
| What is something about compressed gas cylinders regarding coding |
|
Definition
| it's color coded and labeled |
|
|
Term
| How is duration of flow calculated from an H cylinder of oxygen |
|
Definition
| duration of flow (min) = 3.14 (factor for H cylinder) * pressure/flow. Note that the factors for: G cylinder is 2.41; E is 0.28 and D is 0.16 |
|
|
Term
|
Definition
| standards for threaded high-pressure connections between large compressed gas cylinders and their attachments |
|
|
Term
| What are the large compressed gas cylinders |
|
Definition
|
|
Term
|
Definition
| Pin indexing applies to valve outlets of small cylinders up to and including E. |
|
|
Term
| What type of connection is used for PISS |
|
Definition
| "yoke type where the upper yoke fits over the lower valve stem. Two pins, projecting from the inner surface of the yoke connector, mate with two pinholes bored into the valve stem. Proper pin position aligns the small receiving nipple of the hyoke with the recessed cylinder valve outlet" |
|
|
Term
|
Definition
| "ASS and PISS provide standards for high pressure connections between cylinders and equipment, the DISS was established to prevent accidental interchange of low pressure (less than 200 psig) medical gas connectors. " |
|
|
Term
| Where are DISS connections typically found |
|
Definition
| "at the outlets of pressure-reducing valves attached to cylinders, at the station outlets of central piping systems and at the inlets of blenders, flowmeters, ventilators, and other pneumatic equipment" |
|
|
Term
| WHat does the DISS system consist of |
|
Definition
| "externally threaded body and a mated nipple w/ a nut. as the two parts are joined, the shoulders of the nipple and the bores of the body mate and the union is held tgether by a hand-tightened hex nut. indexing is achieved by varying the dimensions of the borings and shoulders" |
|
|
Term
| "An intubated mechanically ventilated patient is using an HME and starts to develop thick, tenacious secretions. what action should be taken?" |
|
Definition
|
|
Term
| WHat happens when a bourdon gauge encounters back-pressure resistence |
|
Definition
| (bourdon gauge is a flowmeter device that is used in combination with an adjustable pressure-reducing valve). The pressure difference across the orifice and actual output flow decrease. the bourdon gauge flow reading depends on upstream pressure which stays constant. the gauge reading would be falsely higher than the actual delivered flow because it measures upstream pressure. the gauge registers flow even when the outlet is completely blocked |
|
|
Term
| Why is oxygen monitored closedly with COPD patients |
|
Definition
| "COPD patients with chronic hypercapnia ventilate less. Patients hypoventilate when given oxygen because of suppression of the hypoxic drive. Normal response to PCO2 is blunted. The primary stimulus to breathe being lack of O2 as sensed by peripheral chemoreceptors. The increase in O2 levels supresses chemoreceptors, depresses ventilatory drive, and elveates PCO2. High blood oxygen levels may disrupt the normal V/Q balance and cuse an increase in dead space to Vt ratio and an increase in PaCo2" |
|
|
Term
| What action would you take when removing a flowmeter from the wall outlet and there is a sudden massive gas leak |
|
Definition
| "try to reinsert and pull back out again due to a valve not properly closing. If this doesn't work, leave in the wall until it can be fixed" |
|
|
Term
| What are the advantages of a SVN vs MDI |
|
Definition
| "less patient coordination required, high doses possible, no CFC release" |
|
|
Term
| what are some disadvantages of MDI vs SVN |
|
Definition
| "Pt coordination required, Pt activation required, high percentage of pharyneal deposition, risk of abuse, difficult to deliver high doses, not all meds are available, most units still use ozone-depleting CFCs." |
|
|
Term
| "How is total flow from an air entrainment calculated. EX. 50% O2, 15L/min" |
|
Definition
| liters air/liters )2 = (100-%02)/(%02-21) ex. ansser is 41L/min |
|
|
Term
| What are the clincial signs/indications of hypoxemia (abnormal deficiency of oxygen in arterial blood) |
|
Definition
| "PaO2<60 mmHg or Sao2 <90% on room air; PaOc of SaO2 below desirable range for clinical situation; also, tachypnea - tachycardia - cyanosis, distressed overall appearance." |
|
|
Term
| What is retinopathy of preamturity |
|
Definition
| abnormal eye condition occurs in some premature or low-birth weight infants who receive supplemental oxygen. An excessive blood oxygen level causes retinal vasoconstriction which leads to necrosis of blood vessels. |
|
|
Term
| "with retinopathy of prematurity, what happens in response to necrosis of blood vessels" |
|
Definition
| new vessels form and increase in number. Hemmorhage of these delicate new vessels causes scarring behind the retina. |
|
|
Term
| "in retinopathy of prematurity, what does scarring behind the retina often lead to" |
|
Definition
| detachment and blindness. |
|
|
Term
| Who does ROP affect most often |
|
Definition
| "neonates up to approx. one month of age, by which time the retinal arteries have sufficienty matured" |
|
|
Term
| What is Bernoulli's principle |
|
Definition
| fluid's lateral pressure varies inversely with velocity |
|
|
Term
|
Definition
| total gas pressure = sum of partial pressures |
|
|
Term
|
Definition
| rate of diffusion of a gas is inversely proportional to the square root of its gram molecular weight |
|
|
Term
|
Definition
| solubility of a gas in liquid is proportion to its pressure if temp is constant and the gas does not react with the liquid |
|
|
Term
|
Definition
| Hyperbaric oxygen therapy and is the therapeutic use of oxygen at pressures greater than 1 atm. Pressures during HBO therapy usually are expressed in multiples of atmopheric pressure absolute (ATA) |
|
|
Term
|
Definition
|
|
Term
| What pressures are more HBO therapy conducted at |
|
Definition
|
|
Term
| What are the physiologic effects of HBO therapy |
|
Definition
| "bubble reduction (boyle's law), hyperoxygenation of blood and tissue (henry's law), vasoconstriction, enhanced host immune function, neovascularizatoiin" |
|
|
Term
| What acute conditions benefit from HBO therapy |
|
Definition
| "decompression sickness, air or gas embolism, carbon monoxide and cyanide poisoning, acute traumatic ischemi, crush injuries and limb suturing, clostridial gangrene, necrotizing soft tissue infection, ischemic skin graft or flap" |
|
|
Term
| What are some chronic conditions that benefit from HBO therapy |
|
Definition
| "diabetic wounds of lower extrmeties and other non-healing wounds, refractory osteomyelitis, actinomyosis (chronic systemic abscesses), Radiation necrosis (as an adjunct to conventional treatment)" |
|
|
Term
| Nitric oxide is used primarily for what purpose? |
|
Definition
| To treat neonates with hypoxic respiratory failure with associated pulmonary hypertension. |
|
|
Term
| "what are some potential, but currently not used uses for inhaled NO" |
|
Definition
| "ARDS, persistent pulmonary hypertension of the newborn, pulmonary hypertension follwing cardiac surgery, cardiac transplantation, acute pulmonary embolism, COPD, congental diaphragmatic hernia, sickle cell disease, testing pulmonary vascular responsiveness" |
|
|
Term
|
Definition
|
|
Term
| what kind of method is used to create aerosol in a USN |
|
Definition
|
|
Term
| USN - how does the crystal transducer create aerosol |
|
Definition
| "converts radio waves into high-frequency mechanical vibrations(sound). these virbrations are transmitted t aliquid surface wher ethe intense mechanical energy creates a cavitation in the liquid, forming a standing wave or geyser which sheds aerosol droplets. vibrational energy is transmitted either indirectly through a water-filled couplant reservoir or directly to a solution chamber. Gas entering the chamber inlet picks up the aerosol particles and exits through the chamber outlet" |
|
|
Term
| What do the properties of the ultrasonic signal in a USN signal determine |
|
Definition
| the characteristics of the aerosol generated by these nebulizers. |
|
|
Term
| what does the frequenchy of the USN signal determine |
|
Definition
| determines aerosol particle size which is inversely proportional to signal frequency |
|
|
Term
| WHat does signal amplitude of USN signal determine |
|
Definition
| "ignal aplitude directly affects the amount of aerosol produced. the greater the amplitude the greater the volume of aerosol output. Unlike frequency, signal amplitude may be adjusted by the clinician" |
|
|
Term
| What is the treatment for laryngitis or croup |
|
Definition
| cool mist nebulizer - mist tent |
|
|
Term
| what are the indications for the use of humidity therapy |
|
Definition
| "primary: humidifying dry medical gases, overcoming the humidity deficit created when the upper airway is bypassed. Secondary: managing hypothermia, treating bronchospasm caused by cold air" |
|
|
Term
|
Definition
| "special-purpose large-volume nebulizer. used especially for the administration of ribavirinto infants with respiratory synctial virus infection. it incorporates a drying chamber with its own flow control to produce a stable aerosol. it reduces medical gas source from teh normal 50 pounds per square inch gauge (psig) line pressure to as low as 26 psig with an adjustable regulator. used to treat infants with RSV, respiratory synctial virus treated ribaririn" |
|
|
Term
| what does one cubic foot of liquid oxygen equal |
|
Definition
|
|
Term
| WHat devices are capable of delivering 100% relative humidity at BTPS |
|
Definition
|
|
Term
| Which oxygen delivery device most likely to be tolerated by children |
|
Definition
| Oxygen enclosure such as oxygen tent |
|
|
Term
| What is the main problem with oxygen tents |
|
Definition
| large swings in oxygen concentration due to frequen opening and closing of the canopy |
|
|
Term
| What is the best method of administration of controlled oxygen therapy to infants |
|
Definition
|
|
Term
| How is oxygen delivered to an oxygen hood |
|
Definition
| it is delivered to the hood through either a heated air entrainment nebulizer or a blending system iwth a heated humidifier. a minimum flow of 7 L/min should be set to prevent accumulation of CO2. |
|
|
Term
| WHat flow would need to be used to maintain stable high oxygen concentration in an oxygen hood |
|
Definition
|
|
Term
| WHat may cause stress on neonatal patients with regard to an oxygen hood |
|
Definition
| flows greater than 10-15 L/min due to harmful noise levels |
|
|
Term
| What must be precisely maintained in an oxygen hood for an infant |
|
Definition
| the temperature of gases provided to an infant in an oxygen hood should be precisely set to maintain a neutral thermal environment (NTE). The NTE varies with weight and age. |
|
|
Term
|
Definition
| plexiglas enclosures that combine servo-controlled convection heating with supplemental oxygen |
|
|
Term
| WHat is the best way to control oxygen delivery to infants in an incubator |
|
Definition
|
|
Term
| "With an infant in an incubator using an oxyhood, where must hte oxygen concentration and gas temperature be assessed" |
|
Definition
| within the oxyhood and not the incubator |
|
|
Term
| What devices would most likely cause over hydration when used on a continuous basis |
|
Definition
| large volume jet nebulizers and USNs |
|
|
Term
|
Definition
| liquid particles suspended in a gas |
|
|
Term
| what is the most common device used to generate bland aerosols |
|
Definition
| large-volume jet nebulizers |
|
|
Term
| how are large-volume jet nebulizers powered |
|
Definition
| pneumatically powered attaching directly to a flowmeter and compressed gas source |
|
|
Term
| How are liquid particle aerosols generated in large-volume jet nebulizers |
|
Definition
| "by passing a gas at a high velocity through a small jet orifice. The resulting low pressure at the jet draws fluid from the reservoir up to the top of a siphon tube, where it is sheared off and shattered into liquid particles. The large, unstable particles fall out of suspension or impact on the internal surfaces of the device, including the fluid surface (baffling)" |
|
|
Term
| "With a large-volume jet nebulizer, how would heat be added" |
|
Definition
| "as with humidifiers, if heat is required, a hot-plate, wrap-around, yolk collar, or immersion element can be added." |
|
|
Term
| How are heated large-volume jet nebulizers different from humidifiers with regard to the control of delivery temperature |
|
Definition
| "they rarely have servo-controlled systems to control delivery temperature. many systems do not even shut down when the reservoir empties, resulting in the delivery of hot, dry gas to the patient. failure of the element can also cause a loss of heating capacity without warning to the clinician" |
|
|
Term
| How are pulse demand delivery devices advantageous |
|
Definition
| it synchronizes O2 delivery with inspiration to conserve O2 (uses approx 60%) less |
|
|
Term
|
Definition
| "(American National Standards Institute) The institute oversees the creation, promulgation and use of thousands of norms and guidelines that directly impact businesses in nearly every sector: from acoustical devices to construction equipment, from dairy and livestock production to energy distribution. They set the minimum level of humidty for intubated patients at 30 mg/L" |
|
|
Term
|
Definition
| "specs on gas cylinders, regs for safety testing" |
|
|
Term
|
Definition
| National fire protection agency. Compressed Gas Agency. They set cylinder storage guidelines |
|
|
Term
| what are the guidelines that apply to cylinder storage |
|
Definition
| "store in racks or chain to wall; other than the wooden racks, store no other combustible material; store away from sources of heat; store flammagle gases separately from those that support combustion; keep protective cap in place; don't store compressors and cylinders together; contain and store cylinder supply systems with one hour fire resistive rating; segregate full and empty cylinders; warning sign regarding oxidizing gas and alert against smoking; cool, well-ventilated area; " |
|
|
Term
| what are the guidelines that apply to cylinder transport |
|
Definition
| "use cylinder carts with securing mechanism; keep cylinder caps in place; protect cylinders from striking other cylinders or objects; avoid dropping, dragging, etc; make sure appropriately labeled" |
|
|
Term
| what are the guidelines for cylinder use |
|
Definition
| secure to pt bedside that prevents cyl from falling; do not use flammable materials; never cover with any material; open cyl valve slightly to remove dust before attaching to regulator; never use cyl that need repair; do not alter markings/color; never place near heat; never secure to movable objects; make sure connection is appropriate (ASSS for H and G and PISS for E); post no smoking sign |
|
|
Term
| what are the variable FIO2 low-flow O2 delivery systems used in RT |
|
Definition
| "nasal cannula, nasal catheter, transtrachial catheter" |
|
|
Term
| What are the fixed FIO2 low-flow O delivery systems employed in RT |
|
Definition
| "AEM, AE neb, blending system, isolette, incubator" |
|
|
Term
| what are the controls of an ultrasonic nebulizer |
|
Definition
| amplitude - increase to increase output and flow - increase to decrease density |
|
|
Term
| What would be provided to a pt receiving nasal O2 at 3 L/min complaining of nasal dryness and irritation |
|
Definition
| add a bubbler ( not generally required for flows less than 4 L/min) |
|
|
Term
| What features of an SVN affect its performance |
|
Definition
| "baffles, fill volume, residual drying volume, position, continuous vs intermittent, reservoirs/extensions, vent/valves/gas entrainment, tolerance in manufacturing" |
|
|
Term
| How do you minimize a patient's infection risk between drug treatments wiht an SVN |
|
Definition
| rinse with sterile H2O and air dry |
|
|
Term
| particle distributions produced by a typical MDI |
|
Definition
|
|
Term
| what time period shoudl elapse between each puff of a single MDI treatment |
|
Definition
|
|
Term
| Primary safety concerns in the application of hyperbaric oxygenation |
|
Definition
| "most frequent is barotrauma: ear or sinus trauma or tympanic membrane rupture; alveolar overdistension and pneumo, gas embolism. oxygen toxicity: CNS reaction, pulm reaction; fire, sudden decomp, reversible vision changes, claustrophobia, decreased cardiac output" |
|
|
Term
| what factor is used to compute the duration of flow for an E cylinder |
|
Definition
|
|
Term
| what factor is used to compute the duration of flow for an H cylinder |
|
Definition
|
|
Term
| what factor is used to compute the duration of flow for a D cylinder |
|
Definition
|
|
Term
| what does the plus sign on a cylinder mean |
|
Definition
| approved for filling 10% over its service pressure |
|
|
Term
| what is the humidity output of a simple unheated humidifier |
|
Definition
|
|
Term
| "when monitoring a pt receiving O2 therapy, what needs to be assessed" |
|
Definition
| "cardiac, pulm, and neuro stats" |
|
|
Term
| what is the simplest way to increase the humidity output of a humidifier |
|
Definition
|
|
Term
| double the length of an oxygen tube would have what effect on resistance to flow |
|
Definition
|
|
Term
| what is the approximate half life of carboxyhemoglobin |
|
Definition
| "room air: 5 hours, 100% fio2: 80 minutes; 3 ATA HBO: 23 min" |
|
|
Term
| when is a continuous nebulizer appropriate treatment |
|
Definition
|
|
Term
| what are the characteristics of servo-controlled heated humidifier |
|
Definition
| "adjusts heater power automatically, through feedback from thermistor placed at or near pt airway. provides automatic heater shutdown, includes temp safety alarms." |
|
|
Term
| what is the key functional difference between disposable partial rebreathing and nonrebreathing O2 masks |
|
Definition
| nonrebreathers have one-way insp and exp valves |
|
|
Term
| How would you clean a cylinder valve outlet of foreign material |
|
Definition
|
|
Term
| what are the advantages of passover humidifiers |
|
Definition
| "advantages over bubblers are: maintain sats at high flows, add little or no resistane to spntaneous breathing circuits, do not generate aerosols" |
|
|
Term
| for what should sputum collected by aerosol therapy induction be inspected |
|
Definition
| "for diagnosis of TB, pneumocystis carinii pneumonia, lung cancer" |
|
|
Term
| compressed gas cylinders are manufactured from what mainly |
|
Definition
|
|
Term
| What are problems commonly associated with mist tents |
|
Definition
| "CO2 buildup which can be reduced by providing sufficiently high gas flow rates, and heat retention. manufacturers handle differently, i.e. high fresh-gas flows to prevent heat build-up" |
|
|
Term
| Large hospital air compressor systems must be capable of maintaining 50 psig at what flows |
|
Definition
|
|
Term
| What procedures may cause an air embolism |
|
Definition
| "certain cardiovascular procedures, lung biopsy, hemodialysis, central line placement" |
|
|
Term
| Transport of a patient receiving O2 |
|
Definition
| "if using cyl with regulator, use bourdon gauge, because thorpe tube must be vertical to be accurate" |
|
|
Term
| Air for medical use in a hospital |
|
Definition
| "produced by filtering and compressing atmospheric air and must provide high flow (at least 100 l/min) @ std working pressure 50 psig. must be dry, free of oil or particulate contamination. Most common method is cooling to produce condensation. medical air compressors have air inlet fillers and teflon piston rings" |
|
|
Term
| What ;patients are HME used for |
|
Definition
| "traditionally for humidification of vented pt, but also used short-term with non-vented trachs. not recommended for use with infants. it is associated with thickened secretions in some individuals" |
|
|
Term
| which principles are used by the ultrasonic nebulizer |
|
Definition
|
|
Term
| How can one determine whether a pressure-reducing valve uses multiple stages |
|
Definition
| count number of pressure relief vents |
|
|
Term
|
Definition
| "flowmeter device that is always used in conjunction with an adjustable pressure-reducing valve. fixed-orifice, variable-pressure flowmeter device" |
|
|
Term
| Heated humidifier outputs |
|
Definition
| "AARC guidelines - 3 +/- 2 C; min 30 mg/L, can provide 44 mg/L @ 37C" |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| "directs gas over water surface. simple reservoir, wick and membrane. maintains saturation at high flow rates, add little or no flow resistance to spontaneous breathing circuits. do not generate aerosols posing minimal risk of spreading infection" |
|
|
Term
|
Definition
| "directs gas over surface of fluid, passover humidifier" |
|
|
Term
|
Definition
| wick is placed upright w/ gravity dependent end in water reservoir and surrounded by heating element. passover humidifier |
|
|
Term
|
Definition
| separates water from the gas stream by means of hydrophobic membrane. passover humidifier |
|
|
Term
| what are the three types of HME |
|
Definition
| "simple condenser, hydroscopic condenser, hydrophobic condenser" |
|
|
Term
|
Definition
| "HME - condenser element, recaptures 50% of patients exhaled moisture" |
|
|
Term
|
Definition
| HME - 70% efficiency. low thermal condensing element impregnated with hydrocopic salt |
|
|
Term
|
Definition
| "HME - uses water-repellent elemt w/ large surface area. low thermal conductivity, 70% efficiency and some provide bacterial filtration" |
|
|
Term
| How can one determine wheter a pressure-reducing valve uses multiple stages |
|
Definition
| # of relief vents present |
|
|
Term
|
Definition
| breaks/diffuses underwater gas streams into small bubbles. provides absolute humidity levels between 15&20 mg/L. Less efficient with increased gas flow. has pressure relief valve. can produce aerosols at high flow rates. |
|
|
Term
|
Definition
| "results vary. direct pMDI actuation by simple elbow adapters results in the least pulmonary deposition. use of spacer provided optimal results. dosage amount is similar, techniques for assessing response differ.Time with beginning of inspiration, allow at least 15s between actuations" |
|
|
Term
| How would you assess the effectiveness of a partcular aerosol delivery device selection |
|
Definition
| "proper technique, pt response to or compliance with a procedure, objectively measured improvement ( incr %FEV1 or peak flow)" |
|
|
Term
| filtration and compression |
|
Definition
|
|
Term
| fractional distillation of 02 |
|
Definition
| "filtration and compression, cooling by expansion, heated in distillation tower" |
|
|
Term
|
Definition
| through molecular sieve that absorbs non-O2 gases -> 90% O2 or vacuum through semi-permeable plastic membrane (common to home units) -> 40% O2 |
|
|
Term
| non-rebreather mask liter flow and problems |
|
Definition
| "flow at least 10 L/min to prevent bag collapse. leaks (limit Fio2) device displacement, and skin irritation" |
|
|
Term
| what property of helium makes it useful as a therapeutic gas |
|
Definition
| low density. breathing low density gas mixtures can decrease pressure in the airways which decreases work of breathing |
|
|
Term
|
Definition
| "body temperature and pressure, saturated. correction factors are used from ambient temperature and pressure correction factors are used from ambient temperature and pressure (ATPS) to (BTPS). Another common computation is STPD to BTPS. factor tables exist" |
|
|
Term
| MMAD size deposition of aerosolized medication |
|
Definition
| mass median aerodynamic diameter. in an aerosol distribution with a specific MMAD. 50% of particles are smaller and have less mass and 50% are larger and have greater mass. MMAD is an expression of average particle size - expression of measure of central tendency |
|
|
