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Mar: Sem 3 - Principles I > Exam 3 Anesthesia Machine I [7/8/24] > Flashcards

Exam 3 Anesthesia Machine I [7/8/24] Flashcards

1
Q
  • What group oversees the standards of the anesthesia machine?
  • When was this group founded?
A
  • American Society for Testing and Materials
  • Since 1979 (reapproved in 2005)

slide 2

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2
Q

What should the anesthesia machine do?

A
  • Provide Storage/shelving
  • Provide a Housing for monitoring devices
  • Provide Accurate and safe gas delivery
  • Provide a Means for ventilating patients
  • Provide Electrical outlets for things that the machine needs, not for external items
  • Provide a place to prop your feet during long cases lol

SHAME on the anesthesia machine if it does not provide these things

slide 3

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3
Q

What features of the anesthesia works if the Master Switch is OFF?

A
  • All electronic functions disabled except:
  • Oxygen flush valve is active
  • Auxillary oxygen flowmeter
  • Battery charger
  • Electrical outlets

Only ABE! works when the machine is OFF
Oh BAE

slide 4

Still have to have things plugged in if it is off for these things to work

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4
Q

What features of the Anesthesia Machine work when the master switch is on?

A
  • Pneumatic and electrical functions
  • activates alarms and safety features
  • power-up protocol can be bypassed

Everything should be on and working

slide 4

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5
Q

Things to know about the power failure indicator

A
  • Will be visual or audible
  • Keep the machine plugged in
    • battery backup at the highest level
  • Duration of backup depends on power usage
    • manual ventilation vs ventilation

slide 5

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6
Q

for the power failure indicator what is the primary indicator visual or audible?

A
  • visual is the primary indicator
  • ideally we want both visual and audible

S5- lecture

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7
Q

What is the best way to save power on your ventilator if you lose power during an operation?

A
  • Switch from control ventilator to manual ventilation

S5-lecture

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8
Q

how do we know the power failure/battery life of machine?

A

S6

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9
Q

anesthesia machine should always be plugged into a red outlet, why?

A
  • this is the hospitals backup
  • all critical machines should be plugged into the red outlet

S7

If plugged into the white outlet, when the power goes out so the does the anesthesia machine.

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10
Q

What are the electrical outlets on the anesthesia machine used to power?
What kind of stuff can be plugged in?

A
  • Power the Anesthesia monitors
  • Used for add on monitors like BIS, CO.
  • If requirements exceed outlet; circuit breaker will activate

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11
Q

Can bair huggers, suction machines, x-rays machines be plugged into the electrical outlet on anesthesia machne?

A
  • No, other appliances should be plugged into hospital’s main outlets

S8

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12
Q

What are the 3 parts of the pneumatic system?

A
  • High Pressure
  • Intermediate Pressure
  • Low Pressure

slide 9

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13
Q

Click here for the picture of the pneumatic system

A
  • everything on the left side is high pressure
    • circles are the canisters of gases on the back of machine
    • arrows are check valves
  • middle is intermediut
  • right is low presure system
    • flow meeters
    • vaporizers
    • common gas outlet

slide 10-lecture

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14
Q

Where does the high-pressure system recieve gas from? At what pressure?

A
  • Receives gas from cylinders
  • at HIGH, VARIABLE pressure of 2200 psi

slide 11

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15
Q

How does the high pressure system reduce the pressure to a lower more constant pressure?

A
  • Uses the pressure regulator (1st stage regulator) to reduce to a lower more constant pressure

slide 11

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16
Q

In a high pressure system the pressure is reduced by a pressure regulator. What is the pressure reduced to?

A
  • Reduced to 45 psi [from 2200 PSI]

S11

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17
Q

Without pressure regulators what would we constantly be changing?

A
  • flow meters
  • this is not efficient, not time friendly, and not cost friendly*

S11

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18
Q

What is the purpose of pressure regulators?

A
  • Reduce high, variable pressure in cylinders to lower constant pressure for the machine.
  • One pressure regulator must be present for each cylinder

Andy

Pressure regulators are also called reducing valves

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19
Q

What is the purpose of the Hanger Yoke?

A
  • Orients and support the cylinder
  • Provide a gas-tight seal
  • Ensures unidirectional flow

OPE

slide 12/13

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20
Q

With a hanger yoke, how many “o” rings do you use?

A
  • only use one
  • if you use 2 the pin index safety system (PISS) could be bypassed

S12-lecture

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21
Q

It is required to have at least one hanger yoke for ____ and one hanger yoke for ____?

A
  • 1 for oxygen
  • 1 for nitrous

S13

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22
Q

What are the parts of the Hanger Yoke?

A
  • Body- principle framework
  • Retaining screw- tightens cylinder (clamp)
  • Nipple- thru which gas enters the machine
  • Index pins- prevents attaching an incorrect cylinder (PISS)
  • Washer- forms seal between cylinder and yoke
  • Check valve assembly- ensure unidirectional flow

slide 14

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23
Q

What is the purpose of the check valve assembly of the hanger yoke?

A
  • Prevent gas from exiting the machine when there is no cylinder in the yoke
  • Prevent gas from being transferred from a cylinder with higher pressure to one with lower pressure (if both are in a yoke and ON)

Ensures Unidirectional Flow

slide 15/16

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24
Q

How does check valve assembly work?

A
  • Either coiled spring or valve seat that allows to get around or occlude gas flow.
  • Coiled Spring:
    • Collpased –> gas gets around
    • Open –> occludes gas flow
  • Valve Seat:
    • Lifted valve –> air gets around

S16

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25
Q

Cylinder pressure indicator must be present for what?

A
  • must be present for each gas supplied by cylinders

slide 17

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26
Q

What are Bourdon Tubes?
What do they do?

A
  • curved hollow tubes
    • working mechanism for analogue pressure devices
    • pressure changes ↑/↓ curve
    • motion is transmitted to gauge

S17

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27
Q

The cylinder pressure indicator gauge is required to be calibrated in what?

A
  • kilopascals kPA]
  • may also be in psi

S17

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28
Q

What were the components of the high-pressure system?

A
  • Cylinder
  • Pressure Reducing Valve
  • Bourdon Guages
  • Hanger Yoke

Can Pressure Be High

S11-18

29
Q

Where does the intermediate system receive gas from/ get its pressure from?

A
  • Receives gases from the pressure regulator or pipeline

slide 19

30
Q

The intermediate pressure system receives gases from the pressure regulator or pipeline. What is the psi from these?

A
  • 1st pressure regulator: 45 psi
  • pipeline: 50-55 psi

S19

31
Q

What is the intermediate pressure system pressure if the master switch is OFF?

A
  • 0 mmHg

slide 19

32
Q

What is included in the intermediate pressure system?

A
  • Pneumatic part of the master switch
  • Flow control valves
  • Pipeline inlet connections
  • Oxygen pressure failure devices
  • Oxygen flush valve
  • Piping

POOF PP

P For POOP

slide 19

33
Q

What is the pipeline inlet connection?

A
  • The entry point for gases from the pipelines.
  • Pipeline inlet connects are fitted with a diameter index safety system (DISS)

slide 21

34
Q

The anesthesia machines are required to have pipeline inlets for what gases?

A
  • Required: Oxygen and Nitrous
  • Most also have air
  • inlets are fitted with DISS

slide 21

35
Q

Pipeline Inlet connections must conatin what to prevent the anesthesia machine gas from returning to the pipeline?

A
  • Unidirectional check valve

slide 21

36
Q

Where is the pipeline pressure indicator located?

A
  • Found on the front of the anesthesia machine
  • indicator is required for each gas monitored

slide 23

Picture next to the pressure indicator signifies whether gas is from the pipeline or cylinder.

37
Q

Pipeline pressure indicators:
* indicator must be where?
* What do newer machine have?

A
  • Indicator must be on pipeline side
    • if downstream and cylinder valve open will have adequate pressure reading until cylinder is 0/empty
  • digital and newer machines have LED

slide 23

38
Q

The intermediate system contains piping.
* What is the function of piping?
* What must piping be able to withstand?

A
  • Function: The piping connects the components inside the machine
  • Must be able to withstand 4x the intended pressure (about 200 psi)

slide 25

39
Q

With piping, leaks must not exceed ____ ml/min inside the anesthesia machine.

A
  • 25 ml/min

slide 25

40
Q

How does the oxygen failure safety device work?

A
  • If O2 pressure is reduced to 30 psi, other gases like nitrous will decrease or discontinue to maintain at least 19% O2 concentration at the common gas outlet.
  • this continues until O2 flow ceases - simulated in machine check

slide 26

41
Q

O2 failure alarm will sound within ____

A

5 seconds

slide 26

42
Q
  • What two places does the oxygen flush get its supply?
  • Where does it send O2?
A
  • Receives oxygen from pipeline inlet or cylinder pressure regulator
  • sends O2 to common gas outlet

slide 27

43
Q

What are the standards for the oxygen flush?

A
  • Have flow between 35-75 L/min (can cause barotrauma)
  • Designed to minimize accidental use
  • Must be operable with 1 hand
  • Single purpose
  • Self-closing

Flush MOSS

slide 27

44
Q

What are the hazards of using the oxygen flush?

A
  • If stuck on, could cause:
    • Barotrauma
    • Awareness

slide 28

45
Q

What is the function of the flow adjustment control?

A
  • Regulate the flow of oxygen, air, and other gases
  • Mechanical or electrical
  • Must be only one control for each gas; must be adjacent to its flowmeter

slide 30

46
Q

What is unique about the oxygen flow knob?

A
  • It must be fluted and larger than other gases (looks and feels different)

slide 30

47
Q

What kind of pressure does the low Pressure system have? What is this dependent on?

A
  • Pressure is slightly above atmospheric and variable
    • Depends on flow from flowmeters and backpressure from breathing circuit

slide 32

48
Q

What are the components of the low-pressure system?

A
  • Flowmeters
  • Hypoxia prevention devices
  • Unidirectional valves (within the machine)
  • Pressure relief devices
  • Common gas outlet

UP CHF
PH(F)UC

slide 32

49
Q

Where is the low-pressure system located?

A
  • located downstream from flow control devices (knobs)

slide 32

50
Q

What indicates the rate that gas passes through?

A
  • Flowmeter

slide 34

51
Q

What is the Thorpe tube?

A
  • Flowmeters have a Thorpe tube- vertical glass tube design
    • Smallest diameter at bottom
    • Free floating indicator
    • A stop at top of tube
    • A flow scale

slide 34

52
Q

What are the flowmeter requirements?

A
  • Must be marked with appropriate color and chemical symbol
  • 2nd stage regulator maintains 14-30psi
  • Gases empty into a common manifold

slide 34

53
Q

what does the 2nd stage regulator do?
What does the 1st stage regulator do?

A
  • 2nd stage regulator: Maintains flows at 14-30psi
  • 1st stage regulator: at the cylinder to drop pressure to 45 PSI

S34- lecture

54
Q

30 psi is important. What alarm goes off here?

A
  • At 30 PSI is where the O2 pressure alarm occurs.

S34 - lecture

55
Q

What is the flowmeter sequence?
Which comes 1st with Drager flowmeter & Ohmeda/Daytex?

A
  • Normal gas flow from:
    • bottom to top
    • Left to right
  • Drager: N2O
  • Ohmeda: Air

slide 36

56
Q

What is the standard for the flowmeter sequence?

A
  • The standard requires oxygen flowmeter to be placed on the right side.
  • By having the O2 flowmeter on the right, there is the least chance of leaking and being hypoxic

slide 36

57
Q

Which is the safe option in flowmeter sequence?

A
  • C or D becuase O2 is at the end
  • in A or B if there is a leak up stream pt risk not getting O2

S37-lecture

58
Q

What are the hypoxia prevention devices?

A
  • Mandatory Minimum Oxygen Flow
  • Minimum Oxygen Ratio

slide 38

59
Q

For the mandatory minimum oxygen flow:
* What is the minimum flow?
* When is it activated?

A
  • Minimum of 50 to 250 ml/min flow
  • Master switch needs to be ON for mandatory minimum oxygen flow to work.

slide 38

60
Q

What is the minimum oxygen ratio?

A
  • Gas ratio between oxygen and nitrous uses mechanical linkage with nitrous
  • Link engages when oxgyen concentration is 25%.`

slide 38

-doesn’t allow you to give all nitrous without turning oxygen on
-doesn’t allow you to turn O2 down to 0 with nitrous going on
-when O2 concentration drops to ~25% the link between nitrous and oxygen engages and when the oxygen goes down, it will pull down the nitrous also
-if you hit the 25% concentration mark —> there’s a mechanism in there that lets it disengage/fall off or engage and tighten up to where youre turning on both of them

61
Q

Where are the unidirectional valves located in the low-pressure system?

A
  • Located between the vaporizer and common gas outlet.
  • Upstream from oxygen flush valve.

slide 40

62
Q

What is the function of low-pressure unidirectional valves?

A
  • Unidirectional valves will lessen the back pressure from flush or breathing circuit
  • Prevents back pumping /pumping effect

slide 40

63
Q
  • Pressure relief devices are located where?
  • what do they do with excess pressure?
A
  • Near common gas outlet
  • Opens to atmosphere and vents if preset pressure is exceeded

slide 41

64
Q

What is the drawback to the pressure relief device of the low-pressure system?

A
  • Limits the ability of the machine to provide adequate jet ventilation

Jet ventilation = sending jets of O2 or air

slide 41

65
Q

What component receives all gases from the machine and delivers the mixture to the circle system?

A
  • Common gas outlet

S42/43

66
Q

The Common Gas outlet must be what?

A

must be difficult to disconnect

slide 42

67
Q

The common gas outlet should not be used for what? Why?

A
  • Common gas outlet should not be used for supplemental oxygen because:
    • it can cause delay in emergencies
    • and if used during emergencies, potential delivery of inhalation agents to the patient

slide 42

68
Q

What can deliver oxygen in case of an electronic power failure?

A
  • Alternate Oxygen Control

slide 44

69
Q

What happens if you press the on/off button on the alternative oxygen control?

A
  • If you press this button, everything shuts off except for O2.
  • this is for when there is an emergency and you need volatiles and everything else off and just need to deliver O2

S44- lecture

Mar: Sem 3 - Principles I (29 decks)

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