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october exam > anesthesia machine > Flashcards

anesthesia machine Flashcards

1
Q

where does the high pressure system begin and end

A

begins at cylinder and ends at cylinder regulators

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2
Q

components of high pressure

A

hanger yoke, yoke block with check valves, cylinger pressure gague, cylinder pressure regulators

gas pressure= cylinder pressure

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3
Q

where does intermediate pressure system begin and end

A

begins: pipeline
ends: flowmeter valve

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4
Q

components of intemediate

A

pipeline inlets, pressure gagues, ventilator power inlet, oxygen pressure failure system, oxygen second stage regulator, oxygen flush valve, flowmeter valve

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5
Q

gas pressure if using pipeline vs tank

A

50 psi if pipeline
45 psi if tank

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6
Q

where does low pressure begin and end

A

beggins at flow meter tubes and ends at common gas inlet

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7
Q

components of low pressure

A

flowmeter tubes, vaporizers, check valves, common gas outlet

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8
Q

5 tasks of oxygen in anesthesia machine

A

o2 pressure failure alarm, o2 pressure failure device, o2 flowmeter, o2 flush valve, ventilator drive gas (if pneumatic bellows)

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9
Q

pin index safety system

A

PISS- prevents inadvertent misconnections of gas cylinders

on each hanger yoke

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10
Q

what could lead to bypass of PISS

A

presence of more than one washer between hanger yoke and tank

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11
Q

diameter index safety system

A

DISS- prevents inadvertent misconnectios of gas hoses- each hose and connector are sized and threaded for each individual gas

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12
Q

max pressure and volume for o2 tank

A

1900 psi
2, 5 pin
660 L

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13
Q

air tank

A

625 L
1900 psi
pin 1, 5

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14
Q

n2o tank

A

1590 L
745 psi
pin 3,5

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15
Q

what does n2o tank weigh empty

A

14.1 lb (about 20 lb full)

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16
Q

how do you know if a cylinder is mri safe

A

most of it will be silver- only the top will be colored so you know what gas it is

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17
Q

gas cylinders should neber be exposed to temperatures above

A

130 F

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18
Q

if a gas cylinder is exposed to a temperature too high what can happen

A

a fire or explosion

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19
Q

how may the oxygen pressure failure device permit the delvery of a hypoxic mixture

A

the failsafe device responds to pressure NOT flow- if there is a pipeline crossover- the pressure of the second gas produces pressure to defeat the failsafe device- the patient gets exposed to a hypoxic mixture

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20
Q

what situation devices will hypoxia prevention safety devices not allow delivery of hypoxic mixture

A

oxygen pipeline crossover, leaks distal to flowmeter valves, administration of 3rd gas, defective mechanic or pneumatic components

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21
Q

whats the difference between oxygen pressure failure device and hypoxic prevention safety device

A

oxygen pressure failure device: fail safe device- shuts off and reduces n2o flow is o2 pressure drops below 20 psi

hypoxia prevention safety device: proportioning device- prevents you from setting hypoxic mixture with flow control valves- limits n2o flow to 3x o2 flow

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22
Q

where should o2 flowmeter be positioned

A

always furthest right

made of glass- most delicate part of the machine!!! - a leak can cause hypoxic mixture- oxygen should be closest to manifold so leak in any of the others will not reduce fio2 delivered to the patient

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23
Q

what is the vaporizer splitting ratio

A

modern variable bypass vaporizers split fresh gas into 2 parts

  1. some fresh gas enters the vaporizing chamber and becomes 100% saturated with a volatile agent
  2. the rest of the gas bypasses the vaporizing chamber and does not pick up any volatile agent

before leaving, they mix and this determines the final anesthetic concentration enxiting the vaporizer

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24
Q

what is the pumping effect

A

it can increase vaporizer output.

basically anything causing gas that has already left the vaporizer to re enter the chamber causes the pumping effect. generally due to pos pressure ventiilation or oxygen flush valve

not a risk in modern machines

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25
Q

what is an injector type vaporizer

A

desflurane

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26
Q

what temp is des vaporizer heated to

A

39 C

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27
Q

are vaporizers in circuit or out of circuit

A

out

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28
Q

what does the oxygen analyzer monitor

A

oxygen concentration (not pressure)

it is the only device downstream of flowmeters that can detect a hypoxic mixture

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29
Q

what system do leaks most often occur in the machine

A

low pressure system

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30
Q

what do you do if there is an oxygen supply line crossover

A
  1. turn ON oxygen cylinder
  2. disconnect pipeline oxygen supply - KEY STEP

turning on cylinder will not save pressure b/c it will still pull from pipeline if pressure is fine regardless of the gas inside

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31
Q

2 risks of pressing oxygen flush valve

A

barotrauma and awareness

the gas from here does not flow through vaporizers so no anesthesia in it

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32
Q

what is volume controlled ventilation

A

delivers a preset tidal volume over predetermined time- volume is fixed so inspiratory pressure will vary as patients compliance changes. the inspiratory flow is held constant during inspiration

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33
Q

what is pressure control ventilation

A

delivers preset inspiratory pressure. pressure and time fixed

tidal volume and inspiratory flow varies- depends on pt lung mechanics

if resistance rises or lung compliance decreases- vt suffers and higher inspiratory flow is needed to achieve preset airway pressure

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34
Q

what do you do if you notice soda lime has been exhausted in the middle of the surgical procedure

A

increase fresh gas flow to convert it into a semi open configuration

increasing minute ventilation will not help

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35
Q

what is dessication

A

when absorbent is devoid of water

ethyl violet tells you about exhaustion but it does not tell you about the water content

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36
Q

what does a dessicated soda lime cause

A

carbon monoxide-> carboxyhemoglobinemia

compound a-> renal dysfunction

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37
Q

7 ways to monitor for disconnection of breathing circuit

A

precordial, visual inspection of chest rise, capnography, resp volume monitors, low expired volume alarm, low peak pressure alarm, failure of bellows to rise with ascending bellows (not with descending)

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38
Q

what is the purpose of unidirectional valves

A

ensure gas moves in one direction

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39
Q

what happens if a valve becomes incompetent

A

patient rebreathes exhaled gas- if you cannot fix the valve- increase FGF

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40
Q

what is decreased pulmonary compliance due to

A

a reduction in static compliance (PIP and PP increase)

-endobronchial intubation, pulmonary edema, pleural effusion, tension pneumo, atelectasis, chest wall trauma, abdominal insufflation, ascites, trend, inadequate muscle relaxation

41
Q

what conditions increase pulmonary resistance

A

usually due to reduction in dynamic compliance

kinked ett, endotracheal tube cuff herniation, bronchospasm, bronchial secretions, compression of the airway, foreign body aspiration

42
Q

what are the 4 phases of a normal capnograph

A

phase 1: (first flatline) exhalation of anatomic dead space
phase 2: (upstroke) exhalation of anatomic dead space and alveolar gas
phase 3: (top flatline): exhalation of alveolar gas
phase 4: inspiration of fresh gas not containing co2

43
Q

what happens if the alpha angle increases

A

alpha angle is the angle on the capnography on the left-

indicates expiratory airflow obstruction

copd, bronchospasm or kinked ett

44
Q

what does an increased beta angle mean

A

rebreathing

faulty unidirectional valve

45
Q

list some reasons that cause increased etco2

A

increased BMR, malignant hyperthermia, thyroxicosis, fever, sepsis, seizures, laproscopy, tourniquet/ vascular clamp removal, na bicarb administration, anxiety, pain, shivering, increased muscle tone (after nmb reversal), med side effect

46
Q

list some reasons of decreased etco2

A

decreased bmr, increased anesthetic depth, hypothermia, decreased pulmonary blood flow, decreased co, hotn, pulmonary embolism, v/q mismatch, med side effect

47
Q

what are some equipment causes of increased etco2

A

rebreathing, co2 absorbent exhaustion, unidirectional valve malfunction, leak in breathing circuit, increased apparatus dead space

48
Q

what are some equipment malfunction causes of decreased etco2

A

ventilator disconnection, esophogeal disconnect, esophogeal intubation, poor seal with ett or LMA, sample line leak, airway obstruction, apnea

49
Q

what law is the pulse ox based on

A

beer lambert law

50
Q

explain beer lambert law

A

relates intensity of light transmitted through a solution and the concentration of the solute within the solution

51
Q

what 2 wavelengths of light does the pulse ox emit

A

red light (660 nm) - preferentially absorbed by deoxyhemoglobin (higher in venous blood

near infrared light (940 nm) - preferentially absorbed by oxyhemoglobin - higher in arterial blood

52
Q

what will impair the reliability of the pulse ox

A
  1. decreased perfusion- vasoconstriction, hypothermia, raynauds
  2. dysfunction hgb- carboxyhemoglobin, methemoglobin, nOT hgbS or hgbBF
  3. altered optical characteristics: methylene blue, indocyanine green, indigo carmine, NOT fluroscein
  4. non pulsatile flow- CBP, LVAD
  5. shivering/ movement
  6. electrocautery, dark skin, venous pulsation, NOT jaundice or polycythemia
53
Q

what is the ideal bladder length of BP cuff

A

80% of extremity

54
Q

what is the ideal bladder width of BP cuff

A

40%

55
Q

as pulse moves from aortic root to periphery what changes with SBP and DBP

A

at aortic root SBP is lowest, DBP is highest, PP is narrowest

dorsalis pedis SBP is highest, DBP lowest and PP is widest

56
Q

if bp cuff is above heart bp reading will be false

A

decreased (less hydrostatic pressure)

57
Q

what does it mean to be optimally damped

A

baseline is re-established after 1 oscillation

58
Q

what does it mean to be under damped

A

the baseline is re-established after several oscillations (SBP is overestimated, DBP is underestimated, and MAP is accurate)

59
Q

what does it mean to be over damped

A

the baseline is re established with no oscillations (SBP is underestimated, DBP is overestimated and MAP is accurate)

causes: air bubble, clot in pressure tubing or low flush bag pressure

60
Q

what does a mean on cvp waveform

A

rA contraction

61
Q

what does c mean on cvp waveform

A

tricuspid valve elevation into RA

62
Q

what does x mean on cvp waveform

A

downward movement of contracting RV

63
Q

what does v mean on cvp waveform

A

RA passive filling

64
Q

what does y mean on cvp waveform

A

RA empties through open tricuspid valve

65
Q

what increases cvp value

A

transducer below phlebostatic axis, hypervolemia, RV failure, tricuspid stenosis or regurg, pulmonic stenosis, peep, vsd, constructive pericarditis, cardiac tamponade

66
Q

factors that decrease CVP

A

transducer above phlebostatic axis, hypovolemia

67
Q

what conditions cause loss of a wave on CVP waveform

A

when synchronized contraction fo RA is lost

-a fib
-v pacing (if underlying rhythm is asystole)

68
Q

what causes an increased a wave on cvp waveform

A

tricuspid stenosis, diastolic dysfunction, myocardial ischemia, chronic lung dz rv hypertrophy, av dissociation, junctional rhythm, v pacing asyn, pvs

69
Q
A
69
Q

what causes large v waves

A

tricuspid regurg, acute increase in intravascular volume, RV papillary muscle ischemia

70
Q

what does the pressure and waveform of PA look like in RA

A

1-10 (flat wave)

71
Q

what does the pressure and waveform of PA look like in RV

A

15-30/ 0-8

tall!

72
Q

what does the pressure and waveform of PA look like in PA

A

you see the dicrotic notch

15-30/ 5-15

73
Q

what does the pressure and waveform of PA look like in PAOP

A

lvedp

still see notch but it gets short (can see a, c, v)

5-15

74
Q

the tip of the PAC should be in what west zone

A

3

75
Q

what causes decreased svo2

A

increased o2 consumption: stress, pain, thyroid storm, shivering, fever

decreased o2 delivery: decreased pao2, decreased hgb, decreased CO

76
Q

what causes increased svo2

A

decreased o2 consumption: hypothermia, cyanide toxicity

increased o2 delivery: increased pao2, increased hgb, increased CO

77
Q

what are the bipolar leads

A

I, II, III

78
Q

what are the limb leads

A

avl, avr, avf

79
Q

what are the precordial leads

A

v1-v6

80
Q

causes of R axis deviation

A

copd, acute bronchospasm, cor pulmonale, pulmonary htn, pulmonary embolus

81
Q

causes of L axis deviation

A

chronic htn, LBBB, aortic stenosis, aortic insufficiency, mitral regurg

82
Q

class 1 antiarrhythmic

A

Na channel blockers

depresses phase 0; prolongs phase 3

83
Q

class 2 antiarrhythmics

A

beta blockers

slows phase 4- depol in sa node

84
Q

class III MOA

A

K channel blockers

prolongs phase 3 repolarization- ex: amiodarone

85
Q

class IV antiarrhythmic

A

ca channel blockers- decreases conduction velocity through AV node (verapamil and diltiazem)

86
Q

what ekg findings are consistent with wolff parkinson white syndrome

A

delta wave caused by ventricular preexcitation

short PR interval <0.12 seconds

wide QRS complex

possible T wave inversion

87
Q

what increases risk of torsades de pointes

A

POINTES

phenothiazines
other meds (methadone, droperidol, amiodarone w/ hypokalemia)
intracranial bleed
no known cause
t1 antiarrhtyhmic
electrolyte (low K, ca, mag)
syndromes (timothy, romano-ward)

88
Q

treatment for torsades

A

mag
cardiac pacing to increase HR - reduce AP duration and QT interval

89
Q

what conditions increase the risk of failure to capture

A
  • high and low K
    -hypocapnia
    -hypothermia
    -MI
    -fibrotic tissue buildup around the pacing leads
    -antiarrhtyhmic meds
90
Q

how does the cerebral oximetry work

A

utilizes NIRS (near infrared sectroscopy)- to measure cerebral oxygenation

91
Q

how do brain waves change during GA

A

-indution of GA is associated with increased beta wave acitvity
-light anesthesia is associated with increased beta wave activity
-theta and delta waves predominate during GA
-deep anesthesia produce burst suppression
-at 1.5- 2.0 MAC GA cause complete suppression or isoelectricity

92
Q

name 2 drugs that are most likely to reduce the reliability of the BIS

A

-nitrous oxide - increases amplitude of high frequency activity and reduces the amplitude of low frequency ativity. does not affect the BIS value

-ketamine- increases high frequency activity- can produce a higher BIS than the level of sedation/ anesthesia

93
Q

what is the difference between macro and microshock

A

macroshock: comparatively lg amount of current that is applied to the external surface of the body. the skins impedance offers a high ersistance so it takes a larger current to induce v fib

microshock: comparatively smaller amount of current that is applied directly to the myocardium- high resistance to skin is bypassed- takes a significantly smaller amount of current to induce v fib

94
Q

what is the role of the line isolation monitor

A

line isolation monitor assess the integrity of the underground power system in the OR

tells you how much current could potentially flow through you or the pt if a second fault occurs

95
Q

what is the main purpose of the LIM (line isolation monitor)

A

alert the OR staff at first fault

96
Q

can the LIM protect you or the patient from macro or micro shock

A

no- not by itself

97
Q

when will the LIM alarm

A

when 2-5 mA of leak current is detected

98
Q

if the alarm sounds what do you do

A

last piece of equipment that was plugged in should be unplugged

october exam (12 decks)

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