Anesthesia Machine III Flashcards by Kacie Brien

what are the two types of drive mechanisms of a ventilator?

piston
or bellows

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true/false: there are volume issues on piston ventilators?

FALSE- no volume issues

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name the advantages and disadvantages of the piston driven design

advantage: quiet, tidal volume is precise, capable of all modern vent modes
disadvantageS: not visible, quiet

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Historically, an important difference between ascending
and descending bellows is that when there is a
disconnection or major leak, the _____ bellows will
collapse.

ascending

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When a disconnection occurs with a ______
bellows ventilator, the ventilator will continue its upward
and downward movements, drawing in room air and
driving gas during its descent and discharging it during
the upward movement.

descending

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what is the ascending bellows doing during exhalation?

it expands upward- it ASCENDS

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what is the descending bellows doing during inhalation?

it compress upward during inspiration

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what is the other name for the descending bellow?

the hanging bellow

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to know how much oxygen is consumed during mechanical ventilation, you must add the minute ventilation to the ____

desired flow rate

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what is the standard alarm requirements and safety features?

the ASTM F1850

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what is the low oxygen safety alarm assembly and when is it activated?
what machine has this?

also known as the ritchie whistle
warns the operator when the oxygen pressure in the machine is low and needs to be reestablished
it is activated when oxygen pressure falls below 30PSIG
Ohmeda

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what is the purpose of the oxygen pressure failure alarms?

warn the operator when oxygen supply pressures are critically low

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what alarm MUST sound for a minimum of 30 seconds?

the low oxygen safety alarm

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in the drager, what warns operator when oxygen supply pressure is low?

oxygen suppply pressure alarm switch

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in the ohmeda, what does the fail safe system do in the presence of insufficient oxygen pressure?

shuts OFF gases

(all or nothing effect)

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in the drager, the oxygen failure protectice device _______ the flow of gases other than oxygen in the event of a partial or complete loss of oxygen supply pressure?

proportionately restricts

(conical shaped valve)

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the link 25 proportion limiting control system helps prevent the secondary regulator from exceeding a ____ ratio or ____% oxygen fresh gas mixture

3:1 ratio or 25%

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the drager sensitive oxygen ratio controller guarantees a minimum oxygen concentration of ____%

23%

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the drager sensitive oxygen ratio controller shuts off nitrous oxide if the oxygen flow is less than ____mL/min

200 mL/min

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the hypoxic guard/proportioning systems can still permit hypoxic breathing mixtures when:

wrong supply gas in oxygen pipeline or cylnder
pneumatic or mechanical components are detective
leaks exist downstream of flow control valves

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what is the only way to discern a contaminated oxygen supply?

the oxygen analyzer

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contains two electrodes, a lead anode, and a gold cathode, surrounded by an electrolyte bath:

galvanic cells in the oxygen analyzer

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once again, explain what to do when you suspect contaminated oxygen supply:

Open emergency E cylinder
– Disconnect DISS anesthesia machine hose fitting from the wall or
boom arm
■ E cylinder may not flow (45 psi) if the anesthesia machine remains
fitted to the DISS wall connection (50 psi)
– Use low fresh gas flows – Manually ventilate the patient

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what prevents more than one inhalational anesthetic from being
administered by the operator? it is An interlock system allows only one vaporizer to be used at a time

the ohmeda selectatec vaporizer manifold system

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what Combines cams, pins and levers to allow only one vaporizer to be turned on at a time. For example, when the vaporizer on the right is turned on, the top of the handwheel acts as a cam, forcing the pin backward.

the drager vaporizer exclusion system

what are the clinical implications of the ohemda tidal volume monitor?

patient disconnect failure to ventilate the paptient anoxic encephalopathy

what are the advantages of the drager ultrasonic flow sensor:

no moving parts easy to clean autoclavable accuracy independent of gas composition low resistance

how do you calibrate an oxygen analyzer?

two types: galvanic sensor (an older "plug in" type), and the paramagnetic. Galvanic sensor- calibrate to room air (15-20 seconds, takes longer than 40-60 seconds to read 21%, change the sensor). Expose to 100% oxygen and ensure it reads close ■ Newer paramagnetic sensors use internal calibration routines. So they only need periodic (every 3-6 months) exposure to calibration gas, and they last for years.

what can you do to fix an oxygen analyzer that is reading an FiO2 of 16% during general anesthesia?

Don't attempt to fix it- trust monitors until you can prove they are wrong. – Call for help – Tu r n o n e m e r g e n c y ox yg e n c y l i n d e r a n d d i s c o n n e c t p i p e l i n e from wall

can you give an anesthetic when there is no connection for hoses? or if a cylinder is missing?

yes- can give anesthetic even when there is no connection to hospital pipeline or if a tank is missing

The pipeline supply of oxygen has failed. How can you make your emergency E tank of oxygen last as long as possible?

Driving a vent with cylinders will cause their rapid depletion. Manually ventilate the patient, assist spontaneous ventilation if possible, use air or nitrous oxide with oxygen if possible, and use low flows

Your pipeline supply fails, and your cylinder gauge shows 1000 psi. How long will your emergency oxygen supply last if you are giving 2L O2/min?

Contents L / Gauge Pressure = Capacity L / Service Pressure x L/1000 psi = 660 L/1900 psi; and x = 347 L. If you are flowing 2 L/min oxygen, the tank will last 17 3 . 5 m i n u te s .

What is the most common site of disconnections? What is the most important monitor for disconnection?

The most common site is the Y-piece. Monitors for disconnection (apnea alarms) can be based on gas flow (tidal volume), circuit pressure (if peak inspiratory pressure is below threshold an alarm rings), chemistry (carbon dioxide) or acoustic (sound of the precordial, or normal sounds of the ventilator cycle).

In the middle of a case, your soda lime is exhausted. Should you change it?

No. Increase fresh gas flow (FGF) to 5 to 8 L/min for an adult (1 to 1.5 times minute ventilation). Soda lime can be more easily changed in the ADU, without interrupting ventilation.

What do you do to the machine if a patient has a history of malignant hyperthermia?

Preferably scheduled for first case of the day ■ Remove or at least drain all vaporizers and tape over the dial. ■ Change all breathing circuit disposables and soda lime. ■ Flush with high (10 L/min) fresh gas flow for at least 10 minutes. ■ Monitor ETCO2 and core temperature in all patients ■ Avoid triggers (volatile agents and succinylcholine)

What is the main disadvantage of the descending bellow design?

When a disconnection occurs, the ventilator will continue its upward and downward movements, drawing in room air.

the drager sensitive oxygen ratio controller (S-ORC) has audible and visible alarms sound if pipeline pressure is less than ___ PSI

20 Fabius

the drager oxygen ratio monitor controller shuts off nitrous when oxygen pressure is less than ___ PSI

you're at a new clinical site and you have a vent you've never used before. what is the best and safest way to learn about the machine?

use the manual or the internet, find a PDF manual or instructions for use

what are you testing when you do a low pressure leak test?

flowmeters, vaporizers, and common gas outlet

calculate the FiO2 if you have 2L air 3L O2

(0.4+3 = 3.5) 3.4/5L= 0.69 or 0.7 FiO2

what is an advantage that the Bain system has?

it has a pressure relief valve

what single anesthestic agent would you theoretically avoid on a patient with a creat of 2.4?

sevo

if you smell vapor in the OR, what is the first thing you should look at?

the scavenger for a disconnect

name the two types of oxygen analyzers:

galvanic cells and polargraphic cells

name the gases

in order: desflurane isoflurane halothane enflurane sevoflurane

name the problems with each picture of the circle circuit:

a: normal function b: incompetent inspiratory valve c: incompetenet expiratory valve d: incompetenece of both valves- creates dead space

the Bain system has what 3 components?

entry point of fresh gas resevoir bag an APL valve

what system is a tube inside a tube or circuit inside a circuit?

the king system

what machine are these safety features for? PISS/DISS oxygen supply pressure alarm switch oxygen failure protection device oxygen ratio monitor control vaporizer exclusion system vaporizer safe T fill minute volunteer breathing pressure monitoring system oxygen analyzer

the Drager

what machine has these safety features? PISS/DISS low oxygen supply alarm assembly pressure sensor shut off valve secondary regulator link 25 proportion limiting control selectatec vaporizer manifold vaporizer safe T fill tidal volume monitor airway pressure transducer oxygen analyzer

Ohmeda

Airspace is occupied at what % of Volume of absorber canister?

50%

What is the average CO2 production of soda lime?

200mL/min or 12L/hr

What provides positive or negative pressure to prevent gasses from going to the ventilator?

The interface (part of scavenger)

What is a major problem of an open system?

FIREEEEE

Gas is more soluble at _____ temps?

HIGH

What is the PSI of oxygen at the common gas outlet for GE vs Drager?

14 PSI GE 24 PSI drager

there is a CO formation risk with CO2 dessicated absorber materials containing higher concentrations of what two things?

potassium hydroxide and sodium hydroxide

what kind of reaction is in the CO2 absorber?

exothermic

what are 3 important factors for absorbent granules?

size porosity nature of granule surface