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AS - N928 Basic Principles of Anesthesia > Anesthesia Gas Machine > Flashcards

Anesthesia Gas Machine Flashcards

1
Q

Pipeline Supply

A

Bulk gases delivered to back AGM
Intermediate pressure
50psi
DISS/KISS

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2
Q

Cylinder Supply

A

High pressure
Requires pressure regulator to ↓45-50psi
PISS

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3
Q

Floating Valve

A 
Unidirectional or check valves (FUCk)
Interface b/w pipeline supply & AGM
Opens & closes w/ pressure
Allows gas to enter machine
Promotes one-way flow & prevents backward flow into tank or pipeline
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4
Q

Ball & Spring

A

All or nothing
O2 flush 35-75L/min @ 50psi directly from gas supply to CGO (bypasses vaporizers ↓volatile agent delivered to patient → recall risk)

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5
Q

Diaphragm Valve

A

Pressure reducing ↓pressure to lower, constant
1st & 2nd stage regulators
Maintains constant gas flow w/o changing supply pressure

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6
Q

AANA Standard 6

A

Equipment

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7
Q

American Society for Testing & Materials

A

ASTM

Specifies minimum performance & safety requirements used in AGM design for human use to enhance patient/operator safety

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8
Q

FDA

A

Federal food, drug, & cosmetic act

Regulates medical gases contained in cylinders

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9
Q

US Pharmacopeia

A

FDA

Sets potency & purity standards

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10
Q

Department of Transportation

A

DOT

Cylinder design, construction, testing, marking, handling, filling, & transportation

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11
Q

Compressed Gas Association

A

CGA

Sets standards on safe practice

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12
Q

National Fire Protection Association

A

NFPA

Location, construction, & bulk systems installation

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13
Q

Critical Temperature

A

Temperature below which gas converted to liquid form by pressure
Oxygen -118°C

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14
Q

Safety Systems

A
  • Color coding
  • Key filler caps & ports
  • DISS/KISS/PISS
  • Interlock system
  • Link 25 or hypoxic guard
  • CO2 absorber
  • Unidirectional valves
    Safety relief devices to prevent rupture
  • Frangible copper disc
  • Spring-loaded valve
  • Fusible plug (Wood’s metal)
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15
Q

Pin Index Safety System

A

PISS
Holes in cylinder valve that corresponds w/ 2 pins in the hanger yoke
6 numbered positions

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16
Q

Hanger Yoke

A

Connects cylinder to AGM
Orients the cylinder
Provides unidirectional flow (floating valve)
Ensures gas-tight seal

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17
Q

Oxygen PISS

A

2 + 5

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18
Q

Air PISS

A

1 + 5

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19
Q

N2O PISS

A

3 + 5

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20
Q

Wood’s Metal

A

Safety pressure relief device
Fusible plug that melts at predetermined temperature to release gas from cylinder
Alloy w/ bismuth, lead, tin, & cadmium

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21
Q

Cylinder Labeling & Markings

A

Regulatory body DOT cylinder type & material
Serial number
Purchase, user, & manufacturer
Manufacturer’s number
Manufacturer’s identifying symbol
Re-test date, re-tester, ID symbol, 110% filling, 10yr test interval
Neck ring owners ID

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22
Q

Cylinder Construction

A

Walls 3/8” thick
Tested at 1.66x the service pressure
Interior hydrostatic pressure test at least 1x every 5yr

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23
Q

Adiabatic Compression/Expansion

A

Rapid compression (exothermic) heat liberation does not have time to dissipate
Things in vicinity or in contact w/ gas will heat up
Rapid expansion (endothermic) surrounding area will feel cold
OR insulated area where compression/expansion occurs ჻ heat trapped and unable to dissipate

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24
Q

Oxygen Cylinder

A

660L/1900psi
Ensure at least 1000psi
2 & 5
Green

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25
Q

N2O Cylinder

A

1590L/745psi
Critical temperature 36.5°C
3 & 5
Blue

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26
Q

Air Cylinder

A

625L/1900psi
1 & 5
Yellow

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27
Q

E-Cylinder Calculation

A

Available psi x 0.347 = L

Total L / L/min flow = min remaining

28
Q

Boyle’s Law

A

P1V1= P2V2

29
Q

Low Pressure System

A

Flowmeters
Vaporizers
Fresh gas outlet (CGO)
Check valves

30
Q

Intermediate Pressure System

A 
45-55psig
Receives gases from pipeline
Unidirectional check valve
DISS/KISS
Pipeline inlets
Check valves
Pressure gauges
Flowmeter valve
31
Q

High Pressure System

A 
Receives gases from cylinders at high variable pressures → regulators → lower, more constant pressures
Pipeline supply 50psi
E-Cylinders (745-1900psi)
Hanger yoke & PISS
O2 flush 35-75L/min @ 50psi
Ends at regulator
32
Q

Failsafe Valve

A

Designed to prevent unintentional hypoxic mixture delivery

Stops N2O delivery when O2 supply pressure falls below threshold setting

33
Q

Low O2 Pressure Alarm

A

Low O2 pipeline or cylinder delivery

<30psi

34
Q

Low Flow L/min

35
Q

High Flow L/min

36
Q

O2 Flowmeter

A

Fluted knob w/ 8 flutes
Positioned closest to the CGO to prevent hypoxic mixture (less likely to mix when downstream - closest to patient)
O2 always added to the gas mixture last (prior to vaporizers)

37
Q

Flowmeter Components

A

Rotameters

  • Knob
  • Needle valve controls gas flow
  • Valve stops prevent damage to needle valve from excessive force
  • Flow tube
  • Indicator float (ball or bobbin)
38
Q

Minimum AGM Flow

A

O2 flow 200-300mL/min

39
Q

Flowmeters

A

Thorpe tube
Tapered glass tube
Constant-pressure, variable orifice
R = P/ Q

40
Q

Link 25

A

Hypoxic guard system
Proportioning system
N2O:O2
3:1 ratio

41
Q

Dalton’s Law

A

Volume % = partial pressure / total ambient pressure x 100

P1 + P2 + P3 + PN = Total pressure

42
Q

Vapor Pressure

A

Molecules escape from volatile liquid into vapor phase creating saturated vapor pressure at equilibrium
Pressure exerted by vaporized molecules
↑temperature ↑vapor pressure

43
Q

Variable Bypass Vaporizers

A

Flow over vaporization method
Concentration dial splits stream into bypass & carrier
Flow over gas picks up liquid volatile agent
Calibrated specific to each volatile anesthetic agent
DO NOT TIP >45°

44
Q

Vaporizer Complications

A

Vaporizer tipped >45° ↑concentration → overdose
Overfilling → volatile anesthetic liquid able to enter bypass chamber
Leaks - loose filler cap, O-ring junction, or malposition
Simultaneous inhaled agent administration - vaporizers not side-by-side interlock system possible to override
Higher VP agent place in lower VP agent vaporizer ↑concentration delivered

45
Q

Gas-Vapor Blender

A

Tec 6
Measured flow
Bubble through vaporization
Heated to 39°C

46
Q

Desflurane Tec 6

A

Gas-vapor blender
VP 669mmHg
BP 24°C
Electrically heated 39°C

47
Q

Tec 6 Alarms

A 
Warm-up mode = amber
Operational = green
No output = red
Alarm battery low = amber
- Lack agent, tilting, or malfunction
- Low agent <250mL
Internal battery only powers alarms NOT vaporizer
48
Q

Circle System Components

A 
FGF inflow source
Overflow valve APL
Gas reservoir bag
Unidirectional valves
Corrugated 22mm diameter tubes x2
Y-piece connector
CO2 absorber
49
Q

Semi-Closed System

A

Low FGF < minute ventilation

Some rebreathing

50
Q

Semi-Open System

A

High FGF > minute ventilation

No rebreathing

51
Q

Closed System

A

FGF = patient uptake
Complete rebreathing
Requires functional CO2 absorber
APL valve closed

52
Q

CO2 Absorption

A

Soda lime & baralyme
Colorless when fresh
Exhausted pH 10.3 → purple (soda lime) & blue-grey (baralyme)
4 to 8 mesh

53
Q

Soda Lime

A 
Ca(OH)2
NaOH
KOH
Silica
H2O
54
Q

Mapleson

A

Semi-open (non-breathing)

A-F

55
Q

Mapleson A

A

APL on patient side

56
Q

Mapleson B

A

Both APL & FGF on patient side w/ corrugation

57
Q

Mapleson C

A

No corrugation

58
Q

Mapleson D

A

Distant APL

59
Q

Mapleson E

A

Easy (no bag or valve)

60
Q

Mapleson F

A

Jackson-Rees modification to Mapleson D

No APL valve on FGF

61
Q

Bain Circuit

A

FGF warmed by exhaled gases (improved humidification)
100-300mL/kg to prevent hypercarbia
↑resistance
Pethick test to check inner gas hose integrity
Rebreathing d/t unrecognized inner tube disconnect or kink

62
Q

Ascending Bellows

A

Standing bellows
Ascend on expiration
Descend on inspiration
Unable to fill when disconnected or leak present

63
Q

Descending Bellows

A

Hanging bellows
Fall/lower on expiration
Fill even when disconnected

64
Q

WAGs

A

Waste anesthesia gases

65
Q

Scavenger Systems

A

Active (suction)
Passive
Open
Closed

AS - N928 Basic Principles of Anesthesia (18 decks)

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