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The BIG Test > Equipment > Flashcards

Equipment Flashcards

1
Q

Check valve in pipeline inlet assembly is a floating valve and seats according to pressure. What is the function of this valve?

A

Prevents oxygen cylinder gas from escaping the anesthesia machine

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2
Q

Power outlet valve for ventilator

A

DISS fitting
Ball and spring type valve
YOU supply the energy

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3
Q

Hanger yoke valve

A

Pins : Air - 1,5/ O2 - 2,5/ N2O - 3,5
Free floating valve
Prevents a full cylinder from emptying into an empty cylinder or wall oxygen from entering a cylinder

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4
Q

What is the name of the gauge that shows oxygen tank pressure?

A

Bourdon

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5
Q

You have a dual hanger yoke with 2 oxygen E cylinders. Both cylinders are turned on; which one will supply the gas machine?

A

The E cylinder with the highest pressure

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6
Q

Pressure Regulators

A

Diaphragm valves

ONLY role = REDUCE PRESSURE

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7
Q

First Stage Regulators

A

High (cylinder) pressure decreased to intermediate pressure (40-50 psig)
*Diaphragm valve

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8
Q

Second Stage Regulators

A

Intermediate pressure decreased to low pressure (16 psig)
Receives oxygen from first stage regulator OR wall pressure oxygen
*Diaphragm valve

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9
Q

Oxygen Flush Valve

A

Flow rate: 35-75 L/min
Pressurized: 40-50 psig (intermediate pressure)
Ball and spring valve
YOU supply the energy

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10
Q

What are the 2 negatives of the oxygen flush valve?

A
  1. May cause barotrauma

2. Dilutes anesthetic gas

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11
Q

Pressure Sensor Shut-Off Valve

Oxygen Failure Pressure Device

A

Senses oxygen pressure at intermediate pressure
Shuts off nitrous oxide if oxygen PRESSURE falls (< 25 psi)
Ball and spring valve

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12
Q

Oxygen Flow Meter

Flow Control Valve

A

Receives low pressure (16 psig)

Thorpe tube is gas specific and tapered

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13
Q

Check Valve Located b/t the Vaporizer Outlet and the Machine CGO
*Ohmeda machine only!

A

Prevents reversal of flow to vaporizer (back pressure)

Free-floating type valve

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14
Q

What happens if the inspiratory valve sticks open?

A

Expiratory volume will exhaust through the inspiratory limb

ETCO2 waveform will become elevated

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15
Q

What happens if the expiratory valve sticks open?

A

Inspired volume will not enter the ETT

It will exhaust through the expiratory limb

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16
Q

Inspiration and Expiration Check Valves

A

Flutter valves

Unidirectional flow

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17
Q

APL valve

A

Pop off
Attached to the exhalation check valve
Adjusts the limit of pressure in that patient circuit and rebreathing bag

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18
Q

Waste Gas Scavenging System

A

Adjusting the needle valve alters the FLOW of waste gases into the vacuum

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19
Q

What will happen when the vaporizer is tipped?

A

Liquid vapor will get into the vaporizer chamber
Carrier flow will carry MORE agent
Do NOT use, needs to be re-calibrated

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20
Q

High Pressure (cylinder)

A

Cylinder pressure
Bourdon gauge
Check valves in the hanger yoke
Index pins on the hanger yoke

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21
Q

Intermediate Pressure (40-50 psi)

A 
Flush valve 
Second stage regulator
Oxygen pressure "failsafe" shut-off valve 
Pressure gauges from pipeline
DISS
Flow control valve of manifold 
Flow meter valves 
Ventilator power inlet
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22
Q

Low Pressure (16 psi)

A

Vaporizer
CGO
Manifold/Flow meters
Check valves

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23
Q

Free Floating Valve

A

DISS
Dual hanger yoke systems
Prevent gases from leaking out of the system

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24
Q

Ball and Spring Valve

A

Oxygen flush valve

Oxygen pressure sensor valve

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25
Q

Diaphragm valve

A

First and second stage regulators

Reduce pressure

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26
Q

The path…

A

Oxygen cylinder - open cylinder valve - hanger yoke system - free floating valve - first stage regulator - NOW 4 options

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27
Q

What are the 4 options following the first stage regulator?

A
  1. Oxygen pressure sensor valve
  2. Flush valve
  3. DISS
  4. Second stage regulator - flow meters - vaporizer - CGO - soda lime - inspiratory valve - inspiratory limb - ETT
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28
Q

What type of anesthesia machines should be tested with a negative-pressure leak test?

A

Machines with check valves
Suction bulb is attached to the CGO - squeezed repeatedly until the bulb is fully collapsed - leak-free if the bulb remains collapsed for a least 10 sec

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29
Q

Your next patient has MH. What 3 steps will you take?

A
  1. Flush gas machine for 10 min
  2. Replace the breathing circuit and the CO2 canister
  3. Remove vaporizers
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30
Q

What is the purpose of the interlock system?

A

Prevents more than one vaporizer from being turned on at a time

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31
Q

What are your actions when the oxygen low-pressure alarm sounds?

A

D/c pipeline
Open E cylinder
Use low flow FGF

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32
Q

The vacuum control valve should be adjusted to allow the evacuation of what volume of waste gas per min?

A

10-15 L/min

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33
Q

What is the purpose of the proportioning system?

A

Prevent hypoxic mixture
N2O and O2 are mechanically/pneumatically linked
Min O2 concentration at CGO is b/t 23-25%
Max N2O-O2 flow ratio of 3:1

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34
Q

Who controls such processes as the filling and manufacturing of gas cylinders?

A

The US Department of Transportation

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35
Q

What is the working pressure of the hospital pipeline system?

A

50 psig

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36
Q

What is the most common contaminant of medical gas lines?

A

Water

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37
Q

Which 2 gases are in liquid form in pressurized cylinders?

A
  1. N2O

2. CO2

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38
Q

When should you change the O2 cylinder?

A

When < 1000 psi

Half full

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39
Q

The nitrous oxide tank reads 700 psi. What is the significance of this?

A

N2O pressure below 745 psi indications that the cylinder has NO liquid and is < than 1/4 full (400 L)
Change!
*Does NOT follow Boyle’s Law

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40
Q

Calibration of flowmeters is based upon what physical property of gases: density or viscostiy?

A

Low flows - viscosity - laminar

High flows - density - turbulent

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41
Q

All compressed gas cylinders are constructed according to…

A

Interstate Commerce Commission specifications
ICC3S
Must have 7 cylinder markings

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42
Q

Each cylinder must be subject to a test by interior hydrostatic pressure at least once every…

A

5 years

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43
Q

Explain the safety device on each valve stem on the cylinder.

A

Under hazardous conditions of excessive heat or fire the cylinder will become exhausted
This is a simple plug of soft metal alloy called Wood’s metal

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44
Q

What does it mean when you crack the cylinder?

A

Open the cylinder slightly to clear the outlet of possible dust

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45
Q

Open System

No Mask On Face

A

No dead space
No rebreathing or reservoir bag
No valves

Pediatric induction

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46
Q

Semi-Open

Mask On Face

A

No rebreathing

Unidirectional valve
Reservoir bag
Room pollution
High FGF

Open drop technique

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47
Q

Semi-Closed

Mask On Face

A

No room air inspired

CO2 absorber
Unidirectional valves
Reservoir bag
FGF can be < MV

Circle system

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48
Q

Closed

Mask On Face

A

Rebreathing gases - pop off closed
CO2 absorber
Unidirectional valves

Flow 150-500 mL/min - physiological requirements

Flow 150-250 mL/min - under anesthesia

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49
Q

Specific Semi-Open Systems
Mapleson Systems - 5 Components

No rebreathing 
Unidirectional valve 
Reservoir bag 
Room pollution 
High FGF
A
  1. Face mask
  2. Spring-loaded pop-off valve
  3. Reservoir tubing
  4. Fresh gas inflow tubing
  5. Reservoir bag
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50
Q

Mapleson A is best for what? Worst for what?

A

Best for spontaneously breathing patient

Worst for controlled ventilation

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51
Q

What is the most commonly used breathing system today?

A

Bain Circuit

Modification of the Mapleson D system

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52
Q

Which Mapleson systems are rarely used today?

A

A, B, C

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53
Q

Which Mapleson systems can you ventilate an apneic patient?

A

All Mapleson systems

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54
Q

Mapleson Systems

Preventing rebreathing during spontaneous ventilation

A

A > DFE > CB

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55
Q

Mapleson Systems

Preventing rebreathing during controlled ventilation

A

DFE > BC > A

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56
Q

Which Mapleson System has the fresh gas inlet and popoff valve at opposite ends?

A

A

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57
Q

Which Mapleson System has the fresh gas inlet at mask end, next to popoff valve?

A

B, C

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58
Q

Which Mapleson System has fresh gas inlet at mask end and popoff valve at other end — also called the T-piece group?

A

D, E, F

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59
Q

American Society for Testing and Materials standards for reservoir bags require that with a bag distended to ___x its normal capacity, the pressure will not exceed ___cmH2O.

A

4x

50 cmH2O

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60
Q

What are the 5 components of the circle system?

A
  1. Gas reservoir bag
  2. 2 corrugated tubes
  3. 2 unidirectional valves
  4. CO2 absorbent
  5. Overflow valve
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61
Q

What is the most common site for breathing circuit disconnection?

A

B/t breathing system and ETT

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62
Q

Where does the FGF enter the breathing circuit in the circle system?

A

Semi-closed system

B/t the absorbers and the inspiratory valve

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63
Q

In a circle system, where is dead space located?

A

B/t Y piece and the patient

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64
Q

When does a semi-closed, or semi-open, system exist?

A

When high FGF are used with a circle system

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65
Q

Which breathing circuits, open or closed, have the slowest induction time?

A

Closed

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66
Q

What flow rate must be achieved when using an Ayre’s T-piece to prevent rebreathing or air entrapment?

A

2-3x the patient’s MV

67
Q

Mapleson ___ is the Jackson-Reese modification of Mapleson ___.

A

F

E

68
Q

Where should the oxygen sensor be placed in a circle system?

A

Inspiratory limb

69
Q

Don’t use an LMA with the following…

A

Risk of aspiration - NPO violations, > 14 weeks pregnant, hiatal hernia
Delayed gastric emptying issues - obese, DM, opiate use
Trauma
Acute abdomen
Thoracic injury
Decreased pulmonary compliance - peak airway pressures > 20 cmH2O

70
Q

What nerve could you damage with insertion of an LMA?

A

Hypoglossal nerve

71
Q

What is the max use per LMA?

A

40x

72
Q

Is a NG tube compatible with an LMA?

A

Yes

Pass NG before LMA

73
Q

Where does the LMA rest?

A

Against the upper esophageal sphincter

74
Q

How can the head be turned when an LMA is in place?

A

Side to side

Do NOT flex or extend the neck

75
Q

The following nerve injuries will cause hoarseness of the voice…

A

Bilateral superior laryngeal nerve injury
Unilateral recurrent laryngeal nerve injury
Unilateral vagus nerve injury

76
Q

What nerve injury will cause aphonia?

A

Chronic bilateral recurrent laryngeal nerve injury

(Acute - stridor, respiratory distress

77
Q

Avoid vocal cord paralysis by not inflating the LMA cuff too much! What are the maximum cuff volumes for each size?

A 
1 (5 kg) - 4 mL
1.5 (5-10 kg) - 7 mL 
2 (10-20 kg) - 10 mL 
2.5 (20-30 kg) - 14 mL 
3 (30-50 kg) - 20 mL 
4 - 30 mL 
5 - 40 mL 
6 (> 100 kg) - 50 mL
78
Q

Fasttrach LMA

A

Epiglottic elevating bar int he mask aperture

79
Q

What is the aspiration risk with an LMA? Incidence of sore throat?

A

Aspiration 2 per 10,000

Sore throat 10%

80
Q

What type of lubricant should be used with LMAs?

A

Water-soluble

NOT silicone-based, lidocaine-containing

81
Q

With use of an LMA…
Airway pressures should be < than?
TV should not be > than?
Mask should be inflated to a pressure of ____ cmH2O.

A

20 cmH2O
8 mL/kg
60 cmH2O

82
Q

What do the initials RAE stand for?

A

Ring - Adair - Elwyn tube

83
Q

List 5 risk factors for difficult mask ventilation from greatest to least.

A
  1. Beard
  2. BMI > 26
  3. Edentulous
  4. Age > 55
  5. History of snoring
84
Q

What is the max ETT that can be passed through an intubating LMA?

A

8.0

85
Q

What is the distance an ETT moves from flexion to extension?

A

3.8 cm (1.9 each direction)

86
Q

During apnea, PaCO2 will rise by ___ mmHg during the first min, and _____ mmHg each minute thereafter.

A

6

3-4

87
Q

Name 3 rigid, fiberoptic laryngoscopes.

A
  1. Bullard
  2. Wu
  3. Upshur
88
Q

What is Ludwig’s angina? What is the most common cause?

A

Generalized septic cellulitis of the submandibular region
Cause: hemolytic strep
*Trach candidate

89
Q

What do you need for transtracheal jet ventilation?

A 
12-14-G needle
3 mL syringe
Self-inflating reservoir bag 
ETT tube adapter 
Oxygen supply 
Driving pressure of at least 50 psi
90
Q

What is the best way to assess mobility of the TMJ?

A

Ask the patient to open his/her mouth

Simultaneously assess cervical spine mobility

91
Q

What BIS level corresponds to flat-line EEG?

A

10-0

92
Q

Pulse Ox

A 
Beer-Lambert Law
Principles of oximetry and plethysmography 
2 wavelengths
Red light - deoxyhgb - 660 nm 
Infrared light - oxyhgb - 940 nm 
Accurately detects SaO2 (predicts PaO2)
93
Q

List 4 examples of low perfusion states that can cause pulse ox artifact.

A
  1. Low CO
  2. Anemia
  3. Hypothermia
  4. Increased SVR
94
Q

List examples, unrelated to low perfusion, that interfere with an accurate pulse ox reading.

A

Carboxyhemoglobin - false HIGH
Methemoglobinemia - locked at 85%
Methylene blue dye

*NOT - fetal hgb or bilirubin

95
Q

What 2 measurements assess blood oxygen?

A
  1. PaO2

2. SaO2

96
Q

Capnometry vs. Capnography

A

Capnometry: #s
Capnography: waveform

97
Q

Abnormal Capnogram
Incompetent Expiratory Valve
Incompetent Inspiratory Valve
Exhausted Soda Lime

A

Capnogram does NOT return to baseline

*Incompetent Inspiratory Valve - inspiratory limb prolonged, “take-off” angle

98
Q

Does the capnogram of a patient with MH return to baseline?

A

YES

Very, very rapid increase in CO2

99
Q

Abnormal Capnogram
ETCO2 is low
Alveolar plateau is angled
Rate is increased

A

Pulmonary Embolism

100
Q

Which phase of the capnogram reflects a mixture of anatomic and alveolar dead-space?

A

Phase II

101
Q

What phase of the capnogram is the alveolar plateau?

A

Phase III

102
Q

What phase of the capnogram represents inspiration?

A

Phase IV

103
Q

The slope of Phase III of the capnogram depends on…

A

V/Q status

*Airway obstruction and PEEP cause an increased slope and a larger alpha angle

104
Q

What are the normal degrees of the alpha and beta angles on the capnogram?

A

Alpha: 100-110 deg
Beta: 90 deg

105
Q

What gases are measured by mass spectrometry?

A

CO2, O2, N2, inhaled agents

106
Q

Can the mass spectrometer detect a V/Q mismatch?

A

NO

Doesn’t assess PaO2

107
Q

CVP waveform

A 
A: atrial contraction + 
C: tricuspid valve elevation + 
X: ventricular systole -
V: venous return to atrium +
Y: early ventricular filling -
108
Q

Large A waves

A

Tricuspid stenosis
Pulmonic stenosis
Pulmonary HTN
Decreased RV compliance

*Absent in Afib

109
Q

Large V waves

A

Tricuspid regurgitation
RV papillary muscle ischemia/RV failure
Constrictive pericarditis
Cardiac tamponade

110
Q

The RVEDP is ___ the LVEDP in a healthy heart.

A

3/4

111
Q

When the CVP line is inserted via the RIJ, the tip of the cath on x-ray will be seen at the level of what thoracic vertebrae?

A

Below the inferior border of the clavicles
Above the T4-T5 interspace
Above the level of the 3rd rib

112
Q

What would cause the CVP > PCWP?

A

RV failure
Pulmonary HTN
PE

113
Q 
Pulmonary Artery Cath Distances 
Insertion Sites 
Subclavian
RIJ
LIJ
R AC
L AC
Fem 
*RA to RV to PA
A 
Subclavian - 15
RIJ - 20 
LIJ - 25 - should NOT be used for PA? 
R AC - 40 
L AC - 45 
Fem - 50 
Those are to RA 
To get to RV + 10 
To get to PA + 25
114
Q

Describe the RV tracing while placing a PA cath.

A

Pressure - 15-25/1-8

No dicrotic notch

115
Q

Describe the tracing once the PA cath reaches the PA.

A

Pressure - 15-25/8-15

Dicrotic notch

116
Q

RAP = CVP = RVEDP =

A

0-8 mmHg

117
Q

RVA = PAS =

A

15-25 mmHg

118
Q

PADP =

A

8-15 mmHg

119
Q

PCWP

A

Normal: 6-12 mmHg
Measures “back pressure” from the pulmonary veins
Max wedge time is 15 sec
PCWP is NEVER higher than PADP

120
Q 
What will happen to CVP and PCWP with the following? 
Hypovolemia
LV failure 
RV failure 
PE
Pulmonary HTN
Cardiac tamponade
A

Hypovolemia - low CVP and PCWP

LV failure - normal CVP and high PCWP

RV failure - high CVP and normal PCWP
PE - high CVP and normal PCWP
Pulmonary HTN - high CVP and normal PCWP

Cardiac tamponade - high CVP and PCWP

121
Q

List 3 contraindications to use of a PA cath.

A
  1. Complete LBBB
  2. WPW
  3. Ebstein’s malformation
122
Q

Is the area under a thermodilution curve directly related or inversely related to CO?

A

Inversely

Smaller area - Higher CO

123
Q

Why is it important to inject such a precise volume when measuring CO via thermodilution curve?

A

If you inject too small of volume - false high CO

If you inject a large volume - false low CO

124
Q

Insufficiency of what 2 valves may lead to a falsely high thermodilution CO reading?

A

Regurgitation of either the tricuspid or pulmonic valve

125
Q

Any PA cath measurements are equivalent indirect indicators of _____ in the absence of mitral stenosis or pulmonary HTN.

A

Preload

126
Q

Does PCWP under or overestimate LVEDP in the patient with mitral valve stenosis?

A

Overestimate

*Mitral valve insufficiency is NOT a factor that can lead to a false estimate

127
Q

Identify 3 situations where PCWP > LVEDP.

A
  1. Mitral stenosis
  2. Elevated alveolar pressure
  3. Pulmonary venous obstruction
128
Q

PCWP will underestimate LVEDP in patients with what valve issue?

A

Aortic regurgitation

129
Q

If the BP cuff is too big, then the BP will be _____.

A

Lower

130
Q

What sounds identify the onset of systole?

A

Karotkoff sounds

131
Q

What 3 valuable CV parameter are obtained from an Aline?

A
  1. LV volume
  2. LV function
  3. SVR
132
Q

Where is the proper placement of the pressure transducer in a sitting position?

A

At the base of the ear

133
Q

What does the dicrotic notch represent on the Aline tracing?

A

Closure of the aortic valve

134
Q

Overdamping of the Aline results in what?

A

Underestimation of the SBP
Overestimation of the DBP
MAP remains constant

135
Q

What nerve could you possibly damage when placing an aline in the brachial artery?

A

Median nerve

136
Q

The width of BP cuff should be ___% of the arm’s circumference.

A

40%

137
Q

Is the BP reading erroneously high or low when the cuff is too narrow or wrapped loosely?

A

High

138
Q

When using a tourniquet, where can most damage occur to a limb, proximal to, distal to, or under the cuff?

A

Under the cuff

139
Q

The BIS reading is a derived # that correlates with the level of:

A

Hypnosis

140
Q

Department of Transportation

A

Defines compressed gas standards

Established design, construction, testing, marking, labeling, and transportation requirements for gas cylinders

141
Q

Interstate Commerce Commission

A

Sets specifications for compressed gas cylinder construction

142
Q

Federal Food, Drug, and Cosmetic Act

A

Regulates the medical gases contained in cylinders

143
Q

US Pharmacopeia

A

Develops purity standards for medical gases

144
Q

National Fire Prevention Association

A

Has recommendations for the construction and location of bulk oxygen containers

145
Q

Compressed Gas Association

A

Set standards of safe practice

146
Q

American National Standards Institute

A

Performance and safety requirements for components of anesthesia machine, ETT, connectors, vacuum, and gas pressure regulators

147
Q

American Society for Testing Materials

A

Assess technology and revises standards

148
Q

What vaporizer delivers isoflurane, enflurane, halothane, and sevoflurane?

A

Variable-bypass vaporizers

  • Agent-specific
  • Temp compensated
  • Flow over
  • Maintains constant partial pressure
149
Q

Describe the vaporizer for desflurane.

A

Tec 6
Dual-gas blender
39 deg C
1500 mmHg
Maintains constant concentration of vapor output (must adjust in higher altitudes - increase concentration)
Why is it special? Vapor pressure is near atmospheric pressure, boils at sea level and it is only 1/5 as potent as other agents so a large volume must be delivered to the patient

150
Q

In most instances, ___ psi is a sufficient inspiratory pressure.

A

25

151
Q

Operation of the jet ventilator is based on what principle?

A

Venturi effect

Bernoulli principle

152
Q

What are the 5 final products when CO2 reacts with soda lime?

A
  1. Calcium carbonate
  2. Sodium hydroxide
  3. Potassium hydroxide
  4. Water
  5. Heat
153
Q

What are the 4 final products when CO2 reacts with Baralyme?

A
  1. Calcium carbonate
  2. Barium hydroxide
  3. Water
  4. Heat
154
Q

Does the descending bellows descend during the inspiratory or expiratory phase?

A

Expiratory

155
Q

Which bellows are safer when there is a disconnect…ascending or descending?

A

Ascending

will not rise if disconnection occurs

156
Q

What is another name for the bougie?

A

Eschmann introducer

157
Q

What are the 3 characteristics of the high frequency jet ventilator? What does it require?

A
  1. Small TV (< dead space)
  2. High ventilation rate
  3. Low airway pressures

Requires a high-pressure oxygen source (central wall outlets, tank regulators, flush valve) and a regulating valve

158
Q

What is the most common complication to a patient being jet ventilated?

A

Tracheal mucosal damage and thickened secretions blocking the airways (inadequate humidification)

159
Q

What site gives the most reliable approx of core body temp?

A

Lower 25% of the esophagus

Most accurate - PA cath

160
Q

Where is the ideal placement of the esophageal stethoscope?

A

Lower 1/3 of the esophagus

161
Q

Intraoperative Blood Salvage
Contamination with what is relatively common?
What coagulopathy is expected?

A

Bacteria, skin organisms

Dilutional coagulopathy - washing process removes all clotting factors and most plts

162
Q

Will fail safe valve prevent delivery of hypoxic mixture?

A

NO

163
Q

Most volatile agents produce about 200 mL of gas for each mL of liquid.
100 mL of Sevo, 3 L/min, 2%

A

3000 x 0.02 = 60 mL/min of Sevo
100 x 200 = 20,000 mL of gas
20,000/60 = 333 min

The BIG Test (21 decks)

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