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Monitoring > Anesthesia Machine > Flashcards

Anesthesia Machine Flashcards

1
Q

Where is the high pressure system? What is included?

A

Begins at cylinder and ends at the first pressure regulator

Hanger yoke and yoke block

Cylinder pressure gauge and regulator

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2
Q

Where is the intermediate pressure system?
What is included?

A

Begins at pipeline and ends at the flow meters

-Pipeline inlets
-Pressure gauges
-O2 pressure failure device
-O2 second stage regulator
-O2 flush valve
-Vent power inlet
-Flowmeter valve

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3
Q

What is the pipeline pressure?

What is the tank pressure after the first pressure regulator?

A

Pipeline = 50 psi
Tank = 45 psi

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4
Q

Where is the low pressure system? What is included?

A

Begins at flowmeter tubes and ends at the common gas outlet

-Flowmeter tubes
-Vaporizers
-Check valve
-Common gas outlet

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5
Q

What is the low pressure leak test (negative pressure test)?

When should this be done

A

-Checks the low pressure system

-Creates pressure at Negative 65 and if the bulb reinflates within 10 seconds, it fails

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6
Q

What is the high pressure leak test?

A

Close the apl valve to 30 and watching the gauge - should remain constant

-Evaluates the low pressure system

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7
Q

What signifies a failed low-pressure leak test?

A

If the bulb reinflates within 10 seconds after creating -65 of pressure

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8
Q

How much negative pressure should be created for a proper negative pressure test?

A

-65 cm H2O

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9
Q

Should the vaporizer be on or off during a low pressure leak test?

A

Off at first but then repeated with them on

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10
Q

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

A
  • O2 pressure failure alarm
    -O2 pressure failure device
    -O2 flowmeter
    -O2 flush valve
    -Ventilator drive gas
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11
Q

What are the 4 components of the SPDD model?

A

Supply
Processing
Delivery
Disposal

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12
Q

The PISS system is used to:

A

prevent the hookup of the wrong cylinder

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13
Q

The DISS system is used to:

A

Prevent the wrong hose from being hooked up

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14
Q

What does the pressure change to when going from the high pressure system to the low?

A

1900 to 45 PSI

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15
Q

What is the PISS configuration of O2?

A

2,5 - green

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16
Q

What is the PISS configuration of Air?

A

1,5 - Yellow

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17
Q

What is the PISS configuration of NO2?

A

3,5 - Blue

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18
Q

Good way to remember the PISS?

A

The second number is always 5

O2 - 2
Air - 1
N20 - 3 (3)

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19
Q

What is the best way to identify what gas is in the tank?

A

The LABEL

NOT color

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20
Q

How many Liters are in a full tank of O2? What is the PSI?

A

660 L

1,900 PSI

Pin 2,5

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21
Q

How many Liters are in a full tank of Air? What is the PSI?

A

625 L
1900 PSI

Pin 1,5

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22
Q

How many Liters are in a full tank of N20? What is the PSI?

A

1590 L
745 PSI

Pin 3,5

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23
Q

How is N2O stored? What is the only reliable way to measure how much is left?

A

Liquid form till it’s almost empty

Weigh it

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24
Q

When should the N2O tank be changed?

A

When the PSI drops

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25
Q

How should a cylinder be stored? Changed?

A

-Always store upright
-Okay to lay down when changing
-Never apply lubrication
-Take plastic cover off before installing
-Place yoke plug if no tank in use
-Never take into an MRI room
-Okay to use one yoke washer but never two

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26
Q

What helps prevent a cylinder explosion?

A

-Never store at temps higher than 130F or 57 C
-Use a fusible plug made from Woods metal; Bismuth, lead, tin, cadmium (BLT w/ Cheese)
-A valve that opens at high temps
-A disk that ruptures under pressure
-Always open slowly

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27
Q

How often must a cylinder be tested?

A

Every 5 years
10 years with a special permit

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28
Q

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

A

American Society for testing

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29
Q

Who sets the standards for the required anesthesia machine checkout?

A

FDA

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30
Q

Who sets the standards for the required compressed has cylinders?

A

DOT

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31
Q

Who sets the standards for the required volatile gas exposure?

A

OSHA

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32
Q

When is the oxygen pressure failure activated? Where is it located?

A

O2 supply falls below 20 PSI

Does NOT monitor for a crossover or a flowmeter leak

Intermediate system

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33
Q

The hypoxia prevention safety device on the anesthesia machine will limit what?

A

A hypoxic mixture. Does not allow N2O to be more than 3x the flow of O2

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34
Q

What are 4 situations where the proportioning device can not prevent a hypoxic mixture?

A

A flowmeter leak
A crossover
Defective pneumatics
A third gas

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35
Q

What is the minimum FiO2 of the proportioning device?

A

25%

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36
Q

What is Reynolds number?

A

The flow rate through the tube that determines if something is laminar or turbulent

<2000 - laminar

2000-4000 Transitional

> 4000 turbulent

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37
Q

Where should the o2 flowmeter be located?

A

The last one. Furthest to the right

Prevents hypoxic mixture

Because flowmeters are made of glass. If it breaks the glass will leak out.

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38
Q

What is the equation for Reynolds number?

A

Density
*Diameter
*Velocity

Divided by

Viscosity

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39
Q

How to calculate FiO2?

A

FiO2 = (air flow rate * 21) + (O2 flow * 100)

Divided by

Total flow rate

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40
Q

What should you do if a vaporizer tips over?

A

Drain the vaporizer to remove all liquid

Turn the dial to the highest setting and run high FGF for 20-30 minutes

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41
Q

What is the T setting on the vaporizer?

A

Transport mode- Don’t need to worry about the vaporizer tipping over

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42
Q

What is the most common cause of a vaporizer leak?

A

Loose filler cap

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43
Q

Does a variable bypass vaporizer need to be calibrated for elevation?

A

No

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44
Q

How does the vaporizer minimize the effect of cooling on vapor pressure and vaporizer output?

A

The temperature compensating valve adjusts the ratio of flow

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45
Q

Isoflurane dial is set to 2%. What percent of fresh gas exiting the VAPORIZING CHAMBER is saturated with iso?

(This is a variable bypass)

A

100%

Some fresh gas enters and saturates with 100%

The remainder of fresh gas bypasses and mixes after the vaporizer

Flow over method

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46
Q

How does a TEC 6 vaporizer work? (This is Injector)

A

Des has a vapor pressure closer to atmospheric pressure

Tec 6 injects a precise amount of vaporized Des directly into the fresh gas flow

Output is increased inside a hyperbaric chamber

Pressurized to two atmospheres

Heated to 39 degrees

Does not split gas

Heat creates vapor

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47
Q

Which vaporizers compensate for elevation?

A

Variable bypass

*Tec 6 needs to be recalibrated

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48
Q

Which vaporizer requires electrical power?

A

Injector (Tec 6)

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49
Q

Which vaporizer has a dual circuit design?

A

Injector (Tec 6)

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50
Q

Which device is the first to detect an oxygen pipeline crossover? Where is it located?

A

O2 analyzer - Inspiratory limb

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51
Q

What are the two types of O2 analyzers?

A

Galvanic fuel cell - must be calibrated daily and replaced

Paramagnetic device - self calibrating, FASTER response time

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52
Q

** What is the normal O2 consumption of the average adult?

A

250mL/min

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53
Q

Why will a pyrexic 70kg patient become hypoxic with an O2 flow rate at 250mL/min in a closed circuit system?

A

Pyrexic patients require more O2 then the standard 250mL.

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54
Q

What other conditions increase O2 consumption?

A

Fever, Sepsis, thyrotoxicosis

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55
Q

What are the most critical actions to perform during an O2 pipeline crossover?

A

-Disconnect the pipeline supply
-Turn on O2 tank

56
Q

What should be at the top of your differentials when the O2 analyzer alarms?

A

O2 pipeline crossover

57
Q

What minimizes the risk of barotrauma when using the O2 flush valve?

A

Ventilators with fresh gas decoupling

58
Q

When the O2 flush valve is pressed, What is the flow of O2? What is the pressure?

A

35-70L

50 Psi from the pipeline

59
Q

Using the O2 flush valve can cause what?

A

Barotrauma

Awareness from dilution of anesthetic gas

60
Q

What are the two functions of the drive as on a pneumatic ventilator?

A
  1. Compress the bellows
  2. Opens and closes the ventilator spill valve
61
Q

Methods to reduce barotrauma?

A

Fresh gas decoupling (isolate the tidal volume from the flowmeters and O2 flush valve)

Inspiratory pressure limiter (APL valve)

62
Q

What is an off label use for the O2 flush valve?

A

As a jet ventilator (Not recommended by manufacturer

63
Q

What position is the ventilatory spill valve in during inspiration?

A

Closed - to ensure delivery of set TV

64
Q

What is the minimum expiratory pressure needed to open the ventilator spill valve?

A

3 cm h2o

65
Q

If there is a hole or leak in the bellows of a pneumatic ventilator what may happen?

A
  • An INCREASE in the O2 analyzer
  • Barotrauma

*bellows can still drive

66
Q

What changes with Descending or upside down bellows

A

-Falls with expiration
-May continue to rise and fall with circuit disconnect
-May cause low volume and low pressure alarms

67
Q

What is different with a piston driven ventilator?

A

-Preserves tank oxygen because it is not relying on the gas for the driving pressure
-Allows for a more precise delivery of tidal volumes

68
Q

Which ventilator delivers 3cm h2o of intrinsic peep?

A

-Bellow driven

69
Q

Which ventilator decouples FGF from Vt

A

Piston driven

70
Q

Which ventilator contains a negative pressure relief valve?

A

Piston driven

71
Q

Which ventilator contains a positive pressure relief valve?

A

Piston driven

72
Q

Does the reservoir bag inflate with expiration on a piston ventilator? On inspiration?

A

No

Inflates with inspiration

73
Q

Is lung injury increased or decreased with a pressure controlled ventilation?

A

Decreased

74
Q

Does gas flow accelerate or decelerate during inspiration with PCV?

A

Decrease

75
Q

What is a disadvantage of PCV?

A

Increased in airway resistance or decreased lung compliance reduces tidal volume

Requires extra attention with conditions that alter pulmonary resistance or compliance

76
Q

PCV - What conditions decrease compliance?

A

Pneumoperitoneum

Trendelenburg position

77
Q

PCV - What conditions decrease resistance?

A

Bronchodilators
Removing airway secretions

78
Q

PCV - What conditions increase compliance?

A

Release of pneumoperitoneum
Going from Trendelenburg to supine

79
Q

PCV - What conditions increased resistance?

A

Bronchospasm
Kinked ETT

80
Q

What increases Vt?

A

increased compliance
decreased resistance

81
Q

What decreases Vt?

A

Decreased compliance
Increased resistance

82
Q

When is PCV better than VCV?

A

-Patient has low compliance
-High Pip would be dangerous
-Compensate for a leak

83
Q

What patients are at risk for low compliance?

A

Pregnancy
Obesity
Laparoscopy
ARDS

84
Q

What patients would high PiP be dangerous?

A

LMA
Neonate
Emphysema

85
Q

What patients need to compensate for an air leak?

A

LMA
Uncuffed ETT in children

86
Q

What ventilator mode has a fixed inspiratory flow?

A

VCV

87
Q

What ventilator mode has a fixed tidal volume?

A

VCV

88
Q

What ventilator mode has a fixed PiP?

A

PCV

89
Q

What ventilator mode has a variable Inspiratory flow?

A

PCV

90
Q

What ventilator mode has variable tidal volume?

A

PCV

91
Q

What ventilator mode has a variable PIP?

A

VCV

92
Q

What ventilator mode is best for an LMA

A

SIMV
Pressure Support

93
Q

When is Inverse Ratio ventilation (IRV) used?

A

Small FRC and ARDS

*****MUST be paralyzed and sedated

Risk of hyperinflation or auto peep

94
Q

When using assist control, is respiratory acidosis or alkalosis a risk?

A

Respiratory alkalosis

95
Q

Does pressure support have a backup for apnea?

A

No

96
Q

Does BiPap require a set Vt?

A

No

97
Q

At what pH does the ethyl Violet turn purple?

A

10.3

98
Q

How does soda lime react?

A

-CO2 and water create carbonic acid
-Carbonic acid creates sodium carbonate
-Sodium carbonate creates calcium carbonate and sodium hydroxide

99
Q

What is the best balance of mesh granules?

A

4 - 8 Mesh

Granules around 1/4 diameter

100
Q

What are the two main problems with soda lime?

A

-Exhausted - unable to neutralize CO2

-Desiccated - too dry

101
Q

What role does silica play in CO2?

A

Provides hardness and minimizes dust production and decreases flow resistance

102
Q

Does turning purple indicate desiccation ?

A

No. Only if it is exhausted

103
Q

What are the benefits of Calcium hydroxide lime?

A
  • No Carbon monoxide production
    -Minimal Compound A production
    -Lower risk of fire
104
Q

What are the drawbacks of Calcium hydroxide lime?

A

Lower CO2 absorption

Frequent cannister changes

More expensive

105
Q

A patient is ventilating spontaneously with an ET tube, a FGF of 10L is required to fill the breathing bag and you determine it is a malfunctioning scavenger system. Why?

A

An active system is using too much suction because the negative pressure relief valve has failed

106
Q

What is the function of the scavenging system? What is the most critical component?

A

Remove excess gas from the anesthesia circuit

Interface

107
Q

What happens if they scavenger removes too much gas? Too little?

A

Too much - negative pressure in circuit

Too little - barotrauma

108
Q

What controls the scavenger during spontaneous ventilation?

A

APL valve

109
Q

What controls the scavenger during mechanical ventilation?

A

Ventilator spill valve

110
Q

What are the five components of the scavenging system?

A
  1. Gas collecting assembly
  2. Transfer tubing
  3. Interface
  4. Gas disposal tubing
  5. Gas disposal system
111
Q

What determines if the scavenger system is open or closed?

A

-The interface

112
Q

What type of scavenging system communicates with the atmosphere with pressure valves

A

Closed

113
Q

What valves must be present on closed interface - active system?

A
  1. Negative and Positive pressure relief valves
114
Q

What is the most common cause of low circuit pressure?

A

Circuit disconnect

  1. Y piece
  2. Co2 cannister
115
Q

What is the most common source of preventable equipment related complications?

A

Circuit disconnect

116
Q

4 ways to evaluate circuit disconnect

A

-Pressure
-Volume
-EtCO2
-Your vigilance

117
Q

You notice a high-pressure alarm but it goes away when the ventilator is switched over to bag. What is the cause?

A

Ventilator spill valve malfunctioned

118
Q

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

A

-Decreased Venous return
-Decreased cardiac output
-Hypotension
-Cardiovascular collapse

119
Q

If the ventilator spill valve fails during a case, what do you do?

A

Bag
TIVA

120
Q

What are the OSHA recommendations for gas exposure?

A

Solo Nitrous < 25 ppm

Solo agents < 2 ppm

Combined agents < 0.5 ppm and <25 ppm

121
Q

What would cause a negative pressure inside the breathing circuit?

A

-Malfunctioned of a closed system scavenger
-OG in the trachea

122
Q

What is the most likely cause of a lower-than-expected concentration of sevo in the breathing circuit?

A

A bellow leak

123
Q

What would cause a higher concentration of sevo in the breathing circuit?

A

-Tipped vaporizer
-Pumping effect

-NOT altitude because sevo automatically adjusts

124
Q

What is the minimum pressure when performing a high pressure leak test?

A

30

125
Q

When will you see a negative deflection in the airway pressure waveform ? What about a positive?

A

-Negative - The patient is initiating the breath

-Positive - Machine initiated

126
Q

What two devices will notify you of a pipeline crossover?

A

-O2 Analyzer

-SpO2 (Very very late sign)

127
Q

What is laminar flow dependent on? What law?

A

Gas viscosity - Poiseuille

128
Q

What is turbulent flow dependent on? What law?

A

Gas density - Graham

129
Q

How do you determine the tidal volume on a ventilator that uses fresh gas coupling?

A

Vt = Vt on ventilator + FGF

130
Q

When using a ventilator that couples fresh gas flow to tidal volume, what types of changes will impact the Vt delivered to the patient?

A

Increase Vt
-Decrease RR
-Increase I:E
-Increase FGF
-Increase bellow height

Decrease Vt
-Increase RR
-Decrease I:E
-Decrease FGF
-Decrease Bellow height

131
Q

If the soda lime is exhausted in the middle of gas what is the best action to take?

A
  1. Replace cannister
  2. Increase FGF to convert to a semi-open system from a circle system
132
Q

What is produced from Sevo? What does this lead to?

A

Compound A

Renal Dysfunction

133
Q

What is produced from Iso and Des? What does this lead to?

A

Carbon monoxide - carboxyhemoglobinemia

Des > Iso

134
Q

What role does water play in CO2 absorbent?

A

Required to facilitate the reaction of CO2

Granules are 15% water weight

135
Q

What safety mechanism does not monitor for a disconnection of the breathing circuit?

A

O2 analyzer - Just monitors the concentration

Monitoring (10 decks)

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