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AGM Flashcards

1
Q

What are the 5 tasks of oxygen?

A
  1. O2 pressure failure alarm
  2. O2 Failsafe (pressure failure device)
  3. O2 Flush valve
  4. O2 Flowmeter
  5. Ventilator drive gas
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2
Q

What does the PISS system do?

A

Prevents connection/installation of the wrong gas cylinder on the gas machine

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3
Q

What does the DISS system do?

A

Prevents connection of the wrong gas hose to the gas machine

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4
Q

What is the PSI and L volume of an oxygen tank?

A

1900-2200 psi

660L

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5
Q

What is the PSI and L volume of a nitrous oxide tank?

A

745 psi

1590 L

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6
Q

What is the PSI and L volume of an Air tank?

A

1900 psi

625 L

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7
Q

What is the most delicate part of the gas cylnder?

A

Cylinder valve

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8
Q

The oxygen pressure failure device is senses and ALARMS when pressure drops below what value?

A

Below 28-30psi

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9
Q

The oxygen pressure failure device is ACTIVATED when pressure drops below what value?

A

Below 20psi

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10
Q

What is another name for the oxygen pressure failure device?

A

The oxygen failsafe

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11
Q

What does the oxygen failsafe do when oxygen pressure drops below 20psi?

A

It stops flow of Nitrous Oxide into the AGM

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12
Q

What does the hypoxia prevention device do?

A

Pneumatic or mechanical device that limits the nitrous oxide flow to be only up to 3 times the flow of Oxygen flow

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13
Q

What is another name for the hypoxia prevention device?

A

Proportioning device

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14
Q

What FiO2 will the proportioning device (hypoxia prevention device) not let you go below?

A

25% (N2O up to 3x the flow of O2 –75%N20:25%O2)

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15
Q

What is the annular space?

A

The space between the float and the sides wall of the flowmeter.

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16
Q

At what point do you read a skirted float in a flowmeter?

A

At the top

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17
Q

At what point do you read a ball float in a flowmeter?

A

The middle of the ball

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18
Q

What are the two most critical first steps when a pipeline crossover is suspected?

A

Open oxygen cylinder.

Disconnect pipelines to AGM

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19
Q

How much flush does the oxygen flush valve provide?

A

35-75L/min

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20
Q

At what pH does ethyl violet change color to purple?

A

10.3 pH

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21
Q

What is the maximal CO2 absorbent capacity of Soda Lime?

A

23L of CO2/100g absorbent

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22
Q

What is the ideal size of CO2 absorbent material?

A

4-8 mesh which means 4-8 holes per square inch absorbent.

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23
Q

Which harmful substance can be created with dessicated soda lime?

A

Carbon monoxide; especially with use of anesthetic gases

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24
Q

List two benefits of calcium hydroxide lime over soda lime:

A

No carbon monoxide production.

Less Compound A production

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25
Q

List the drawbacks of calcium hydroxide lime compared to soda lime:

A

Lower CO2 absorbency=more frequent changing required=higher cost

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26
Q

What are the four ways you can monitor for circuit disconnect?

A

Volume.
Pressure.
ETCO2.
Your own vigilance.

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27
Q

How are active and passive scavenger systems different?

A

Active scavengers require suction while a passive scavenger relies on the positive pressure made by fresh gas leaving the interface

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28
Q

What happens when the negative pressure relief valve fails?

A

It is possible for this to create a vacuum which will remove/deplete gas from the breathing circuit.

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29
Q

What happens when the positive pressure relief valve fails?

A

This will cause fresh gas to accumulate in the breathing circuit which will result in high pressures- even barotrauma.

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30
Q

Per OSHA, what is the maximum amount of anesthetic gases that can be found in the air of the OR?

A

Halogenated Gases <2ppm
N20 <25ppm
Halogenated and N20 <0.5ppm&25ppm respectively

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31
Q

No rebreathing and no reservoir is an example of what type of breathing circuit?

A

Open breathing circuit

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32
Q

What is an example of an Open breathing circuit?

A

Nasal cannula.
Insufflation
Open drop technique.
Simple mask

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33
Q

Complete rebreathing with a reservoir is an example of what type of breathing circuit?

A

Closed breathing circuit

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34
Q

Partial rebreathing with a reservoir is an example of what type of breathing circuit?

A

Semi-closed breathing circuit

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35
Q

No Rebreathing with a reservoir is an example of what type of breathing circuit?

A

Semi-open breathing circuit

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36
Q

What is an example of a close breathing circuit?

A

Circle system with very low FGF and APL closed

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37
Q

What is an example of a semi-open breathing circuit?

A

Circle system with >MV FGF
or
Mapleson circuit

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38
Q

What is an example of a semi-closed breathing circuit?

A

Circle system with

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39
Q

What three things are produced from chemical neutralization of CO2?

A

Carbonic Acid.
Heat.
Water

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40
Q

Degradation of inhaled anesthetics produces what?

A

Heat.
Compound A.
Carbon Monoxide

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41
Q

How much flow is required to drive bellows?

A

5L/min

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42
Q

SOAP-ME

A 
Suction
Oxygen
Airway 
Positive Pressure.
Medications
Extra Equipment
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43
Q

PALMS

A 
Positive Pressure.
Airway.
Laryngospasm.
Monitors.
Suction.
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44
Q

If high pressure alarm goes off and circuit pressure is sustained during manual ventilation what could have happened?

A

Scavenger Obstruction.

Scavenger relief valve

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45
Q

What are two disadvantages of using an inline HME?

A
  1. Increases dead space.

2. Increases resistance

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46
Q

What is an example of a Thorp Tube on the AGM?

A

Flowmeters. Tapered, balls seals it at the bottom.

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47
Q

What to do with oxygen pipeline failure…

A

Trust the alarm until proven inaccurate.
Use Low-flow oxygen.
Shut off vent and bag manually.
Call for help and calculate time remaining in cylinder.
DO NOT reconnect pt to vent until system is checked.

48
Q

What safety feature in the AGM is in place when there is a loss of pipeline supply?

A

Fail-safe valves will halt all gas delivery.

Also, low oxygen pressure will alarm.

49
Q

At what PSI is the Intermediate pressure system?

A

40-50psi.

Basically pipeline pressure/

50
Q

What is the purpose of the Hanger Yoke?

A 
Orients the cylinder.
Provides a tight seal.
Ensures unidirectional flow.
Contains a filter.
Minimizes trans-filling (one way valve)
51
Q

What is considered the cornerstone of anesthesia?

A

Airway management

52
Q

What are the 7 Ps?

A

Prior Preparation Prevents Piss Poor Performance

53
Q

At what spine level is the Softpalate?

54
Q

At what spine level is the hypopharynx?

55
Q

What does damage to the RLN cause?

A

Hoarseness or stridor

56
Q

Which nerves provides sensory innervation to the nasopharynx?

A

Trigeminal Nerve

57
Q

What is the reason for such a large surface area within the nose?

A

To warm and humidify the air going in

58
Q

What are the 3 single cartilages of the larynx?

A

Epiglottis.
Cricoid.
Thyroid.

59
Q

What are the 3 paired cartilages of the larynx?

A

Arytenoids
Corniculate
Cuniform

60
Q

What are the 4 main functions of the larynx?

A
  1. Protect lower airway.
  2. Patency.
  3. Gag and Cough reflex.
  4. Phonation.
61
Q

What are the main responsibilities of the intrinsic muscles of the larynx?

A

Vocal cord movement.

Epiglottis movement

62
Q

What will stimulation of the carina do?

A

Induce cough

63
Q

Difficult to ventilate definition:

A

When signs of inadequate ventilation can not be reversed by mask ventilation or the patient’s oxygen saturation can not be maintained above 90% with mask ventilation.

64
Q

Difficult to intubate definition:

A

A trained anesthesia provider, using conventional laryngoscopy, requires more than 3 attempts or more than 10 minutes to complete tracheal intubation.

65
Q

Difficult airway definition:

A

A trained anesthesia provider experiences difficulty with facemask ventilation, laryngoscopy, intubation, or all of these.

66
Q

Even with proper evaluation, what percentage of difficult airways are found prior to induction?

67
Q

What is the best determinant of a difficult airway?

A

History of difficult airway

68
Q

What is the LEMON Law?

A 
Look externally.
Evaluate the 3-3-2 rule.
Mallampati.
Obstruction or Obesity.
Neck Mobility
69
Q

What is the 3-3-2 rule?

A

3 (fingers) min distance the mouth should open.
3- distance from tip of mandible to the laryngeal cartilage (with neck extended).
2- Distance from floor of the mouth to the prominence of laryngeal cartilage

70
Q

What thyromental distance is considered best for intubation?

A

> 7cm= east intubation

71
Q

When someones uses the term “anterior larynx”, in what position is the larynx actually?

72
Q

What is the A-O Angle?

A

Atlanto-Occipital angle. A measure of good mobility.

Always ask if any pain, numbness, tingling, or inability to move further.

73
Q

What tool do we use to know if mask ventilation will be difficult?

74
Q

What does BONES mean?

A 
Beard.
Obesity.
No Teeth.
Elderly.
Snoring.
75
Q

What is the #1 reason for difficult mask ventilation?

A

Having a beard.

Surgilube will help.

76
Q

What assessment do we use to know if laryngeal visualization will be difficult?

77
Q

What are the 4 D’s?

A
  1. Disproportion
  2. Distortion.
  3. Dismobility.
  4. Dentition
78
Q

What is the best progression of tasks when experiencing difficulty ventilating?

A
  1. Reposition into good sniffing position.
  2. Oral airway/nasal airway.
  3. Two Hand technique to bag
  4. LMA
  5. ETT
  6. Cricothyroidotomy.
    * NEVER GO BACKWARDS on this progression*
79
Q

What is apneic oxygenation?

A

Idea that oxygen blown into the lungs will cause alveolar oxygenation

80
Q

Following an airway assessment, the person performing the intubation should be in a position to decide between three possible options. What are they?

A
  1. Awake intubation.
  2. Quick look (give a little prop, DL, then give more drugs for intubation).
  3. Induction and paralysis
81
Q

What are the two techniques for pre-oxygenating a patient?

A
  1. TV breathing of oxygen for 3-5mins

2. Vital capacity breaths x 4 within 30seconds

82
Q

What is the goal of pre-oxygenation?

A

Replaces nitrogen with oxygen. Increases arterial oxygen tensions (PaO2)

83
Q

With good pre-oxygenation, we can increase the time before desaturation from 2-3min to how long?

A

8-9mins in a healthy patient

84
Q

What is Jet ventilation?

A

High flow through a large bore needle

85
Q

Is LMA/SGA considered a “secure” airway?

86
Q

LMA size and cuff volume for adults?

A

LMA size 4 with 30ml or 5 with 40ml.

87
Q

What is another name for an Eschmann Stylet?

88
Q

What are 6 things to consider when extubating?

A
  1. Acceptable hemodynamics.
  2. Normothermia
  3. Ability to maintain patent airway.
  4. Adequate muscle strength (enough reversal).
  5. Adequate respiratory mechanics.
  6. Ability to maintain adequate oxygenation
89
Q

Which complication of airway management is associated with a 1 in 35,000 incidence?

A

Aspiration

90
Q

What does an increases Alpha angle mean on a capnograph waveform?

A

Signifies expiratory outflow obstruction

ex: COPD, Asthma, bronchospasm, or kinked ETT

91
Q

At what point in the capnograph waveform is the Alpha angle measured from?

92
Q

At what point in the capnograph waveform is the Beta angle measured from?

93
Q

What does the Beta angle of the capnograph tell us?

A

Called the Rebreathing angle.

Should be 90*. If increased, could be sign of rebreathing, Faulty unidirectional valve, or exhausted CO2 absorbent

94
Q

If curare cleft is visible in spontaneously breathing patient, what might this signify?

A

Suggest inadequate muscle relaxant reversal. Lack of synchronization between diaphragm and intercostal muscles.

95
Q

Pulse oximeter emits 2 light waveforms. What are they?

A

Infrared=940nm

Red light=660nm

96
Q

Which light waveform is absorbed by oxygenated hemoglobin (oxyhemoglobin)?

A

940nm=infrared light

97
Q

Which light waveform is absorbed by de-oxygenated hemoglobin (deoxyhemoglobin)?

A

660nm= red light

98
Q

Which law is associated with the way the pulse oximeter works?

A

Beer-Lamberts law

99
Q

What happens to the SBP with a BP cuff that is too large?

A

Underestimates SBP (lowers)

100
Q

What happens to the SBP with a BP cuff that is too small?

A

Overestimates SBP (increases)

101
Q

Which method of measurement does an automatic BP cuff use?

A

Oscillometric method (oscillatory)

102
Q

For every inch above or below the heart, the BP is increased/decreased by how much pressure?

103
Q

If BP location is sampled from above the heart, what will the BP be?

A

It will be underestimated (decreased reading from the actual pressure)

104
Q

What does the dicrotic notch on an peripheral arterial waveform signify?

A

Aortic Valve closure

105
Q

What does the “a” wave represent on a CVP/RAP waveform?

A

Right Atrial Contraction

106
Q

What does the “c” wave represent on a CVP/RAP waveform?

A

Tricuspid valve closure

107
Q

What does the “v” wave represent on a CVP/RAP waveform?

A

Passive filling of RA

108
Q

Central venous pressure is a function of what three things?

A
  1. Intravascular volume.
  2. Venous tone.
  3. Right Ventricular compliance
109
Q

What happens to “a” wave on CVP if pt in atrial fibrillation?

A

“a” wave will be lost

110
Q

What would happen to “v” wave on CVP if pt has tricuspid regurgitation?

A

“V” wave will be increased

111
Q

What happens to waveform as catheter tip moves from RV to PA?

A

Diastolic pressure increases
Systolic pressure stays the same.
Dicrotic notch visible.
Narrower pulse pressure

112
Q

What does the dicrotic notch signify on a Pulmonary artery waveform?

A

Pulmonic valve closure

113
Q

In which lung zone should the tip of the pulmonary artery catheter be placed for PAWP?

A

Lung Zone III

114
Q

What two things might cause a falsely elevated PAOP?

A

Presence of PEEP.

Diastolic dysfunction

115
Q

What might cause a falsely decreased PAOP?

A

Aortic valve insufficiency

116
Q

Preload responsiveness is expected to be intact if a 250ml fluid bolus increases stroke volume by at least what percent?

APA Fundamentals (10 decks)

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