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AGM > AGM > Flashcards

AGM Flashcards

1
Q

High Pressure System (PSI)

A

750-2200 PSI

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2
Q

What are the high pressure systems on the AGM?

A
  • Cylinders
  • Hanger yoke
  • Yoke block with check valve
  • Cylinder pressure guage
  • Cylinder pressure regulator
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3
Q

Cylinder reserve supply is for ________ use only

A

emergent

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4
Q

Tanks should ONLY be opened when

A

They are checked or pipeline is unavailable

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5
Q

What color tank is oxygen cylinder?

A

Green

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6
Q

What is the PSI of a full oxygen cylinder

A

1900-2200 PSI

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7
Q

How many L of gas is in a full oxygen tank?

A

660L

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8
Q

What color tank is air cylinder?

A

yellow

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9
Q

What is the PSI of a full air cylinder

A

1800 PSI

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10
Q

How many L of gas is in a full air tank?

A

600L

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11
Q

What color tank is Nitrous Oxide

A

Blue

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12
Q

What is the PSI of a full nitrous oxide cylinder

A

745 PSI

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13
Q

What state is nitrous oxide in when in cylinder

A

gas and liquid

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14
Q

How many L in a full tank of nitrous oxide?

A

1600L. (Will stay at 750 until liquid gone)

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15
Q

What is the Pin Index Safety System (PISS)

A

The pin arrangement matches holes in the yoke where cylinders are attached to the gas machine.
The PISS is a method to prevent misconnections.

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16
Q

What is the most fragile part of the cylinder?

A

The cylinder valve

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17
Q

What are the parts of the cylinder valve?

A

a body, the port where gas exits, a conical depression for the securing screw, PISS pins, and safety relief devices

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18
Q

Importance of hanger yoke

A

Orients the cylinder

Provides a gas tight seal

Ensures unidirectional flow

Contains a filter required by standard

Check valve to minimize transfilling

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19
Q

Intermediate Pressure System PSI

A

40-50 psi

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20
Q

What are the intermediate pressure systems on the AGM?

A 
Ventilator power inlet
Pipeline inlet
Check valves
Pressure gauges
Flow meter valves
Oxygen pressure-failure devices
Oxygen second stage regulator
Flush valve
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21
Q

Is oxygen stored as a gas or a liquid?

A

Pipeline - Liquid @ 184*C

Cylinder - gas

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22
Q

What is the PSI of oxygen in the pipeline?

A

50 PSI

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23
Q

Guideline for oxygen supply failure

A

Do not attempt to fix the oxygen analyzer. It must be trusted until proven inaccurate.

Turn on backup oxygen cylinder on machine fully, and disconnect pipeline. If inspired 02 does not increase, ventilate by bag mask.

Use low flow of oxygen.

Turn off ventilator and bag manually.

Call for help, calculate the time remaining on the cylinder.

Find out details of problem and how long.

DO NOT reconnect patient to pipeline unless it is tested.

Ventilate with an oxygen source or room air via bag valve mask.

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24
Q

5 tasks of oxygen in the AGM

A
  • Proceeds to the fresh gas flowmeter
  • Powers the oxygen flush
  • Activates the fail safe device
  • Activates oxygen low-pressure alarm
  • Compresses the bellows of mechanical ventilators
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25
Q

Explain free floating valves

A

Moves in the direction or “push” of gas flow

Prevents gas from leaking out of system

Found in DISS and dual hanger yoke systems

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26
Q

Where do you find free floating valves?

A

oxygen flush (anesthesia panic button)

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27
Q

Where are the diaphragm valves located?

A

First stage regulator

Second state regulator

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28
Q

Low pressure system PSI

A

16 PSI

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29
Q

What are the low pressure systems on the AGM?

A

Flow meter tube

Vaporizers

Check valves

Common gas outlet

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30
Q

Where do you read a ball-float in the flow meter

A

middle of the ball

31
Q

Where do you ready an arrow float

A

at the top of the float

32
Q

What is the Thorpe Tube?

A

Gas specific and tapered with largest diameter at the top

33
Q

What is the proportioning system?

A

“hypoxic guard”

Nitrous oxide and O2 chained together. That way you CANNOT give nitrous alone

34
Q

How much concentration of gas is given through modern anesthesia gas vaporizers?

A

A constant amount, regardless of temperature change or flow

35
Q

What will happen if the vaporizer is tipped then leveled out?

A

Liquid vapor will get into the vaporizer chamber and the carrier flow will be MORE agent to the patient. DO NOT USE after being tipped.

36
Q

Inspiration and expiration check valves do what?

A

Permits direction of gas flow to and from the patient (unidirectional)

37
Q

What does the APL (pop off) valve do?

A

Adjusts the limit of pressure in the patient circuit and rebreathing bag

38
Q

On inhalation, gas flows through the

A

Inhalation check valve and the soda lime

39
Q

Gas flows down through the soda lime from where?

A

Directly from the common gas outlet and from the rebreathing bag

40
Q

On exhalation, gas flows through the exhalation check valve to where?

A

APL/rebreathing bag

41
Q

What happens if the inspiratory valve sticks open?

A

The expiratory volume will exhaust through the inspiratory limb. The EtCO2 waveform will become elevated.

42
Q

What happens is the expiratory valve sticks open?

A

Due to the path of least resistance, the inspired volume will not reach the ET tube but instead will bypass and exhaust through the expiratory limb.

43
Q

APL (pop off valve) range

A

0-70

44
Q

What does the APL valve control?

A

Controls how much pressure the patient gets.

45
Q

What happens if you ventilate with to much pressure?

A

Will cause barotrauma. Normally ventilate at 25 but don’t go about 40 cm H2O

46
Q

What is the open system?

A

No mask on face. Anesthetic to patient by insufflation. (Not in control how much anesthesia they get)

47
Q

What is semi-open system?

A

Mask on face. Placed over face and pt spontaneously breathes inhaling anesthetic and room air. No rebreathing. CO2 accumulates under mask.. Portable/can use with any agent.

48
Q

What is a unique hazard of the Bain Circuit?

A

is occult disconnection or kinking of the inner, fresh gas delivery hose. If this occurs, the entire corrugated limb becomes dead space. This results in respiratory acidosis which is unresponsive to increased minute ventilation.

49
Q

How to perform a thicket test on the Bain Circuit

A
  1. Occlude the patient’s end of the circuit (at the elbow).
  2. Close the APL valve.
  3. Fill the circuit, using the oxygen flush valve.
  4. Release the occlusion at the elbow and flush. A Venturi effect flattens the reservoir bag if the inner tube is patent
50
Q

Characteristics of Soda Lime

A

Mesh Size: 4-8
Absorptive Capacity: 14-23
Content: Ca Na K hydroxide

51
Q

Advantage of heat and moisture exchanger (HME)

A

Heat and moisture exchangers (HME) are inexpensive, silent, easy-to-use devices that help retain heat and moisture within the anesthesia circuit

No need for water or electrical power source 
No risk of hyperthermia
No risk of overhydration 
No risk of burns 
No risk of  electrical shock.
52
Q

Disadvantages of HME

A

not nearly as effective at warming and humidifying the patient’s airway as water-based, electrical devices. Increase deadspace and can increase the work of breathing. Airway obstruction can occur if the HME becomes blocked with fluid, blood, secretions, nebulized drugs

53
Q

Hydrophobic HMEs

A

Have a hydrophobic membrane with small pores that is pleated to provide a greater surface area.

More effective at preventing transmission of Hep C

54
Q

Hygroscoptic HMEs

A

Contain a wool, foam, or paper like material that is coated with a chemical that helps it to retain moisture. If become wet, they may lose their ability to filter airborne pathogens and airway resistance may increase substantially

55
Q

What is the closed system?

A

Mask on face.

  • Anesthetic agents are contained in the system and are not vented.
  • Rebreathing of all gases ~ pop off closed (less pollution)
  • Carbon dioxide absorber in system to neutralize CO2
  • Unidirectional valves
  • Flow 150-500 ml/min for physiologic requirements
  • Flow 150-250 ml/min under anesthesia
  • Unknown gas concentrations
56
Q

Volume control ventilation

A

Delivers a constant tidal volume for each breath. Pressure will vary with changes in lung compliance and resistance.

57
Q

Pressure control ventilation

A

Delivers a constant inspiratory pressure with each breath. Volume with vary with changes in lung compliance and resistance. (make sure watching TVs!)

58
Q

SIMV (synchronized intermittent mandatory ventilation)

A

VCV or PCV breaths are provided at the preset rate. Spontaneous efforts can trigger these breaths. Spontaneous breaths that EXCEED the preset rate trigger are PSV.

59
Q

Ve =

A

minute ventilation

60
Q

Vt =

A

tidal volume

61
Q

How do decrease FiO2

A

2L nitrous, 2L O2 = 50 FiO2

62
Q

F=

A

rate

63
Q

PIP (Pmax) =

A

Peak inspiratory pressure

64
Q

Ascending Bellows (standing)

A

Bellows goes up with expiration and down with inspiration. Safety feature.

65
Q

When using the O2 flush valve during inspiration, how much O2 is the pt getting?

A

600-1200 ml/sec

66
Q

Potential problems with bellows driven machines

A

Tidal volume discrepancies between set and actual TV delivered to the patient.

Ventilator fresh gas coupling (gives even more TV if fresh gas flow is up. 6L flow, I:E ratio 1:2, rate 10 = extra 200ml/braeth

67
Q

Advantages of modern piston driven AGMs

A 
Quiet
No PEEP
Precision of tidal volume
System controlled leak and compliance compensation
Fresh gas decoupling
68
Q

What is the compliance measurement used to calculate?

A

how much additional volume must be added to each breathe to deliver the set volume to the patient’s airway.

69
Q

What does fresh gas decoupling do?

A

Ensures that the set and delivered tidal volumes are equal.

70
Q

In fresh gas decoupling, where is the fresh gas diverted to?

A

diverted to the manual breathing bag, which remains in circuit during mechanical ventilation, and is not added to the delivered tidal volume.

71
Q

How to respond to a sustained high pressure in breathing circuit

A

START at pt and work was back to vent.

  • Switch to “bag mode” or manual ventilation
  • Try manually ventilating the patient
  • Assess and treat patient related causes
72
Q

If high circuit pressure is sustained during manual ventilation

A
  • Scavenger obstructed
  • Scavenger relief valves have failed
  • Disconnect scavenging system if possible
  • Use ambulance bag to ventilate pt
73
Q

If high circuit pressure is relieved after removing ventilator from system

A
  • Ventilator relief valve is malfunctioning

- Ventilator must be repaired and is NOT TO BE USED!!

74
Q

What is the scavenging system?

A

Receives waste gas from the AGM (APL) and the ventilator.

AGM (1 decks)

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