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FNA > Anesthesia Machine > Flashcards

Anesthesia Machine Flashcards

1
Q

How can the hypoxic guard fail?

A
  • Crossover
  • Leak (crack in FM)
  • Defective guard
  • Inert gas (ex Helium)
  • Use of Air
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2
Q

What are the types of O2 analyzers available?

A
  • Electrochemical/Galvanic fuel cell (Aestiva, Aespire, Fabius)
    • Paramagnetic Analyzer (used in most models)
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3
Q

Rate of vaporization depends on what 3 factors?

A
  • Temp
    • VP of liquid
    • Pressure above evaporating gas
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4
Q

What are some hazards of contemporary vaporizers?

A
  • You can fill with wrong agent
    • Tipping/Spills
    • Overfilling
    • Leaks
    • Electronic failures
    • Reliance on breath by breath gas analysis rather than preforming regular preventative maintenance)
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5
Q

(Wash-in Time Constant) You have a patient on 5L/min FGF and the circle system is about 10L, in 4min how much of 6% Des will you have given your patient?

A
  • 2nd constant (86%) so 6 x 0.86 = 5% Des
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6
Q

How can resistance in a breathing circuit be minimized?

A
  • Reduce tubing length
    • Increase its diameter
    • Avoid sharp bends/kinks
    • Ensure laminar flow
    • Eliminate valves
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7
Q

Advantages of Rebreathing?

A
  • Reduced cost
    • Increase tracheal heat and humidity
    • Reduce staff exposure
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8
Q

Effects of rebreathing N2O?

A
  • Delayed induction
    • Longer to reach agent % concentration
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9
Q

Effects of rebreathing CO2?

A
  • Respiratory acidosis
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10
Q

Where does dead space end?

A
  • Y-piece
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11
Q

Anesthesia gases are considered what and why?

A
  • Dry gases to reduce internal corrosion and bacterial colonization
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12
Q

Describe the types of circle systems?

A
  • SEMI OPEN
    - Rebreathing unlikely
    - FGF > Ve
    • SEMI CLOSED
      • Rebreathing likely
      • FGF < Ve
    • CLOSED
      • 100% Rebreathing
      • FGG <= 1L/min
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13
Q

Describe Open circuit? What are some features?

A
  • Mask, NC, or Mapelson models
    • Features
      • No unidirectional valves
      • No CO2 absorber
      • FGF determines amount of rebreathing
      • Resistance and WOB are low
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14
Q

When can you use a Mapleson A or D, and what is a modified mapelson D?

A
  • Mapleson A = spontaneously breathing
    • Mapelson D = controlled ventilation
    • Modified Mapelson D = Bain
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15
Q

Disadvantages of non-rebreathing

A
  • Unrecognized disconnect
    • Increased cost
    • Increased staff exposure
    • Loss of heat from pt
    • May require disconnect for assembly and can be reassembled improperly
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16
Q

What is the name of the leak test for a nonrebreathing system like a Bain?

A
  • Pethick Test
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17
Q

What are 2 reasons for inspired CO2

A
  • Exhausted CO2
    • Faulty unidirectional valves
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18
Q

Advantages of a Circle System

A
  • Constant inspired concentrations
    • Conserve heat & humidity
    • Min Staff Exposure
    • Low resistance
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19
Q

Disadvantages of Circle System

A
  • Complex
  • Misconnection/Disconnection
  • Malfunction of unidirectional valve
  • Less portable
  • Increased dead space
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20
Q

When do you want to use High FGF:

A
  • Smoke inhalation injury
    • MHT
    • Uncuffed ETT
    • Rigid broncoscopy
    • Face mask use
    • Older equipment
21
Q

What is the chemical formula of co2 absorbent process?

A
22
Q

Where do reactions take place for CO2 absorber?

A
  • On surface
23
Q

Why are hardeners used in CO2 absorbers?

A
  • To reduce dust and irritation
24
Q

What is the manufactured water content and size of granules for CO2 absorber?

A
  • Water content 13-20%
    • Size of granules is 4-8 Mesh (pass through 4-8 holes/inch)
25
Q

Clinical Signs of Exhausted CO2 absorbent

A
  • Increased ETCO2
    • Resp acidosis
    • Hypervent
    • Increased bleeding
    • Color of CO2 indicator (purple)
    • SNS activation
    • Late signs: increased HR & BP, dysrhythmias
26
Q

How do you identify a disconnected Piston Ventilator

A
  • Low pressure alarm
    • No ETCO2 waveform
    • Movement of manual breathing bag (which should not be in use during vent)
27
Q

What are the benefits of FGD

A
  • Constant Vt
    • Pt safety (reduce barotrauma)
    • enhanced control of low flow
28
Q

Disadvantages of FGD

A
  • Limited effect in some cases
    • Technical complexity
    • Not suitable for spontaneously breathing pt
29
Q

When would you want to use FGD

A
  • Low flow anesthesia
    • Pt on vent with low compliance (ex. ARDS, COPD, OBESE)
    • Pediatric anesthesia
30
Q

Benefits of Low Flow

A
  • Reduced pollution
    • Environmental sustainability
    • Reduced cost
    • Preserve tracheal heat and moisture
    • Prevent CO2 from desiccating
    • Preserve body temp
    • Electronic peep
31
Q

Causes of Low Pressure

A
  • Disconnect (Y-piece most common site)
    • Poor seal absorbent, defective absorbent (second common site)
    • Failure of bag/vent switch
    • Leak in corrugated tubing
    • Incompetent spill valve
    • Gas sampling line preventing manual ventilation
    • Ventilator failure due to moisture in flow sensors
32
Q

How can you tell when there is barotrauma

A
  • Excessive inflow (positive pressure)
    • Flutter valve may be stuck closed
    • Control assembly problems
33
Q

What is the primary monitor for a disconnect

A
  • Continuous auscultation (stethoscope) & visual chest rise
34
Q

What causes high pressure in the circuit

A
  • Spill valve malfunction
    • Failure to remove plastic of co2 absorber
    • Failure to remove plastic from anesthesia mask
    • Occlusion of lumen of circuit
    • Malfunctioning PEEP valve
    • Malfunction flutter valve or scavenger
35
Q

What would you do if your machine shoots the High pressure alarms

A
  • Assess pt related causes
    • Switch to bag mode and manually vent pt
    • Consider disconnect and use ambu bag/TIVA
36
Q

If high pressure is resolved when you switched to bag mode, what was the most likely cause?

A
  • Spill valve
37
Q

If high pressure is sustained when you switch to bag mode, what is the most likely cause?

A
  • APL or scavenger
38
Q

Describe an Active Open Scavenging system

A
  • Suction with canister open to room air
    • Too much suction: room air is entrained into system
    • Too little suction: scavenged gas released into room
    • No need for (+) or (-) pressure relief valves
39
Q

Describe an Active Closed Scavenging system

A
  • Suction with bag
    • Has positive and negative relief valves
40
Q
  • Describe a Passive Closed Scavenging system
A
  • No suction with bag
    • Has positive relief valve
    • No negative relief valve needed as no suction is applied
41
Q

5 tasks of O2

A

Flowmeter
O2 Flush
Drive Gas
Low O2 Pressure Alarm
Fail Safe

42
Q

Describe the channeling effect

A

The channeling effect in CO₂ absorbers reduces efficiency by allowing gas to bypass the absorbent, limiting CO₂ removal.

The channeling effect in CO₂ absorbers occurs when the gas follows paths of least resistance, bypassing large portions of the absorbent material. This reduces the absorber’s efficiency, as less CO₂ is removed due to limited interaction with the absorbent. Proper packing, maintenance, and timely replacement of the absorbent help minimize this effect.

43
Q

OSHA Regulations for Exposure to Waste Anesthetic Gases

A
  • Halothane < 2PPM
  • Halothane + N20 < 0.5PPM
  • N20 < 25PPM/8hr

Levels in unscavenged anesthetizing locations may be as high as 7000PPMM (0.7%) N2O and 85 PPM (0.008%) Halothane

44
Q

What does American Society for Testing & Materials (ASTM) set

A

Sets standards for required components of anesthesia machine via document ASTM F1850

45
Q

What does FDA regulate

A

1993 Anesthesia Machine Checkout and requirements for medical gases.

  • slide states: equipment/vaporizer/monitor/volatile
46
Q

What does DOT (dept of transportation) regulate

A

Manufacturing, handling, transport, storage and disposal for CYLINDERS

47
Q

What does Compressed Gas Association (CGA) and the National Fire Protection Association (NFPA) regulate

A

Role in setting cylinder standards

48
Q

What does US Pharmacopeia (USP) regulate

A

Requirements of medical gases like FDA

FNA (6 decks)

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