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equipment > exam 1 > Flashcards

exam 1 Flashcards

1
Q

APSF critical requirements

A
  • ability to administer O2 up to 100%
  • reliable means of positive pressure ventilation
  • backup ventilation equipment available and functioning
  • controlled release of positive pressure in the breathing circuit
  • anesthesia vapor delivery (if intended)
  • adequate suction
  • means to conform to standards for patient monitoring
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2
Q

AANA monitoring requirements

A
  • ventilation monitoring continuously
  • monitor oxygenation continuously
  • CV status continuously (HR and BP q5min)
  • monitor body temp on peds continuously and other patients as necessary
  • monitor and assess patient positioning
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3
Q

Non-RSI sequence

A
  1. pre-anesth. safety check
  2. apply monitors
  3. pre-oxygenate
  4. induction drugs (make sure you can ventilate before giving paralytic)
  5. mask ventilation
  6. airway management device placement
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4
Q

manual ventilation indications

A
  • bridge to a more secure airway
  • anesth machine ventilator failure or circuit malfunction
  • excessive sedation and resp depression in MAC case
  • transporting patients from OR to PACU or ICU
  • any emergency code situation or other loss of airway
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5
Q

manual ventilation general contraindications for GA

A
  • full stomach or increased aspiration risk
  • anticipated or known difficult airway
  • facial trauma or known anomolies that would make mask vent difficult
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6
Q

“ramped”position….where is EAC

A

-at level of sternum

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7
Q

fitting mask

A

-should fit over the bridge of the nose without putting pressure on patient’s eyes
-side should seal just lateral to the nasal folds
-bottom sits between lips and chin
0-3 for children; 4-5 for adults

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8
Q

oral airways are good for:

A
  • edentolous patients
  • Down syndrome/pediatric patients (large tongues)
  • sleep apnea patients
  • never really hurts to place one (mind loose teeth)
  • gag reflex must be out first
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9
Q

NP airway insertion

A
  • bevel towards septum

- if using left nostril, rotate 180 degrees once halfway in

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10
Q

NP advantages and contraindications

A
  • better for awake patients
  • good when pt can’t open mouth
  • tolerated better with intact gag reflex
  • may cause nosebleeds (caution with anti-coags)
  • contraindicated with basilar skull fx
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11
Q

risk factors for difficult mask airway

A
  • facial hair
  • lack of teeth
  • obesity
  • facial anomolies
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12
Q

adjustable pressure limit (pop-off)

A
  • only gas exit from from breathing system during spontaneous, assisted, or manually controlled ventilation if there are no circuit leaks
  • controls pressure in circuit, which in turn adjusts bag filling
  • higher gas flows pressurize circuit more quickly
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13
Q

why pre-oxygenate

A

fill FRC with O2

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14
Q

Mask induction: who?

A
  • peds who are NPO where IV placement may be distressing

- adult patients who are NPO and a hard stick or unable to cooperate for IV placement

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15
Q

typical mask induction sequence

A
  • hook up to monitors
  • nitrous/o2 then add sevo
  • gentle mask vent until IV placed (too deep: bradycardia, too light: laryngospasm)
  • intubate
  • always have atropine
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16
Q

laryngospasm mediated by:

A
  • superior laryngeal nerve
  • in response to irritating glottic or subglottic stim
  • reflexive response to prevent aspiration
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17
Q

laryngospasm mechanism

A

-false VC and epiglottis come together firmly and allow no air flow or vocal sound

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18
Q

Laryngospasm treatment

A
  • forward displacement of the jaw and positive pressure with 100% O2
  • severe spasm may req small doses of sux (0.1 to 1 mg/kg) and re-intubation
  • will eventually cease as hyper arnica and hypoxia develop
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19
Q

IV induction sequence

A
  • pre-oxygenate
  • IV induction agent
  • mask airway
  • IV paralytic if ETT used (not always req), no paralytic if LMA
  • placement of airway device and confirmation
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20
Q

RSI sequence

A
  • preoxygenate up to 5 mins
  • IV anesthetic
  • SUX
  • cricoid pressure
  • intubation with ETT
  • release of cricoid pressure after confirm of ETT
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21
Q

Modified RSI: what is it/indication

A
  • patient is masked with gentle pressure with cricoid pressure is maintained
  • may be done if you need extra oxygenation or feel the need to see if pt has a good mask airway
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22
Q

Cricoid pressure

A
  • used to prevent pulmonary aspiration
  • hypothetical basis is that pressure on the front of the cricoid cartilage is transmitted to its posterior lamina, which occluded esophagus by compression against the vertebral bodies
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23
Q

Cricoid pressure disadvantages

A
  • reduces tone of lower esophageal sphincter, so risk of regurgitation from stomach to esophagus is increased
  • impair insertion of the laryngoscope
  • degrade view off larynx
  • impede passage of an introducer or tracheal tube
  • cause airway obstruction
  • application of cricoid pressure by an assistant impedes external laryngeal manipulation by anesthetist
  • fracture of cricoid cartilage
  • rupture of the esophagus from vomiting in the presence of cricoid pressure
  • low levels of pressure might be safe in the presence of vomiting
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24
Q

If unable to incubate or mask a patient, next line of treatment is:
Last option:

A

LMA

Surgical airway

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25
Q 
Mac/Miller size 0
1
2
3
4
A

0: neonates
1: infant
2: child
3: most adults
4: large adults

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26
Q

Advantages of Mac blade

A

-displaces more tissues; place between epiglottis and vallecula

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27
Q

Advantages of Miller blade

A

-displaces epiglottis; good for kids

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28
Q

If you don’t see epiglottis with Mac blade….

A

Pull back, may be in to deep and epiglottis may be under blade

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29
Q

Placement of Miller blade

A
  • deliberately place in R paraglossal space, no tongue present on R side of the blade
  • can move distal end medially, but not proximal end
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30
Q

Gold standard for unstable C spine intubation

A

Flex fiberoptic laryngoscope

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31
Q

Pros & cons of LMA

A

Pros: less invasive and irritating (reactive airway), less anesthetic required, quick and easy, no special equipment, if removed inflated secretions come out with device, less chance of kinking, can avoid mask ventilation
Cons: may be more likely to dislodge

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32
Q

Pros/cons of ETT

A

Pros: theoretical aspiration protection (GERD, full stomach, laparoscopy), more secure (prone or lateral case), ability to positive pressure vein at higher peak (LMA limit: 20), used if post op vent required, protects against laryngospasm while in place

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33
Q

Sizes of ETT based on

A

Internal diameter

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34
Q

Who gets what size ETT

A

Adults: 7-9

Children (age/4)+4, compare ETT to pinky, depth = ETT x 3

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35
Q

Microlaryngoscopy tube purpose

A

-small diameter, longer ETT to facilitate view of the airway (5-6 mm)

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36
Q

ETT cuff is ___ volume, ____ pressure

A

High volume, low pressure

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37
Q

Wire reinforced ETT

A

Prevents kinks

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38
Q

Laser resistant ETT – WHY

A

ETT made of PVC are flammable, used if going to be lasering around vocal cords

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39
Q

Ring Adair Elwin ETT (RAE)

A

Very flexible, made for nasal intubations like dental cases or tonsils

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40
Q

Nasal RAE insertion

A
  • place ETT in warm saline to soften
  • mix actin with 2% lido jelly to prevent bleeding
  • dilate nasal passage with nasal trumpets
  • use McGill forceps to guide tube, but often with external laryngeal manipulation, ETT is directed naturally through VC
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41
Q

Laryngectomy/tracheal stoma ETT

A

J tube

  • placed through stoma
  • can be done awake or asleep
  • a regular tube can be used, but these are much more convenient
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42
Q

Proseal LMA

A

Has a drain tube for stomach and bite block

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43
Q

LMA supreme

A

Bite block

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44
Q

LMA insertion

A
  • press tip of LMA against hard palate
  • press cuff further into mouth, maintaining pressure against palate
  • swing device inward with a circular motion, pressing against hard and soft palate
  • advance until resistance is felt
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45
Q

LMA size 3, 4 5

A

3: children 30-50 kg
4: adults 50-70 kg
5: 50 -100 kg

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46
Q

Complications from supraglottic airway

A
  • sore throat, trauma from insertion
  • nerve injury including hypoglossal nerve, vocal cord paralysis, excessive high cuff pressures (use of nitrous will make cuff bigger from diffusion, monitor pressure)
  • gastric distention and aspiration
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47
Q

Compressed gas definition

A

-any material or mixture having in the container either an absolute pressure exceeding 40 psi at 130F or any liquid flammable material having a vapor pressure exceeding 40 psi at 100F

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48
Q

Service pressure of common gasses at 70F:

Oxygen, nitrogen, helium, air (E cylinders)

A

-oxygen: 1800-2400 psig
-nitrogen: 1800-220 psig
-helium: 1600-2000 psig
Air: 1800 psig

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49
Q

Liquified compressed gas

A

Becomes liquid in a container at ordinary temperatures and pressures from 25-2500 psig

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50
Q 
Liquid at T and service pressure at 70F 
CO2
Nitrous
Ethylene
Cyclopropane
A

CO2:

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51
Q

Non flammable

A

Will not burn, support combustion, explode

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52
Q

Combustion supporting

A
  • increase the rate and intensity of anything that’s burning or could burn
  • combustible material ignited in pure o2 or nitrous may be explosive
  • minimum of 15 feet from flame
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53
Q

Flammable

A

Can be readily ignited

-explosive in presence of oxygen

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54
Q

Air

A
  • ready available and usually free
  • can be compressed from atmosphere, dried and purified by chemical and mechanical means
  • may also be synthetically produced from already purified major components nitrogen and oxygen
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55
Q

Helium

A
  • chemically inert, lighter than air, colorless, odorless, nonflammable, will not support life
  • main source is from natural gas wells
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56
Q

Oxygen (green)

A
  • gas in a cylinder b/c critical temp is below room temp
  • colorless, odorless, tasteless, supports life
  • non-flammable but supports combustion
  • liquid at -300 F
  • when combined with most elements produces _____ oxides
  • most commercial o2 produced by liquefaction and separation
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57
Q

Heliox

A

(Green/brown)

  • helium oxygen mix (40 or 20% o2)
  • reduces airway resistance
  • reduces airway fires during laser surgery
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58
Q

Nitrous oxide

A

N20 (blue)
Weight: 44; BP: -88; vapor pressure: 39000
-liquid at room temp BC critical temp is above room temp
-condenses into a liquid at 747 psig
-full E cylinder has 1590L of gas, weighs 20.7 lbs (pressure gauge is not helpful, always 747)
-produced by thermally decomposing ammonium nitrate

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59
Q

Carbon dioxide

A

Grey

  • colorless, odorless, acidic taste, will not support life
  • non-flammable, does not burn-solid form converts from solid to gas at atmospheric pressure and room temp without going liquid
  • collected as waste gas from burning of other combustibles, purified and liquified
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60
Q

Gas cylinders are made of:

Tested to:

A
  • chrome molybdenum alloy (aluminum in MRI)

- tested to 166% service pressure q 10 years

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61
Q

7 required DOT cylinder markings

A 
DOT type and material
Serial number
Purchaser/user/manufacturer
4. Manufacturers mark
5. Manufactureer's identifying symbol
6.  Retest date, retested symbol, 110% filling, 10 year interval
7. Neck ring owner's ID
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62
Q

Cylinder testing looks for

A
  • leaks, expansion, wall stress
  • fill with h20 and submerge in water, pressurized to 3000 psig causing expansion (returned to original size, should be no change in water level measurement)
  • if cylinder displace more water after than before pressurization, has residual expansion (10% dq’ed)
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63
Q

Psi vs psig

A

Psi: pounds per square inch
Psig: pounds per square inch gauge (difference between measured pressure and the surrounding atmosphere, most gauges I’ll read zero at atmospheric pressure)

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64
Q

PSIA

A

Pounds per square inch absolute

PSIA = psig + local atmospheric pressure

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65
Q 
1 atm = 
KPa
Mbar
Mm Hg
cm mH20
Psi
A 
100 kPa
1000 mbar
760 mm Hg
1030 cm H20
14.7 psi
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66
Q

Bourdon pressure gauge

A

Measures pressure of GAS remaining in cylinder

  • made of a small hollow metal tube, soldered at one end and bent into a curve and linked to clockwork
  • an increase in pressure cause tube to straighten, decrease to regain its curve. Movement transmitted to clock mechanism and accompanying scale
  • kPa or psi
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67
Q

1 cu ft of nonliquified gas = ____ L

A

28.3

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68
Q

E cylinder versus H cylinder

A

22 cu ft (622 L) vs 244 cu ft or 6905 L

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69
Q

Conversion factor PSI to L gas

A

Cylinder volume x 28.3/pressure

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70
Q

Full nitrous cylinder: weight, volume, pressure
Half empty: weight and psig
No liquid
Empty

A
  1. 7 lb, 1590 L, 745 psig
  2. 3 lb, 745 psig
  3. 2 lb, 250 L
  4. 1 lb, 125 L, 350 psig
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71
Q

Pin index safety system

A

Each gas cylinder has it’s own unique PIN position (2 in anesthesia machine and 2 in cylinder valve)

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72
Q

What should you do before connecting cylinder to a machine?

A
  • ID
  • remove protective cover
  • cracking cylinder before attaching to yolk - keeps dirt out
  • check for plastic seal washer
  • PISS is there fore a reason, no match no mount
  • open slowly to flow compression of gas within the machine and prevent explosions (adiabatic heat of compression)
  • check for reading on pressure gauge
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73
Q

Rupture disc

A

Pressure relief device, under a cadets cap that bursts as specific pressures

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74
Q

Fusible plug

A

Pressure relief device that melts between 170 and 212 F, constructed of “woods metal”

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75
Q

Pressure relief valve

A

Spring loaded device that codes when pressure returns to limit

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76
Q

First stage regulator purpose

A

Decreases cylinder pressure to 45 psig, lower than pipeline pressure

  • prevents cylinders from emptying into the pipeline
  • diaphragm valve that covers both yokes
77
Q

Second stage regulator

A

Reduces from 45-50 psig to 16 psig

78
Q

Oxygen flush valve

A

Pure o2 at 35-75 L/min flow rate, pressurized at 40-50 psig, ball and bring valve, can cause barotrauma. Bypasses everything.

79
Q

BP of o2, air, and nitrogen

A

-183, -194, -196

80
Q

Diameter indexed safety system

A

Located on the macho,e quick connect for wall hoses that is sized and indexed for a specific gas and will not allow another those to be hooked up in that spot
Valve in diss prevents cylinder gass from escaping machine through pipeline hoses

81
Q

Laminar flow depends more on _____; turbulent flow is more dependent on ______

A

Viscosity; density

82
Q

Most important factor in resistance/impedance to flow

A

Radius

83
Q

Compliance ratio

A

Delta Volume: delta pressure

84
Q

Fresh gas flow varies _______ with rebreathing

A

Inversely

85
Q

If fresh gas flow > minute ventilation =

A

No rebreathing, if scavenging or exhaust of exhaled gases at point close to respiratory tract

86
Q

If fresh gas flow > minute ventilation, rebreathing =

A

Required to make up volume

87
Q

Mechanical dead space

A

Volume in a breathing system occupied by gases that are rebreather without any change in composition

88
Q

How to minimize mechanical dead space

A

Separate the inspiration and exploratory gas streams as close to the patient as possible

89
Q

Mapleson circuit dead space is dependent on what

A

Flow

90
Q

Effects of rebreathing

A
  • rebreathing alveolar gas will cause a reduction in the inspired oxygen concentration
  • during induction, rebreathing will reduce inspired anesthetic gas concentration and prolong induction
  • during emergence, alveolar concentration exceeds that of inspired gases so rebreathing will slow agent elimination
  • rebreathing of co2 will cause an increase in etco2 if not absorbed
  • heat and moisture retention
91
Q

Bushings

A

Mounts that modify internal diameter

92
Q

Sleeves

A

Modify external diameter

93
Q

APL valve

A

The only gas exit from a breathing system unless ventilator is being used
-used to control pressure in the circuit

94
Q

APL during spontaneous respiration

A

OPEN, always

95
Q

APL uses

A
  • can be used to add CPAP
  • close as needed during assisted respiration to be directed to the patient
  • isolated from circuit during mechanical ventilation
96
Q 
Mapleson A
FGF where
Tubing
APL where
Bag yes or no
Use
Lack modification
A

FGF at back; corrugated tubing, APL near patient, bag yes
Use: spontaneous gen anesthesia; flow = 70-100 ml/kg/min, min 3x MV
Lack modification: exploratory limb from patient to APL, moves control closer to provider and easier to scavenge, but increases WOB

97
Q

Mapleson B

A

FGF near patient but distal to APL, corrugated tubing, bag
Use: uncommon, not used today
Advantage: less dead space, more mixing of air

98
Q

Mapleson C

A

FGF near patient but distal to APL, no corrugated tubing, bag (AMBU)
Min 15 LPM

99
Q

Mapleson D

Bain modification

A

FGF near patient, corrugated tubing, APL at back, bag yes
Use: spontaneous IPPV, gen anesthesia
FGF: 150-200 mL/kg/min for SV; 70-100 mL/kg/min for IPPV
Bain: exhaled gases go around FGF, coaxial system for warming

100
Q

Mapleson E

A

FGF near patient, no APL, no bag
T-piece
Use: uncommon

101
Q

Mapleson F

A

Jackson-Rees
FGF near or, APL at back, bag at back and has a mech to venting excess gas
Use: pediatrics, offers less WOB than circle system, FGF 2.5-3 x MV, min 4 LPM

102
Q

Advantages of maplesons

A
  • simmple, inexpensive, rugged
  • variations in MV have less effect on PaCO2 than circle
  • low resistance to breathing
  • lightweight
  • easy to use
  • lower compression and compliance volume losses than circle
  • FGF changes = rapid changes in inspired gas concentration
  • no CO2 absorbent problems
103
Q

Disadvantages of maplesons

A
  • high FGF (cold pt, wasted gas)
  • difficult to determine ideal FGF
  • APL location in A, B, C is awkward (lack overcomes)
  • difficult scavenging
  • can’t be used with possible MH pt BC you may not be able to blow off enough co2
104
Q

What leads to compound A formation

A

Older absorbents had high amount of K or Na hydroxides, when combined with Devi –> compound A and CO

105
Q

Best indicator of exhausted CO2 absorbent

A

FiCO2 monitor

106
Q

Precautions when using Na or K hydroxide absorbents

A
  • turn gas flow off when not in use
  • turn vaporizers off when not in use
  • change at least weekly
  • do not use fresh gas to dry breathing circuits
  • monitor temp of canister (was big prob with barium OH)
107
Q

ETCO2 elevated baseline

A

Carbon dioxide is being rebreathed, should be at baseline

108
Q

ETCO2 with delayed downslope

A

Expiratory valve issue maybe

109
Q

Goals for circle system

A

Minimize absorbent desiccation

  • max inclusion of FGF in the inspired limb and max venting of alveolar gas in the expiratory limb (faster induction and emergence, imp in the use of lower FGF rates)
  • accurate readings from the spirometer monitoring system (close to FGF may alter readings)
  • max humification of gases
  • minimal dead space
  • low resistance
  • convenient
110
Q

What is unique about GE ADU circle system

A

FGF is on other side of the inspiratory valve

111
Q

Drager Fabius and apollos ventilator is where

A

B/t FGF and inspiratory valve, not isolated from APL valve

112
Q

Circle system issues

A

-increased resistance when compared to Mapelson- not really been shown
-dead space, not really an issue unless extension used at Y port
-heat and humidity increased
-gas concentrations: no rebreathing, gas and vapor concentrations in the inspired mix are the same as those in FGF; rebreathing: use analyzers
-low flow/closed circuit
Cleaning/maintenance

113
Q

Basic function of anesthesia machine

A
  • deliver gases to keep or alive and asleep
  • makes sure gases don’t contaminate air
  • means to provide mechanical ventilation
  • means to monitor patient and anesthetic gases
114
Q

Required monitors on anesthesia machine

A

-fio2
-o2 supply failure
-hypoxic guardian
-anesthetic vapor
-spo2, BP, ecg
-breathing circuit pressure limited to 125 (valve usually 70-80)
Electric cord non-detachable
-o2 cylinder
-cylinders: PISS, check valve to prevent teams-filling, cylinder pressure gauge
-pipeline gas at 50 psi (DISS)
-flow meters + unique shape to oxygen flow control knob
-valve stops
-o2 on right side of flow meter bank, oxygen enters downstream of all gases
-auxiliary oxygen flow meter recommended
-oxygen crush (35-75 LPM flow that bypasse vaporizers, operates w/o electricity)
-vaporizers
-one common gas outlet (22 mm OD and 15 mm ID hard to d/c)
-pipeline gas supply with pressure gauge
-inlets for oxygen and nitrous
-in line filter
-check valve
-checklist
-digital data interface

115
Q

Which devices on anesthesia machine are not reliant on electrical power?

A
  • spontaneous and manual assist ventilation
  • mechanical flow meters
  • scavenging
  • variable bypass vaporizers
  • monitoring with 5 senses
116
Q

Devices with require wall outlet electrical power on anesthesia machine

A
  • mechanical ventilators (some are pneumatic ally driven but electrically controlled)
  • electronic monitors
  • digital flow meter displays
  • gas vapor blenders for vaporizers with electronic controls
117
Q

High pressure system

A

Cylinder pressure : hangar yoke, cylinder pressure indicator, cylinder pressure regulators, check valves

118
Q

Intermediate pressure system

A

37-55 psig
-master switch, pipeline connections, pipeline pressure indicators, piping, gas power outlet, oxygen pressure failure devices, gas selector switch, second stage pressure regulator, oxygen flush, flow adjustment control

119
Q

Low pressure system

A
  • distal to flow meter valves
  • flow meters, hypoxia prevention safety devices, unidirectional valves, pressure relief device, low pressure piping, common gas outlet, auxiliary oxygen flow meter
120
Q

Failure of pipeline gas

A
  • contamination
  • inadequate pressure
  • accidental crossover
121
Q

Fail safe device/oxygen pressure failure device

A

Only detects pressure of o2 while administering n20, shuts off if pressure falls below 25

122
Q

Why is fail safe valve not fail safe

A

-hypoxic gas mixture can still result from an incorrect gas supply, defective or broken safety devices, undetected downstream leaks (circuit or flow meter)

123
Q

Loss of pipeline gas steps

A
  1. Open emergency oxygen cylinder fully
  2. D/c wall pipeline connection
  3. Ventilate by hand
124
Q

Check valve role

A
  • unidirectional
  • located b/t vaporizer and the common gas outlet upstream of where the oxygen flush flow joins FGF
  • prevents back pressure to the vaporizer and flow meters from positive pressure in the breathing circuit or from oxygen flush
  • negative pressure leak test checks fxn of valve
125
Q

Vulnerable area of the circuit

A

LPC, most susceptible to leaks and breaks, located downstream from all safety features except O2 analyzer
-if a negative pressure leak test is preformed incorrectly, leak in the LPC will not be discovered

126
Q

Link system

A

Only allows you to turn n20 up so high based on oxygen flow

127
Q

Variable orifice flow meters

Flow is dependent upon

A
  • pressure drop across the constriction
  • size of the annular opening
  • physical properties of the gas (viscosity at low flow, density at high flow)
128
Q

Advantages of the circle system

A

Stable inspired concentrations

  • conserve moisture and heat
  • prevention of OR pollution
  • low gas flows
129
Q

Size of reservoir bag

A

2-5 x patients TV

130
Q

Pressure requirements for reservoir bag

A

Less than 1.5 L pressure should not be less than 30 or more than 50 when expanded 4x
More than 1.5 L pressure not less than 35 or more than 60 when expanded 4x

131
Q

Purposes of reservoir bag

A
  • reservoir
  • manual ventilation
  • visual tactile monitor
  • protects from excess pressure
132
Q

Sources of gas pollution in OR

A
  • anesthetic technique: failure to turn off agent at end of case, mask fit, flushing circuit into the atmosphere, filling vaporizers, I cuffed ETT
  • equipment issues: leaks, poorly functioning scavenging system
133
Q

Which devices on anesthesia machine are not reliant on electrical power?

A
  • spontaneous and manual assist ventilation
  • mechanical flow meters
  • scavenging
  • variable bypass vaporizers
  • monitoring with 5 senses
134
Q

Devices with require wall outlet electrical power on anesthesia machine

A
  • mechanical ventilators (some are pneumatic ally driven but electrically controlled)
  • electronic monitors
  • digital flow meter displays
  • gas vapor blenders for vaporizers with electronic controls
135
Q

High pressure system

A

Cylinder pressure : hangar yoke, cylinder pressure indicator, cylinder pressure regulators, check valves

136
Q

Intermediate pressure system

A

37-55 psig
-master switch, pipeline connections, pipeline pressure indicators, piping, gas power outlet, oxygen pressure failure devices, gas selector switch, second stage pressure regulator, oxygen flush, flow adjustment control

137
Q

Low pressure system

A
  • distal to flow meter valves
  • flow meters, hypoxia prevention safety devices, unidirectional valves, pressure relief device, low pressure piping, common gas outlet, auxiliary oxygen flow meter
138
Q

Failure of pipeline gas

A
  • contamination
  • inadequate pressure
  • accidental crossover
139
Q

Fail safe device/oxygen pressure failure device

A

Only detects pressure of o2 while administering n20, shuts off if pressure falls below 25

140
Q

Why is fail safe valve not fail safe

A

-hypoxic gas mixture can still result from an incorrect gas supply, defective or broken safety devices, undetected downstream leaks (circuit or flow meter)

141
Q

Loss of pipeline gas steps

A
  1. Open emergency oxygen cylinder fully
  2. D/c wall pipeline connection
  3. Ventilate by hand
142
Q

Check valve role

A
  • unidirectional
  • located b/t vaporizer and the common gas outlet upstream of where the oxygen flush flow joins FGF
  • prevents back pressure to the vaporizer and flow meters from positive pressure in the breathing circuit or from oxygen flush
  • negative pressure leak test checks fxn of valve
143
Q

Vulnerable area of the circuit

A

LPC, most susceptible to leaks and breaks, located downstream from all safety features except O2 analyzer
-if a negative pressure leak test is preformed incorrectly, leak in the LPC will not be discovered

144
Q

Link system

A

Only allows you to turn n20 up so high based on oxygen flow

145
Q

Variable orifice flow meters

Flow is dependent upon

A
  • pressure drop across the constriction
  • size of the annular opening
  • physical properties of the gas (viscosity at low flow, density at high flow)
146
Q

Advantages of the circle system

A

Stable inspired concentrations

  • conserve moisture and heat
  • prevention of OR pollution
  • low gas flows
147
Q

Size of reservoir bag

A

2-5 x patients TV

148
Q

Pressure requirements for reservoir bag

A

Less than 1.5 L pressure should not be less than 30 or more than 50 when expanded 4x
More than 1.5 L pressure not less than 35 or more than 60 when expanded 4x

149
Q

Purposes of reservoir bag

A
  • reservoir
  • manual ventilation
  • visual tactile monitor
  • protects from excess pressure
150
Q

Sources of gas pollution in OR

A
  • anesthetic technique: failure to turn off agent at end of case, mask fit, flushing circuit into the atmosphere, filling vaporizers, I cuffed ETT
  • equipment issues: leaks, poorly functioning scavenging system
151
Q

It is not a requirement to monitor what type of gas

A

Volatile a esthetics

152
Q

Diverting gas sampling

What can be monitored this way

A

-gas is aspirated from sampling site and through a tube to sensor located inside or on top of machine
-oxygen (paramagnetic), CO2, volatiles use infrared
Not as accurate for fast RR

153
Q

In line gas sampling

A

-sensor is locating directly in the gas stream
-only Co2 and o2 monitored
Oxygen: fuel cell
Co2 infrared
Good for high RR

154
Q

Infrared analysis

A

Molecules containing dissimilar atoms will absorb infrared radiation

  • doesn’t work for o2 or n2
  • most molecules will absorb infrared at specific wavelengths and hence the molecule can be identified and its concentration measured
  • absorption is according to beer-lambert law, which states that there is a logarithmic dependence between the transmission of light through a substance and concentration of that substance
155
Q

Dispersive infrared vs non-dispersive infrared

A

Both use diverting sampling usually

  • DIR uses signed optical filter plus prism or grating system to separate component wavelengths of each agent
  • NDIR incorporates multiple narrow band optical filters through. Which infrared emission is passed for analysis of mixture (more common)
156
Q

Pros and cons of side stream sampling

A

Pro: automatic calibration and zeroing, minimal added dead space, low potential for cross-contamination between patients
Cons: multiple places that leaks could occur, more variability in co2 readings that in-line sampling, slower response to changes than inline, water contamination

157
Q

Issues with all conventional anesthesia gas analyzers

A
  • relatively high sample flow (200 ml/min)
  • high flow rate can impede use with infants whose inspiratory/expiratory flows are similar to that of analyzer
  • essential that water vapor, liquid, patient secretions be kept isolated form system
  • arbiter ok or any other vaporized meds can interfere
158
Q

Paramagnetic versus electrochemical oxygen analyzers

A

Para: more expensive, no need to calibrate, fast enough to differentiate between inspired and expired o2 concentrations
Electrochem: polarographic needs external power source, not in use anymore; galvanic/fuel cell: calibration needed

159
Q

Electrochemical oxygen analysis

A

Oxygen diffuses through sensor membrane and electrolyte to cathode ray tube, reduced there allowing a current to flow. Rate at which o2 enters cell and generates current is proportional to the partial pressure of gas outside membrane

160
Q

ETCo2 monitoring in anesthesia. Purpose:

A
  • validation of proper ETT placement
  • detection and monitoring of respiratory depression
  • hyper/hypoventilation
  • cardiac function
  • adjustment of parameter settings in mechanically ventilated patients
  • estimate paco2
161
Q

Capnography works off what type of gas analysis

A

Infrared absorption

162
Q

Non-survivors vs survivors of cardiac arrest ETCO2

A

non: 4-10
Survivors: >30

163
Q

Flat ETCO2

A

Can establish PEA during arrest, increasing ETCO2 can alert you to ROSC

164
Q

Non-patient reasons an ETCO2 can change waveform

A

Obstruction

165
Q

Factors that will increase ETCO2

A
  • increased muscular activity (shivering)
  • MH
  • increased CO during resuscitation
  • bicarbonate
  • tourniquet release
  • effective drug therapy for bronchi spasm
  • decreased MV
166
Q

Factors that will decrease ETCO2

A

Decreased muscular activity (relaxants)

  • hypothermia
  • decreased CO (arrest)
  • pulmonary embolism
  • bronchospams
  • increased MV
167
Q

Normal arterial CO2 levels in mmHg, kPa, %

A

35-45 mmHg

  1. 7-6 kPa
  2. 6-5.9%
168
Q

Normal ETCo2 values mmHg, kPa, %

A

30-43 mmHg, 4-5.7 kPa, 4-5.6%

169
Q

Capnography vs capnometry

A

Capnography is a measurement and display of both ETco2 and capnogram
Capnometry is measurement and display of ETco2 value without waveform

170
Q

Value of the co2 waveform

A
  • validation of the etco2 value
  • visual assessment of patient airway integrity
  • verification of proper ETT placement
  • assessment of the ventilator and breathing circuit integrity
171
Q

Quantitative vs qualitative etco2

A

Quant: provides an actual numeric value, found in capnogram ha and capnometers; sensitive to acid, but waveform is better information
Qual: changes color to detect co2; only provides a range of values. Co2 detector

172
Q

Inadequate seal around ETT will look like what on capnography

A
  • no plateau
  • leaky or deflated ETT cuff or trach cuff
  • artificial airway too small for patient
173
Q

Hypoventilation: etco2 changes and possible causes

A
  • baseline rise, plateaus rise

- decrease in RR, decreased TV, increased metabolic rate, rapid rise in body temp (hyperthermia)

174
Q

Hyperventilation: ETCO2 changes and causes

A
  • decreasing baseline and plateaus

- increased RR, increased TV, decreased metabolic rate, fall in body temp

175
Q

Rebreathing ETCo2 changes and causes

A

-rising baseline, plateaus the same
-faulty expiratory valve, inadequate inspiratory flow, insufficient expiratory flow, malfunction of co2 absorber.
Fix: max flows, get rid of extra co2 out of pop off valve. If can’t change absorber

176
Q

Obstruction: etco2 changes and causes

A

Ethos: decreased and sloped reading. Plateaus disappear

-kicked or occluded airway, foreign body in airway, obstruction in expiratory limb of the circuit, bronchospam

177
Q

Spontaneous breathing effort with controlled vent: etco2 changes and how to fix

A

Curare cleft (quick down divot)
-appears when muscle relaxants begin to subside
-depth is inversely proportional to the degree of drug activity
Fix: give muscle relaxant, let them breathe, increase RR, give narcs

178
Q

Cardiac oscillations

A

Cardiac impulses transmitted through mediastinum, more notable in apnea, vent assisted breath.
-divots that match pulse rate

179
Q

Faulty ventilator one way circuit valve on etco2

A

Baseline elevated and abnormal descending limb on capnogram (extra Bump)
-allows patient to rebreathe exhaled gas

180
Q

How many breaths does it take to determine co2 level with colorimetric co2 detector

A
  1. Gold is golden to
181
Q

Temperature compensated concentration calibrated variable bypass vaporizer

A

Fresh gas enters vaporizer, flow is split b/t larger bypass flow and smaller flow to the vaporizing chamber or sump. In the sump is the agent at its saturated vapor concentration. Saturated vapor mixes with the bypass flow which dilutes to the concentration dial setting

182
Q

Saturated vapor pressure

A

Gas phase above a liquid contains all the vapor it can hold at a given temperature

183
Q

SVP of sevo

A

160 mm Hg

184
Q

Sip of iso

A

238 mmHg

185
Q

SVP of Des

A

660 mm Hg

186
Q

Why is temperature compensated in vaporizers

A

Energy is required to promote the vaporization process

  • heat is drawn from the liquid anesthetic itself as well as the container in the vaporization process
  • as vaporization proceeded, cooling of the liquid anesthetic and the container would tend to slow the process
  • vaporization is a temperature dependent process
187
Q

Simple variable bypass issues

A
  • high flows result in inadequate vaporization (wiking increases surface area)
  • accuracy of concentration with mechanical control knobs
188
Q

Aladdin cassette

A

Similar to the mechanical variable bypass vaporizer, except a computer controls flow through the vaporizing chamber

189
Q

Why is desflurane different for vaporization

A
  • conventional vaporizer would require really high flows to dilute down to acceptable concentration
  • low boiling point (23.5): at RT, intermittently boil resulting in large fluctuations in agent delivery. When boiling, excessive agent delivery; when cool large loss of latent heat of vaporization, resulting in an exponential decrease in SVP and under-delivery
  • electrical filament heats des to 29, easing its SVP to 194 kPa, or 2 arm
  • high pressure removes need for a pressurized carrier gas. Fresh or silent gas is entirely separate from vaporizing chamber

equipment (1 decks)

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