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5102-Clinical > Anesthesia Machine > Flashcards

Anesthesia Machine Flashcards

1
Q

What are the 5 tasks of oxygen?

A
  • ventilator driving gas
  • flush valve
  • flow meters
  • oxygen pressure failure alarm
  • oxygen pressure sensor shut-off valve
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2
Q

High pressure system parts

A

consists of those parts which receive gas at cylinder pressure:

  • cylinder
  • hanger yoke assembly (including filter, block, and unidirectional valve)
  • cylinder pressure gauge
  • cylinder pressure regulators
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3
Q

Intermediate pressure system parts

A

Receives gases at low, relatively constant pressures (37-55 psi, which is pipeline pressure or cylinder regulator):

  • pipeline connection
  • pipeline pressure gauges
  • ventilator power outlet
  • master switch
  • oxygen pressure failure device (fail-safe)
  • flowmeter control valves
  • oxygen and nitrous oxide 2nd stage regulators
  • oxygen flush valve
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4
Q

Low pressure system parts

A

includes components distal to the flowmeter needle valves:

  • flowmeter tubes
  • vaporizers
  • check valves
  • low pressure pipes
  • common gas outlet
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5
Q

PISS purpose

A

Pin Index Safety System- a safety mechanism that places pins in different spots specific to the gas so that cylinders of one gas can only connect to that yoke.
air- 1,5
O2- 2,5
N20- 3,5

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6
Q

DISS

A

Diameter Index Safety System- Safety system on machine for connections specific to each gas. Each connection has different diameter.

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7
Q

Flowmeter

A

calibrated to specific gas
laminar flow=viscosity
turbulent flow=density

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8
Q

What does a fail-safe system do?

A

O2/N2O ratio controller- links the O2 & N2O to prevent administration of hypoxic mixture. Operated by pressure. As O2 pressure decreases, the N2O moves proportionally.

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9
Q

Vaporizers

A

located b/w the flow meter & common gas outlet. interlocking device to only allow administration of one agent

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10
Q

common fresh gas outlet

A
  • only one outlet through multiple inlets
  • anti disconnect device to prevent detachment
  • oxygen flush 35-55 L/min through it
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11
Q

4 functions of anesthesia machine

A

receive, measure, and deliver O2 & other gases & inhalation agents at a safe pressure

  • provide ventilation to pt
  • remove CO2
  • remove excess gas
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12
Q

4 major causes of injury from anesthesia machine

A
  • insufficient O2 delivery to brain
  • insufficient CO2 removal
  • excessive anesthetic gas pressure-barotrauma
  • foreign matter injury to airway-aspiration
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13
Q

3 models for anesthesia machine

A
  • simplified
  • pneumatic
  • intermediate pressure
  • low pressure
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14
Q

What are 2 options for receiving medical gases

A
  • hospital gas delivery system

- attached cylinders

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15
Q

What are 3 pressure areas of anesthesia machine?

A

High pressure system=cylinder pressure=2000 psig
intermediate pressure system= 45-55 psig
low pressure system= 16 psig

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16
Q

What are the three primary valves in anesthesia machine and their purpose?

A

free floating valve- pushed by gas flow, prevents gas leak from system

ball & spring valve=primary function permit gas flow after connection is made, “all or nothing”

diaphragm valve= reduce pressure, the 1st and 2nd stage regulators

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17
Q

Critical temp of O2

A

-119 degrees C

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18
Q

Critical temp of N2O

A

39.5 degrees C

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19
Q

Adiabetic process

A

constant heat that occurs when cylinder is opened rapidly in closed space. Temp will raise rapidly d/t change occurring quickly and heat cannot dissipate

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20
Q

5 rules for safe handling of a cylinder

A
  • always stand upright with support, if no support lay on side
  • do not leave empty cylinders on machine
  • do not leave plastic cover on port when installing
  • never oil valves
  • place yolk plugs if leaving space empty
  • never use more than one washer b/w cylinder port and yoke
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21
Q

What is the starting and ending pressure of oxygen in the intermediate pressure circuit?

A

start around 50 psig and decrease to 12

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22
Q

Starting and pressure of N2O in the intermediate pressure circuit?

A

around 50 psig and decreases to around 16

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23
Q

What does the check valve do?

A

prevents back-flow into the vaporizer during positive pressure ventilation

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24
Q

What is the back up for the pipeline supply?

A

The E-cylinders

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25
Q

What are the two steps that must be followed if a suspected crossover of gasses in the pipeline system occurs?

A

1st-turn on cylinder

2nd- turn off the pipeline supply

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26
Q

What system is used to prevent crossing-over of gas to the machine?

A

The DISS

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27
Q

What is used to prevent back flow of anesthetics and gasses into the pipeline?

A

Each DISS fitting has a back flow check valve

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28
Q

What measures cylinder pressure?

A

The Bourdon pressure gauges

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29
Q

What size filter does each pipe inlet have to contain?

A

100 micrometers or less pore size

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30
Q

What is the most fragile part of a cylinder?

A

The cylinder check valve

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31
Q

What is the purpose of the fragile valves in the cylinders?

A

To break or open under extreme pressure to vent the gas so the cylinder does not combust

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32
Q

What is woods metal?

A

Fusible plug to cover the tank during transport

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33
Q

What are the functions of the dual yoke system?

A

orient cylinders, provide gas-tight seal, ensure a unidirectional flow, facilitate changing of supply without stopping flow of gas

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34
Q

Why would you not open both cylinders in the yoke at the same time?

A

Transfixing can occur, which generates heat and can cause fire

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35
Q

Explain the working of the O2 regulator on the cylinders

A

Two diaphragms connected by a rod move together, as the user adjusts the wanted pressure, a screw and spring decrease pressure on one of the diaphragms, thus raising the other up, opening the outlet valve to allow more gas to flow out

36
Q

Why are regulated cylinder pressures less than pipeline pressures?

A

Prevents “silent leak” of the cylinders is the machine uses the gas source with the higher pressure.

37
Q

What is purpose of O2 flush valve?

A

Rapidly fill breathing circuit with O2

38
Q

How should O2 flush valve be used?

A

Should be used in short bursts during expiratory phase only

39
Q

What are some negative effects that can occur by misuse or over use of the O2 flush valve?

A

Barotrauma and dilution of anesthetics leading to lessened depth of anesthesia

40
Q

What are the 5 tasks of O2 in the machine?

A
  • proceeds to the fresh gas flow meter
  • powers the O2 flush valve
  • activates O2 low pressure alarms
  • activated fail-safe mechanism
  • compresses the bellows of mechanical ventilators
41
Q

What are the components of the flowmeter?

A
  • flow control knob
  • needle valve
  • valve stops
  • flow tube
  • indicator flow
42
Q

How do the flowmeters for different gasses differ?

A

They are color coded and labeled. The flow control knobs are uniquely shaped so they can be controlled without looking directly at knobs

43
Q

What can happen if flow meters are left open at end of case? What can prevent this?

A

Float can shoot to top of tube and crack it. Flow tubes should be shut off at the end of the case or day and should be off when connecting pipeline or cylinders. It can also dry out CO2 scrubber.

44
Q

Where do you read to determine flow?

A

Ball-middle

flat top- at top of float

45
Q

What does the low pressure alarm signify?

A

Pressure has been lost in the O2 circuit

46
Q

What is the last safeguard before the gases reach the patient?

A

Thorpe tube

47
Q

How are flowmeters calibrated at low flow rates?

A

the gas pattern is laminar and viscosity is primary determinate (hagen-poiseuille law)

48
Q

How are flowmeters calibrated at high flow rates?

A

toward’s top of tube, gas flow is turbulent and a function of gas density (Graham’s law)

49
Q

Rate of gas flow is dependent upon what in the anesthesia machine?

A
  • pressure drop across the constriction
  • size of the annular opening
  • the physical properties of the gas
50
Q

Why is the oxygen flowmeter always the furtherest to the right?

A

-to decrease the chance of hypoxic mixture

51
Q

when is an O2 analyzer reading erroneous?

A

When used with a nasal cannula

52
Q

How many sprockets are on an oxygen flowmeter?

A

23

53
Q

How many sprockets are on a N2O flowmeter

A

14

54
Q

What is minimum O2:N2O ratio?

A

1:3

55
Q

What is the purpose of the safety devices in the low flow system?

A

decrease risk of hypoxic mixtures

56
Q

When can the hypoxic guard system allow a hypoxic mix?

A
  • wrong supply gas in oxygen pipeline or cylinder
  • defective pneumatic or mechanical components
  • leaks exist downstream of flow control valve
  • a third inert gas is used
57
Q

What is the method of regulating output concentration?

A
  • concentration calibrated

- measure flow

58
Q

What is the method of vaporization?

A
  • flow over
  • Injection
  • bubble through
59
Q

How is temperature compensated for with vaporizers?

A
  • thermocompensation

- supplied heat

60
Q

How is specificity related to specific vaporizers?

A
  • agent specific

- multiple agent

61
Q

How is resistance classified with specific vaporizers?

A
  • plenum

- low resistance

62
Q

What are the unique characteristics of vapor pressure?

A
  • independent of atmospheric pressure
  • increases with an increase in temperature
  • depends only on the physical characteristics of the liquid and temperature
63
Q

Trace flow of gas from common gas outlet to and from the patient in the bag mode

A

CGO, insp check valve and O2 analyzer, circuit, unidirectional valve, exp check valve, vol monitor, bag, PIP, absorber, circuit.

64
Q

Trace flow of gas from common gas outlet to and from the patient in the vent mode

A

CGO, insp check valve, O2 analyzer, unidirectional valve, pt unidirectional valve, exp check valve, vol monitor, vent bellows, PIP monitor, absorber, breathing circut

65
Q

What steps would you take if there were a power failure for one hour

A

Turn off vent, switch from des, hand bag pt, get extra O2 tank, possibly move to TIVA

66
Q

What does a check valve do?

A

make sure gas is unidirectional

67
Q

what does 1 psi mean?

A

pressure per square inch which is equals to 1 psig if calibrated at local atmosphere

68
Q

Who regulates cylinders?

A

The department of transportation

69
Q

Who makes guidelines for for safe practice?

A

The Compressed Gas Association

70
Q

Who promulgates purity and device standards?

A

The FDA and USP

71
Q

If bottle is full at 100F, how full is it at 50F in the OR?

A

half full

72
Q

What is an unacceptable high-pressure leak?

A

drop of 50 psig in 2 minutes

73
Q

What is an unacceptable low-pressure leak?

A

350 ml/min

74
Q

What are the signs of CO2 rebreathing on the gas analyzer?

A

Elevated baseline of ETCO2, prolonged downstroke of sections D & E of ETCO2 waveform

75
Q

What are the signs of V/Q mismatch on the gas analyzer?

A

Increased variance between ETCO2 and PaCO2. ETCO2 will be decreased. Steep upslope of CO2 waveform.

76
Q

What is the normal gradient between paCO2 and ETCO2?

A

3-5 mmHg

77
Q

What gas is used as a carrier gas?

A

O2

78
Q

Are modern vaporizers within the breathing circuit?

A

no

79
Q

Purpose of the circuit system

A

-prevent rebreathing of CO2

80
Q

If APL valve is closed and the ventilation bag squeezed, where do all the contents go?

A

to the patient

81
Q

If APL valve is open and the ventilation bag squeezed, where will it’s contents go?

A

to the scavenger system

82
Q

What is appropriate water content of sod lime?

A

14-19%

83
Q

What does an ascending bellow do during inspiration?

A

descend

84
Q

parts of a medical gas cylinder

A
  • cylinder
  • valve
  • conical depression
85
Q

How often of low pressure gas gauges need to be tested?

A

5 years

5102-Clinical (1 decks)

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