Machine Scavenging And Capnography Flashcards

1
Q
NIOSH recommended levels of anesthetic gases in OR 
Volatile alone
N2O alone
Both 
Over what time period
A

2 ppm
25 ppm
0.5 ppm
8 hr concentration

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2
Q

5 components of scavenging system

A
Gas collecting assembly 
Transfer means 
Scavenging interface 
Gas disposal tubing 
Gas disposal assembly
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3
Q

Size of transfer tubing to scavenging interface

A

19 mm or 30 mm

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4
Q

Gas collecting assembly
What it does
Outlet connection usually what
Why connection size imp

A

Captures excess gas at emission site, delivers to transfer means tubing
30 mm male fitting
So it doesnt connect to other parts of system

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5
Q

Transfer means
Also called what 2
Delivers gas from where

A

Exhaust tubing or hose and transfer system

Conveys gas from collecting assembly to the interface

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6
Q

Transfer means
Tube has what on both ends
Traits of tube, must be what (2)

A

Female fitting connectors both ends

Short, large diameter, carries high flow w.o increase in pressure

Kink resistant and diff color

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7
Q

Scavenging interface
Prevents what
Also called what
Limits what and where

A
  • Pressure increase or decrease in scavenging sys transmitted to breathing sys
  • balancing valve
  • limits pressure downstream of gas collecting assembly to -0.5 to+5 cmh20
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8
Q

3 basic elements of scavenging interface

A
  1. Pos pressure relief- protects in case system occluded
  2. Neg pressure relief- limits subatmospheric p
  3. Reservoir capacity matches intermittent gas flow from gas collecting assembly to the continuous flow of disposal system
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9
Q

Open interface
Doesnt have what
Requires use of what

A

No valves- open to atmosphere via holes in reservoir

Use of central vacuum and reservoir

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10
Q

What vacuum needs to be on open interface

A

Must be greater than excess gas flow rate to prevent OR pollution

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11
Q

Two types of closed interfaces

A

Positive pressure relief only or

Positive pressure and negative pressure relief

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12
Q

Traits of positive pressure relief closed interface

A

Single positive pressure relief valve, opens when max pressure reached. Passive disposal w no vacuum or reservoir bag

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13
Q
\+ pressure - relief closed interface 
3 components 
What disposal sys is 
Gas vented to atm when what 
Room air entrained if what
A

+ p relief valve, - p relief valve, reservoir bag
Vacuum control valve, activ is reservoir bag is over distended or deflated.
If system p exceeds 5 cm h20
If p less than -0.5 cm h20

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14
Q

Gas disposal tubing
Should be diff what
With passive sys should be what
Where tubing goes

A

Color and size from breathing system
Short and wide
Overhead to prevent kink

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15
Q

Gas disposal
Active needs what
Passive needs what

A

A- neg pressure in tubing, neg pressure relief valve

P- pt exhales, manual squeeze of vent or bag. Needs pos pressure.

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16
Q

Passive sys
Gases go 3 places
Pros
Cons

A

Window, pipe to outside wall, extractor fan to outside
Cheap, easy
Impractical in some bldgs

17
Q

Active system

  • connect what to what
  • pro
  • con
A

Most commonly used

  • exhaust of breathing sys to hospital vacuum by needle valve
  • convenient where many machines in use in large hospital
  • expensive. Needle valve may need adjustment
18
Q

How to do scavenging system check

A

Connections b/w scavenge and APL and vent relief valve and waste gas vacuum. Open APL, occlude Y. Allow scaveng bag to collapse, verify p is 0. O2 flush, distend bag, p should be <10.

19
Q

Gold standard of ETT placement

A

Capnography

20
Q

Capnography

  • guides what
  • detects which abnormalities
  • contraindications
A

Vent settings

  • PE, arrest, disconnect, obstructed airway
  • none
21
Q

Pa CO2 ____ PEtCO2

A

>

22
Q

Average gradient between paco2 and petco2

A

2-5mmHg under GA

23
Q

Capnography can evaluate what, what indicates it

A

If gradient wider than 2-5, less gas exchange occurring= dead space

24
Q

2 methods of measuring co2 in expired gases

A

Calorimetry or infrared absorption spectrophotometry (most common)

25
Q

Colorimetric
___ assessment of co2
Uses what indicator, what changes it

A

Rapid

Metacresol purple paper, changes color in presence of what, co2 w water- carbonic acid changes paper

26
Q

Infrared absorption Spectro.
__ __ analyzed
Determines what of contents
Gas in mixture absorbs what

A

Gas mixture
Proportion
Infrared radiation at different wavelengths

27
Q

Capnography measurements techniques

2, which most common

A

Mainstream and sidestream

Sidestream More common

28
Q

Mainstream capnopgraphy
Pro
Con
Only gives what

A

Real time measurement, not delayed

Potential burn and kink of ett from weight

Expired co2, not inspired

29
Q

Sidestream capnography
What it does
Con

A

Aspirates fixed amt of gas, if analysis with comparison to know quantity

Time delay and potential disconnect

30
Q
Capnogram 
1
2
3
4
A

1- inspiration, no co2
2- beginning of expiration, rises
3- plateau, before end expiration
4- inspiring, back down to baseline

31
Q
Phase 1 
Inspiratory \_\_\_ 
\_\_ co2 
\_\_ and first part of \_\_ 
\_\_ \_\_ \_\_ exhaled
A

Baseline
No
Ins, exp
Dead space gas

32
Q
Phase 2 
\_\_\_ upstroke 
Represents rise in \_\_ level
Slope determined by evenness of \_\_ \_\_
Mixture of \_\_ \_\_ and \_\_ \_\_
A

Expiratory
Co2
Alveolar emptying
Dead space, alveolar gas

33
Q
Phase 3 
\_\_ plateau 
Constant or slight \_\_ 
\_\_\_ phase 
\_\_ \_\_ sampled
A

Alveolar
Upstroke
Longest
Alveolar gas

34
Q

Phase 3
Peak at end is where reading is taken: ___
Normal value= __-__
Reflection of __ and __

A

PEtCO2 end tidal partial pressure of CO2

30-40

PACO2, Paco2

35
Q

Phase 4
Beginning of __
CO2 conc

A

Inspiration

Rapid decline