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By Garrioch, Magnus

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Although this can be used therapeutically to ‘recruit’ alveoli in atalectatic lung, excessive PEEP, as with any excessive airway pressures, may cause barotrauma and possible pneumothorax. indd 54 15/10/14 11:37 AM QUESTION 42 42 The adult advanced life support algorithm is shown (42a) with certain parts missing. i. What three instructions are missing from the box marked 1? ii. If the return of spontaneous circulation does not occur and the rhythm is not ‘non-shockable’, what does box 2 instruct one to do?

Ii. A peripheral nerve injury can lead to increased sodium channel expression causing increased sensitivity in pain fibres. These sensitised primary afferent nerves discharge spontaneously to increase glutamate release from nerve endings, which then act on glutamate receptors to trigger pain impulses, reduce pain thresholds and increase the effects of peripheral stimuli. A number of factors are thought to influence the development of the condition: pre-existing pain; genetic variability (single nucleotide polymorphisms coding for the catechomethyl-transferase enzyme are associated with the development of chronic pain conditions); and psychosocial factors such as severe fear of surgery or a history of depression/anxiety.

Why does a full N2O cylinder (with a lower pressure) contain more molecules of gas/vapour than a full oxygen cylinder (with a higher pressure)? iii. Do the pressure gauges indicate how much of the contents remain? Explain why or why not. The fact that N2O is not an ideal gas at room temperature explains this. What is an ideal gas, and why is N2O not ideal at room temperature? iv. Will the cylinder pressures change with altitude and temperature? v. What percentage of N2O content remains when the delivered pressure starts to decrease?

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