Term
| normal systemic vascular resstance |
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Definition
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Term
| pulmonary vascular resistance is? |
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Definition
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Term
| normal mean left atrial pressure is |
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Definition
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Term
| With cardiac ischemia will you see changes in T wave or ST segment first? |
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Definition
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Term
| What leads would you add to your ECG monitor to increase the sensitivity to a ichemic episode? |
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Definition
| Add V5 and get 75% detection rate, add V4 and V5 to get 90% sensitivity. V5/V4/II will yield a 95% sensitivity detection rate. |
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Term
| what BP measurement involves feeling for a palpable pulse with inflating/deflating a cuff |
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Definition
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Term
| Automated BP machines are generally similar to A lines except there is a variation in the diastolic pressure of ___ mmHg |
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Definition
| 10 mmHg higher NIBP difference than a line. |
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Term
| the principal source of blood flow to the hand is via what artery? |
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Definition
| ULNAR! So DONT CANNULATE IT! |
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Term
| for invasive arterial monitoring the further you go from the heart will result in more or less resonance? What does this mean? |
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Definition
| There will be more resonance as you measure Arterial BPs further from the heart. This will result in higher systolic peaks and lower diastolic troughs. The dicrotic notch will disappear. |
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Term
| What measure of blood pressure will not be affected regardless of where you place an ALINE |
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Definition
| MAP is generally not affected regardless of where you take your measurement. |
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Term
| For every ____ cm change in height of a tranducer on your aline there will be a corresponding change of ___ mm Hg in your reading |
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Definition
| every 15 cm change in height will correspond with a 10 mm Hg change in blood pressure reading. |
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Term
| one of the major determinants that will influence optimal cardiac contractility is?...frank sterlings curve |
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Definition
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Term
| The CVP consist of how many positive waveforms and what are their labels |
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Definition
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Term
| Describe what the waves in the CVP represent A,C,X,V,Y |
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Definition
A: atrial contraction
C: Tricupsid closing from systole
X: Descent due to atrial relax during v-systole
V: Atrial filling (passive)
Y: tricupsid opens |
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Term
| Use your CVP waveform to diagnosis Tricupsid regurgitation. During this you will see>? |
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Definition
| remarkable elevated C and V waves |
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Term
| canon A waves in CVP measuresments are from? |
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Definition
| tricupsid regurg or Junctional rhythms |
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Term
| loss of the A wave in CVP is from? |
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Definition
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Term
| a pulmonary artery pressure greater than >___ will correlate with the onset of fluid movement into the alveoli |
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Definition
| >20 mm Hg for a wedge pressure will correlate with fluid shift into the alveoli. |
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Term
| Normal partial pressure of O2 in the venous system is? |
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Definition
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Term
| normal saturation of venous Oxygen is |
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Definition
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Term
| A drop in your mixed venous indicates? 2x |
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Definition
Either or combination of:
1. increase metabolic demand
2. reduction of O2 delivery (decrease CO, decrease O2 carrying capacity - blood loss, CO poisioning ect) |
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Term
| What things can an ECHO show a clinician |
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Definition
1. wall motion abnormalities
2. stroke volume
3. cardiac valve function (aortic and mitral)
4. intracardiac air
5. fluid status. |
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Term
| In what state is the wedge pressure remarkable less than the pulmonary diastolic pressure? So PADBP is higher > Wedge |
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Definition
| Pulmonary embolism!!! Back up of blood results in higher pulmonary artery diastolic pressure more than wedge. Blood can't get to left heart!! |
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Term
| pulse oximetry is based upon what law |
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Definition
| Beers-Lambert law: which refers to how it picks up on sats based on lights reflection in the blood. |
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Term
| What are the two wavelengths for pulse oximetry |
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Definition
| 660-nm red / 940-nm infrared light |
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Term
| measurement errors with pulse oximetry is usually due to? |
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Definition
| other substances absorbing light at the same wave lengths as the unit |
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Term
| which wave length for pulse oximetry is red light and which is infrared light |
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Definition
red light = 660 nm
infrared light = 940 nm |
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Term
| intravascular dyes will do what to your pulse oximetry |
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Definition
| drops oxygen saturation to about 65% |
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Term
| Evoked potentials are described in terms of? 2x |
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Definition
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Term
| which type of evoked potentials will be indiciative of posterior cord ischemia |
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Definition
| Somatosensory evoked potentials. Remember that posterior cord supplies sensory information to brain via the dorsal lateral-medial lemisicus pathway. |
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Term
| Inhaled anesthetics cause a dose related effect on somatosensory evoked potentials such as __ on amplitude and ___ on latency |
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Definition
1. Decrease Amplitude
2. Increase latency |
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Term
| What drug do we give will have no effect on somatosensory evoked potentials |
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Definition
| Muscle relaxants do not effect SSEP |
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Term
| motor evoked potentials reflect what spinal pathways |
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Definition
| motor evoked potentials reflect corticospinal tract and the motor afferent signals. |
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Term
| the difference between arterial and end-tidal carbon dioxide is? |
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Definition
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Term
| A BIS score of ___ represents the awake state |
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Definition
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Term
| optimal BIS number for routine general anesthesia |
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Definition
| BIS 45-60 goal BIS for general anesthesia. |
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Term
| In the first hour after induction what happens to a patients body temperature |
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Definition
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Term
| Describe the fail safe valve for anesthesia machines |
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Definition
The fail safe valve is to prevent a hypoxic gas mixture from being delivered. It does so in two ways.
1. Drop in pressure (<30psi of any gas, so not specific to O2)
and / or
2. drop in O2 concentration (via O2 analyzer) |
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Term
| what is the pin index safety system for anesthesia machines... PISS |
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Definition
| To prevent the wrong gas deliver to the wrong ports each type of gas has its own unique plug that will only fit in its corresponding system. |
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Term
| nitrous oxide has the color _______ |
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Definition
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Term
| What gas does the pressure gauge for the gas not indicate the amount of gas remaining in the cylinder |
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Definition
| Nitrous Oxide. B/c as long as there is liquid nitrogen oxide there will be the same pressure. |
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Term
| When will the pressure change in a cylinder of nitrous oxide |
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Definition
| only after all liquid nitrogen oxide is depleted, at which point the pressure begins to drop and you can assume at least 75% of the tank is depleted |
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Term
| What is the principle that relates gas flow to pressure |
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Definition
| Flow of gasses is based on the principle that flow past a resistance is proportional to pressure. |
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Term
| What part of the bobbin ball in the flow meter tube is where you measure the actual liters? What part of the ball in the flowmeter do you measure from |
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Definition
| top of the bobbin (Its not a ball)...or middle of the ball |
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Term
| What characteristics of a gas will determine the relatinship of flow/resistance |
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Definition
1. gas density
2. gas viscosity
3. tube resistance |
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Term
| are flowmeters interchangeable |
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Definition
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Term
| memorize figure 15-3, page 200 |
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Definition
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Term
| memorize figure 205 figures |
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Definition
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Term
| what is the gas flowmeter is last to be added to the respiratory circuit..why? |
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Definition
| Oxygen.. to minimize risks associated with leaks |
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Term
| what is the oxygen flush valve? Describe its constuction and why its good to have in the case of an emergency |
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Definition
| the oxygen by-pass valve directly connects high pressure O2 tank to the low pressure line, effectively bypassing the flow meters and maniford. Therefore you can hit that oxygen by-pass valve and send a large volume of oxygen . The risk is barotrauma. |
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Term
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Definition
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Term
| if temperature decreases what happens to flow through the vaporizing unit |
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Definition
| Increase flow through the vaporizing unit. Decrease temperature causes decrease vapor pressure so the anesthesia compensates by increasing flow through the vaporizing unit. |
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Term
| what gas requires its vaporizer to be heated |
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Definition
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Term
| desflurane and CO2 absorbent can result in what toxic elemetn |
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Definition
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Term
| overfilling of the vaporizer liquid would be greater than > ___ |
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Definition
| >> 125 mL will over fill the vaporizer chamber |
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Term
| what volatile has a vapor pressure that is near 1 ATM |
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Definition
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Term
| what angle do you want on your t -[piece for your breathing circuit |
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Definition
| curved, a 90 degree piece would add more resistance |
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Term
| what is the best method for determining the optimal fresh gas flow |
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Definition
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Term
| whether the circle vent system is open,close or semi something what does it depend on |
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Definition
| the amount of fresh gas flows |
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Term
| A full cylinder of O2 will have what PSI? How much volume is associated with that |
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Definition
| full O2 cylinder will have 2000 PSI and that contains 625L of oxygen. |
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Term
| a full cylinder of air will have what PSI? How much volume is associated with that |
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Definition
| Full Air cylinder will have 1800 PSI and 625 L of Air |
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Term
| a cylinder of Nitrous oxide will have what PSI |
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Definition
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Term
| what type of system only allows one gas to be on at any given time? |
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Definition
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Term
| Where should the APL Valve be during spontaneous breathing |
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Definition
| Fully open so that you don't have pressure on patient's lung during insp/exp cycles |
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Term
| The reservoir bag holds the most flow of fresh air which is ___ and great for the spontaneous awake patietn |
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Definition
| reservoir bag can supply a flow of 60L/min |
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Term
| a closed system is present when fresh gas inflow into the circle system satisfies ? |
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Definition
| fresh gas flow satisfies patients metabolic oxygen needs. |
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Term
| what are the advantages of a completely closed circle system |
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Definition
1. save money, less waste
2. less pollution
3. maximal humidification and warming |
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Term
| disadvantage of the completely closed circle system |
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Definition
| 1. cant rapidly change gas mixtures since it runs at such a low flow rate. |
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Term
| two biggest dangers of a completely closed circle system |
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Definition
1. unpredictable and possible insufficent concentrations of O2
2. unknown and possible toxic levels of anesthesia. |
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Term
| when the bag/vent selector switch is set to vent what happens to the APL and resevoir bag |
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Definition
| APL and resevoir bag are comletely bypassed |
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Term
| why would bellows not rise |
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Definition
| because there is a leak so patients expiration cannot fully lift up the bellows. |
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Term
| the positive pressure relief valve on the scavenging system will open if pressure exceeds > _____ ? |
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Definition
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Term
| air in the operating room should be exchanged at least ____ per ____ |
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Definition
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Term
| what type of system scrubs out CO2 via neutralization? open? Semi-open? Closed? Semi-closed? |
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Definition
| Only semi-closed and closed systems scrub out CO2 via CO2 absorbers |
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Term
| soda lime granules can turn into dust which is an irritant to what part of the body |
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Definition
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Term
| what is the reaction that takes place with CO2 and soda lime? |
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Definition
| CO2 combines with H20, formation of carbonic acid occurs in presence of soda lime. Carbonic acid then reacts with hydroxides also present there. From this carbonates are formed along with water and heat. |
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Term
| final products of CO2 neturalization are? |
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Definition
1. heat
2. water
3. carbonates |
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Term
| which neutralizing product results in monovalent bases at the bottom of the canister which are corrosive to the skin? |
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Definition
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Term
| if a neutralizing canister does not get warm what are you worried about? |
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Definition
| that means there is not a chemical reaction and you shoulud presume that CO2 is not being scrubbed. |
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Term
| what are the two main factors that influence the efficiency of CO2 neutralization |
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Definition
1. granule size
2. presence of absence of channeling |
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Term
| the granular size of neutralizing systems is |
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Definition
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Term
| to ensure normal channeling of air through the neturalizing container what should you do to it prior to inserting it? |
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Definition
| shake it slightly to make sure all the granules seat well. |
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Term
| absorpitive capacity of co2 neutralizing canister is determined by the amt of carbon dioxide that can be absorbed by _____ of co2 absorbent |
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Definition
| how much co2 absorbed by 100G of CO2 absorbent |
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Term
| the dye in the co2 neutralizing systems is reactive to changes in? |
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Definition
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Term
| which co2 neutralizing system does not degrade or desiccate inhaled anesthetics |
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Definition
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Term
| what two gases can result in compound A when the soda lime becomes degraded/desicated |
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Definition
| halothane and sevoflurane |
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Term
| all gases can lead to CO formation from soda lime degradation. Which one is the most |
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Definition
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Term
| desication of soda lime usually occurs from what |
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Definition
| backwards flow up the canister |
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Term
| desication requires a prolonged period of ___ hours of retrograde gas flow to occur |
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Definition
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