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PRINCIPLES OF ANESTHESIA EXAM 3 > exam 3 part 1 > Flashcards

exam 3 part 1 Flashcards

ANESTHESIA BREATHING MACHINE and SUPPLY

1
Q

WHAT IS THE COMMON USE OF AN E CYLINDER

A

as a portable oxygen tank, particularly as a backup supply on the anesthesia machine, during patient transport, and in emergency situations

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2
Q

Size values of general E cylinder
height, diameter, weight

A

26 inches tall and 4.25 inches in diameter. When empty this cylinder weighs 14 lbs

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3
Q

WHAT IS THE COMMON USE OF AN H CYLINDER

A

is most commonly used to store and deliver a large volume of medical oxygen, serving as a central oxygen supply for patients

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4
Q

Size values of general H cylinder
height, diameter, weight

A

51 in tall, 9.25 inches in diameter, When empty this cylinder weighs 119lbs

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5
Q

ORGANIZATIONS THAT REGULATE MEDICAL COMPRESSED GASES

A

DOT - department of transportation
FDA - food and drug administration
CGA - the compressed gas association
NFPA - national fire protection association
ASME - american society of mechanical engineers

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6
Q

what does the DOT regulate

A

the manufacture, filling, labeling, inspection, storage, and transportation of cylinders

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7
Q

what does the FDA regulate

A

the quality and purity of the medical gas contents

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8
Q

DOT standards that must be met

A

need to find this

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9
Q

FDA standards that must be met

A

need to find this

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10
Q

OXYGEN E CYLINDER FACTS
color, PISS, capacity, psig, critical temp

A

green
2,5
660L
1900 psig
-119

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11
Q

NITROUS OXIDE E CYLINDER FACTS
color, PISS, capacity, psig, critical temp

A

blue
3,5
1590 L
745psig
36.5

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12
Q

AIR E CYLINDER FACTS
color, PISS, capacity, psig, critical temp

A

yellow
1,5
625L
1900 psig
-140

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13
Q

CARBON DIOXIDE COLOR

A

grey

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14
Q

NITROGEN E CYLINDER COLOR

A

black

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15
Q

HELIUM COLOR

A

brown

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16
Q

relationship between pressure and volume with gas (oxygen and air)

A

varies directly

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17
Q

relationship between pressure and volume when stored as gas and liquid (N2O)

A

pressure remains constant until liquid all vaporized

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18
Q

what law/formula is used to calculate pressure and volume changes for an oxygen tank at a constant temperature

A

Boyle’s Law
P1V1=P2V2

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19
Q

if N2O tank is partially full at 1000L what is the psig

A

745psig

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20
Q

How to determine volume of nitrous in the E cylinder

A

you have to weigh it and subtract the current weight from the ‘tare weight’ (empty cylinder weight) that is stamped on the outside of the tank

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21
Q

critical temperature

A

The critical temperature of a substance is the temperature at and above which vapor of the substance cannot be liquefied, no matter how much pressure is applied

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22
Q

structure and function of cylinder valves

A

designed to control the flow of gas from a pressurized cylinder, typically featuring a threaded stem with a hand-wheel to open and close the valve, a pressure seal to prevent leaks, and often incorporating safety features like pin index connections to ensure proper equipment compatibility; its primary function is to allow controlled release of a gas from the cylinder while preventing accidental mixing with other gases due to its unique design and connection type

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23
Q

structure and function of cylinder outlet ports

A

allows for the secure attachment of oxygen delivery devices, such as nasal cannulas or oxygen masks, to an oxygen source. These ports typically come in standardized sizes and shapes to ensure compatibility with various oxygen delivery systems.

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24
Q

structure and function of cylinder pressure relief devices
(3 types)

A

frangible disc - bursts
fusible plug - melts
valve - opens

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25
Q

yoke connectors for cylinders

A

The yoke assembly is made up of a yoke block, yoke screw, and pin index system. The yoke block is attached to the regulator or device and contains a hole with a specific number of pins arranged in a specific pattern. The yoke screw is used to secure the gas cylinder to the yoke block.

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26
Q

6 rules for cylinder handling

A

do not oil valves
protect the valve when transporting
turn valve off with no more force than necessary to seal
no temperature above 125 F or below 20F
never stand upright without support
never drop, drag or roll

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27
Q

rules for storage of cylinders

A

do not store multiple cylinders in a small closed space in case of a leak
- combustion and suffocation risk
separate full and empty cylinders clearly

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28
Q

MRI SAFE OXYGEN CYLINDERS ARE

A

silver body and green top

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29
Q

how is medical Air sourced

A

by air compressors that dry, filter, and compress ambient air to fill medical air pipeline (location of this compressor is important)

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30
Q

COMPONENTS OF A MEDICAL GAS PIPELINE FOLLOW THE ______MODEL

A

SPDD MODEL

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31
Q

S - SUPPLY
site- back of the machine

A

pipeline: wall outlets, connecting valves and hoses, filters and check valves, pressure gauges
cylinder: hanger yokes, filters and check valves, pressure gauge, pressure regulators

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32
Q

P-PROCESSING
site- within machine proximal to common gas outlet

A

fail-safe, flowmeters, oxygen flush, low oxygen pressure alarms, ventilator-driving gas, hypoxic guard, oxygen second-stage regulator, vaporizer, check valve distal to vaporizer, common gas outlet

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33
Q

D- DELIVERY
site- breathing circuit

A

gas delivery hose connecting CGO to breathing circuit, breathing circuits (circle and nonrebreathing), CO2 absorption, ventilators, monitors (oxygen analysis, disconnection, spirometry), ventilator alarms, addition of PEEP, means of humidification

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34
Q

D-DISPOSAL
site- scavenger

A

scavenger systems:
Interface (closed or open, active or passive)
scavenger flowmeter

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35
Q

components of the high pressure pneumatic system

A

hanger yoke, yoke block with check valve, cylinder pressure gauge, cylinder pressure regulator

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36
Q

components of the intermediate pressure pneumatic system

A

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

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37
Q

components of low pressure pneumatic system

A

flowmeter tubes, oxygen proportioning system, vaporizers, vaporizer mannifold, check valves, common gas outlet

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38
Q

who published guidelines for pipeline systems

A

NFPA
CGA

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39
Q

PIPELINE SYSTEMS DELIVER GAS AT INTERMEDIATE PRESSURE WHICH IS ______PSIG

A

50-55 PSIG

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40
Q

PIPELINES SAFETY SYSTEMS INVOLVE THE _________ AND ________

A

DISS (diameter index safety system) and quick coupler system

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41
Q

high pressure system psig

A

above intermediate, example is psig of the cylinders 45-2200psig

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42
Q

Low pressure ssytem psig

A

below intermediate 14.7 (1 atm) (760mmHg)

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43
Q

a group of gas cylinders connected together to act as a central storage unit, supplying pipeline gas by feeding the gas from the cylinders through a manifold system into a pipeline network, which then distributes the gas to various points of use, essentially acting as a backup or supplemental source of gas when the main pipeline supply might be insufficient or unavailable

A

cylinder bank

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44
Q

advantages to storing oxygen as a liquid

A

greater storage capacity in a smaller space, easier transportation due to lower weight, longer duration of supply compared to gas cylinders, and often a higher purity level; making it a cost-effective and efficient option for high oxygen demand situations within healthcare facilities

45
Q

disadvantages of storing liquid oxygen

A
46
Q

liquid oxygen is stored at what temp

A

-150 to -175 C in a large flask

47
Q

proportioning systems

A

mixes O2 and N2

48
Q

each anesthetizing location must have a ________ for each gas
ICU and PACU have zone specific ones as well

A

shut off valve

49
Q

shut off valves in OR

A

typically individual, color-coded, manually operated valves located within a recessed panel usually near patients head or where gases are delivered to system, accessible by removing a cover plate

50
Q

An on/off switch in a pneumatic system …

A

acts as a primary control to manually start or stop the flow of compressed air within the system, essentially turning the system on or off by allowing or blocking air supply to the pneumatic components, like actuators or cylinders, depending on the switch position; essentially acting like a tap to control the air flow.

51
Q

All the possible upstream entry points of compressed gas into the high pressure systems

A

the connections on the gas cylinders at the central gas supply manifold and the backup O2 supply on the back of the anesthesia machine

52
Q

function of check valves

A

prevents reverse flow of gases from machine to pipeline or cylinder

53
Q

location of check valves

A

in the anesthesia machine downstream from the pipeline and cylinder inlets and down stream from vaporizer upstream from CGO or internal to vaporizer

54
Q

what do the first-stage pressure regulators do to the gas pressure from the cylinders entering the anesthesia machine

A

takes the very high, variable pressure from a gas cylinder and reduces it to a significantly lower, intermediate pressure, essentially acting as a first step to deliver a consistent, usable pressure to the machine, even as the cylinder depletes

55
Q

gas pressure at the pipeline inlet compared to the pressure leaving the first stage regulator

A

reduced to a much lower level like going from 500psi to 20 psi

56
Q

describe the second-stage pressure regulator

A

the intermediate pressure is then further reduced to reach the desired working pressure for the anesthesia machine
(from 45psig to 14psig for O2 and 26psig for N2O)
provides further precision
can be adjustable whereas first-stage is not

57
Q

most upstream and most downstream components of a high pressure system

A

The cylinder is the most upstream component, and the pressure regulator that reduces the pressure to a lower level is the most downstream component.

58
Q

most upstream and most downstream components of an intermediate pressure system

A

The pipeline inlet connection is the entry point for the gas, making it the most upstream component. The flowmeter, where the gas flow is controlled, is usually considered the most downstream component in this system

59
Q

what allows for a rapid delivery of a high volume of pure oxygen directly to the patient’s breathing circuit by bypassing the vaporizer, used primarily during critical situations like mask ventilation when a quick oxygen boost is needed, or when establishing an airway; it delivers a large flow of oxygen at high pressure when activated by a button or lever

A

oxygen flush valve

60
Q

When the oxygen flush valve is activated, it provides a direct connection to the high-pressure oxygen supply, bypassing flowmeters and vaporizers, delivering a large volume of oxygen at a high flow rate of _____

A

35-75L/min

61
Q

Improper use of the oxygen flush valve can lead to ________ due to the high pressure of the delivered oxygen

A

barotrauma

62
Q

barotrauma

A

tissue damage caused by a difference in pressure between the body and the surrounding gas or fluid. It can occur when there is a sudden change in air or water pressure, it can affect many parts of the body, including the lungs, ears, eyes, sinuses, and gastrointestinal tract. Symptoms vary depending on the affected area

63
Q

Think about barotrauma and scuba divers

A

Barotrauma can be prevented by equalizing pressures. For example, divers can equalize pressures to avoid being crushed or squeezed on descent, or stretching and bursting on ascent.

64
Q

oxygen supply failure alarm is based on

A

pressure of oxygen supply

65
Q

explain the O2 supply failure alarm
when
what does it indicate

A

safety feature designed to alert medical professionals when the pressure of the oxygen supply drops below a safe level (50psig), typically by sounding an audible alarm, indicating a potential lack of oxygen available for patients and prompting immediate action to address the issue

66
Q

how to address the O2 supply failure alarm

A

switch from pipeline supply to O2 tank

67
Q

what automatically happens when there is an O2 supply failure

A

N2O is shut off and patient gets medical air instead (remember this only has 21% O2)

68
Q

automatically shut off the flow of all other gases (like nitrous oxide) if the oxygen supply pressure drops below a certain level, preventing the delivery of a hypoxic gas mixture to the patient in case of an oxygen supply failure; essentially, it prioritizes oxygen delivery and cuts off other gases when oxygen pressure becomes critically low

A

fail-safe valve aka pressure sensor shut off aka oxygen failure protection device

69
Q

The rate of flow to the common gas outlet on an anesthesia machine is determined by

A

by the setting on the flowmeter, which is manually adjusted allowing for precise regulation of the gas delivery based on the patient’s needs

70
Q

common gas outlet

A

This is the point on the machine where the combined gas mixture exits and connects to the breathing circuit

71
Q

Thorpe tubes (TT)

A

a device used to measure the flow rate of a gas, such as oxygen. It’s a type of variable-area flowmeter, also known as a rotameter, and is a key instrument in medical gas delivery systems.

72
Q

4 components of a thorpe tube

A

Gas source connection: Connects to the gas source
Needle valve: Controls the flow rate by opening and closing with an attached dial
Float: Rests in a clear, tapered tube
Outlet port: Allows the gas to exit

73
Q

low flow in thorpe tube

A

small annular space, flow is laminar and is a function of gas viscosity

74
Q

high flow in thorpe tube

A

large annular space, flow is turbulent and a function of gas density

75
Q

low pressure manifold is the

A

common gas outlet –> where the different anesthetic gases mix together after passing through their respective flowmeters and vaporizers

76
Q

with a ball float in a flow meter you should read it in the

A

middle of the ball

77
Q

with a bobbin float in a flow meter you should read it at the

A

top of the bobbin

78
Q

the most upstream components of the low pressure system

A

Flowmeter control valve - This is where the gas flow is regulated before entering the flowmeters

79
Q

the most downstream component of the low pressure system

A

Vaporizers, check valves (if present), and the common gas outlet.

80
Q

On an anesthesia machine, flowmeters are typically arranged as

A

individual, vertical glass tubes with a visible bobbin inside, each controlled by a separate knob, where the oxygen flowmeter is easily identifiable by its larger size and often a distinct color (usually green)

81
Q

O2 flow meter should be ______ from all other gases to prevent a hypoxic mixture

A

downstream

82
Q

minimum oxygen flow is

A

200-300ml/min

83
Q

proportioning device maintains O2 to N2O ration of

A

1:3

84
Q

hypoxic mixtures will occur despite proportioning device if (4 things)

A

wrong gas to pipeline or cylinder
defective pneumatic or mechanical components
leaks downstream of flow control valve
3rd inert gas is used

85
Q

oxygen ration monitor controller shuts N2O off if O2 ratio falls below

A

30%

86
Q

high pressure-cylinder pressure(1900psig)-begins @ _______- ends @ __________

A

cylinder
cylinder regulators

87
Q

intermediate pressure- pipeline(50psig) or tank(45psig)- begins @ _______- ends @ __________

A

pipeline
flowmeter valves

88
Q

low pressure- slightly above atmospheric but varies- begins @_______- ends @ ________

A

flow meter tubes
common gas outlet

89
Q

if a cylinder is left open, the first alarm you would here for oxygen supply fail would be when _____

A

the cylinder loses pressure, not the pipeline

90
Q

if there are two oxygen yokes present, they both feed into one

A

first stage pressure regulator

91
Q

if your primary O2 source is from an E cylinder and not the pipeline then you must have

A

2 hanger yokes and a second O2 cylinder

92
Q

cracking the O2 tank serves what purpose

A

to confirm it is closed when you do, confirm the adequate pressure of the cylinder to and to remove any dust or debrie

93
Q

what is the most fragile part of the cylinder

A

cylinder valve

94
Q

yoke plug must be placed when

A

yoke is empty

95
Q

5 tasks of oxygen

A

power the
oxygen flush valve
oxygen supply failure alarm
oxygen pressure failure safety device
oxygen flowmeters
ventilator driving of pneumatic bellows

96
Q

devices that do not rely on wall outlet electrical power

A

spontaneous or manually assisted ventilation
mechanical flowmeters
scavenging
variable bypass vaporizers

97
Q

after 30 min has passed and you still don’t have power for anesthesia system then you would no longer have

A

NO LONGER HAVE VOLATILES

98
Q

if check valves malfunctioned it would cause transfiling which can cause

A

heat production and explosions

99
Q

the bodock seal refers to the

A

1 washer on the hanger yoke system

100
Q

electronic pressure indicators for cylinders have light emitting diodes what colors and what do they indicate

A

dark - closed
green - open and adequate pressure
red - open and inadequate pressure

101
Q

what must be on to allow flow to flow meters

A

master switch

102
Q

what is independent of the master switch being on and is always available

A

O2 flush valve and auxiliary flowmeter

103
Q

gas will always flow from wherever there is _______pressure

A

higher

104
Q

fail-safe device is great but it will not recognize a ________mix-up

A

pipeline

105
Q

Ohmeda uses the _______ for O2 supply fail

A

pressure sensor shut off

106
Q

Drager uses the _______ for O2 supply fail

A

oxygen failure protection device

107
Q

O2 supply failure alarm sounds when pipeline reaches below_____, can be silenced but not deactivated

A

30psig

108
Q

both fail-safe and pressure alarm measure pressure of O2, NOT

A

flow or concentration of O2

PRINCIPLES OF ANESTHESIA EXAM 3 (3 decks)

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