9. Equipment Flashcards
LASERS
Stands for
How are they varied
Carbon dioxide lasers are used to
Argon or krypton Use & spectrum
Nd YAG
Light Amplification by Stimulated Emission of Radiation
Differing mediums are used in order to vary the depth of penetration, wavelength of light and power of the beam
CO2 cut tissues and coagulation precisely.
needs He laser - aiming guide
cornea risk > retina
Argon - blue-green - maximally absorbed by red
Ophthalmology, photocoagulation and dermatology.
400-700
Neodymium yttrium-aluminium-garnet (Nd YAG)
near infra-red lasers,
debulk tumours photocoagulation.
1064nm laser -
waves are Parellel monochrotmatic in phase non divergent high energy intesinty w/ low power source
Trachy where inserted size connector tip cut fenestrated metal LT properties
Where - stoma trach rings 2-4 15mm connector as standard Tip cut square reduce obstruction v wall Great curve - air directed vocal cord Metal - long term, bactericidal, uncuff, inner - removed clean
Lasers safety
LSO
Laser safey officer
Trained + aware precautions
Eye safety & approp for wavelength
Entry controlled + signs
Reflective surfaces avoided (not necc matt black)
Good ventilation for fumes
Manley MP3 How work number bellows & valves TV max How adjust Mapleson?
FLOW GENERATED MIN VOL DIVIDER
Minute volume divider pneumatic driven
Entire FGF delivered to pt - diveded into set volume
FGF drives - rapid detect failure
2 sets bellows & 3 unidirectional valve
TV 1000
Inflation pressure adjust weight on a rail
Like mapleson D during spontaneous vent
Not suit poor complinace
The relationship between frequency (f), wavelength (λ) and velocity (v) is as follows:
λ = v/f
Straight blade laryngoscopes
Name 4
how are they used
Miller, Soper, Wisconsin and Seward.
advanced over the epiglottis which is then lifted in order to view the larynx. Straight blades are commonly used for intubating neonates and infants but can be just as easily be used in adults.
What side is the macintosh
Right sided as standard (left for facial deform)
Polio - angle
20-135 degrees to the handle
Irong lung ventilators during the polio epidem
McCoy
Based on the standard Macintosh blade
(not Robertshaw’s), with a lever operated hinged tip, which can improve the view at laryngoscopy.
PA catheter
Number of lumens
Calculate temp
Baloon
meaures LAP
4 lumens (blue=right atrial, yellow=pulmonary artery, white=proximal infusion port, red=balloon air inflation). A further channel contains a wire connecting to a thermistor.
thermistor at its distal end can measure core temperature and cardiac output using a thermodilution technique
The balloon is filled with air to enable catheter migration in the direction of blood flow.
The left atrial pressure is measured indirectly as the catheter wedges in a pulmonary artery, the tip measuring the pressure in the pulmonary capillaries which are in continuity with pulmonary veins and hence the left atrium.
LMA - weight + cuff volume
Size Weight Maximum Air in Cuff 1 <5 kg 4 ml 1.5 5 to 10 kg 7 ml 2 10 to 20 kg 10 ml 2.5 20 to 30 kg 14 ml 3 30 kg to small adult 20 ml 4 Adult 50-70 kg 30 ml 5 Big adult 70-100 kg 40 ml 6 Adult >100 kg 50 ml
High frequency ventilation (HFV)
What is it
Rate+ volumes
small tidal volumes delivered at high frequencies, maintaining gas exchange without barotrauma or other deleterious effects of intermittent positive pressure ventilation (IPPV).
s ventilation at four times the normal rate (not ten times), and uses tidal volumes of 1-3 ml per kg (not per hour).
can use conventional ett
three modes used (not two):
High frequency positive pressure ventilation (HFPPV)
High frequency jet ventilation (HFJV) and
High frequency oscillation (HFO).
vasive form of ventilation that uses high frequency oscillation within a cuirass.
to a cuirass, so that it covers them from the axilla to the lower abdomen. It is not connected directly to an endotracheal tube. The Hayek oscillator works by decreasing and increasing the pressure within the cuirass, causing inspiration and expiration respectively.
Doppler effect
Apparent change in frequency -
movement object in relation to the source.
Human hearing frequency
Medical ultrasound
15Hz - 20000hz
- 2.5 MHz to 15 MHz
LMA Size
Prox end size
Size 2 is 7 mm
Size 3 is 10 mm
Size 4 is 10 mm
Size 5 is 11.5 mm.
Proximal end is a standard 15 mm (not 22 mm).
Wrights respirometer What is it What does it measure Where should it sit how accurate Vane revolutions per l gas Min flow Accuracy @ high & low flow
one way system exhaled TV & MV
Expiratory size (trachea ) - lower pressure v inspiratory side inaccuracy from gas leaks expansion tubing.
accuracy of +/- 5 to 10%.
The vane does 150 revolutions (not 250) when one litre of gas
A minimum flow of 2 litres per minute is required for the respirometer to function accurately, but it tends to over-read at high flow rates and under-read at low flows.
HAFOE
Work
on Bernoulli principle
Venturi effect - entertainment air
100ax21b = 30 x req fio2
a = oxygen flow
b entrained airlow rate
Rely Peak inspiratry flow <30lmin
Highest Fio2 60%
15lmin flow
8l min = 35% Fio2
10l = 40%
Waters circuit
Resevor bag
fgf
apl
patient
NIBP
MAP most accurate - osscillomtery - max oscillations occur at mean
DBP = least acc
incc pinpoint when disappear
mean = diastolic + 1/3 systolic - diastolic
wavelengths of laser
birthmarks
Pulsed dye
Argon
NDyag
488 - pulsed dye laser - birthmark vascular skin lesion
515 - argon - destroy cancer
532 ndyag - diabetic retinop -
660 - visble spec - barcodes hair remove
1064 nd yag - debulk tumor
Servo ventilators
Minute volume divieres
Bag - filled gas from FGF
Spring compresses bag = push gas into insp limb
Flow measure pneumotachogrph
Divide vol deliver - inspirtory limb clamp =- exp limb opens
Diathermy
current
cutting pattern
Uses AC 0.5-1 MHz
Sine wave pattern - cutting + damped / pulsed sine - coa
filter for blood
200 microns
filter for epidural and hme size
.2
fibreoptic cables
Propagated light will remain within the core material which will have a higher refractive index than the cladding
core surrounded by cladding
light propagated by total internal relection
- light incideent on boundray completely reflect back to the core
DLT
derived
Derived from Carlens tube
Robertshaw - classic red rubber
designed avoid RUL collapse vs bronchocath
ex small sml large med
broncocath fr gauge 35-41 + 28L
left side tube best Right sided surgery - decomp r lung left lung ent
Drip counter
reliant on
drop size vary how much
what varies
where imporntant
Reliant LED + Photo detection
Drop size vary 20% vary density surface tenson temperature composition fluid
acurrat - important in paeds
liq in drip counter - occupy 1/3 of space
If a ray of light in an optical fibre post refraction emerges from the side of the fibre
angle of incidence of the ray of light < critical angle of the fibre
Maggil
Mapleson A
Fxn sim to lack
suit kids >25kg
Inneficcient IPPV
effective for spont vent
FGF req = al min vent 70/kg
. If some rebreathing of this dead space gas is accepted, a flow approximating to around 70% of the minute volume can be used:
Vent x3 alveolar min vent
Where would expect high pressure airway alarm to be positioned
Patient side inpsiratory and expiratory valves
Min FGF on mapleson E
if scavengin good on an F
What vol should be in corrugated tubing
bag moving on bain = FGF deliver
Manley set to SV
example of a
3-4l/min
lower - inhling air end insp = if tv> volume tube
No
volume greater than tv in the F
No - confirmed movement gas
no warning inner tube disconnect
Vol currgated tubing attach bain - important
Small = ventilator dribing gas diltuing fgf
Rec Vol <500
manley - sv = non coacil mapleson D
Piezoelectric effect
Mechanical distortion electrical potential produced depend on thickness of crystal (frequency_
inverse also applies
field applies - realigment creates electric energy
Velocity =
sound frequency in air
short wl have a higer or lower freq
Sounds with low freqency sound low or high pitched
radiowaves lower freq / higher vs cray
frequency x wavelength
v constant = wavelenght decrase frequency increases
343 m/s
Short w/l = higer freq
Sound LOW frequency = LOW pitched
lower
Sterilisation
what does it do
whats the prefered method
what other methods
how long do these take
all types micro ogranism incl spore killed
Steam - efficient safe + preferred method if can withstand
others
Chem - glutaraldehyde 2%,
>10h
Ethylene oxide
2-12h
alkylisation proteins
gas plasma
Highly ion gas
75m
Gamma irrad - commercial use - expensive + not prefered method hosp use
Pacemaker
Letter positioning
1 Paced 2 Sensed 3 Response sense 4 Porgram + rate modulating 5 antiarrhy fxn
Hypercapnia can increase thereshold excitation
newer pacemakers are bipolar
anode + cathode closer = reduced risk artefact interupting
LASERS waves properties
waves are Parallel monochromatic in phase non divergent high energy intensity w/ low power source
