Equipment #1 Flashcards

Question 1

Q

What is the ideal gas Law Triangle,

Answer

A

Can these guys possibly be violinests

Question 2

Q

What is the Combinded Gas Law?

Calculate Kelivn.

Answer

A

C=K-273

C + 273 = Kelvin

F=(C*9/5)+32

C= (F-32)*5/9

Question 3

Q

What is Vapor pressure?

What are the Gas vapor pressures?

Answer

A

KNow that N2O is liquid with 745psi in has on top

The point at which the molecules going into the gas phase equal the molecules in the liquid phase, at a particular pressure,

Vapor pressure is a funtion of temperature, vapor pressure will not change with a change in altitude.

Question 4

Q

What effects MAC

Answer

A

MAC- Higher in -Infants, hyperthermia, alcoholism

Lower- hypothermia, hypotension, pregancy,

Non Factors- Gender, hight, weight.

Declines 6% per decade

Vapor pressure is temp dependent

At a higher elevation it will boil more easily

A Tec-6 Vaporizer calibrated in LA, will result in greater Volatile delivered in Colorado

Question 5

Q

MAC and Elevation, for volatile agents

Answer

A

For Des you will need to dial a higher concernation at high elevation to attain the same clinical effect.

For Iso you don’t, however the partial pressure of iso will be diffrent, but the altitue will effect it appropriatly.

Question 6

Q

Calculate the % and Pressures

ATM

CAlculate Maxiumum agent concentration

Calculate Concentration in mmHg

Question 7

Q

Question 8

Q

Graham’s Law

Answer

A

Graham’s Law
– The rate of diffusion is inversely proportional
to the square root of the molecular weight
• Large molecules diffuse more slowly

Heilium baloon story, over time the heilium molecules will make it outside the ballon

FYI (Graham’s law and Ficks law both apply to N20) b/c the both explain the diffusion of N20

Question 9

Q

E-cylinders,

What are the volumes?

Whater the Features?

Answer

A

• E-cylinders:
Measures 2’ x 4”
Internal volume of 5000 cc
Specific wall thickness for the gas to be stored

• Features:
Pin Index Safety System
Pressure relief system
Yoke assembly

Question 10

Q

O2 Cylinder

What is the critical temp of O2?

What Law?

Cull cylinder? Liters/psi

When changed?

Answer

A

Oxygen Cylinder
• Must be stored as a gas
– critical temperature is
-
118 C
• Follows Boyle’s Law
• Full cylinder contains 660 liters
• Full cylinder at 2000 psi
• Tank pressure correlates linearly with tank
volume
• Tank should be changed if < 1000 psi

Change anything if it is below half

Most questions are about O2 tank

Question 11

Q

Nitrous Cylinder-

critical temp

what law?

pressure gauage?

liters?

PSI?

Answer

A

Nitrous Oxide Cylinder
• 90-95% filled with liquid N2O
• Critical temperature is 36.5 C
• Does not follow Boyle’s law until all liquid
in the cylinder is consumed
• Pressure gauge does not correlate with
volume until all liquid is consumed
• Full E-cylinder contains 1590 liters
• Full E-cylinder pressure = 750 psi

When gauage moves you are almot empy

Question 12

Q

The anesthesia Machine Basic Layout

Question 13

Q

Anestheisa Machine componets

Answer

A

Machine Components
• Oxygen supplies
• Nitrous and other gas supplies
• Gauges
• Regulators
• Fail-Safe Valve, Oxygen supply alarm
• Flow meters
• Oxygen ratio proportioning systems
• Flush valve and gas outlet

Question 14

Q

Oxygen Supplies

Answer

A

Wall supply at 40-60 psi uses labeling, color coding and DISS
• Tank supply
from E-cylinder on yokes
• Oxygen flows to 5 places:
Flush valve
Oxygen supply failure alarm
Fail-Safe valve
Flow meters
Pneumatically powered devices e.g. ventilator

Question 15

Q

Nitrous & Other Gas Supplies

Answer

A

Nitrous and other gases also supplied by

wall outlets or E-cylinders
Also uses labeling, color coding and DISS

• Nitrous oxide flow is only to the flow
meters, through the fail-safe valve
• Other gases, e.g. air, follow similar
pathway, but may not be involved in the
fail-safe valve

Question 16

Q

What gauges are used?

What principle used?

Answer

A

Gauges
• Uses the Bourden principle*******
curved metallic tube that straightens with increased pressure
• Designed to read 33% higher than
maximum working pressure
• Heavy metal case and plate glass front in
case of Bourden tube rupture

**-In every text boo****

Question 17

Q

What do Regulators do?

Answer

A

• Converts variable high pressure to
constant low pressure
Machines have 2 nd stage regulator after inlet of the
pipelines to further reduce pressure and maintain a constant pressure even if wall outlet pressure varies
• E-cylinder regulators designed to deliver
less pressure than the wall outlet
If tanks are accidentally left on, wall supply is used preferentially

Question 18

Q

Fail-Safe Valve,

O2 Alarm

Answer

A

• Fail-Safe (Oxygen Pressure Cutoff) Valve
shuts off other gas flow if O 2 pressure falls below 25 psi d_oes not prevent delivery of hypoxic mixtures_

• Oxygen Supply Failure Alarm
oxygen fills a cylinder when the machine is on, if pressure drops suddenly O2 will come out of the cylinder and slowly pass through a whistle, this will alert you to loss of pressure. If O2 is lost slowely it may not alarm

Question 19

Q

Flow Meters

diameter?

Flow rate?

Effect of changing barometric pressure,

Answer

A

Flow Meters
• Tapered glass tubes larger at top this allows constant pressure with variable flow
• High flow rate produces turbulent flow density of gas is the major flow rate factor CO 2 and N 2 O have similar densities
• Low flow rate
produces laminar flow viscosity of gas is the major flow rate factor O 2 and Helium have similar viscosities
• Effect of changing barometric pressure
decreased pressure = rotameter too low, underestimating flow
increased pressure = rotameter too high, overestimating flow

Question 20

Q

Oxygen Proportioning Systems

Answer

A

• Machines are equipped with devices to
prevent delivery of FiO 2 < 25%

• Proportioning systems only linked to N 2 O
if other gases are used, hypoxic gas mixtures could be
delivered

Question 21

Q

Flush Valve & Gas Outlet

Flush= what psi and liters?

common gas outlet?- what size?,

Answer

A

• Flush valve bypasses on-off switch
• Delivers oxygen at 40-60 psi
risk of barotrauma under certain conditions
• Estimated rate of delivery: 30-70 Liters/Min
• Common gas outlet
15 mm size; different from breathing circuit or scavenger
Often equipped with check valve to prevent retrograde
gas flow

Question 22

Q

Explain Vaporizers and varible bypass

Answer

A

Flow does not effect concentration, they are flow independent.

Question 23

Q

VAporizer output regulation

Answer

A

Using Dalton’s Law, saturated vapor pressures are:
desflurane = 91%
isoflurane = 31%

sevoflurane = 24%

(The saturated VP is the VP/ ATM 760)

Varible Bypass vaporizers compensate for temp, iso from 20C to 35C will nearly double its VP,// But the vaporizer will compenssate for ambient temp

Question 24

Q

Vaporizer Characteristics

Answer

A

Variable bypass allows a fixed
concentration regardless of the flow
Vaporizers are vapor pressure specific –
only agents with identical vapor pressures can be
interchanged
Vaporizers must have a mechanism to
compensate for temperature variation
Vaporizers must have an efficient heat
transfer system

Question 25

Q

Vaporizer Use Variables

What much gas per ml?

How long will 100ml of sevo last when 3ml/min at 2%

BOARDS

Answer

A

• Most volatile agents produce about 200 cc of
gas for each cc of liquid
• How long will 100 cc of sevoflurane last when
given at 3L/min at 2%?
3000 cc x .02 = 60 cc/minute of sevoflurane used
60cc / 200 cc per 1 cc liquid = 0.3 cc liquid used each minute
100 cc / 0.3 cc/min = 333 minutes

100 cc of sevoflurane will last 333 minutes at 3L/m
at 2%

Question 26

Q

Barometric Pressure Effects

A decrease is barometric pressure casuses whtat to the vaorizer output?

vise versa?

Answer

A

• Decreases in barometric pressure cause
an increase in vaporizer output
• Conversely, increases in barometric
pressure cause a fall in vaporizer output

Question 27

Q

Des Vaporizer

What is the des vaporpressure when delivered?

What happens with N20?

Answer

A

• Desflurane vaporizer heats the agent to 39º C
• This increases the vapor pressure to 1500
• Pressure sensors determine the fresh gas
flow rate and the output is calculated
• Desflurane is then introduced into the fresh
gas flow as a gas
• Output decreases when N2O introduced ??? (canot find why- Maybe ask instructors))

Question 28

Q

Circle System Componets

Answer

A

• CO
2
absorber
• APL “Pop-off”
• Unidirectional valves
• Reservoir bag
• Circuit hoses
• Fresh gas supply

Question 29

Q

What are the Mapleson systems?

Answer

A

You should appreciate that if you need to ventilate an apneic patient with one of
the previously described systems, all six will work.

These six are the

Mapleson A,

MaplesonB, Mapleson C, Mapleson D, Mapleson E, Mapleson F, and the Bain circuit (a modification
of Mapleson D).
During Controlled ventilation: D F E > B C > A.

Question 30

Q

Explain the CO2 absorber

and all questions assosciated with it

Answer

A

Reactions of CO2 in Soda Lime

CO2 + H2O → H2CO3
H2CO3 + 2NaOH (2KOH) → Na2CO3 (K2CO3) + 2H2O + heat
Na2CO3 (K2CO3) + Ca(OH)2 → CaCO3 + NaOH (2KOH)

Composition and Size of Soda Lime Granules
a. 94% Ca(OH)2
5% NaOH
1% KOH

• Irregular granules, 4-8 mesh
– provides maximal surface area with minimal airway
resistance

Canister 50% airspace, 50% absorbent

Indicator (ethyl violet) indicates exhaustion

1000 gm canister can absorb 200 L of CO 2

Question 31

Q

APL & Unidirectional Valves

Answer

A

• APL vents excess gas to scavenger
• U_nidirectional valves_
Disk valves
Prevent rebreathing of CO 2

Question 32

Q

What is the dead space in the ventilated patient?

Answer

A

Treachea,

ETT

MASk

LMA

Y connector

Any other place has both in and out air

Question 33

Q

Reservoir Bag & Circuit Hoses

How big should the bag be?

Answer

A

• Reservoir Bag
Serves as reservoir to buffer high inspiratory & exhaled gas flows
Serves as a shock buffer
Serves as a means of giving positive pressure
Volume of the BAG should exceed inspiratory capacity

The bag will maintain a pressure of 40 even as it gets bigger.

• Circuit hoses
22mm fitting – different from gas outlet or scavenger
Compliance is about 3cc/cmH 2 O/meter
Large diameter offers almost no resistance
Dead space only in areas of bi-directional flow
– Dead space ends at the Y-piece of the circuit

Question 34

Q

Mapelson Circuits

Question 35

Q

Compare Mapelson A to Mapelson D Circutis

controlled vs. Spontaneous?

Answer

A

• Mapelson A
Fresh gas flow and exhaust exactly opposite of
Mapelson D
Very effective for spontaneously ventilating patients
Requires about 200-300 mL/Kg/m fresh gas flow for
controlled ventilation, 70-100 mL/Kg/m for spontaneous
ventilation
• Mapelson D
Used in pediatric cases because of very low resistance
Requires about 200-300 mL/Kg/m fresh gas flow for
spontaneous ventilation, 70-100 mL/Kg/m for controlled
ventilation
Bain modification places fresh gas tubing within the
expiratory hose

Know Controlled vs spontaneous

Mapleson D is also know a coaxial circuit

Question 36

Q

Exporsure to N20 can cause what negative effects?

NIOSH recommendations?

Answer

A

• Chronic low-level exposure to N 2 O:
Spontaneous abortion
Fetal malformation
Cancer
Neuropathy
Behavioral changes
• NIOSH recommendations:
N 2 O < 25 ppm
Halogenated agents < 2 ppm
Halogenated agent + N 2 O < 0.5 ppm

Question 37

Q

Requirments of OR ventilation systems

Answer

A

• Air turnover is the single most important
factor in reducing anesthetic air pollution
• 10 exchanges per hour or more is required
• Fresh air enters the OR through ceiling
vents and leaves through floor vents

Question 38

Q

Rules for the Scavenging System?

Required

size of hose,

Disposal routes?

Answer

A

• Required by JCAHO
• Reduce anesthetic loss to OR by 90%
• 19 mm hose, rigid enough to hold 10kg/cm
• Scavenger interface
Closed reservoir
Open reservoir
• Disposal Routes
Active – to specialized wall suction at > 30L/min
Passive – to floor vents

Question 39

Q

Closed vs. Open Scavenger??

Question 40

Q

What are the delivered #’s for a jet ventilator?

Answer

A

Jet Ventilator
Narrow catheter placed in trachea
Oxygen at 25 – 30 psi delivered for 1 – 1.5 secs x 12/min
Tidal volumes of 400 – 700 mL obtained

-Jet ventilator works on the venturi/bernoulli principle

• High-frequency ventilator
Gas transport by diffusion rather than convection

Question 41

Q

Volume Ventilators

Componets?

Vent Cycle?

What is if effected by?

Answer

A

Commonly used on anesthesia machines
• 2 components
Bellows assembly
Control box
(Hanging bellows ventilators don’t meet standard of
care)
• Ventilatory cycle
Closure of relief valve (to scavenger)
Pressurization of bellows chamber
Discontinuation of pressurization to begin exhalation
Refilling of bellows from exhaled volume and fresh gas Flow
Opening of relief valve to vent excess gases to scavenger

• Unaffected by changes in compliance, but affected by
leak

Question 42

Q

Fresh Gas Flow Coupling

Answer

A

• During inspiratory phase, fresh gas flow
adds to the tidal volume
• High FGF may significantly increase TV
and minute ventilation
• Usually not seen with newer piston-driven
ventilators, which can deliver very
accurate TVs to patients with poor
compliance or very small patients

Question 43

Q

High-frequency Ventilators

rate

indicated for??

Answer

A

Small tidal volumes – at or less than dead space
Rapid rates – 60 or more breaths/minute
CO2 retention corrected by decreasing rate
Indicated for bronchopleural fistula, to improve oxygenation during one-lung anesthesia, tracheal reconstruction and extreme loss of lung compliance

Question 44

Q

Capnography

uses what law?

What are the two types?

How are the measured??

Answer

A

• Two types available
Side stream – gas sample brought to machine analyzer
Main stream – analyzer positioned in gas flow

• Measurement techniques
Infrared – infrared light is strongly absorbed by CO 2
– Beer-Lambert Law
Mass spectrometry– not commonly done
Chemical indicators

Question 45

Q

Capnogram Ohases, What does each one mean?

Answer

A

I. The inspiratory baseline
Fresh gas rushes past the sampling site
CO 2 concentration approaches zero
Dead space gas at end of Phase 1

II. Expiratory upstroke (transition phase)
Exiting alveolar gas contains CO 2 and causes rapid upstroke
Airway obstruction may produce a decrease in slope
Decrease in the alpha angle seen

III. Expiratory plateau
Capnogram plateaus as a stable amount of CO 2 is exhaled
May have a slight incline as lung units with lower V/Q ratios empty

IV. Inspiratory downstroke
Fresh gas drawn past sampling site
Downstroke may be slowed by an incompetent inspiratory valve

Question 46

Q

Answer

A

Increased Airway resistance

Question 47

Q

What causes it>

Answer

A

Rebreathing
Elevated baseline – phase 1
Caused by failed expiratory valve, exhausted CO
2
absorber
Can be caused by inadequate fresh gas flow in Mapelson
circuits

Question 48

Q

what causes cardiac oscillations?

Answer

A

Cardiac Oscillations
Changes in intracardiac volume resulting in gas movement
Rhythm corresponds to pulse

Question 49

Q

Spontaneous ventialtion on capnography can be known as?

Answer

A

Spontaneous ventilation
Sometimes called “Curare Clefts”

Question 50

Q

PaCO2 – PeCO2 Differences

Answer

A

• Normally 3 – 5 mmHg

• Changes in V/Q ratio
Shunt has very little impact on end-tidal CO 2
Changes in dead space have a large impact on end-tidal CO 2

• Sample size
Very small children will have small exhaled volumes. Dilution from
fresh gas flow may reduce apparent end-tidal CO 2

• Machine errors

Question 51

Q

Oxhyemoglobin dissociation curve,

P50

PaO2, = what sat

Formula for Functional Saturation

Answer

A

P50= 27mmHg

PaO2, 40, 50, 60, = Sat of 70, 80, 90

Question 52

Q

Pulse Oximeters

What Law?

Hos is O2 sat determined?

Answer

A

• Makes use of light absorbance
– Beer-Lambert Law

• Tissue contains many absorbers of light
Blood pulsations used to determine arterial absorbance

• Absorbance of 2 wavelengths of light to
determine oxyhemoglobin and reduced
hemoglobin

• Ratio formed and saturation determined

Question 53

Q

What is the accuracy of O2 Sat

What cae cause large decreases in pulse Ox

What can does Carboxyhemoglobin do?

What about another one?

Answer

A

• Accuracy 2% x 1 standard deviation
Accuracy within 2%, 68% of the time

• Dyes can cause large decrease in
measured saturation

• Carboxyhemoglobin causes false
elevation in measured saturation

• Methemoglobin results in sat of 85%

Question 54

Q

Cerebral Oximetery

What technology?

What does is show?

What is a negative sign, how long?

Answer

A

• Cerebral oximeters obtain continuous,
noninvasive cerebral oxygenation values
using near-infrared spectroscopy (NIRS)
technology (650 - 900 nm)

• Saturations are determined by measuring
the light absorbed vs. light transmitted.
• Saturation levels reflect capillary oxygen
saturation levels
• Saturations are lower than seen with pulse
oximetry and trend analysis much more
diagnostic
• Reduction > 20% for more than 4 minutes
indicate potential for neurologic deficits

Question 55

Q

What are 3 Oxygen Analyzers?

And how do they work?

Answer

A

Galvanic- Volts

Polarographic Sensors- amps

Paramagnetic analyzers- require no calibration, institaneous

Question 56

Q

test prompt

Principles of Electricity

Name a common Law?

What is the formula?

DC vs. AC?

Answer

A

• Ohm’s Law
E = IR (E = voltage, I = amperage, R = resistance)
• Power
E x I = power (measured in watts)
• DC vs. AC
Electron flow only in one direction = DC
Electron flow reverses at regular intervals = AC

Question 57

Q

AC Electricity?

What is the resistive fore in AC circuit?

Explain it further

Answer

A

• Impedance  resistive force in AC circuit
• Impedance (Z)
Z = frequency x inductance
Z = 1/(frequency x capacitance)
• Changes in frequency result in changes in
impedance
• Inductance  electrical current can be
induced in a separate wire or iron core

Question 58

Q

Explain Grounded Electrical Power?

Answer

A

• As supplied by electric utility, power is
grounded
• In a grounded system current will flow
between the “hot” wire and any conductor
(patient) with ground
• If patient is touching ground only contact
with the “hot” wire is needed for shock to
occur

Question 59

Q

Electrical Shock Hazards, Explain?

Macroshock?

BOARD Question?

Answer

A

• AC has greater propensity to cause V-fib
• Tissue damage occurs:
Disruption of normal cellular electrical activity
Thermal injury – may be internal along path of
conductivity
• Macroshock (at 60Hz)
1mA = threshold of perception
10-20 mA = “let go” current
50 mA = pain

-DRAG and DROP Question

Question 60

Q

Ungrounded Power

What ungrounds the Power?

What monitors the power?

-Alarm numbers?

Answer

A

• In the OR power is ungrounded
• Isolation transformer is the device that
“ungrounds” the power
• Line isolation monitor monitors the
integrity of the isolated power system
Alarm is usually set to 2-5 mA

Question 61

Q

What distance does a bovie need to be from a pacemaker?

Question 62

Q

Microshock

Answer

A

A catheter or wire in the heart can deliver high current density
As little as 20 microamps may induce V-fib
Isolation transformer does not prevent microshock
Isolation monitor will not detect risk of microshock

Question 63

Q

Explain the diffrent kinds of lasers?

Answer

A

• Laser reactivity depends on wavelength:
Argon – absorbed by hemoglobin and melanin
• CO2
laser blocked by any type of clear- (Cornea)
glass or plastic, absorbed by water, limited tissue penetration
• Nd:YAG and Argon lasers require special protective eyewear, transmitted through clear materials, deep penetration, (retinal damge)
• Airway fires a risk from ETT ignition

Question 64

Q

Airway Fire Management?

Answer

A

• Primary Response
Discontinue O 2 source
Remove endotracheal tube
Mask ventilate with lowest possible FiO 2
• Secondary Response
Recommendations vary from author to author
Re-intubation
Short term steroid administration
Antibiotic administration
Bronchoscopy
Ventilatory support

Answer 59

A

Temperature Monitoring
• Hypothermia – body temperature less than
36 o C
• Postoperative shivering increases oxygen
consumption by a factor of 5
• Radiation accounts for 40% of heat loss.
Convection and evaporation account for
about 30%
• Conduction accounts for 30% of heat loss
• One MAC decreases vasoconstriction and
shivering threshold by 2 – 4 o C.

Radation>Convection>Evaporation>conduction

Answer 60

A

• Three phases of intraoperative hypothermia:
1) Redistribution of heat from core to periphery.
Occurs in 1 st hour and results in a 1 – 2 o fall
2) Steady decline occurs in following 2 – 3 hours
3) Equilibration – losses equal metabolism
• Accurate core temperatures can be obtained from:
PA, distal esophagus, tympanic membrane,
nasopharynx
• Mouth, rectum, bladder, axilla are reasonable

Answer 61

A

Warming Methods
• Treatment of hypothermia is ideally focused on
intraoperative prevention
• Active rewarming – application of an external heat
source:

-Heated blankets – conductive heat source
-Radiant warmers – radiant heat source
-Forced air warmers – convective heat

source. Forced air warmers have been
shown to be the most effective

• Burn injuries have been associated with all types of
active rewarming devices
– Use of external heat sources are contraindicated in pts
with severe PVD or during hypoperfused states (i.e. aortic
cross-clamping)

Answer 62

A

Blood Salvage (Cell Saver)
• Device anticoagulates blood as it leaves the
surgical field
• Cells are washed in NS and centrifuged to a
HCT of 45 – 65%
• Contraindications – presence of infection,
malignant cells, urine, bowel contents and
amniotic fluid
• Washing process removes platelets and
coagulation factors, but not bacteria
• Leukocyte filters often used to trap bacteria

Answer 63

A

• BIS ranges
– 100 - 90 = awake, unanesthetized patient
– 90 – 70 = light to moderate sedation
– 70 – 60 = deep sedation (probable amnesia)
– 60 – 40 = general anesthetic state
– 40 – 10 = deep anesthetic state & burst suppression
– 10 – 0 = flat-line EEG pattern
• Causes of unexpected BIS results/changes
– Change in level of surgical stimulation
– Change in level of anesthesia or sedation
– Change in body temperature
– Change in level of neuromuscular blockade & shivering (falsely
↑
s EMG)
– Presence of high-frequency electrical device e.g. Bovie, pacemaker
– Placement of temporal lead over temporal artery
– Use of pressors, ketamine
**BIS lags behind real-time by approximately 10-15 seconds

Answer 64

A

Back of the machine,

ball and spring, you supply the endergy.

It is for the Gaslines to be plugged into the wall, only DISS for the wall.

VS. the Pin Index- designed for the Tank to be hooked up to the machine.

Answer 65

A

hanger yoke
yoke block with check valves
(free floating)
cylinder pressure gauge
cylinder pressure regulators

ventilator power inlet
pipeline inlets, check valves,
pressure gauges
flow meter valves
oxygen pressure-failure
devices
oxygen second stage regulator
flush valve

flow meter tube
vaporizers
check valves
common gas outlet

Answer 66

A

Free Floating- Examle DISS- prevents gas from leaking

Ball and Spring- You supply the energy (all or none)

Diaphragm- Diaphram (1st and 2nd stage regulators)

Answer 67

A

––empty oxygen cylinder
––incorrect cylinder on oxygen yoke
––closed oxygen cylinder valve
––oxygen flow meter off
––oxygen leak within the machine or flow meter
––incomplete or absent circuit unidirectional valves
––breathing circuit leak
––inadequate ventilation

Answer 68

A

Oxygen E cylinder → open cylinder valve → hanger yoke system → opens free floating valve of this
E cylinder
AND simultaneously closes the free-floating valve of the other hanger yoke system AND
activates the Bourdon Gauge to read cylinder pressure. Now back to the open free-floating valve →
first stage regulator (diaphragm valve) reducing cylinder pressure to intermediate pressure, which is
45psig, and now simultaneously to the following:
→ oxygen pressure sensor valve
→ flush valve
→ DISS ( closes free floating valve and PREVENTS CYLINDER OXYGEN FROM ESCAPING THE
GAS MACHINE !!!!!!
→ second stage regulator (converts intermediate pressure to low pressure or 16 psig) → to gas flow
manifold (flow meters) → vaporizer → common gas outlet → down through the soda lime canister
→ inspiratory valve → inspiratory limb of the breathing circuit → endotracheal tube/patients lips.

Answer 69

A

Department of Transportation (DOT)—established requirements for the design, construction, testing,
marking, labeling, filling, storage, handling, maintenance, and transportation of compressed gas cylinders

National Fire Prevention Association (NFPA)—same as for CGA: contains recommendations for the location,
construction, and installation of bulk oxygen systems (NFPA 50)

American National Standards Institute (ANSI)—sets basic performance and safety requirements for
components of anesthesia machines, endotracheal tubes and connections, pressure and vacuum, and gas
pressure regulators.

National Institute of Occupational Safety and Health (NIOSH) and Occupational Safety and Health Act of
1970 (OSHA)—standards to protect the health and safety of workers.

Food and Drug Administration (FDA)—promulgates standards for medical devices and gases.

American Society for Testing Materials (ASTM)—assesses technology and revises standards.
Joint Commission on Accreditation of Hospitals (The JC)—voluntary accrediting agency.

Answer 70

A

Will carry more gas than anticipated, need to send back to company for recalibration.

Answer 71

A

Hanger yoke is actually the valved, immideatly after the O2 tank,

A dual hanger yoke allows gas to be taken from the tank with the most pressure.

Answer 72

A

Avagadros # is 6.02 X10 >23,

Avagodras law is, any gas with one mole of occupies a volume of 22.4 liters at 1 atm and 0 degrees C.

Answer 73

A

Deviation from the ideal state (PV = nRT) is described mathematically by the
van der Waal’s equation.

Real gases deviate from
this ideal state.

van der Waal’s equation corrects for deviations from ideal.

van der Waal’s relationship (expressed below) assumes that gas
molecules have finite volume a and that gas molecules attract one another b.

Answer 74

A

Application for Ficks Law of diffustion

(1) the concentration effect,
(2) the second gas effect,
(3) diffusion hypoxia, and

(4) why turning on the N2O leads to an increase in volume (or
increase in pressure) in gas spaces in the patient’s body.

According to Fick’s law of diffusion, the rate of diffusion of a gas into or out of the blood is proportional
to its blood solubility.

Fick’s First Law
– For a given solute, the major determinant of
the rate of diffusion is the concentration
gradient

Factors that effect Ficks Law

The partial pressure difference of the gas across the membrane.
The area of the membrane
the solubility of the gas in the membrate
The tickness of the membrane
the square root of the molecular weight of gas.

Gases that are more soluabe will diffuse in greater quantites into the blood - ( This is Ficks law)

Ficks law explaines the diffusion of gases between a gas phase and a liquid phase.

Answer 75

A

Ficks law, and Grahms law.

Answer 76

A

You sitting and breating

Applying pressure to a bag

500 ml at 2 ATM is 1000ml at 1 TM

Plethysmography - (measures changes in volume)

Bellows Ventilator

An O2 tank will releaase 660 liters into the atmosphere

Answer 77

A

ET tube in autoclave

Answer 78

A

The ideal gas law

PV=nRT

n=number of moles

R- universal gas constant

Answer 79

A

Permits calculation of the % concentration of a gas by dividing the partial pressure of the gas by the total pressure.
Permits calculation of the partial pressure of a gas by multiplying % concentration by total pressure.

N2O is 80% of the atmosphere= so its partial pressure 9s 600 0.8 X 760=600

If you are in the mountains it is lower pressure. so the O2 will still be the same % but will be a lower pressure.

2L/4L O2/N20 at 710mmgh = 236mm vs 474 mm

Do not confuse with Henry’s Law= amount of gas that dissolves in a liquid is proportional to the partial pressure of the gas in the gas phase.

Answer 80

A

Henry’s Law= amount of gas that dissolves in a liquid is proportional to the partial pressure of the gas in the gas phase.

the amount of O2 dissolved in blood 0.003
the amount of CO2 dissolved in Blood 0.067

Answer 81

A

It takes energy to break from the liquid state, A liquids heat of vaporization is the number of calories necessary to convert 1ml liquid into a vapor.

Latent heat of vaporzation is more precisely defined as the number of calries required to change 1 G of liquid into vapor without a temperature change.

Answer 82

A

the ratio of the amount of water vapor present in the air, to the maximum amount of vapor the air can hold at the same temp.

-The more heat in the air- the more vapor it can hold

Answer 83

A

adiabatic cooling of the gas in the cylinder,

compressed gas release (Compressed Air Tank)

Joule is COOL! cryoprobe uses the Joule-Thompson effect

Answer 84

A

temp above which a gas cannot be liquidfied no matter how mouch pressure is applied.

O2- -119 Centigrade

Critical pressure- minimum pressure necessary to liquify a gas at its critcal temp.

Answer 85

A

the point at which a liquids vapor pressure equals that of the total atmosphere pressure.

Des will boil in the moutains, because its vapor pressure will be greater than the barometric pressure

Answer 86

A

Math whise ,

flow through a tube is inversaly proportional to resitance,

Omhs law allows calculation of SVR, CO, MAP and CVP

Answer 87

A

flow is directly proportional to

the pressure drop along the tube
the forth power of the radius

inversly

the length of the tube
vicosity of the fluid

If the radius is doubled- the flow increases by 16X

If the radius is tripled- the flow increases by 81X

It is 81 because it is 1/3⁴

Answer 88

A

flow is inversley proportional to viscosity

Answer 89

A

2000

Flow becomes turbulent when viscosity reaches critical level.

Conditions that change Laminar to turbulent

changing directions
increased velocity
rough walled

The greater the density, the less the flow

When flow is high and turbulent- Density determines flow.

When Flow is slow and laminoar- Viscosity determines the flow.

Turbulent (orifice flow) can occurr when the length is greater than the diameter.

Answer 90

A

It operates on the Bernoulli principle, the lateral pressure exerted by a fluid going through a tube of varying diameter is lowest at the narrowest part, where the velocity is greatest.

Used in

nebulizers
atomizers
high frequency jet ventilotors
Venturi mask

Answer 91

A

tension in the wall of a hollow structure is proportional to the radius.

Cylinders: T = Pr
Spheres: T = Pr/2

Surfactant
is a chemical in alveoli that lowers surface
tension. It is more concentrated in smaller
alveoli and lowers the surface tension more in
smaller alveoli than larger alveoli.

In ARDS- The alvoli act like soap bubbles, small empting into big due to greater pressure inside the soap bubble.

Answer 92

A

Macro= voltage applied to skin or tissue, 1-25 amps can cause V-fib

Micro= small volts directly to the heart, 50 microamps required to cause V-fib

Answer 93

A

power supply
the patient
the floor

Answer 94

A

if isolate powerline is less than 60,000 ohms or ir fault would draw more than 2mA,

If the alarm goes off- It could be to much equipment plugged in, could be 1 piece of faulty equipment, identify by unplugging each piece one at a time, if not for life support measures it should be removed from the room.

Answer 95

A

USP/NF- writes regulations for purity of gas

FDA- enforces teh purity standrsds, inspect

DOT- filling and manufacturing of gas cylinders

cylinder inspected every 5 years,

Answer 96

A

every 5 years unles special permit, up to 10 years.

Answer 97

A

oil, water(most common), bacteria, particulate matter, and residual sterilizing solution.

Answer 98

A

It is a soft wood metal, tht will be come soft at high temperature and let the cas discharge from the cylinder. It does not help with overfilling, only elevated temp.

Answer 99

A

to remove dust and debrie from the valve, to help prevent fire or explosion when the valve is opened later.

Answer 100

A

2 Tubes means you just have one taper,

1 tube means you need to dual taper in one tube,

so that you can accuartely dial low flow/ high flow

Answer 101

A

Low flow is the viscosity,

High flow is the density,

O2 knob is

fluted
projects beyod control knobs
larger in diameter than other control knobs

Answer 102

A

concentration-calibrated
interlock
must indicate the liquid level in order to prevent overfilling
keyed-filler devices
must not dicarge anestheic from vaporizer even at maximum fresh gas flows
agent specific
temp compendated
flow over (variable bypass)

Vaporizer shoul be located between flow meter and common gas outlet (this is out side the circle system)

The work station is defined by ASTM,

gas supply
ventilator
monitoris
protection devices

Answer 103

A

It is not varible bypass, it is ectromechanically coupled dual circuit, gas vapor blender,

Des has to be heated to 39C, which delives a pressurized vapor of 1300 or 1500

Fresh gas flow never comes in contact with Des liquid,

The Tech6 does not compensate for changes in elevation- The concentration is unaffected, but the partial pressure delivered is less, therefore you will need to increase concentration to deliver equivaent partial pressure.

If you are asked to calculate partial pressure of des at 5% all you do is .05 X 760 =

Answer 104

A

Back pressure during low flow would cause and increase concentration to be delivered.

Newer vaporizers decrease the size of the vaporizing chamber, vapor saturated gas cannot make its way back into the bypass channel, so the pumping effect is prevented.

Answer 105

A

incorrect agent
tipping
overfilling
electronic falure
reliance on breath by breath gas analysis,

Answer 106

A

they prevent retrograde flow, and minimize downstream pressure, during postive pressure ventilation,

Answer 107

A

exhaled volume
inspired O2
oxygen supply failure alarm
hypoxic guard system
anesthetic vapor concentration
pulse oximetery
blood pressure
ECG

Answer 108

A

maximum of 2 minutes.

Answer 109

A

gas collecting system
transfer tubing
scavenging interface
gas disposal tubing
active or passive gas disposal

Answer 110

A

wrong supply gas
defective pneumatics or mechanics
leaks downstream,
inert gas
dilution of inspired oxygen

The link system for the N20 is the link-25 proportioning system, it allows a 3:1.

Answer 111

A

separates breathing system gas from driving gas.

Answer 112

A

VC
PaO2 >60
maximal negative inspitory pressure >20
normal pH
RR rate <20
6.

Answer 113

A

10-15ml/kg slow breathing 6-8

Answer 114

A

increased ETCO2,
respiratory acidosis,
hypervntilation,
sympathetic activation
increased bleeding
color indcatior

late signs

increased HR and BP
dysrhythmias

Answer 115

A

Calcium carbonate
sodium hydroxide
potassium hydroxide
heat
water

Amsorb

Ca (Oh)2
Ca CL2
CaSO4
polyvinylpyrrolidone,
water

Calcium hydroxide is the most abundant component of both soda lime and amsorb

The reaction that takes place is known as Neutralization.

Answer 116

A

Spontaneous- A>DFE>CB

Controlled- DFE>BC>A

The most commonly used system for delivery of anesthetic gass and O2 to children and adults. = Semi- closed

Answer 117

A

on the inspiratory limb

Answer 118

A

THe lower pressure circuit b/c it is subject to breakage and leaks.

Answer 119

A

battery 30min
almars
monitors
breathing circuit pressure limited to 125cm
nondetachale electrical supply cord
cylinder supplies
flowmeters

Answer 120

A

due to compression of gasses, epansion of the breathing circuitry,

gas that enters the bellows during expiration, consistis of the patient gas as well as fresh anestheitc gases.

Answer 121

A

lighted sylet oral J shape, 75-120 (60-80 peds)degrees.

Nasal- should take shape of the paient.

Answer 122

A

sterilzation includes baterial spores

Autoclave just uses steam.

121C=15min
a few seconds 150C

Answer 123

A

amonium componds
alcohols
glutaralehydes
hydrogen peroxide
formaldehyde
chrine

Ethylene oxide- for temperature sensitive equipment.

hydrogen perxoide and glutaraldehyde will destory spores.

Answer 124

A

alphat, 8-12Hz
beta, >12
delta, -0-4Hz
theta. -4-7 Hz

Anesthesia is theta waves -

delta- sleeping

beta- thinking, awak

When anesthesia is incresed, you get increased amplitude, followed by isoelectric EEG at a MAC of 1.5-2

Answer 125

A

somatosensory evoked potentials- integrity of posterior/dorsal spina cord, of the dorsal-lemniscal system.

neuromuscular blockade will not alter transmission of action potentials in the sensory tracts.

Halotane effects it the least, Enflurane the most, Nitrous also effects it.

Things that effect SEPs

temp- (effects the most)
hyotension
hypoxia
hypocarbia
isovolemic hemodilution (the least)

SEPs monitor flow through the posterior spinal arteries.

autitor SEPS- VIII- Most resistant to SEPs

Optic monitoring appropriate for pituitary and transsphenoidal surgery

Optic SEPS= most sensative,

Aesthesia with minimual effect- prop. barbs, fent, ketamine, etomidate, opieates - dont effect SEPs

hyothermia can effect as well.

MEPs-the wake up test measures the anterior spinal cord

BIS is not effected by hypnotic agents, opioids or analgesics. The BIS is slightly increased with Ketamine.

Answer 126

A

measures regional blood hemoglobin stauration with near-infrared optical spectroscopy.

NRIS measures all hemoglobin, pulsatile and nonpulsatile in a mixed microvascular bed. It measures objectively for hyoperfusion.

It has the advantage of being used during non-pulsatile flow like that of Circulation arrest.

Answer 127

A

21
25
29
33
37

1-5 liters per min

Answer 128

A

You need to work on this one and now it!!!

Answer 129

A

Reactions of CO2 in Soda Lime

CO2 + H2O → H2CO3
H2CO3 + 2NaOH (2KOH) → Na2CO3 (K2CO3) + 2H2O + heat
Na2CO3 (K2CO3) + Ca(OH)2 → CaCO3 + NaOH (2KOH)

Answer 130

A

Hydrophobic HMEs have a hydrophobic membrane with small pores that is pleated to provide a greater surface area. High ambient temperature may decrease the effectiveness of hydrophobic HMEs. The airway resistance of hydrophobic HMEs increases only slightly if wet.

Hygroscopic HMEs contain a wool, foam, or paperlike material that is coated with a chemical that helps it to retain moisture. Hydrophobic HMEs are effective at preventing the transmission of the hepatitis C virus than hygroscopic HMEs. if hygroscopic HMEs become wet, they may lose their ability to filter airborne pathogens and airway resistance may increase substantially. Are considered more effective at preserving heat and humidity than hydrophobic HMEs.

Answer 131

A

50-Hz for 5 sec tetanic stimulation is applied, followed by a 3 second pause, then 1-Hz single twitch stimulations are applied in a series.

The number of stimulations that produce a visible muscle twitch is the post-tetanic count.

Answer 132

A

when the ventilator is being used a portion of the fresh gas flow will contribute to the tidal volume. This effect increases if the fresh gas flow rates are high, if the I:E ratio is high, and if the patient has a slower respiratory rate.

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