Term
| Your patient is 6ft 4 inchs, weights 200 lbs. What is his BSA |
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Definition
BSA = Sqrt (Ht in cm x kg/3600)
BSA = 2.2 |
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Term
| what is the hydrogen concentration for a solution with a pH of 7.53 |
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Definition
H30 = 10^-pH
2.95 x 10 ^-8 |
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Term
| what gas has the highest blood / gas coefficent? Does this mean it is very fast acting or slower acting for induction |
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Definition
| ISoflurane has the highest blood/gas coefficent which means it is slowest acting. Its B:G is 1.4. |
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Term
| which gas is the most potent. What is its coefficent that reflects this |
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Definition
| ISoflurane is most potent. Oil:Gas reflects potency. Isoflurane's O:G is 91. |
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Term
| how many liters of nitrous comes from a full E cylinder |
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Definition
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Term
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Definition
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Term
| viscosity and density are two major factors in gas flow. Which correspond most importantly to high flows and to low flows |
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Definition
High flows: density
Low flows: viscosity |
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Term
| Does flow meter accuracy improve with low or higher flows |
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Definition
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Term
| how does a flow meter respond to large changes in atmospheric pressure? |
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Definition
| Gases are all conditionally related to atmospheric pressure. So if total pressure is lower than normal than the flowmeter will not rise as much b/c not as much pressure behind it to begin with. |
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Term
| are vaporizers with the highest or lowest vapor pressure placed furthest upstream? So will Isoflurane or sevoflurane be placed in what order? |
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Definition
| Vaporizer with the lowest vapor pressure are placed furthest upstream. So Sevoflurane which has a vapor pressure of 185 compared to isoflurane with a vapor pressure of 250 will be placed furthest up stream. |
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Term
| Isoflurane: 1. Molecular weight of 184.5 gm/mole 2. Density of 1.5 gm/cc - At room temp 20C and 1 ATM; how long will 2 cc of isoflurane last with a FGF of 5 liters compared to 2 liters? |
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Definition
| Step 1: Solve for Vapor mL per 1 mL liquid Ans: 182 mL vapor / 1mL liquid at 0C/1ATM Step 2: convert to room temperature (Charles law) ANS: 195mL vapor/1mL liquid at 20C/1ATM Step 3: Determine mL of vapor added to circuit with FGF x % on dial. Ans: 5L FGF at 1.15% = 57.5mL Ans: 2L FGF at 1.15% = 23mL Step 4: Divide total Vapor for 2 mL liquid / Vapor output per FGF. 2mL liquid isoflurane = 390mL vapor isoflurane at 1 AMT and 20C. At 5 lpm FGF and 1.15% isoflurane (20C and 1 ATM) 2 mL liquid Isoflurane will last 390 vapor / 57.5mL = 6.8 minutes At 2 lpm FGF and 1.15% isoflurane (20C and 1 ATM) 2 mL liquid Isoflurane will last 390/23 = 17 min minutes |
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Term
| what does the vaporizer do to desflurane |
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Definition
| heats the agent to 39 C in order to put it in a completely gas state. This was desflurane can be more easily managed. The gas at this state has a pressure of 1500 mm Hg. |
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Term
| what is the only approved anesthetic that reacts with CO2 absorber ? |
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Definition
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Term
| sodalime can absorb CO2 levels how fast and efficently |
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Definition
| We we exhale the end tidal registers a # which is in mm Hg. So if a normal end tidal is 45 then that is 45 out of 760 (atmospheric pressure at sea level. Therefore the % of end tidal exhaled = 45/760 or 5.9%. Soda lime can absorb 5% Co2 mixture down to 0.5% in 160 mseconds. (1000 msec in 1 second) |
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Term
| explain the difference between the mapleson A and D circuit |
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Definition
Mapleson A: A: APL A:AT P: Patient.
-has the APL closest to the patient and FGF behind the resevoir bag. This set up is good for spontaneous breahting people since the resevoir is filled with O2 rich air and gives adequate volume for spontaneous breathing which requires LARGE Flow rates. Exhaled gases are immediately vented at the one way valve on the APL which is closest to the patient.
Mapleson D: (D:Dead End of circuit)
- is better for vented pt. The APL is at the BAG furthest from patient. But the bag is mostly all exhausted air. The O2 rich air is directly inputed at the patient. The bad air acts as a force to push good air in and out. APL can open every positive breath delivered to expel bad air and control pressure to system. |
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Term
| what is the relative humidity in the human airway |
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Definition
| in the trachea and airway of an adult the relative humidity is 100% which means that the percent in there is 100% of the absolute humidity which is the max humidity in any space of air. So its just saying the body maxes out the most amount of humidity it can. |
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Term
| 5x consequences of drying out an airway because you fail to maintain normal humidity |
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Definition
1. drying of airway mucosa
2. thickening of secretions
3. reduction in surfactant activity
4. reduction in ciliary function
5. heat loss |
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Term
| NIOSH recommends halogenated agents be < ___ ppm. If halogenated agents + nitrous than they should be < ____ |
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Definition
halogenated < 2.0 ppm
halogenated + nitrous < 0.5 ppm |
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Term
| Nitrous should be < ___ ppm in room |
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Definition
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Term
| is the primary job of the scavenger to remove anesthetic gases? |
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Definition
| no. Its primary job is to prevent barotrauma. primary job of room vacuum to remove gases. |
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Term
| how much CO2 is produced each minute by an average size adult |
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Definition
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Term
| what minute ventilation is necessary to maintain a Co2 level of 40 in a patient whose minute co2 production is 250 and is at sea level. AND WHAT VENT SETTINGS WILL YOU SET THEM AT |
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Definition
P1 = sea level (760) V1 = 250 mL / min of CO2 P2 = 40 mm Hg (Goal co2 end tidal) V2 = Solving for amount of mL/min needed to maintain that 40 mm Hg co2 level V2 = 4,750 Ve or 4.75 L Ve (of ALVEOLAR VENTILATOIN) Still need to compensate for dead space loss.
Vent settings will be 475mL TV at rate of 10. |
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Term
| at rest, normal O2 consumption in an adult is mL/min? how large is a normal FRC? Therefore how long do you have for an apnec period before hypoxia |
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Definition
250 mL / min
FRC = 2,500 mL
2,500 / 250 = 10 minutes
LIMITED by CO2 elimination |
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Term
| does oxygenation or co2 elimination more drastically effected by shunts |
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Definition
| oxygenation. No blood for air exchange is bad. |
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Term
| does oxygenation or co2 elimination more effected by dead space. |
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Definition
| Co2 elimination. More CO2 sitting in the lungs |
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Term
| what is the difference between SIMV and IMV |
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Definition
| SIMV (Syncrhonous) will not breath stack and actually pays attention if patient takes a breath. So that it does deliver a mandatory breath after a patient already took one and may not have exhaled all of it out. |
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Term
| If your pt goes into apnea. How fast will co2 increase |
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Definition
| in the first minute it will increase by 6 mmHg. Then 3 mm Hg every minute after that. |
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Term
the o2 flush valve will deliver
1. What psi a
2. At what flow rate |
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Definition
1. 40-60 psi
2. flow rate of 35 Liters/min |
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Term
| the awake unanesthetized patient has a BIS score of |
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Definition
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Term
| burst suppresion on BIS will likely be seen with a BIS score of |
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Definition
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Term
| to obtain deep sedation and likely amnesia you should maintain a BIS of |
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Definition
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Term
| what is the difference between deep and light sedation on the BIS monit |
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Definition
| Deep sedation is 60 to 70 while light sedation is 70 to 90 |
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Term
| what three types of patients are most at risk for being aware during their case |
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Definition
| 1. trauma 2. cardiac surgery 3. C Section |
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Term
| what things do we give that may artifically increase the BIS monitoring. |
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Definition
| 1. ketamine and 2. pressors |
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Term
| Dramatic drops in the BIS can be contributed to what three things |
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Definition
| 1. hypothermia 2. hypoglycemia 3. cerebral hypoperfusion |
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Term
| BIS works at what frequency while brain works at what frequency |
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Definition
| 250 Hz for BIS while brain is 0.5 to 50 Hz |
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Term
| a large increase in EMG burst indicates what at the end of the case |
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Definition
| a likely imminent bucking of patient as they are getting light. perhaps pre treat with propofol or lidocaine. |
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Term
| what on the BIS machine is actually real time |
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Definition
| EMG number and EEG tracing. |
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Term
Which of these gives you your blood pressure?
CO, LVEDP, MAP, SVR, PVR, CVP |
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Definition
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Term
| for every 10 cm of height there is a gravitational effect of how any mm Hg |
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Definition
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Term
| vascular disease can decrease peripheral invasive readings by how much |
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Definition
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Term
| hyperdynamic circulation will be reflected on the invasive A line as |
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Definition
|
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Term
| high cardiac output is reflected on the arterial line as |
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Definition
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Term
| aortic valve closure can be seen on the arterial wave form as |
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Definition
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Term
| if your arterial waveform is underdampen you would expect your arterial readings to be higher or lower? |
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Definition
| Falsely higher A line readings |
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Term
| the frequency of the arterial line afte the square wave test should be |
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Definition
|
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Term
| The SBP and DBP in a manual BP will be higher or lower compared to Arterial line |
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Definition
| SBP is lower compared to A line and DBP is higher caompared to aline since aline is a computer and smarter than you and can pick up the upstroke of the sbp and lowest possible DBP better than you can listening to it with your stupid stehoscope. |
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Term
| what blood pressure parameter (MAP, DBP, SBP) is a calculation during oscillometric blood pressure monitoring |
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Definition
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Term
| side stream analyzers suction how many mL of air to its analyzer |
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Definition
| 200 mL/min of gas from Y piece |
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Term
| what law applies to the technology used in CO2 analysis |
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Definition
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Term
| Infrared light at what micrometers is strongly absorbed by CO2 |
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Definition
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Term
| the transition phase during capnography is what phase I, II, III or IV |
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Definition
| II. B/c transition is referring to the exchange of dead space and then true alveolar co2 |
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Term
| normally the difference between PaCO2 and PeCO2 is |
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Definition
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Term
| a kinked ETT, mucous plug or bronchospasm can cause the capnography waveform to look like? |
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Definition
| flattening of the expiratory upstroke. ALL DUE TO INCREASED AIRWAY RESISTANCE |
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Term
| when might you see cardiac oscillations on the capnography |
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Definition
| during HIGH cardiac output states. |
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Term
| an elevated baseline indicates what on the capnography |
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Definition
| rebreathing. So it never drops to zero b/c pt never got to fully exhale. |
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Term
| If the capnography indicates the patient is not compltletly exhaling...by indication of what on the capnography? What should you troubleshoot as causes |
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Definition
if the baseline of the capnography Phase I does not reach zero then patient is most likely rebreathing co2 cause they can't get all of it out.
Causes
1. failed CO2 absorber
2. malfunctioning expiratory valve
3. inadequate fresh gas flows in a non-rebreathing circuit. |
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Term
| what is the oxygen content equation |
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Definition
| CaO2 = (1.37 x Hb x O2Hb% / 100) + (0.003 x PaO2) |
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Term
| P50 on the oxyhemoglobin dissociation curve is |
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Definition
|
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Term
| What is the PaO2 quick reference PaO2 / SaO2 reference |
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Definition
40, 50, 60, 70, 80, 90 rule.
So at 40 PaO2 you should have Sat that correlates with 70%. |
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Term
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Definition
|
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Term
| what are the two wavelengths used by pulse oximetry |
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Definition
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Term
| methylene blue will do what to the O2 sat |
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Definition
| decrease by a sudden large amount |
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Term
| MetHb causes the false high or low? |
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Definition
| Neither it is absorbed equally by both wavelengths so it will read more like a O2 Sat of 85%. |
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Term
| what is the penumbra effect in relation to O2 sat monitoring |
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Definition
| a slight beam of light from the OR room or elsewhere can interfere with the O2 sat monitor and cause artificially low O2 readings |
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Term
| the X ray tube uses how much electricity |
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Definition
|
|
Term
| what is scatter radiation |
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Definition
| some beams from x ray bounce of the patient and other objects and scatter in the room. These are the most hazardous to the health care provider |
|
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Term
| what is the difference in the two types of injury from exposure to ionizing radiation |
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Definition
1. deterministic
-causing cell death or tissue damage
2. stochastic
-screws with DNA eventually leads to cancer |
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Term
| which type of radiation exposure damage is more common and worsens over time |
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Definition
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Term
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Definition
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Term
|
Definition
|
|
Term
| annual dose limit for REM is |
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Definition
|
|
Term
| what is the lifetime accumulation limit for radiation for the 60 year old clinician |
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Definition
1 rem x years of age
60 rem limit |
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Term
| the highest radiation exposure is from what two areas of the hospital |
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Definition
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|
Term
| which organs in your body are at most risk for radiation exposure |
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Definition
| those that divide most like gut, gonads, lens, thyroid |
|
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Term
| what are the three cardinal principles of radiation exposure |
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Definition
1. time
2. distance
3. shielding |
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Term
| radiolographic contrast media are iodinated compounds classified according to their 2x characteristics |
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Definition
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Term
| which type of contrast (ionic or non-ionic) cause less discomfort on injection and have less incidence of allergic reaction |
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Definition
|
|
Term
| what is the incidence of contrast induced nephropathy |
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Definition
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|
Term
| what type of contrast media is used during MRI that has a strong association with reactions |
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Definition
| gadolinium based contrast |
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Term
| what is a common side effect of gadolinium use |
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Definition
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Term
| Your pt undergoing neuro surgery is producing 350 mL of co2 / min while you are in the operating room at Yale. You know best practices is to maintain the end tidal lower than 40. Your attending wants the end tidal goal to be 35. What vent settings are necessary if co2 production stays constant to your attendings goal |
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Definition
350 mL CO2 x ATM 760 = 35 x ?
= 7600 minute ventilation
Vent settings 760 mL with rate of 10. |
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Term
| At induction your End Tidal is 40 mm Hg. What will be your CO2 level in 4 minutes if the patient remains apneic and you do not ventilate them? |
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Definition
E: 6 mm Hg increase in first minute then 3 mm Hg of CO2 increase every minute after.
Answer: 55 mm Hg |
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