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N928 Basic Principles of Anesthesia > Final Exam Review > Flashcards

Final Exam Review Flashcards

1
Q

What standard is relevant to the AGM machine?

A

Standard 6

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2
Q

When should a gas machine check be performed?

A

Complete every day, without fail

abbreviated check between each anesthetic

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3
Q

Which organization is responsible for minimum performance and safety requirements used in design of AGMs for human use to enhance patient/operator safety?

A

American Society for Testing & Materials

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4
Q

The critical temperature of oxygen is

A

-118 degrees Celsius

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5
Q

1 L liquid O2 is equal to _______ L of O2 gas

A

860

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6
Q

The intermediate pressure system includes:

A 
Pipeline source at 50 psi
hospital source to wall outlets 
connecting supply hoses
filters and check valves
pressure gauges
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7
Q

The high pressure system includes:

A

pressure regulator, E cylinder or H cylinder, Hanger yoke, filter and check valves, pressure gauge

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8
Q

Concerns & issues with the pipeline supply include:

A

+/- pressure (50 psi)
cross-connection of supply pipelines
contamination- particulate, bacterial, water
leaks

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9
Q

Describe the key index safety system.

A

Connects gas hose to the wall outlet

uniquely key connect for each gas

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10
Q

Describe the diameter index safety system.

A

Connects host to machine

Each fitting has a different diameter nd internal key unique for each gas

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11
Q

Floating valves work by

A

opening and closes with pressure
moves in direction gas flow pushes it
“check valve”= interface between pipeline and AGM
unidirectional valves in circle system

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12
Q

The ball and spring valve is

A

the flush valve, all or none, you supply the energy

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13
Q

The diaphragm valve is the

A

pressure reducing valve; 1st and 2nd stage regulators

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14
Q

The Bourdon Tube pressure gauge measures

A

high pressures (cylinder pressures) relative to atmospheric pressure

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15
Q

The hanger yoke is used to

A

connect the cylinder to the AGM

ensures a gas-tight seal

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16
Q

Describe the PISS.

A 
there are holes in cylinder valve that fit two pins in the yoke
pins in numbered positions
Air: 1, 5
oxygen: 2, 5
Nitrous oxide: 3, 5
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17
Q

Safety relief devices that prevent rupture of the cylinder include:

A

frangible copper disc
spring-loaded valve
Fusible plug (Wood’s metal)- Bismuth, lead, tin, and cadmium

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18
Q

Cylinder construction is overseen by

A

the department of transportation

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19
Q

Cylinders are made of

A

steel & meet certain chemical/physical requirements
walls are 3/8th inch thick
tested at 1.66 times their service pressure

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20
Q

The United States Pharmacopoeia

A

sets standards for potency/purity of medical gases

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21
Q

The National Fire protection association is responsible for

A

location, construction, and installation of bulk systems

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22
Q

Safe handling of cylinders includes:

A

never stand a cylinder upright without support; lay it on its side
never leave empty cylinders on the machine
never leave the plastic cover on the port while installing the cylinder
never rely on a cylinder’s color for ID of its contents
Never oil valves
Never remove a cylinder from a yoke without filling with space with a yoke plug

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23
Q

The critical temperature of nitrous oxide is

A

36.5 degrees celsius

745 psig until liquid is depleted

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24
Q

O2 tanks must have

A

> 1000 psi

cylinder supply is for emergencies only

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25
Q

The diaphragm-type valve is

A

regulator or pressure reducing device
reduces the high, variable pressure to a lower constant pressure
maintains constant gas flow without changing the supply pressure- tension springs and diaphragm supply constant force

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26
Q

List the specs regarding the oxygen gas cylinder

A

oxygen, green, 1900 PSI, 660 L, pin position 2,5

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27
Q

List the specs regarding the nitrous oxide gas cylinder

A

nitrous oxide, blue, 745 PSI, 1590 L, 3 & 5

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28
Q

List the specs regarding the air gas cylinder

A

yellow, 1900 PSI, 625 L, 1 & 5

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29
Q

What law can be utilized to determine how much time is left in the gas cylinder?

A

Boyle’s law

P1 x V1= P2 X V2

30
Q

The low pressure system is

A

distal to the flowmeter needle valve and includes:

flowmeter tubes, vaporizers, check valves, & common gas outlet

31
Q

The high pressure system is

A

exposed to cylinder pressure and includes: hanger yoke; yoke block with check valves; cylinder pressure gauge and cylinder pressure regulators

32
Q

The intermediate pressure is

A

exposed to pipeline pressure ~50 PSI
it includes: pipeline, check valves, pressure gauges, ventilator power inlet, oxygen pressure-failure devices, flowmeter valve; oxygen second stage regulator & the flush valve

33
Q

Describe the “Fail-safe” design system.

A

Designed to prevent unintentional delivery of a hypoxic mixture to the flow control valves
can still occur if the pipeline is switched

34
Q

Describe the position of the flowmeters.

A

O2 is positioned closest to the common gas outlet.
Leak in any other flowmeter tube least likely to affect O2 supply to the patient
Protects against accidental decrease in delivered O2 (hypoxic mixture)
when O2 is mounted downstream, there is less chance of a hypoxic mixture

35
Q

The minimum O2 flow is

A

200-300 mL/min.

36
Q

The flowmeters are

A 
color and touch coded 
have balls (read in the middle) or bobbins (read at the top)
known as thorpe tubes or variable orifice tubes
diameter is gas specific and not interchangeable among gases
37
Q

Describe the proportioning system.

A

hypoxic guard system
links N2O & O2 in a 3:1 ratio to ensure appropriate mixture
also known as the pneumatic link or link 25

38
Q

These can result in a hypoxic mixture:

A

wrong supply of gas in oxygen pipeline or cylinder
defective pneumatics or mechanics
leaks downstream of flow control valves on flowmeters
use of a third inert gas (helium)

39
Q

Vaporizers are used to

A

blend fresh gases from flowmeters with sufficient vapor to form clinically useful concentration

40
Q

The vapor pressure increases with

A

temperature

41
Q

The vapor pressure of isoflurane is

A

239 mmHg

42
Q

The vapor pressure of halothane is

A

243 mmHg

43
Q

The vapor pressure of sevoflurane is

A

170 mmHg

44
Q

The vapor pressure of desflurane is

A

669 mmHg

45
Q

Modern vaporizers are

A

temperature compensated- ensures steady vaporizer output over wide range of ambient temperatures
agent specific- only calibrated for a single agent
out of circuit- outside the breathing circuit

46
Q

Variable bypass vaporizers have

A

concentration dials that split the stream into bypass gas and carrier gas

47
Q

Factors that influence output include:

A

flow rate- rates <250 mL or >15 mL/min result in agent output that is

48
Q

The bimetallic strip

A

decreases flow through the vaporizing chamber when temperature increases

49
Q

Safety with vaporizers:

A

key index safety system to fill
don’t tip
don’t overfill- causes liquid agent to enter bypass chamber
leaks- loose filler cap, malposition
simultaneous inhaled agent administration- removing center vaporizer can defeat interlock system

50
Q

The vaporizer interlock system ensures that

A

only one vaporizer can be turned on at a time

51
Q

If a higher VP agent is placed in a vaporizer of a lower VP aget,

A

concentration of agent delivered will be higher than dialed setting and vice versa

52
Q

The Tec 6 vaporizer is a

A

gas/vapor blender; not variable bypass
has to be plugged in to be usable- battery ONLY powers alarms, not vaporizer
yellow light- warm up, low agent, alarm battery low
no output- red- vaporizer can’t add agent vapor to gas flow due to lack of agent, tilting, or malfunction
operational (green)- vaporizer functional

53
Q

Describe the oxygen flush valve.

A

Ball & spring valve
standard delivery= 25-75 L/min @ 50 psi
proceeds directly from gas supply (pipeline or E-cylinder)
can cause barotrauma or awareness b/c no gas is delivered when this is used

54
Q

5 tasks (direction) of oxygen:

A 
proceeds through flowmeter
supplies O2 flush valve
activates fail-safe mechanism
activates low oxygen pressure alarm
drives the ventilator
55
Q

Describe the open circuit

A

No reservoir bag, no rebreathing, example is open drop ether

56
Q

Describe the semi-open circuit

A

Reservoir bag, no rebreathing, example is nonrebreathing circuit or circle at high FGF

57
Q

Describe the semi-closed circuit

A

Reservoir bag, yes partial rebreathing, circle at low FGF

58
Q

Describe the closed circuit

A

Reservoir bag, complete rebreathing, circle with APL valve closed

59
Q

What is the APL valve?

A

it is the adjustable pressure limiting valve or pop-off valve
used to regulate the pressure in the circuit during normal ventilation
it is bypassed in mechanical ventilation

60
Q

The most dead space exists in the

A

Y piece and the patient

61
Q

When exhausted soda lime is _____ and baralyme is ______

A

purple; blue-gray

they are colorless when fresh!

62
Q

What is the granule size of the carbon dioxide absorber?

A

4 to 8 mesh

compromise between resistance to airflow and surface area for absorptive capacity

63
Q

Describe the Mapleson A circuit.

A

FGF, tubing, exp. valve, patient

64
Q

Describe the Mapleson B circuit.

A

bag, tubing, FGF, exp valve, patient

65
Q

Describe the Mapleson C circuit.

A

same as B but has shorter expiratory limb

bag, tubing, FGF, exp. valve, patient

66
Q

Describe the Mapleson D circuit.

A

opposite of Mapleson A

Exp. valve, tubing, FGF, patient

67
Q

Describe the Mapleson E circuit.

A

Valveless and bagless- basically a T-piece
EASY because no exp valve or bag
Tubing, FGF, patient

68
Q

Describe the Mapleson F circuit.

A

Adaption of the Mapleson D.

Exp. valve, bag, tubing, FGF, patient

69
Q

The Bain circuit has

A

bag w/ overflow valve, FGF, corrugated tubing, and face mask
improved humidification, ease of gas scavenging
disadvantages include increased resistance, rebreathing due to unrecognized disconnect of inner tube

70
Q

Describe the types of bellows

A

ascending- go up on expiration

descending- go down on expiration

71
Q

Disposal systems can be

A

open- used only with active disposal systems (safer for the patient) or closed (safer for the OR staff)

N928 Basic Principles of Anesthesia (16 decks)

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