Kates last minute set Flashcards
Required FGF to prevent rebreathing in SV with mapleson D
2-3 x MV
Required FGF to prevent rebreathing in CV with mapleson D
1-2 X MV
most common mapleson in peds
mapleson D
To prevent rebreathing, a Bain circuit during CV/SV requires flows of
CV: 70 mL/kg/min
SV: 200 to 300 mL/kg/min
most ideal mapleson for peds <20 kg
mapleson E -> minimal resistance r/t no valves
Length of tubing in mapleson E must
exceed the TV
Required FGF to prevent rebreathing in SV with mapleson E
2-3 x MV
Required FGF to prevent rebreathing in SV with mapleson F
2-3 x MV
Similarities between maplesons and circle systems (3)
Accept a FGF
Supply theft with a sufficient volume of gas from a reservoir to satisfy the inspiratory flow and volume requirements
eliminate CO2
size specifics of corrugated tubing
T piece, 22 mm male fitting. 15 mm female coaxially fitting for ETT
internal volume = 400 - 500 mL / m
FGF in closed circle systems
inflow gas will exactly match metabolic needs/o2 consumption of the patient using very low flows (~250 mL/min)
a third of malpractice claims are related to
disconnections /misconnections of the circuit
DISS contains
filter, check valve, pressure gauge
nipple, nut, body
the delivered oxygen concentration shall not
decrease below 19% at the common gas outlet
fail safe devices are in ______
intermediate pressure system.
Oxygen failure supply alarm ; low pressure whistle.
FAIL SAVE DEVICES:
drager proportional valve
dates ohmeda threshold valve
Fail save valves are designed to
prevent the delivery of hypoxic gas mixtures from the machine in the event of failure of oxygen supply
pressure not flow!
INTERMEDIATE SYSTEM
Datex ohmeda threshold
drager proportional valve
Hypoxia prevention devices are designed to
prevent an operator selected delivery of oxygen concentration below 21%
Electrical flow sensors (3)
multiple different methods to measure.
must have a bag up to control and simply o2 flows
chamber fo known volume - the amount of heat required to maintain the set temperature is proportional to specific heat and gas flow rates
CO2 rebreathing will depend on
FGF MV mode of ventilation (CV/SV) CO2 production of individual patient Respiratory waveform characteristics
The circle system (5 things)
hall mark: unidirectional flow via unidirectional valves
arranged in a circle
can be used as semi-open to closed
prevents rebreathing of co2 by chemical neutralization
allows re-breathing of other exhaled gases.
tec 6 vaporizer setting in changed altitude
normal dial concentration (%) x 760 mmHg // AMBIENT PRESSURE
Reservoir bags are made of
neoprene or rubber
Minimum pressure is 30 cmH2o and maximum is 60 cmH2o
vaporization is dependent on
vapor pressure
temperature
amount of carrier gas used
Specifics of breathing tube
low resistance, flexible, kink resistance, clear plastic, acts as a reservoir, contributes negligible resistance
22 mm diameter, female fitting with machine
patient end 22 mm male fitting, coaxial 15 mm fitting
Gradual decrease in ETCO2 =
hyperventilation, reflects increase MV
Sudden decrease in ETCo2 =
PE (thrombus, fat, amniotic fluid)
V/Q mismatch. Increase in PaCO2 - Petco2 gradient .
Cardiac arrest
Sampling error, - disconnect
Things in a vaporizers
wicks
baffle system
temperature compensating bimetallic valve
concentration control dial
Instances when maplesons are used - 5
Pediatrics
Transportation of patients
Procedural sedation
Weaning tracheal intubation
pre oxygenation during out of OR management
Advantages of Mapleson F - 4
Used for both spontaneous and controlled ventilation
Inexpensive, can be used with face mask or ETT
Is light weight, can be repositioned easily
Pollution of the atmosphere with anesthetic gases while using this system can be decreased by adapting it to scavenging system.
Requirements of breathing system- 5
- Deliver the gases from the machine or device to the alveoli in the same concentration as set and in the shortest possible time
- Effectively eliminate carbon dioxide
- Minimal apparatus dead space
- Low resistance to gas flow
- Allow rapid adjustment in gas concentration and flow rate
Advantages of the circle system - 8
Relative stability of concentration of inspired gases
conservation of moisture and heat
Low resistance (but not as low as mapleson)
can be used for closed-system anesthesia
Can be used with fairly low flows with no rebreathing of co2
economy of anesthetics and gases
can scavenge waste gases
prevention of OR pollution
Disadvantages of circle system - 6
complex design
has at least 10 connections
potential of malfunctioning valves
increased resistance to breathing (Compared to mapleson)
less portable and convenient than mapleson system due to its bulkiness
increased dead space BUT dead space ends at Y piece
APL valve purposes (4)
Purpose: permits PEEP during SV or allows for pressure- limited controlled respiration
Releases gases to scavenge or to atmosphere
User-adjustable, pressure required to open it changed by user
Provides control of pressure in system
Gas flow needed for a semi-open CIRCLE system
10-15 L/min
Clinical Application of Fick’s Law (7)
Allows determination of pulmonary gas exchange
Diffusion Hypoxia
COPD - reduced alveolar surface tension, slower induction
Placental Drug Transfer
2nd gas effect
Apneic oxygenation
Insufflation of N2o to pneumos/abdomen
Alt. Associations having something to do with anesthesia machine standards (4)
Internacional Electrochemical Commission (IEC)
Compressed Gas Association (CGA)
Institute of Electrical and Electronic Engineers (IEEE)
Federal Drug Administration (FDA)
US department of transportation issue regulations (7)
regulate: manufacture marking/labeling filling handling transport storage disposal of cylinders
Second Stage Pressure Regulator (5)
located downstream of intermediate pressure system
- protects against fluctuations off pipeline pressure
supply constant pressure to the flow control valves and proportioning system
lowers the pressure to 14 - 35 PSI
ensures oxygen is the last gas flowing
Low Pressure System Components (6)
Flowmeters Hypoxia prevention safety devices Unidirectional valves (info only) Pressure relief devices (info only) Anesthesia vaporizers/vaporizer manifold (info only) Common gas outlet
Flowmeters regulate
the flow of gases entering the breathing circuit
only oxygen safety feature after the flow meter =
Oxygen analyzer
Cylinder Label shows (3)
the compressed gas association marking system.
Diamond shape, name of gas, signal word with statements of hazards and measured to be taken. Hazard Status Caution words
7 safe handling procedures for cylinders
- Never stand a cylinder upright without support
- Never leave empty cylinders on the machine
- Never leave the plastic tape on the port while installing the cylinder
- Never rely on the cylinders color for identification of its contents
- Never oil valves
- Before any fitting is applied to the cylinder valve, particulates of dust, metal shavings, and other foreign matter should be cleared from the outlet by slowly and briefly cracking the valve a way from you and/or other personnel
- The valve should always be fully open when a cylinder is in use. Marginal opening may result in failure to deliver adequate gas
copper kettle calculation
(Carrier Gas x Vapor Pressure) / Barometric Pressure - Vapor Pressure = Vapor output in mL/min
then! [Vapor Output] in mL/min / [total gas] flow in mL/min
Open interface scavenging system
No valves!
Is open to the atmosphere via “relief ports” in reservoir, avoiding build up of positive and negative pressure
- must have high vacuum flow to prevent pollution of OR.
requires OPEN reservoir and vacuum
Reservoirs in scavenging systems should match the
intermittent volume from pt expiration/gas collecting assembly to the continuous flow of the disposal system
“Purposes” of capnograhy (8)
- gold standard to determine if patient is being ventilated, critical, life-saving monitor
- used to confirm ETT/LMA placement
- Without an airway, helps determine if pt is adequately exchanging air/oxygen
- Guide ventilator settings (avoids too much or too little ventilation )
- Detect circuit disconnections
- Detect CIRCULATORY abnormalities - (PE, occult hemorrhage/hypotension)
- Detect excessive aerobic metabolism (Malignant hyperthermia)
- Standard for VAE detection
Infrared Absorption Spectrophotometry works
- by analyzing the gas mixture
- determination by proportion of gas contents
- each gas in mixture absorbs infrared radiation at different wave lengths, amount of CO2 is measured by detecting its absorbable at specific wavelengths and filtering the absorbance related to other gases
Indications of tracheal intubation on capnogram
presence of stable CO2 waveforms for 3 breaths >30mmHG
Causes of rebreathing = (3)
equipment dead space
exhausted CO2 absorber
inadequate FGF
Contributors to rising CO2 when ventilation unchanged (6)
- malignant hyperthermia
- release of tourniquet
- release of aortic/major vessel clamp
- IV bicarb administration
- insufflation of CO2 into peritoneal cavity
- equipment defects, (expiratory valve stuck CO2 exhausted)
Gradual Decrease in ETCO2
likely hyperventilation, reflects increased minute ventilation
Rapid decrease in ETCO2
- PE, V/Q mismatch
- Cardiac arrest
? Sampling error
Capnogram pattern in obstructive lung disease
COPD/Asthma/Bronchoconstriction/Acute obstruction
- slow rate of rise in Phase ii
- steep upslope of phase iii (in extreme cases may not see phase iii)
oxygen flush valve can function even when
the machine is off