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Biophysics and Chem for NA > AGM Exam > Flashcards

AGM Exam Flashcards

1
Q

Gas machine MAIN purpose

A

deliver O2 to pt

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2
Q

Gas machine 2nd purpose

A

deliver means of positive pressure ventilation

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3
Q

Gas machine 3rd purpose

A

deliver anesthetic gas to pt

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4
Q

Key safety features for AGMs

A

BATTERY BACKUP, alarms, monitors, flow meter controls

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5
Q

MOST IMPORTANT key safety feature

A

BATTERY BACKUP ~30mins

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6
Q

Oxygen’s 5 Tasks ( gas machine purpose founded on this)

A

-ventilator driving gas
-flush valve
-O2 pressure fail alarm
-O2 pressure sensor shut off valve (fail safe)
-drive flowmeters

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7
Q

_ - _ _ measures amount of potent inhaled anesthetic agent to be added

A

concentration-calibrated vaporizer

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8
Q

_ deliver a controlled gas mixture in terms of concentration of o2 and other gases and total gas flow rates via gas flow controls

A

Flowmeters

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9
Q

Fresh gas mixture of known composition and metered production leaves anesthesia machine at :

A

CGO

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10
Q

The _ _ is a minienvironment that allows respiratory exchange and control of anesthetic and respiratory gas tensions

A

Patient Circuit

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11
Q

Anesthesia ventilator _ or _ may be connected to breathing circuit to provide mechanical ventilation

A

bellows or pistons

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12
Q

Excess gases are vented from breathing circuit and at end-exhalation when not using a ventilator via the _ _

A

APL valve

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13
Q

Excess gases are vented from breathing circuit and at end-exhalation when using a ventilator via the ventilator _ _ valve

A

ventilator pressure relief valve

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14
Q

SPDD stands for?

A

Supply Processing Delivery Disposal

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15
Q

Using SPDD model, where does supply occur on AGM and what components are involved?

A

Site: back of machine

Components: pipeline and cylinder

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16
Q

Using SPDD model, where does processing occur on AGM and what components are involved?

A

Site: within AGM, proximal to CGO

Components: Failsafe, Flowmeters, Flush Valves

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17
Q

Using SPDD model, where does Delivery occur on AGM and what components are involved?

A

Site: Breathing Circuit

Components: Hose, CO2 Monitors

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18
Q

Using SPDD model, where does Disposal occur on AGM and what components are involved?

A

Site: Scavenging System

Components: Scavenging System

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19
Q

The high pressure system of the AGM starts and ends where?

A

Start- Cylinders

End- AGM Pressure Regulators

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20
Q

O2 tanks have standards written by the US _ and are made of _ typically.

A

DOT, steel

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21
Q

O2 tanks that are MRI safe are made of _

A

aluminum

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22
Q

O2 tanks are tested every _ years to _ times their service pressure

A

5 years, 1.66 x service pressure

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23
Q

What is the PSI of O2 and does it follow Boyle’s Law?

A

1900 PSI, yes

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24
Q

What is the PSI of N2O and does it follow Boyle’s Law?

A

745 PSI, No

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25
Q

What is the PSI of Air?

A

1900 PSI

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26
Q

What is the capacity of an O2 tank?

A

660L / tank

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27
Q

What is the capacity of an N2O tank?

A

1590L / tank

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28
Q

What is the capacity of a tank of Air?

A

625L / tank

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29
Q

What is the Pin Position of O2?

A

2-5

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30
Q

What is the Pin Position of N2O?

A

3-5

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31
Q

What is the Pin Position of Air?

A

1-5

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32
Q

What is a way to determine accurately how much N2O is in tank?

A

Weigh it;
Full tank = 20.7lb
Empty tank = 14.1lb

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33
Q

O2 exists as a gas @ room temp in a tank because its critical temp is _*C

A

-118*C

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34
Q

A half empty tank of O2 will have a capacity of _ L and a pressure around _ PSI

A

330L and 1100 PSI

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35
Q

Critical temp is the highest temp in which a substance can exist in a _ state REGARDLESS of pressure applied

A

liquid

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36
Q

N2O has a _ relationship with volume and pressure

A

non-linear

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37
Q

T/F:
When N2O tank is full some of its contents are in gas and liquid state?

A

true

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38
Q

The critical temp of N2O is _ *C which is _ room temperature and this is why it exists in 2 states in a pressurized tank.

A

36.5C, above room temp =20C

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39
Q

When to change N2O tank?

A

if PSI is anything less than 745 change ASAP

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40
Q

O2 tanks = green
N2O tanks = blue
Air tanks = yellow
but best way to check tank contents is to _ _.

A

Read Label

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41
Q

The vaporizers would be which part of the SPDD model?

A

Processing

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42
Q

Which 2 instances to open tanks on machine?

A

-machine checks
-emergency use
WILL DEPLETE IF LEFT OPEN AND BE EMPTY IF EMERGENCY HAPPENS

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43
Q

The 2 safety devices on the tank in case of fire or high pressure could be:

A

Frangible Disk - ruptures under pressure

Woods Metal (BLTC) bismuth, lead, tin, cadmium- fusible plug that melts >150-170*F

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44
Q

Most delicate part of tank?

A

valve

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45
Q

Hissing tank troubleshoot steps: (moving forward if problem isn’t solved)

A

1) tighten check valve on back on yoke- use yoke plug to tighten
2) get new washer
3) ensure hose connection are ok
4) get a whole new tank

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46
Q

N2O tank will always read 745PSI until it is about _ empty

A

3/4

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47
Q

Goal of correct gas placement is correct cylinder onto correct _.

A

yoke

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48
Q

How can PISS system be bypassed?

A

more than 1 washer on a cylinder

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49
Q

When to replace washer?

A

when changing cylinders bc heat from inlet can warp washers

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50
Q

What could happen if there is no washer on a cylinder?

A

a leak if it is open

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51
Q

Intermediate Pressure System starts and ends where?

A

Start- pipeline

End- flowmeter VALVES

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52
Q

Intermediate Pressure System:
Pipeline > Pressure Gauge > _ _ > Failsafe > _ _ _ _ > 2nd stage Regulator > _ _ _ > Flowmeter Valves

A

-check valves
-O2 supply failure alarm
-O2 flush valve

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53
Q

High Pressure System:
Cylinder > _ _ > Check valve > _ _ _ > Cylinder Pressure Regulator

A

-Hanger Yoke
-Cylinder Pressure Gauge

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54
Q

The check valve on the hanger yoke’s purpose is to:

A

ensure unidirectional gas flow if gas source pressure is less than machine’s

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55
Q

Each gas tank-yoke connection has a regulator valve that reduces the cylinder’s PSI down to _ PSI

A

45
-this is to ensure gas is preferentially pulled from pipeline if cylinder is open

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56
Q

The pressure regulator on the yoke/tank connection reduces tank PSI to 45 because pipeline pressure is _ PSI

A

50 PSI

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57
Q

If tanks were left open while using wall source too and low O2 alarm sounds, what happened?

A

There was a loss of pipeline pressure and your AGM was seamlessly drawing O2 from opened tanks which you now realize are EMPTY and you’re screwed

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58
Q

If tanks were closed while using wall source and low O2 alarm sounds, what happens next?

A

You have time to switch open and use backup tanks for O2, with plenty of time to get new tanks until wall source issue is solved

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59
Q

Equation to see how much O2 left in cylinder:

A

[Total Capacity (L)/ Full Tank Pressure (PSI)] X ( Y(L) / current Gauge Pressure (PSI)

OR (bc O2 capacity/full pressure = ~0.35)

0.35 X [Y (L) / gauge pressure (PSI)]

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60
Q

Equation to see how long O2 tank will last:

A

Contents Remaining (L) / FGF (L/Min) = X

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61
Q

The pressure gauge on O2 tank reads 600 PSI and you’re running it at 2L/min, how many more minutes do you have before tank runs out?

A

0.35 = (X/ 600)
210L left

210L/ 2= 105 minutes

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62
Q

Pressure gauge on O2 tank reads 500PSI, running at 6L/min, how much time is left before tank is empty?

A

0.35 = (X/500)
= 175L

175L / 6L/min= 29.1 ~ 29 mins left

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63
Q

Pressure gauge on O2 tank reads 350PSI, running at 4L/min, how much time is left before tank is empty?

A

0.35=(X/350)
= 122.5L

122.5/4 = 30.625 = 30mins

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64
Q

What safety system is in place to prevent inadvertent misconnection of gas cylinders to the anesthesia machine?

A

PISS

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65
Q

The pressure change that happens as Oxygen from the cylinder enters the pressure regulator is from ___ to ____?

A

1900 - 45PSI

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66
Q

T/F The pipeline is part of the high pressure system

A

false- intermediate

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67
Q

What is the working pressure of the AGM?

A

50 PSI

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68
Q

T/F there are pressure gauges and check valves on both the high pressure system and the intermediate pressure system prior to entering the AGM

A

true

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69
Q

T/F DISS system is for the cylinders and the wall source pipeline

A

false, just the wall source

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70
Q

What pressure will trigger the O2 supply failure alarm and what does it mean?

A

<30 PSI
-pipeline failure, hose disconnection, OR tank is almost empty

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71
Q

What O2 pressure will trigger Failsafe valve on N2O/Air to lower or completely stop flow?

A

<20 PSI of O2

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72
Q

In the intermediate system, with GE AGMs what will the failsafe valve do if O2 drops below 20PSI?

A

It will completely shut off flow of N2O

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73
Q

In the intermediate system, with Drager AGMs what will the failsafe valve do if O2 drops below 20PSI?

A

It will proportionately lower flow of N2O to the flow of O2

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74
Q

How can a hypoxic mixture still occur even with a failsafe valve?

A

If there is a pipeline crossover/ leak because the failsafes are only PRESSURE sensitive
-the flowmeter is further downstream too and won’t detect a leak at first

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75
Q

What is the pressure and flow when using the O2 flush valve on AGMs?

A

50 PSI and about 35-75L/min

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76
Q

T/F You can use O2 flush valve while hooked onto breathing circuit with a patient to decrease anesthetic agent concentration because it bypasses vaporizers.

A

FALSE! Holy barotrauma!
-Must disconnect from pt 1st to “flush it”

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77
Q

O2 Flush valve can be used to:
-pressurize circuit during a machine check
-set up AGM
-during a facemask leak ( put volume back in circuit)
-flush out agent if pt is hypotensive (once disconnected from pt!!)
-AND_

A

flush machine at end of case to remove agent

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78
Q

The primary driving gas in the ventilator power inlet of the AGM is _ and it helps push bellows _ during + pressure vent.

A

O2, down

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79
Q

T/F Using ventilator while using a tank to supply O2 doesn’t affect speed of O2 depletion.

A

false, uses O2 more quickly

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80
Q

The pipeline pressure regulator(2nd stage pressure regulator), which isn’t in every model, has a goal to reduce pressure to _ PSI so flow is smooth before entering flowmeters.

A

16-26PSI

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81
Q

The Low Pressure System starts and ends where?

A

Start- Flowmeter Tubes

End-CGO

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82
Q

What are 2 appropriate steps with suspected pipeline gas crossover?

A

1) Turn on backup cylinder
2) Disconnect O2 pipeline ASAP

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83
Q

What safety system is in place to avoid inadvertent connection of gas hose to anesthesia machine?

A

DISS

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84
Q

Pressure change that occurs at the DISS system:

A

Pipeline pressure -> 50PSI; higher than Cylinder change

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85
Q

During a machine check you inadvertently leave the o2 cylinder open. Approximately 1 hour into your case, pipeline pressure is lost. The failsafe alarm sounds. You go to open the oxygen cylinder, realizing it is open. What is the consequence of this action?

A

O2 Cylinder is EMPTY, call for help for backup O2 source ASAP :(

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86
Q

The failsafe device located in the intermediate pressure system consists of what 2 components?

A

-O2 Supply Failure Alarm
-Failsafe Valve

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87
Q

Low Pressure System consists of: (4things)

A

-flowmeters / thorpe tubes
-vaporizers
-one way valves
-CGO

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88
Q

T/F Turning a flow meter control knob clockwise will increase the O2 flow.

A

False!
-Turn it COUNTERclockwise to increase flow

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89
Q

Traditional flowmeters use a needle-valve mechanism and its O2 tube is _ and _ and is located on the _ side.

A

O2 tube is larger and fluted
found on far right side

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90
Q

Pros / Cons to electronic flow valve control mechanisms on AGM:

A

Pro: precision of O2 control, less expensive, collects data
Con: requires electricity/ battery power

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91
Q

T/F The flowmeter is the knobbed device used to adjust flow levels

A

false, it is not the knob itself, but the meter in the tube that measures the flow (float goes up/down)

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92
Q

Position of the float (bobbin or ball) on the flowmeter tube is determined by which 2 forces?

A

-FGF pushing it up
-Gravity pulling it down

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93
Q

Thorpe tubes (old school flowmeter tubes) are made of _ to prevent buildup of _ _ and they are more narrow at the _ and wider at the _.

A

-glass
-static electricity
-narrow at bottom
-wide at top

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94
Q

In thorpe tubes the _ _ is the space where gasses pass around between the bobbin and inside of the tube wall

A

annular ring

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95
Q

In flowmeters, low flow gases are influenced by the _ of the gas and favors _ flow.

A

Viscosity, Laminar Flow

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96
Q

In flowmeters, high flow gases are influenced by the _ of the gas and favors _ flow.

A

Density, Turbulent Flow

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97
Q

T/F In higher altitudes, flowmeters will read higher than the actual flow set.

A

False, will read LOWER because of LOWER atmospheric pressure

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98
Q

To read flowmeter accurately, red the flow at the _ of the bobbin or _ of the float ball.

A

Top of Bobbin, Middle of Float Ball

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99
Q

In which ways can a flowmeter tube not be accurate?

A

-debris in tube
-high altitude
-tube becomes misaligned somehow
-if bobbin gets stuck at top
-crossover of gas (calibrated for each gas individually)
-leak in tube

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100
Q

What is the safety mechanism of the O2 flowmeter sitting farthest right?

A

-last thing going to pt in manifold (last defense of hypoxic mix)
-will still be part of mix if there is a leak or crack in other tubes

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101
Q

If a leak in the flowmeter or manifold area is suspected what actions should you take?

A

-Just call Biomed and get a new AGM; can’t even see issue without removing panels

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102
Q

How are O2 Pressure Failure Device and Hypoxia Prevention Safety Devices different?

A

O2 Pressure Failsafe Device - shuts off/reduces N2O if <20PSI of O2, PRESSURE SENSITIVE

Hypoxia Prevention (O2/N2O Proportioning) Safety Device- adjusts levels of N2O/O2 to ALWAYS give at least 25%FiO2; FLOW SENSITIVE

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103
Q

How can hypoxic mix still be given to pt with AGMs that have O2/N2O Proportioning Devices?

A

-pipeline crossover
-leak distal to the flowmeters
-using a 3rd gas
-defective machine/ pneumatic parts

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104
Q

The 2 main models of AGMs have different mechanisms of O2/N2O proportioning (hypoxia prevention) safety devices and they are:

A

GE: Link 25 Proportioning Limiting Control System

Drager: O2 Ratio Monitor Controller

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105
Q

The GE Link 25 Proportioning Limiting Control System does what?

A

hypoxia prevention device
-ensures at least 25%FiO2 is given at flowmeters when N2O is being used
-needs 2nd stage O2 and N2O regulator, uses 14 teeth N2O and 29 for O2 (3:1 ratio)
-INCREASES O2 flow in relation to N2O flow

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106
Q

The Drager O2 Ratio Monitor Controller

A

Hypoxia prevention device
-limits N2O flow in relation to O2 flow

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107
Q

Gas travels from flowmeters - _ then to CGO

A

vaporizers

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108
Q

Which part of the AGM is the interface between the pneumatic and ventilatory systems?

A

CGO

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109
Q

T/F CGO is considered the last part of the low pressure system and they are found on the outside of all AGMs

A

False, new machines have CGO on inside

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110
Q

T/F The rotameter flowmeter is the narrowest at the top and widest at the bottom

A

false

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111
Q

The high-pressure system of the anesthesia workstation begins at the ___ and ends at the ____.

A

cylinder, pressure regulators ( reduce PSI to 45)

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112
Q

Auxiliary O2 are flowmeters on the side of machine used for supplemental O2 and have a max flow of _ L/ min

A

10L/min

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113
Q

Equation to calculate FiO2 using Flowmeter:

A

X= {(Air Flow Rate [L/min] X 21) + (O2 flow rate [L/min] X 100)}/ Total Flow Rate

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114
Q

What is the FiO2 if Air flows at 1L/min and O2 is flowing at 2L/min?

A

[(1L/min X 21) + (2L/min X 100)] / 3L/min = FiO2

[(21)+(200)]/3L/min = FiO2

221/3 = 73.6 ~74%FiO2

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115
Q

What is the FiO2 if Air flows at 2L/min and O2 is flowing at 3L/min?

A

(21X2) + (100X3)= 342

342/ 5= 68.4 ~68% FiO2

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116
Q

FiO2 of RA is=

A

21%

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117
Q

FiO2 of 1L is?

A

24%

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118
Q

FiO2 of 4L is?

A

36%

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119
Q

T/F Cylinder pressure gauge is part of intermediate pressure system.

A

False- high pressure

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120
Q

T/F Pipeline inlets are part of High Pressure System

A

False- intermediate

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121
Q

T/F Flowmeter Knobs are part of Intermediate System

A

False, Low pressure System

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122
Q

Which part of the system is this AGM component from?
-Cylinder

A

high

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123
Q

Which part of the system is this AGM component from?
-Hanger Yoke

A

High

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124
Q

Which part of the system is this AGM component from?
-Hanger Block/PISS system

A

high

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125
Q

Which part of the system is this AGM component from?
-Check Valves

A

HIGH (hanger yoke connection) AND LOW (before CGO) !!

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126
Q

Which part of the system is this AGM component from?
-Cylinder pressure gauge

A

high

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127
Q

Which part of the system is this AGM component from?
-Cylinder Pressure Regulator

A

high

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128
Q

Which part of the system is this AGM component from?
-Pipeline Inlet

A

intermediate

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129
Q

Which part of the system is this AGM component from?
-Pressure Gauges

A

intermediate (ALL pressure gauges for all gases)

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130
Q

Which part of the system is this AGM component from?
-O2 Pressure Failure Alarm Device

A

intermediate

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131
Q

Which part of the system is this AGM component from?
-O2 2nd Stage Regulator

A

intermediate

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132
Q

Which part of the system is this AGM component from?
-O2 Flush Valve

A

intermediate

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133
Q

Which part of the system is this AGM component from?
-Flowmeter Valves

A

intermediate

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134
Q

Which part of the system is this AGM component from?
-Vent power inlet

A

intermediate

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135
Q

Which part of the system is this AGM component from?
-flowmeter knobs

A

low

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136
Q

Which part of the system is this AGM component from?
-needle valves

A

low

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137
Q

Which part of the system is this AGM component from?
-flowmeter tubes

A

low

138
Q

Which part of the system is this AGM component from?
-vaporizers

A

low

139
Q

Which part of the system is this AGM component from?
-CGO

A

low

140
Q

T/F Vaporizers are closed containers

A

true

141
Q

T/F vaporizers convert liquid anesthetic agent into a gas

A

false - a VAPOR

142
Q

A vaporized anesthetic agent must be diluted into a _ _

A

carrier gas

143
Q

Vapor molecules exerting pressure on walls of their container is the result of _ _

A

vapor pressure

144
Q

SATURATED vapor pressure is:

A

at room temp, SVP is the pressure which an agent is in equilibrium between its molecules entering liquid and entering vapor state

145
Q

Which anesthetic agent has the highest SVP, making it the most volatile?

A

Desflurane
-also has low boiling point ~23.5*C

146
Q

SVP is dependent on the _ and _ of an agent

A

temperature and nature
-higher temp, higher SVP
-lower temp, lower SVP

147
Q

T/F There is a linear relationship between SVP and temperature

A

False

148
Q

With open containers, evaporation happens _ the boiling point and involves molecules on the _.

A

Below boiling point, involves surface molecules only (because they escape container)

149
Q

In closed container, vaporization occurs _ the boiling point and involves the molecules in the _ _

A

at boiling point, involved all molecules in container

150
Q

T/F SVP is dependent on the atmospheric pressure, the temperature, and the nature of the agents

A

False, vapor pressure is INDEPENDENT of atmospheric pressure

151
Q

Dalton’s Law of Partial Pressure

A

total pressure = sum of partial pressure of each gas in mix

152
Q

Heat of Vaporization (Latent Heat of Vaporization)=

A

number of CALORIES required to convert 1g or 1mL of liquid into vapor WITHOUT a temperature change in liquid

153
Q

SVP/ atmospheric pressure =

A

volume of vapor in vapor chamber (%)

154
Q

Vaporization results in heat loss and decrease in liquid temp, this causes a _ in vapor output

A

decrease
-vaporizers compensate for this w heating elements

155
Q

Boiling Point Vaporization

A

-takes place in vapor itself, molecules break free and bubbles rise to surface
-when Vapor pressure = atmospheric pressure=boiling point**

156
Q

Specific Heat

A

number of CALORIES needed for 1g of a substance to increase by 1*C
-reflects heat capacity

157
Q

Vaporizers are made with material that has a high _ _ to minimize temperature changes

A

specific heat

158
Q

Thermal Conductivity

A

measures how fast substance transmits heat

159
Q

Modern Vaporizers are classified as: (5 items)

A

-variable bypass/ calibrated
-agent specific
-flow over
-temperature compensated
-out of circuit vaporizers

160
Q

On variable bypass vaporizers, adjusting the knob varies how much _ goes into vaporizer vs how much _ it.

A

FGF, bypasses

161
Q

T/F When dial on vaporizer is set to 0, no FGF goes thru it at all.

A

False!
-FGF goes thru vaporizers but it is SPLIT into 2 streams (splitting ratio), would not go thru the vaporizing CHAMBER if set to 0

162
Q

Both streams of FGF come together and leave vaporizer through the _ _ which is in the common gas _.

A

outlet port
manifold

163
Q

Splitting ratios are dependent on: (3 items)

A

-specific agent
-temperature
-vapor concentration

164
Q

What safety issue poses a risk with splitting ratios?

A

-if agents were somehow mixed up, could give dangerous amount of anesthetic bc vaporizers have specific splitting ratios per agent

165
Q

Sevoflurane:
Desired Anesthetic %- 1%
splitting ratio- 25:1

What does number on left in splitting ratio represent?

A

How many molecules get sent to BYPASS per 1 molecule that goes to vaporizer

166
Q

Examples of failsafes to prevent mis-filling vaporizer agent:

A

-collars on bottles
-funnel fill systems
-key system

167
Q

Wicks and Baffles help with what inside vaporizers?

A

Expanding surface area, allowing for more vapor to be picked up by FGF

168
Q

Methods of thermocompensation in vaporizers:

A

-bimetallic strips
-metal rods

169
Q

What do the thermocompensation materials in vaporizers compensate for?

A

-temperature of OR room
-Latent Heat of Vaporization!!!!!!

170
Q

In-Circuit Vaporizers

A

older, more inaccurate, part of circle system

171
Q

Out of Circuit Vaporizers PRos/ Cons

A

Pros- accurate, found upstream
Cons- can be tipped, accumulate moisture from exhalation

172
Q

Prevention of Vaporizer hazards:

A

-“t” setting during transport to reduce risk of tipping
-new designs not having us pour in agent to refill it
-“keys” for specific agents during refilling

173
Q

1mL liquid agent =

A

200mL of vapor, VERY DANGEROUS if spilled/tipped

174
Q

If vaporizer tips take these actions:

A

1) drain all liquid from vaporizer and completely flush system (20-30mins) until it detects no more agent prior to next case

175
Q

If you smell agent in OR what could be happening?

A

-Leak may be present (check circuit, check if cap is screwed tight on vaporizer)
-Pt could be underdosed!
-Vaporizer was left ON after previous case (do a wash out)

176
Q

Purpose of interlocking system/rods on AGMS:

A

only lets 1 vaporizer open at a time

177
Q

T/F All vaporizers will alarm when they are low.

A

False, just Des alarms when low

178
Q

Is a variable bypass vaporizer “in” or “out” of circuit?

A

OUT of circuit-modern

179
Q

Which agent has the highest boiling point?

A

Sevoflurane

180
Q

What affects vapor output? (4 items)

A

Gas flow rate
Carrier gas effect
Pumping effect
Pressuring effect

181
Q

How does FGF rate impact vapor output?

A

-decreased % at low flows bc not enough turbulence to pick up molecules
-decreased at high flows bc gas passes too quickly to pick up agent

182
Q

At what rates does vapor output measurement accuracy decrease?

A

-extremes:
-<200/250mL/min
->15L/min

183
Q

Carrier Gas Effect:

A

Air and N2O are more soluble than O2 in liquid anesthetic; gases have diff viscosities and densities that come to play in vaporizer
-when N2O stops, agent will slightly increase in output for a sec

184
Q

Pumping Effect:

A

increased back pressure pushes air back to vaporizer, making it more concentrated, more common with low agent conc.

185
Q

What could be 2 things contributing to pumping effect?

A

-+ PEEP
-O2 Flush Valve

186
Q

Safety Mechanisms used to avoid Pumping Effect: (modern AGMs)

A

-smaller vaporizer/ larger bypass chamber
-long spiral tube to prevent backflow
-backflow check valves

187
Q

Pressuring Effect:

A

decrease in vapor concentration due to increased back pressure with high flows
-with high FGF there are same number of vapor molecules and more carrier gas molecules

188
Q

The Des Vaporizer heats and pressurizes desflurane using a _ _

A

injection vaporizer, not a splitting effect vaporizer

189
Q

SVP of Des=

A

664-669mmHg which is close to atmospheric pressure(760) -no bueno !!

190
Q

Boiling point of Des

A

22.8-23.5*C

191
Q

MAC of Des

A

6%

192
Q

Desflurane Vaporizer is gas vapor _ _ blender.

A

dual circuit

193
Q

Top Limb of Des Vaporizer allows FGF to flow thru and hit a _ _ (R1), this create back pressure that works as a _ _ valve

A

fixed resistor, pressure regulating valve

194
Q

Bottom Limb of Des Vaporizer is connected to the Des reservoir which is a _ of Des _.

A

SUMP of desflurane liquid

195
Q

Sump of Des electrically pressurizes it to _mmHg which is _ the atmospheric pressure and heats it to _ *C which is far above its _ _.

A

1300mmHg-double the atmospheric pressure
39*C,-well above boiling point

196
Q

The Sump of Des does not shut off until:

A

Des is at a temperature and pressure that allows for safe / reliable concentration for pt

197
Q

On the Des Vaporizer there is a _ _ valve that decides how much des goes into the _ _ of the vaporizer.

A

pressure regulator, bottom limb

198
Q

Another _ (R2) is part of the lower limb of Des Vaporizer, actual Des vapor exerts pressure on it and it stays balanced in order to keep a _ _.

A

resistor, working pressure

199
Q

Output / Working Pressure of Desflurane from Vaporizer is determined by (2 things)

A

-FGF
-Dial Concentration

200
Q

The Aladin-Cassette Vaporizer is a permanent electronic vapor control unit in AGMs from which brand?

A

Datex Ohmeda (GE)

201
Q

The Aladin Cassette Vaporizer is color coded for each agent and _.

A

detachable

202
Q

The Aladin Cassette Vaporizer is a _ _ delivery system, contributing to its accuracy.

A

closed loop

203
Q

T/F The Aladin Cassette Vaporizer is adjusted based on dial settings.

A

False, adjusted based on END TIDAL CONCENTRATION in its closed loop system by its AGENT PROPORTIONING VALVE

204
Q

What kind of vaporizers are Maquet Vaporizers?

A

Injection Vaporizers, only used with specialty Maquet machines tho

205
Q

Which anesthetic agent would be closer downstrean to pt on the machine?

A

Des
-they used to be organized from most-least volatile closer to pt but not important with modern interlocking systems now

206
Q

Equation for calculating liquid consumption in vaporizers:

A

3 X FGF X Set Conc. = consumption of liquid in mL/hr

207
Q

Calculate fluid consumed if FGF is 3L/min and set conc. is 1%

A

3 X 3 X 1 = 9ml/hr

208
Q

T/F Altitude affects all vaporizer outputs

A

False!
-DOES affect Desflurane Injector Vaporizers (very sensitive, needs recalibration in high altitudes)
-DOES NOT affect variable bypass vaporizers (uses PARTIAL PRESSURE)

209
Q

Calculate fluid consumed if FGF is 2L/min and set conc. is 1.5%

A

3 X 2 X 1.5 = 9ml/hr

210
Q

The pumping effect in vaporizer creates:
A. Normal vaporizer function
B. Momentary backpressure from ventilation resulting in retrograde vapor flow
C. Prolonged back pressure from the outlet into the bypass flow
D. Vaporizer leak resulting in underdosing of patient

A

B

211
Q

A modern example of an open circuit breathing circuit would be:

A

Nasal Cannula

212
Q

Classifications of Breathing Circuits: (4)

A

-open
-semi-open
-semi-closed
-closed

213
Q

4 main parts of the Semi-Open Mapleson breathing Circuit:

A

-Resevoir Bag
-APL Valve
-Fresh Gas Inlet
-Corrugated Tube

214
Q

Reservoir bags are _ in shape, made of rubber or plastic and come in a _ L size for adults and < _L for peds

A

ellispoidal shape
2L size for adults, <0.5L size for peds

215
Q

What is an APL valve and what are its other names?

A

Adjustable Pressure Limiting Valve
-Expiratory Valve
-Pop Off Valve
-Pressure Relief Valve
-Spill Valve
—helps control pressure in breathing circuit (open for spont. pts and semiclosed or closed in AC/ vent pts)

216
Q

The corrugated tube on breathing circuits is made of plastic, silicon, or rubber and has 3 main functions:

A

-Increase flexibility of circuit
-Prevent kinks in tube
-Provides added turbulent flow to mix the anesthetic agent

217
Q

Which Mapleson circuit would be best suited for a pt who is spontaneously breathing?

A

Mapleson A / Magill
A<D<B

218
Q

Mapleson Circuits are classified based on:

A

positions of APL valve, fresh gas inlet/flow, and reservoir bag

219
Q

Why is Mapleson A the best choice for spont. breathing pts?

A

Can produce a Mv of 80mL/kg/min, requires over 3x more Mv or FGF than others during controlled vent

220
Q

Where is everything on the Mapleson A circuit?

A

APL valve: at pt end
FGF and reservoir bag at end of AGM

221
Q

The ideal Mapleson circuit for a vented pt would be:

A

Mapleson D / Bain Circuit
D>B>A

222
Q

Why is Mapleson D ideal for vented pts?

A

-controlled about 1-2X pt’s Mv
-has a COAXIAL circuit (tubs inside tube) and has inspiratory and expiratory tube, less efficient for spont. breathing pts (2-3x pts Mv)

223
Q

Where is everything on the MApleson D circuit?

A

-FGF is DISTAL to APL and close to mask
-APL and bag are farther away
-inner tube is FGF and outer tube is expiratory

224
Q

Necessary components for circle circuit:

A

-CO2 absorber
-one way valves (insp + exp.)

225
Q

T/F There is no rebreathing in circle circuit because of one way valves/co2 absorber

A

False
There is dead space in Y site of I+E part of tubes where pt can rebreathe CO2

226
Q

A pt’s last possible defense of a hypoxic mix is the _ _ _ and is found on the _ _.

A

Oxygen Analyzer Device; inspiratory limb
-will monitor O2 and alarm if low

227
Q

T/F The APL valve controls pressure in circuit during mechanical venilation

A

False- SV or manual breathing only

228
Q

Reservoir bag helps with _ pt and APL valve helps with _ _.

A

venting pt, generating pressure

229
Q

Respirometer:

A

measures volume of each breath

230
Q

PEEP valve is found in the _ _

A

Circle Circuit NOT VENTILATOR

231
Q

PEEP adds resistance to _.

A

expiration

232
Q

Which type of circuits REQUIRE CO2 Absorbers?

A

Semi-closed and Closed

233
Q

During inspiration the spill valve _ to ensure volume is delivered and _ _ compresses bellows

A

CLOSES , driving gas

234
Q

During Expiration driving gas flow _ and _ gas fills the bellows

A

stops
exhaled gas

235
Q

T/F Gas in bellows when rising during expiration= exhaled Vt

A

False, Exhaled Vt AND FGF during exhalation

236
Q

Ascending bellows rise with _ and will not fill if system is disconnected (safer)

A

EXPIRATION not inspiration

237
Q

Descending bellows _ with expiration AND gravity

A

fall

238
Q

Bellow types are named after their action during _.

A

Expiration!
ex) ascending bellows rise on expirarion

239
Q

Which way do you turn APL valve to OPEN it?

A

counterclockwise

240
Q

Diff between gas + vapor

A

Gas is gaseous form of substance that is gas at room temp, a vapor is the gaseous form of a LIQUID at room temp

241
Q

Piston Vents mechanism:

A

use electricity, not O2 as driving gas to function, allow for greater Vt accuracy

242
Q

Piston vents safety feature:

A

+ and - relief valves
-prevent - opens if pressure insult -8cmH2O)
-+ relief valves open if system pressure > 75cmH2O

243
Q

In which type of ventilator can you see reservoir bag inflate / deflate with expiration?

A

Piston Vents
-if collapsed there is a problem

244
Q

Decoupling occurs with _ and _, this feature is found on _ vents.

A

Vt and FGF, new vents

245
Q

Decoupling AGMs adjust to reduce the risk of _ and ensure the set _ is what pt receives.

A

barotrauma, Vt

246
Q

Coupled AGMs couples _ and _, and this feature is found on _ vents.

A

Vt and FGF, old vents

247
Q

Coupling of Vt and FGF could result in: (3 things)

A

-barotrauma
-errors in Vt and Vm
-losing volume to compliance

248
Q

In vents that couple Vt and FGF: how is total Vt measured?

A

Total Vt = Vt on vent + FGF during insp. - volume lost in compliance

249
Q

T/F Attaching something(extra tubing, etc.) to Y piece will increase dead space.

A

True

250
Q

APL valve is found _ the expiratory unidirectional valve.

A

AFTER

251
Q

T/F APL valve is the Pop off Valve

A

true

252
Q

You are watching your reservoir bag slowly stop inflating and deflating and you realize your pt stopped breathing, use the _ _ which is a stopcock to switch flow from bag/ APL to the vent.

A

Selector Switch!

253
Q

3 Main Alarms on Breathing Circuit:

A

-Low Peak Airway Pressure
-High Peak Airway Pressure
-Sustained Airway Pressure

254
Q

PEEP can be introduced to pt during:

A

-spont. breathing, bagging a pt, and mech vent

255
Q

In Semi Open breathing circuits, FGF is _ than pt’s Mv

A

greater than
-ex) 10L/min at induction

256
Q

In Semi Closed breathing circuits, FGF is _ than pt’s Mv

A

less than
-ex) 2L/min during maintenance phase

257
Q

Traditional open circuit=

A

Mapleson circuits

258
Q

Which 2 are not part of Mapleson circuit but part of the circle circuit?
Mask
Apl
Unidirectional valves
Corrugated tubing
Co2 absorber
Reservoir bag
Fresh gas inlet

A

unidirectional valves, CO2 absorbers

259
Q

Intrinsic PEEP in regards to vents occurs when:

A

after circuit pressure exceeds 3cmH20 (or whatever you set) and vent spill valve opens, letting extra gas out to scavenging system

260
Q

Which type of CO2 absorber risks CO or compound A formation?

A

Soda Lime bc of its strong bases

261
Q

Benefit of Soda Lime CO2 Absorber:

A

-cheap
-Absorbs 14-23L CO2 per 100g of absorbent

262
Q

Benefit of Calcium Hydroxide as CO2 Absorber

A

-far less risk of CO and compound A formation

263
Q

Granules of CO2 absorber are measured in mesh sizes and are optimally

A

4-8mesh
-size creates balance in surface area of absorption ability and airflow resistance

264
Q

CO2 absorbers will turn purple from Ethyl Violet dye and this indicates:

A

need to be changed, no longer absorbing much CO2

265
Q

CO2 absorbers stop working in 2 conditions:

A

-exhausted (~pH10.3)
-desiccated (too dry)

266
Q

Which anesthetic agent poses the greatest risk at creating compound A in the CO2 absorbers?

A

Sevoflurane

267
Q

Active Scavenging systems rely on

A

-suction/evac unit
-negative pressure relief
-positive pressure relief so no barotrauma to pt

268
Q

Which type of scavenging system can be open or closed?

A

Active

269
Q

Passive Scavenging Systems rely on

A

-passive flow of gas from upstream
-don’t risk negative pressure insults
-have high pressure relief

270
Q

Which type of scavenging system can only be closed?

A

Passive

271
Q

ORs cannot have any higher exposures than: _ ppm of N2O, _ppm of volatile agents, and no more than _ppm if using halogen agent and N2O together

A

25ppm of N2O
2ppm of Agent
0.5ppm of Halogen + N2O

272
Q

What part of the bypass vaporizer is this?

A

Anesthetic Agent

273
Q

What part of the bypass vaporizer is this?

A

Concentrating Cone

274
Q

What part of the bypass vaporizer is this?

A

Pressure Compensator

275
Q

What part of the bypass vaporizer is this?

A

Temperature-compensating Bypass

276
Q

What part of the bypass vaporizer is this?

A

Vaporizing Chamber

277
Q

What part of the bypass vaporizer is this?

A

Wick

278
Q

Which kind of Mapleson Circuit is this and does it function better with a vented pt or one spontaneously breathing?

A

A, spontaneously breathing

279
Q

Which kind of Mapleson Circuit is this and does it function better with a vented pt or one spontaneously breathing?

A

D, vented pt

280
Q

A vent leak could indicate or cause:

A

-a crack somewhere
-gas mixing from drive gas and circuit
-increased FiO2
-barotrauma
-dilution

281
Q

If low pressure alarm ringing in breathing circuit could be caused by:

A

-circuit disconnect * most common cause- usually at Y piece between ETT+circuit
-CO2 Absorber having a poor seal
-Moisture in Vent
-malfunctioning bag/vent selector switch

282
Q

Assess these when low pressure alarm on breathing circuit rings:

A

-monitor pt chest rise
-EtCO2 and any changes in Vt
-assess integrity of breathing circuit
-check if ascending bellows are not rising
-check if bag is deflated with piston vent

283
Q

If high pressure alarm ringing in breathing circuit could be caused by:

A

-malfunctioning unidirectional valves-most common
-consider pt having bronchospasm always check pt 1st
-ETT occlusion
-PEEP valve occlusion
-plastic covering from CO2 absorber or mask occluding something
-scavenging malfunction
-vent spill valve issue

284
Q

What does this represent on capnograph?

A

Alpha Angle (measures obstruction~100-110*)

285
Q

What does this represent on capnograph?

A

Alveolar Plateau (where magic gas exchange happens)

286
Q

What does this represent on capnograph?

A

Beta Angle (~90* measures rebreathing)

287
Q

What does this represent on capnograph?

A

Anatomic Dead Space

288
Q

What does this represent on capnograph?

A

Dead Space Transitioning to alveolar plateau

289
Q

What does this represent on capnograph?

A

Inhalation of gas

290
Q

T/F A capnograph of someone with severe COPD, bronchospasm, or ETT kink will not reach plateau before next inspiration.

A

true

291
Q

T/F There is an alarm for when CO2 absorbers are exhausted.

A

False we must NOTICE it!

292
Q

Reduce the risk of CO poisoning by:

A

-changing CO2 absorbers
-use minimum FGF rate of 1-2L/min after 2 MAC hrs can increase

293
Q

CO poisoning shifts the oxyhemoglobin curve to the _.

A

left; reduces pt’s O2 carrying capacity

294
Q

What does this curve show?

A

normal capnograph with 3 phases

295
Q

What does this curve show?

A

Obstruction-no plateau
-COPD
-Bronchospasm
-Kinked ETT

296
Q

What does this curve show?

A

Curare Cleft - spontaneous respiratory effort
-great if waking up, not great if we want deep

297
Q

What does this curve show?

A

Failure of CO2 to return to 0
-bad expiratory valve
-CO2 absorber is exhausted

298
Q

What does this curve show?

A

Persistent exhaled gas during inspiratory cycle
-bad inspiratory valve

299
Q

What does this curve show?

A

Cardiac Oscillations with heart beating against lungs

300
Q

What does this curve show?

A

Shark fin= obstruction
-bronchospasm
-COPD
-Asthma

301
Q

What does this curve show?

A

Hyperventilation

302
Q

What does this curve show?

A

Hypoventilation

303
Q

Where do we measure EtCO2 on curve?

A

top of beta angle

304
Q

Ways to improve SpO2 signal:

A

-wrapping finger and probe in foil from alcohol pad
-warming extremity
-digit block
-vasodilating cream
-give IV arterial vasodilator

305
Q

Things that cause SpO2 artifact:

A

-moving
-hypothermia
-hypovolemia
-shock
-poor placement
-nail polish
-fake nails

306
Q

Methylene Blue can interfere with SpO2 signal for up to _ minutes

A

5

307
Q

Carboyhemoglobinemia can cause falsely _ SpO2

A

high

308
Q

Methemoglobinemia will cause SpO2 to stay around _ %

A

85%

309
Q

T/F SpO2 is a good indicator for successful intubation

A

False, pt sats can stay elevated after intubation for a little due to hyperoxygenation

310
Q

In pulse oximetry, the red light is absorbed _ by deO2 hemoglobin than by O2ed hemoglobin

A

more

311
Q

In pulse oximetry, the INFRAred light is absorbed _ by deO2 hemoglobin than by O2ed hemoglobin

A

less

312
Q

Things that cause a shift left on oxyhgb dissociation curve (Hgb hangs onto O2 more-less affinity for tissues):

A

-low CO2
-high blood pH/ low H+ ions
-hypothermia

313
Q

Things that cause a shift right on oxyhgb dissociation curve (Hgb lets go of O2 more-higher affinity to tissue):

A

-low blood pH/ excess H+ ions
-hyperthermia
-high CO2

314
Q

Different causes of low lung perfusion that result in more dead space, diluted exhaled CO2 and low EtCO2: (3 items)

A

-air embolism
-low CO
-low BP

315
Q

The gradient between PaCO2 and EtCO2 (2-5mmHg) reflects

A

alveolar dead space

316
Q

MH causes EtCO2 to rise because of

A

increased metabolic rate

317
Q

A sudden loss of CO2 during expiration indicates

A

disconnection

318
Q

EtCO2 cannot detect what kind of intubation?

A

mainstem bronchial

319
Q

EtCO2 quickly detects what kind of intubation

A

esophageal

320
Q

T/F anywhere you place a SpO2 probe that picks up a good waveform and reading is fair game

A

true

321
Q

Fastest measurement locations of SpO2:

A

ear, nose, tongue, forehead, esophagus

322
Q

Slowest measurement location of SpO2

A

toe

323
Q

2 Ways to collect CO2 analysis measurement:

A

-from within anesthesia circuit (mainstream or non-diverting)
-from circuit and measured inside monitor component using infrared radiation (side stream or diverting)

324
Q

Pros of measuring CO2 via anesthesia circuit(mainstream):

A

-real time CO2 level at insp and exp
-faster response
-measures CO2 at sample site
-used in ICU
-no water trap

325
Q

Cons of measuring CO2 via anesthesia circuit (mainstream):

A

-only measures CO2- not anesthetic agents
-increases dead space
-electronics are vulnerable to damage
- heavy/bulky

326
Q

Pros of measuring CO2 via monitor component with infrared(sidestream):

A

-measures CO2 and anesthetic gases
-used in AGM
-device is out of airway
-can be used on non-intubated pts
-can analyze mult gases

327
Q

Cons of measuring CO2 via monitor component with infrared (sidestream):

A

-diverts sample off Y piece
-needs scavenging
-measures farther from sample site
-pulls gas from circuit 150-200ml/min-slow
-needs water trap, accumulates condensation

328
Q

During a general anesthetic, you are unable to ventilate a patient due to low pressure in the system. What is the best course of action?

A

-switch to ambubag/ bag-mask vent and convert to TIVA

329
Q

With Nitrous Oxide, as long as liquid remains in the cylinder, the partial pressure measured by the bourdon pressure gauge will read _ psi

A

745PSI

330
Q

Regarding savaging systems- removal of too much gas would create _pressure in the circuit, while removal of too little gas may increase the risk of _ (excess + pressure) .

A

negative pressure, barotrauma

331
Q

Most fragile part of AGM

A

flowmeter glass tubes

332
Q

When installing E Cylinder look for:

A

-cracked cylinder
-damage
-ensure only one washer
-PISS pins
-ensure no audible leak
-ensure good pressure reading

333
Q

Under which conditions will hypoxic guard fail?

A
  1. Wrong gas in wrong canister (aka not administering N2O)
  2. Leak downstream of flowmeter
  3. Pneumatic/mechanical failure (hypoxic guard breaking)
  4. Administration of third gas (helium)
334
Q

How can you supplement the hypoxic guard to prevent failure?

A

Use of an oxygen analyzer

335
Q

What property should material have to help control temperature for vaporizers?

A

High heat conductivity

336
Q

What is the minimum FGF for a non-breathing circuit?

A

5L/min

337
Q

What determines the rebreathing amount for non-breathing systems?

A

FGF rate

338
Q

When to change CO2 granules (optimally)

A

Unless they’re exhausted during a case,
between cases. Changing granules reportedly causes hypoventilation.

339
Q

When to avoid low FGF?

A

Malignant hyperthermia, smoke inhalation, other situations in which you’d want to wash out gas

340
Q

Atmospheric Pressure is

A

760 mmHg or 14.7 PSI

Biophysics and Chem for NA (1 decks)

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