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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
The diaphragm-type valve is
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
26
List the specs regarding the oxygen gas cylinder
oxygen, green, 1900 PSI, 660 L, pin position 2,5
27
List the specs regarding the nitrous oxide gas cylinder
nitrous oxide, blue, 745 PSI, 1590 L, 3 & 5
28
List the specs regarding the air gas cylinder
yellow, 1900 PSI, 625 L, 1 & 5
29
What law can be utilized to determine how much time is left in the gas cylinder?
Boyle's law | P1 x V1= P2 X V2
30
The low pressure system is
distal to the flowmeter needle valve and includes: | flowmeter tubes, vaporizers, check valves, & common gas outlet
31
The high pressure system is
exposed to cylinder pressure and includes: hanger yoke; yoke block with check valves; cylinder pressure gauge and cylinder pressure regulators
32
The intermediate pressure is
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
Describe the "Fail-safe" design system.
Designed to prevent unintentional delivery of a hypoxic mixture to the flow control valves can still occur if the pipeline is switched
34
Describe the position of the flowmeters.
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
The minimum O2 flow is
200-300 mL/min.
36
The flowmeters are
``` 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
Describe the proportioning system.
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
These can result in a hypoxic mixture:
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
Vaporizers are used to
blend fresh gases from flowmeters with sufficient vapor to form clinically useful concentration
40
The vapor pressure increases with
temperature
41
The vapor pressure of isoflurane is
239 mmHg
42
The vapor pressure of halothane is
243 mmHg
43
The vapor pressure of sevoflurane is
170 mmHg
44
The vapor pressure of desflurane is
669 mmHg
45
Modern vaporizers are
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
Variable bypass vaporizers have
concentration dials that split the stream into bypass gas and carrier gas
47
Factors that influence output include:
flow rate- rates <250 mL or >15 mL/min result in agent output that is
48
The bimetallic strip
decreases flow through the vaporizing chamber when temperature increases
49
Safety with vaporizers:
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
The vaporizer interlock system ensures that
only one vaporizer can be turned on at a time
51
If a higher VP agent is placed in a vaporizer of a lower VP aget,
concentration of agent delivered will be higher than dialed setting and vice versa
52
The Tec 6 vaporizer is 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
Describe the oxygen flush valve.
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
5 tasks (direction) of oxygen:
``` proceeds through flowmeter supplies O2 flush valve activates fail-safe mechanism activates low oxygen pressure alarm drives the ventilator ```
55
Describe the open circuit
No reservoir bag, no rebreathing, example is open drop ether
56
Describe the semi-open circuit
Reservoir bag, no rebreathing, example is nonrebreathing circuit or circle at high FGF
57
Describe the semi-closed circuit
Reservoir bag, yes partial rebreathing, circle at low FGF
58
Describe the closed circuit
Reservoir bag, complete rebreathing, circle with APL valve closed
59
What is the APL valve?
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
The most dead space exists in the
Y piece and the patient
61
When exhausted soda lime is _____ and baralyme is ______
purple; blue-gray | they are colorless when fresh!
62
What is the granule size of the carbon dioxide absorber?
4 to 8 mesh | compromise between resistance to airflow and surface area for absorptive capacity
63
Describe the Mapleson A circuit.
FGF, tubing, exp. valve, patient
64
Describe the Mapleson B circuit.
bag, tubing, FGF, exp valve, patient
65
Describe the Mapleson C circuit.
same as B but has shorter expiratory limb | bag, tubing, FGF, exp. valve, patient
66
Describe the Mapleson D circuit.
opposite of Mapleson A | Exp. valve, tubing, FGF, patient
67
Describe the Mapleson E circuit.
Valveless and bagless- basically a T-piece EASY because no exp valve or bag Tubing, FGF, patient
68
Describe the Mapleson F circuit.
Adaption of the Mapleson D. | Exp. valve, bag, tubing, FGF, patient
69
The Bain circuit has
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
Describe the types of bellows
ascending- go up on expiration | descending- go down on expiration
71
Disposal systems can be
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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