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gtown nur641 > Ali intro Final- Things I Can't Remember > Flashcards

Ali intro Final- Things I Can't Remember Flashcards

1
Q

Desired breathing circuit features

A

Economy of FGF
Conservation of heat/humidity
Light weight
Convenient
Effective in SV and CV
Adaptability for kids/adults/mechanical ventilation
Little environmental pollution — safe disposal waste system

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2
Q

Considerations of breathing circuit

A 
Resistance
Rebreathing
Dead space
Dry gases/humidification
Manipulation of inspired content
Bacterial colonization
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3
Q

Advantages of Bain

A

Warm/humidify
Light weight, easily sterilized, reusable
Good for cases with little access to pt head
Ease of scavenge waste gas

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4
Q

Advantages of Mapleson E

A

Less resistance
Minimal dead space
No valves (decr resistance)
Good for peds/neonatal (due to less resistance)

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5
Q

Parts of Ambu Bag (5)

A 
Gas inlet
One way flap valve
Reservoir
Non rebreathing valve
Small bore nipple to allow for O2 addition/attachment
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6
Q

Ambu bag safety features

A

Elasticity of outer cover to limit pressure to 7 kPa

Peds have pressure limiting valve (4 kPa)

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7
Q

Similarities of Mapleson and Circle System

A

Both have FGF
Both supply volume/flow to patient
Both eliminate CO2 in some way

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8
Q

Difference between Mapleson and Circle System

A

Mapleson: bidirectional valve, no rebreathing (FGF high enough to eliminate CO2)

Circle: uni valves, rebreathing occurs, CO2 scrubber, vaporizer, scavenger

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9
Q

Benefits of Circle System

A 
Stability of concentration of gases
Conservation of heat/moisture
Low resistance
Can do closed system anesthesia
Low FGF
Economy of gases 
Ability to scavenge 
Prevent OR pollution
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10
Q

Hallmark component of Circle System

A

Unidirectional gas flow via unidirectional valves

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11
Q

Primary source of resistance in circle system

A 
Tracheal tube (ETT) (larger if possible) 
Valves (keep dry)
CO2 scrubber (short and wide help)
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12
Q

Closed circle system

A

APL closed
Concentration of gases - if want to change them happens SLOWLY
FGF low
Rebreathing occurs

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13
Q

Advantages of Circle System

A 
Retained heat/humidity
Stability of gas concentration
Low resistance
Closed system anesthesia
Low FGF with no rebreathing of CO2
Recycles gas
Scavenge waste
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14
Q

Disadvantages of Circle System

A 
Increase resistance from uni valves
Complex
Malfunction of valves can occur
Less portable
Increases dead space
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15
Q

2 tests of circle systems

A

Leak test- occlude y piece, o2 flush to 30 cm h2o for 10 seconds, ensure holds, listen for sustained pressure alarm
Flow test- breathing bag on y piece, ventilator on, check unidirectional valves

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16
Q

Safe handling of cylinders (NEVER DO THIS…..)

A
  1. Stand alone upright w/o support
  2. Leave empty cylinder on back of machine
  3. Leave plastic tape on port while installing cylinder
  4. Rely on cylinders for color identification
  5. Oil valves
  6. Open towards you (SHOULD OPEN AWAY DUE TO ADIABETIC PROCESS-fire, dust)
  7. Have valve half open (SHOULD BE FULLY OPEN WHEN CYLINDER IN USE due to result in delivering inadequate amounts of gas)
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17
Q

Vapor pressure depends on…

A
  1. Temperature
  2. Vapor pressures
  3. Amount of carrier gas (carrier gas flow)
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18
Q

Latent Heat of Vaporization

A

calories needed to change 1g liquid into vapor WITHOUT a temp change

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19
Q

Specific Heat

A

calories to increase temp of 1g of substance by 1 degree Celsius

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20
Q

Vaporizer desired features (with regards to specific heat and thermal conductivity)

A

Want a HIGH specific heat

Want a HIGH thermal conductivity

21
Q

What happens to temp/vaporization rate as liquids start vaporizing

A

(In absence of outside source of energy)…
Temp of liquid itself will DECREASE during vaporization so rate of vaporization will further DECREASE (heat released to environment, out of liquid itself)
If rate of vaporization decreases, less will turn into vapor (not good)
We need a system where temp of liquid remains constant——specific heat/thermal conductivity comes into play

22
Q

Thermal Conductivity

A

Measure of speed with which heat flows through a substance
Higher conductivity—> better a substance conducts heat (allows heat to flow through)

Vaporizers constructed of metals—high thermal conductivity—helps them maintain uniform internal temp during evaporation

Vaporizers: absorb the environmental heat that is given off during vaporization process to prevent the temp of liquid from decreasing

Keeps rate of vaporization more constant

23
Q

Vaporizers: (temp compensating valve)

COLD vs HOT situations

A

Cold: bends to the LEFT, more FGF goes INTO vaporizer
(Helps overcome decr vaporization rate from decr temp)

Hot: bends to RIGHT, more FGF through BYPASS chamber, less through vaporizer
(Helps overcome increase in vaporization rate that occurs from incr temp)

24
Q

Vaporizers: Concentration Control Vial

A

Controls how much saturated FGF with anesthetic leaves the vaporizer to join FGF to go to pt

Dial turned down (goes into system, less vaporized saturated FGF let out to patient)
Dial turned up (dial comes out of system, less blocked, more vaporized saturated FGF let out to patient)

25
Q

Aladdin Cassets

A

Computer controlled VARIABLE BYPASS
Each has a central processing unit
Able to tirade how much gas is being delivered (precise)
Fresh gas over anesthetic

Desflurane (still has a tec 6 like feature in its Aladdin cassette)

26
Q

Altitude Effects on Vaporization

A

Increased altitude—> decreased barometric pressure (more gas goes into vapor)

Decreased altitude—> increased barometric pressure (less gas goes into vapor)

DESFLURANE REQUIRES RECALIBRATION of dial setting : normal dial setting % * 760/altitude now

27
Q

Chem Physics applied to Vaporization

Altitude applies what law?

A

Dalton law of partial pressures

28
Q

Chem Physics applied to Vaporization

Calibration of vaporizers applies what law?

A

Avogadro’s Hypothesis

29
Q

Chem Physics applied to Vaporization

Tec 6 applies what law?

A

Ideal Gas law

Gay Lussac

30
Q

Chem Physics applied to Vaporization

To properly make a vaporizer applies what laws/ideas?

A

Specific heat

Thermoconductivity

31
Q

Components of High pressure system

A

Cylinder gas supply (E)
Yoke assembly
Bourdon gauge
High pressure regulator

32
Q

Components of Intermediate Pressure System

A 
O2 flush
Second stage pressure regulator
Auxiliary O2 supply
Pipeline gas supply
Pneumatic safety systems/electrical system
33
Q

Components of Low pressure system (6)

A

(Between flow control devices and common gas outlet)

Flowmeters
Hypoxia prevention safety devices
Uni valves
Pressure relief valves
Vaporizer
Common gas outlet
34
Q

Required monitors for anesthesia machine

A

Inspired O2/CO2
Expired O2/CO2

O2 supply failure
Hypoxic guard system

Anesthetic vapor concentration
Vital signs

35
Q

Cylinder Safety Systems

A

Frangible disk- bursts under extreme pressure

Fusible plug- bismuth, lead, tin cadmium, melts at predetermined temp

36
Q

Yoke Assembly

A

Connection of cylinder to machine (PISS)

Orient tanks, gas tight seal, uni flow of gases, filter, check valve (on some)

37
Q

High pressure regulator location

A

Inside of hanger yoke

38
Q

Hospital Supply Connection of Gas to Machine

A 
DISS
Sized and threaded differently
Body, nipple nut combo
Contains a filter, check valve (uni flow), pressure gauge
Gas specific, color specific
39
Q

During power outage, what still works?

A

Monitors DO NOT
Backup battery 30 min/generator hopefully
Auxiliary flowmeters STILL WORKS

40
Q

Pneumatic Safety Systems

A

Part of intermediate pressure system
Help prevent delivery of hypoxic gas mixture to pt

If O2 supply reduced, delivered O2 concentration should never be below 19% O2 at common gas outlet

Fail safe devices (2)- proportioning system, pressure sensor shutoff valve

41
Q

Fail Safe Device- O2 proportioning System

A

Pneumatic Safety Device (intermediate pressure system)

O2 pressure supply opens valve which allows delivery of N2O, as O2 pressure decreases, (when hits 30 psi), valve starts closing and reduces delivery of N2O (in proportion to O2)

Does not prevent anesthesia gases from flowing (just works on N2O)
Works even if wrong gas is supplied

PROPORTIONING DECREASE IN N2O with O2

42
Q

Fail Safe Device (pressure sensor shutoff valve)

A

Pneumatic Safety Device (intermediate pressure system)
Once O2 supply reaches 20 psi, valve closes completely and allows nothing but O2 to flow through

THRESHOLD OF 20 to completely CLOSE VALVE

43
Q

Second Stage Pressure Regulator

A

Part of intermediate pressure system
Protects against fluctuations of pipeline pressure
Lowers pressure of O2 to 14 psi and N2O to 26 psi
Ensures O2 is last gas flowing
Located downstream from gas supply sources in intermediate system
Supplies constant pressure to flow control valves and proportioning system

44
Q

Flowmeters

A

Low pressure system
Regulates flow of gases entering breathing circuit
Traditionally mechanically controlled (newer ones are electrically controlled)
Flows are directed into vaporizer

Narrow at bottom, widen at top (laminar low flow bottom-viscosity, turbulent high flow gas- density)

Calibrated for a specific gas

45
Q

Components of Flowmeters

A 
Flow control knob
Tapered needle valve
Valve seat
Valve stop
Float
Float stops
46
Q

Hypoxia Prevention Devices

A

Designed to prevent delivery of hypoxic mixtures (O2 can’t be less than 21%)
Link proportioning system (Datex Ohmeda)
Sensitive Oxygen Ratio Controller System (Drager)

47
Q

Sensitive O2 Ratio Controller System

A

Hypoxia prevention device- low pressure system component
On Drager
Pneumatic-mechanical interlock
Opening of O2 flow creates a back pressure in the chamber opening N2O flow
Maintains a 25% O2 to 75% N2O flow into breathing system
Needs at least 200 ml/min to operate this device
Lowest amount of O2 delivered is 25%

48
Q

Link 25 Proportion Limiting System

A

Hypoxia Prevention Device on low pressure system
Mechanical integration of O2 and N2O flow control valves
3:1 Ratio
Maintains O2 concentration at least 25%
15 teeth N20, 29 teeth O2, 3:1 ratio N20 to O2

49
Q

5 pathways of O2

A 
O2 flush
Flowmeters
Compresses bellows of ventilator
Activates fail safe valve/mechanism
Activates o2 supply low pressure alarm

gtown nur641 (7 decks)

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