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Anesthesia Flashcards

1
Q

What are some examples of the high-pressure system?

A

Hanger yoke
Yoke block with check valves
Cylinder pressure gauge
Cylinder pressure regulators

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2
Q

What are some examples of intermediate-pressure?

A

Pipeline inlets
Pressure gauges
Oxygen pressure failure device
Oxygen second stage regulator
Ventilator power inlet
Flowmeter valves

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3
Q

What are examples of a low pressure system?

A

Flowmeter tubes
Vaporizers
Check valve
Common gas outlet

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4
Q

What are the components to the SPDD model?

A

Supply: pipeline/cylinder
Processing: vaporizers
Delivery: breathing circuit
Disposal: scavenging system

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5
Q

What are the 5 tasks of oxygen in the anesthesia gas machine?

A

O2 pressure alarm
O2 pressure device
O2 Flowmeter
O2 flush valves
Ventilator drive gas

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6
Q

What is the PISS system?

A

Pin Index Safety System

(Prevents the wrong cylinder from being attached to the machine)

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7
Q

What is the DISS system?

A

Diameter index safety system

(Prevents the wrong pipeline hose from being attached to the machine)

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8
Q

What is oxygens PISS configurations?

A

2,5

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9
Q

What is air’s PISS configuration?

A

1,5

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10
Q

What is Nitrous Oxide’s PISS configuration?

A

3,5

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11
Q

What is the max psi and Liters for a tank of O2?

A

660L
2000 psi

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12
Q

What is the max psi and liters for a tank of air?

A

625
1900L

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13
Q

What is the max psi and liters for a tank of Nitrous oxide?

A

1590 L
745 psi

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14
Q

What is the most delicate portion of the cylinder?

A

Cylinder valve

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15
Q

When should the oxygen cylinder be turned on?

A

Daily machine check and when you are NOT using pipeline gas

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16
Q

What is the only way of determining cylinder content?

A

By reading its LABEL!

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17
Q

What are the standard US colors for gases?

A

Oxygen: green
Air: yellow
Nitrous: Blue

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18
Q

What are the World Health Organization’s colors?

A

Oxygen: white
Air: white and black
Nitrous: blue

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19
Q

What two gases exist as a liquid inside their cylinder?

A

CO2
Nitrous

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20
Q

What is the fire triad?

A

Oxidizer, fuel, and igniter

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21
Q

What are some examples of a safety relief device? For cylinders in the event of a fire

A

Fusible plug
A valve that opens under high pressures
Frangible disk

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22
Q

What is Wood’s metal typical maker of?

A

BLT- with cheese

B: Bismuth
L: Leas
T: Tin
Cheese: cadmium

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23
Q

What sets the standard for compressed gas cylinders?

A

United States department of transportation

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24
Q

Who sets the standards for acceptable occupational exposure to volatile anesthetics?

A

Occupational safety and Health Administration

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25
Q

Who created the 1993 anesthesia machine pre-use checkout procedures?

A

Food and Drug Administration

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26
Q

Who sets the standard for the required components of the anesthesia machine?

A

American society for Testing and Materials

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27
Q

What are the 7 things required on a gas cylinder label?

A
  1. Government agency
  2. Type of metal used to constraint cylinder
  3. Max filling pressures (psi)
  4. Serial number
  5. Manufacturer
  6. Owner
  7. Date of last inspection
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28
Q

At what PSI does the threshold alarm (for the oxygen pressure failure device) sound?

A

<28-30 psi

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29
Q

What what pressure does the pneumatic device stop the flow of nitrous oxide? (In the oxygen pressure failure device)

A

< 20 psi

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30
Q

What are two ways you can still produce a hypoxic mixture with a failsafe?

A

Oxygen-pipeline crossover
Flowmeter leak.

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31
Q

What device prevents you from setting a hypoxic mixture with the flow control valves?

A

The hypoxia prevention safety device (proportioning device)

Limits N2O flow to 3 x O2 flow (N2O max is 75%)

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32
Q

What is the minimum FiO2 permitted by the proportioning device?

A

25%

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33
Q

At low flows, what type of flow is it and what is it dependent on?

A

Laminar flow
Dependent on gas’s viscosity

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34
Q

At high flows, what type of flow is it and what is it dependent on?

A

Flow is turbulent
Dependent on the gas’s density

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35
Q

Where is the oxygen Flowmeter placed in US anesthesia machines?

A

On the far RIGHT!

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36
Q

What is the equation to Reynold’s number?

A

Density x diameter x velocity / viscosity

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37
Q

How do you determine the delivered FiO2 using a nasal cannula?

A

Add 4% for each liter of oxygen administered (to a max of 44% at 6L/min)

0:21%
1L : 24%
2 L: 28%
3 L: 32%
4 L: 36%
5 L: 40%
6 L: 44%

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38
Q

What should you do if the vaporizer is tripped?

A

Run high FGF for 20-30 mins

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39
Q

What is the latent heat of vaporization?

A

Number of calories that is needed to convert 1 g of liquid into vapor without a change in temperature.

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40
Q

What is the pumping effect?

A

Anything that causes gas that has already left the vaporizer to reneged the vaporizing chamber. (Usually due to positive pressure ventilation or the oxygen flush valve)

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41
Q

How do you calculate how long your agent will last? What is the equation?!

A

mL of liquid anesthetic used per hour = vol% x FGF (L/min) x 3

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42
Q

What is the “T” setting on the vaporizer?

A

Transport mode. It eliminates the worry of tipping the vaporizer during transport or removal

43
Q

What is the TEC 6 heated to and pressurized to?

A

2 atmospheres
39 degrees C

44
Q

Does the TEC 6 compensate for changes in elevation?

A

No

45
Q

What is the equation to account for pressure when determining the output of Desflurane at a different atmosphere?

A

Required dial setting = (normal dial setting % x 760) / ambient pressure mmHg

46
Q

What happens to Desflurane’s output of anesthesia takes place at a HIGHER elevation?

A

Atmospheric pressure is lower at higher elevation —> partial pressure in the circuit with be lower (less anesthesia delivered)

47
Q

What happens to Desflurane’s output of anesthesia takes place at a lower elevation?

A

Less elevation = higher ambient pressure

Partial pressure in the breathing circuit will be HIGHER than expected.

48
Q

What is deemed the last line of defense against a hypoxic mixture?

A

Oxygen analyzer (found in inspiratory limb)

49
Q

What are the two things you must do if an oxygen pipeline crossover is assumed!?

A

Disconnect pipeline (you must disconnect!)
Open O2 tank.

50
Q

What is the pressure and/or flow of the oxygen flush valve?

A

Flow: 35-75 L/min
Pressure: 50 psi

51
Q

What are two complications caused by the overuse of the oxygen flush valve?

A

Awareness
Barotrauma

52
Q

When does an ascending bellows rise and fall?

A

Rises during expiration
Falls during inspiration

53
Q

When does a descending (hanging) bellows rise and fall?

A

Remember this is upside down

Falls with expiration
Rises with inspiration

54
Q

Will a piston ventilator consume tank oxygen in the event of a oxygen pipeline failure?

A

No.

55
Q

What are the two pressure relief valves on a piston ventilator?

A

Positive pressure relief valve: opens at 75 cm H2O

Negative pressure relief valve: opens at -8 cm H2O

56
Q

Which ventilator mode adds intrinsic peep?

A

Gas driven adds 2-3 cm H2O of peep

Piston ventilators do NOT

57
Q

What are some traits about volume controlled ventilation?

A

Delivers a preset tidal volume over a predetermined time

Inspiratory pressure will vary as a fx of patient pulmonary compliance

If airway resistance rises or lung compliance decreases, PIP will rise

Inspiratory flow is held constant during inspiration

***flow waveform looks like a square

58
Q

What are some traits about pressure controlled ventilation?

A

Delivers a preset inspiratory pressure over a predetermined time

Vt and inspiratory flow will vary as a function of the patient’s pulmonary compliance

If airway resistance rises or lung compliance decreases, then the Vt will decrease.

Inspiratory flow uses a decelerating pattern. Begins high to achieve inflation pressure and then slows to maintain constant pressure

***flow waveform looks like a triangle

59
Q

What is fixed and what is variable in a volume controlled ventilator setting?

A

Fixed: tidal volume, inspiratory flow rate, inspiratory time

Variable: peak inspiratory pressure

60
Q

What is fixed and what is variable in a pressure controlled ventilator setting?

A

Fixed: peak inspiratory pressure, inspiratory time

Variable: tidal volume, inspiratory flow

61
Q

What are the advantages of PCV?

A

Larger tidal volume for a given pressure

Inspiratory flow pattern may improve gas exchange

Reduces risk of VALI

Useful in patients with low compliance where high PIP is dangerous

62
Q

What are some disadvantages of PCV?

A

Increased airway resistance or decreased lung compliance reduces tidal volume

Requires extra attempting in conditions that alter pulmonary mechanics (increased resistance or compliance)

63
Q

In PCV, what conditions will decrease your tidal volume?

A

Pneumoperitoneum
T-berg
Bronchospasm
Kinked ETT

64
Q

In PCV, what conditions will increase your tidal volume?

A

Release of pneumoperitoneum
Going from t-berg to supine
Bronchodilator therapy
Removing airway secretions

65
Q

What are some conditions where PCV is better than VCV?

A

Pt with low compliance: preg, obesity, laparoscopy, ARDs

High PIP would injure patient: LMA, neonate, emphysema

Need to compensate for a leak: LMA, uncuffed ETT in kiddos

66
Q

What are some traits about controlled mandatory ventilation?

A

Machine initiates breaths and delivers preset Vt and RR on a fixed schedule

Does not compensate for patient initiated breaths (risk for asynchrony)

**best for apneic patients

67
Q

What are some traits about assist control?

A

Machine initiated breaths deliver preset Vt and RR

Spontaneous breaths receive the full preset volume.

Patient that over breathes is at risk for hyperventilation and resp alkalosis

68
Q

What are some traits about SIMV?

A

Machine delivers preset Vt and RR, BUT this still allows patient to breathe spontaneous b/t delivered breaths

If patient breathes before the initiated breath is due, the timing will adjust and coordinate

Promotes synchrony

Spontaneous breaths can be augmented with support

Guarantees a min minute vent.

Useful for weaning or LMA

69
Q

What are some traits about PCV-VG?

A

Benefits of pressure control, BUT also guarantees a predetermined tidal volume

70
Q

What are some traits about PSV?

A

Augments spontaneous breaths with pre-set pressure amount

No machine intimated breaths UNLESS a back up mode is in place (I.e. PSV-Pro)

Use for weaning/LMA

71
Q

What are some traits about PSV- Pro?!? Highlight on the pro.

A

Pro means protect.

Receives benefit of PSV, BUT if patient becomes apneic, will switch to PCV, and will switch back and forth

72
Q

What are some traits of CPAP?

A

Continuous amount of pressure is applied to breathing circuit.

Two benefits: augments pts spontaneous breaths and reduces airway collapse during expiration

(PSV only applies pressure during inspiration, NOT expiration)

73
Q

What are some traits of Bipap?

A

Similar to CPAP, but a DIFFERENT pressure is set between inspiration and expiration. P1 is the pressure set to augment for inspiration and P2 is the pressure set for expiratory.

**useful for patients when CPAP is not quite enough

74
Q

What are some traits of Airway Pressure Release Ventilation (APRV)?

A

Used for spontaneous breaths
Like bipap, but there is a high level of CPAP through most of the resp cycle. This pressure is released at pre-set intervals.

**great for ARDS

75
Q

What are some traits about Inverse Ratio Ventilation? (IRV)

A

This type of setting reverses the I:E ration by allocating more time during inspiration.

**REQUIRES A PARALYZED PT

Useful for ARDs and pts with small FRC

Risk of auto peep

76
Q

What are some traits about high-frequency ventilation?

A

Delivers a tidal volume below anatomical dead space in conjunction with a high RR. Gas transport occurs by molecular diffusion, coaxial flow, and high-velocity flow

(Includes oscillation, jet ventilation, and percussive ventilation)

77
Q

At what pH does the ethyl violet turn purple?

A

10.3

78
Q

What is the reaction of carbon dioxide with soda lime? Full…

A

CO2 + H2O —> H2CO3

H2CO3 + 2NaOH —> Na2CO3 + 2 H2O + heat

Na2CO3 + Ca(OH)2 —> CaCO3 + 2 NaOH

79
Q

How many liters of CO2 can soda line absorb per 100g of absorbent?

A

26L

80
Q

What is the ideal balance of mesh granules used in carbon dioxide absorbents?

A

4-8 mesh granules

81
Q

Small granules in CO2 absorbents have what?

A

Increased surface area
BUT also increased resistance

82
Q

Large granules in CO2 absorbents have what?

A

Lower surface area
And a lower airflow resistance

83
Q

What volatile anesthetics have the highest rate of CO production with desiccated soda lime?

A

Des > Iso > Sevo

84
Q

What can Sevo produce in the presence of desiccated soda lime?

A

Compound A baby!

85
Q

What conditions increase the formation of compound A?

A

Low FGF rates
High absorbent temp
Desiccation
High concentration of Sevo

86
Q

What are the final products of the carbon dioxide and soda lime reaction? Aka final part of the equation

A

CaCO3 (calcium carbonate)

2NaOH (2 Sodium hydroxide)

87
Q

Why is silica added to soda lime?

A

It provides hardness and minimizes dust production

88
Q

What are the major drawbacks of using calcium hydroxide instead of soda lime?

A

More expensive

Requires more replacements

Absorbs 1/2 of what soda lime can

89
Q

What is an active scavenger system?

A

Active uses suction

90
Q

What is a passive scavenger system?

A

Passive system relies on the positive pressure of fresh gas leaving the interface

91
Q

What is a closed scavenger system?

A

Uses valves

92
Q

What is an open scavenger system?

A

Open to the atmosphere

93
Q

Which scavenger system has a higher change of exposing OR staff to waste gas?

A

Open system

94
Q

What is the most common cause of low circuit pressure? What is the second most common?

A

1st: circuit disconnect
2nd: leak around the CO2 absorbent

95
Q

What are the 4 ways to detect a circuit disconnect?

A

Pressure
Volume
EtCO2
Vigilance

96
Q

What are 4 cardiovascular consequences caused by excessive pressure in the breathing circuit?

A

Decreased venous return
Decreased CO
Hypotension
Cardiovascular collapse

97
Q

What are the OSHA’s recommendations for anesthetic gas exposure?

A

Nitrous oxide alone should not exceed 25 ppm

Halogenated agents alone should not exceed 2 ppm

Halogenated agents with Nitrous oxide should be less than 0.5 ppm and 25 ppm respectively

98
Q

What is the minimum recommended pressure when performed a high-pressure leak test in the anesthesia gas machine?

A

30 cm H2O

(Think how you have to turn the APL valve to 30-70)

99
Q

What are the types of breathing systems and their classification?

A

Open: no rebreathing/no reservoir
Semi-open: no rebreathing with reservoir
Semi-closed: partial rebreathing with a reservoir
Closed: complete rebreathing with a reservoir

100
Q

What are examples of an open system?

A

Insufflation
Simple face mask
Nasal cannula
Open drop ether

101
Q

What are examples of a semi open system?

A

Mapleson circuit
Circle system (FGF > minute vent)

102
Q

What are examples of a semi closed system?

A

Circle system (FGF < minute ventilation)

103
Q

What are examples of a closed system?

A

Circle system with very low FGF and APL closed

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