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General Respiratory Care > Medical Gases > Flashcards

Medical Gases Flashcards

1
Q

What is the average barometric pressure at sea level?

A

760 mmHg

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2
Q

Oxygen properties

A

colorless, tasteless, transparent, very common in nature.

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3
Q

Oxygen supports what?

A

combustion

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4
Q

Are there any contraindications to oxygen?

A

NONE

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5
Q

What are some hazards and complications of excessive oxygenation?

A

retinopathy of prematurity, Oxygen toxicity, absorption atelectasis, hypoventilation(rare)

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6
Q

What are some hazards and complications of insufficient oxygenation?

A

cellular damage, neurological damage, cardiac failure/death

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7
Q

Oxygen is considered what?

A

a drug

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8
Q

Carbon Dioxide properties

A

colorless, transparent, very slight taste and odor. Waste product of respiration, cannot support life, will NOT burn

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9
Q

Carbon dioxide must be used how for medical purposes?

A

Mixture of carbon dioxide and oxygen (carbogen)

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10
Q

Hazards and complications of medical carbogen

A

headache, dizziness, dyspnea, disorientation, nausea, and hypertension

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11
Q

Helium properties

A

colorless, odorless, tasteless, transparent, does not support life

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12
Q

Medical Helium indication

A

mixed with oxygen to make breathing gas less dense for patients with sever airway obstruction (severe asthma)

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13
Q

Nitric Oxide properties

A

colorless, tasteless, transparent, slight metallic odor, unstable, does not support life

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14
Q

Nitric Oxide is very commonly used where?

A

ICU setting

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15
Q

Contraindications to medical helium

A

none its inert

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16
Q

Nitric Oxide is a powerful what?

A

vasodilator

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17
Q

Contraindications for Nitric Oxide

A

not used in some patients with some congenital heart defects

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18
Q

Hazards and Complications of Nitric Oxide

A

used in very small quantites, patients are gradually weaned off it,

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19
Q

Nitrous Oxide properties

A

colorless, odorless, tasteless, and transparent, non flammable but it supports combustion

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20
Q

What is Nitrous Oxide used for?

A

CNS depressant and anesthetic (most common)

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21
Q

Nitrous Oxide is sometimes called what?

A

laughing gas

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22
Q

Contraindications for Nitrous Oxide

A

none except any known allergies or sensitivity to this gas

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23
Q

Hazards and Complications to Nitrous Oxide

A

Must be used with Oxygen, very high incidence rates of misuse

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24
Q

Medical Air (room air) properties

A

ordorless, colorless, transparent, tasteless

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25
Q

What is the second most common gas given to patients?

A

medical air

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26
Q

Nitrogen properties

A

nonflammable, non toxic

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27
Q

What is the primary use for nitrogen in medical field?

A

operate pneumatic power tools in surgery

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28
Q

What are the two flammable gases?

A

cyclopropane and ethylene

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29
Q

What are the 3 nonflammable gases?

A

Nitrogen, Carbon Dioxide and Helium

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30
Q

Fractional distillation was invented by who?

A

Carl von Linde

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31
Q

What is fractional distillation?

A

cheapest and most common way of manufacturing oxygen

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32
Q

Fractional distillation procedure is what?

A

air is changed to a liquid by a decrease in pressure, and temperature. As air warms Nitrogen escapes first. This process is repeated several times until oxygen is pure

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33
Q

Bulk medical oxygen definition

A

any oxygen system that can hold 20,000 cubic ft at one site

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34
Q

Liquid Systems

A

very common and best way to store.

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35
Q

How are liquid systems built?

A

must have safety reducing valve. Vaporizing columns are flexible to allow for expansion and contraction due to temp changes

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36
Q

Gas manifold

A

a series of cylinder tanks linked to each other

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37
Q

Continuous system

A

one main reservoir, periodically filled. Reserve supply with 1 days gas supply

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38
Q

Alternating System

A

two gas sources, one operates at a time, while other can be refilled or replaced. Reserve supply with 1 days gas, does not normally operate.

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39
Q

Piping Systems

A

must be capable of delivering 50 psi to each outlet at max flow rates

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40
Q

Zone valves

A

used in cases of emergency or maintenance and they can temporally shut off

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41
Q

How are zone valves placed in a hospital?

A

accessible to general public, must be in boxes with windows. Valves must be labeled to avoid accidental shut off.

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42
Q

Station or wall outlet

A

must deliver 50 psi at all outlets simultaneously and must have label for type of gas being delivered.

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43
Q

what is the connection from wall outlet to equipment called?

A

Quick Connects

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44
Q

What materials are cylinders constructed with?

A

steel or steel alloy, aluminum, and aluminum with epoxy

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45
Q

Storage and distribution of medical gases

A

safe use of cylinders, cylinder markings, color coding, labeling, and standardized testing

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46
Q

What are the large common sizes for cylinders?

A

H, K and M

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47
Q

What are the small common sizes for cylinders?

A

E

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48
Q

Hydrostatic testing

A

underwater testing and then over pressurized and checked to see if cylinder expands. Steel is every 5-10 years and aluminum is every 5 years

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49
Q

Visual inspection

A

use a scope to check cylinder

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50
Q

Dead Ring Test

A

flick cylinder with wrench to see if it rings

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51
Q

Color coding of cylinders

A

decreases the chance of giving the wrong gas to patients

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52
Q

Color code for oxygen

A

green

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53
Q

Color code for air

A

yellow

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54
Q

color code for nitrogen

A

black

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55
Q

color code for nitrogen/oxygen

A

black/green

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56
Q

color code for carbon dioxide

A

grey

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57
Q

color code for helium

A

brown

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58
Q

color code for nitrous oxide

A

blue

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59
Q

color code for cyclopropane

A

orange

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60
Q

color code for ethylenal

A

red

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61
Q

What three must agree to prevent giving patient wrong medical gas?

A

color coding, labels, and connection devices

62
Q

American Standard Safety System

A

large cylinders with pressures greater than 1500 psi, H,K, G, M, threaded

63
Q

Pin Index Safety System

A

small cylinders (E and smaller) pressures greater than 1500. Two pins on regulator and are inserted into cylinder valve.

64
Q

Diameter Index Safety System

A

low pressure gas connections (less than 200 psi) wall outlets, regulator outlets, and quick connect adapters

65
Q

Pressure Relief valves

A

every cylinder has to have one. Means of decreasing internal pressure in the cylinder in the event of a malfunction

66
Q

What are the three types of pressure relief valves

A

spring loaded, frangible disk, and fusible plug

67
Q

What is the pressure most gas cylinders of any size contain?

A

2200 psi

68
Q

Grab and Go cylinders have what permanently attached?

A

regulator

69
Q

What is “cracking” a cylinder?

A

slow open and reclose the cylinder valve. This removes dust, dirt, or rust that may cause malfunction.

70
Q

Cylinder valve factors

A

E (622 liters/2200psi) =0.28 L/psi

H/k (6900 liters/2200) =3.14 L/psi

71
Q

What is the equation used to find the number of minutes left in cylinder?

A

PSI X cylinder factor/Rate of use LPM

72
Q

Reducing valve definition

A

reduces gas pressure from high, variable pressure to a lower more constant pressure

73
Q

Regulator definition

A

combination of reducing valve plus a flowmeter.

74
Q

Principle of operation definition

A

gas pressure vs. spring tension. When 2 opposing forces reach equilibrium, final outlet pressure is achieved

75
Q

What are the two types of regulators?

A

preset and adjustable

76
Q

Preset regulator

A

outlet pressure is fixed. Usually 50 psi

77
Q

Adjustable regulator

A

outlet pressure is variable and can get adjusted by the user

78
Q

Single Stage

A

pressure drops in one step (stage) from cylinder to outlet pressure (2200-50 psi)

79
Q

Multiple Stage

A

pressure drops 2 or more specific stages before reaching out

80
Q

Flowmeter definition

A

used to measure and dispense gas going to patient

81
Q

Bourdon Gauge style flowmeter

A

actually measure pressure but is calibrate to read flow (based on pressure) without restrictions. Handy when transporting.

82
Q

Thorpe tube Non compensated

A

does not read accurately is restriction to flow is added

83
Q

Thorpe tube back pressure compensated

A

always reads accurately even if restriction is added

84
Q

What are the three ways to determine if a flowmeter is back pressure compensated?

A

read label
take apart to determine position of needle valve to float
turn flow meter off, plug into wall outlet, If float jumps its back pressure compensated

85
Q

Flow Restrictors

A

adding restrictions to flow. Used in home liquid oxygen units, on Grab and Go and on some gas regulators.

86
Q

PaO2

A

partial pressure of oxygen in arterial blood, requires a needle stick and run through blood analyzer. Measures amount of oxygen dissolved in plasma.

87
Q

SaO2

A

saturation of oxygen in arterial blood. Measures all species of hemoglobin. Requires arterial blood sample and co-oximeter

88
Q

SpO2

A

saturation of oxygen predicted by pulse oximetery. Indirect measurement by comparing light absorption during systole and diastole in a well perfused capillary bed.

89
Q

Purpose of pulse oximetry

A

non invasive estimate of arterial oxygen saturation using select wave lengths of light.

90
Q

Functional Hemoglobin

A

measurement of percentage of hemoglobin capable of carrying oxygen. Pulse oximeter is capable of doing this.

91
Q

Fractional Hemoglobin

A

True SaO2 via a co-oximeter. This compares the hemoglobin carrying oxygen against all other hemoglobin types for a more accurate measurement(requires needle stick)

92
Q

Range of error for a pule oximeter

A

plus/minus 5

93
Q

Haldane effect

A

is pH changes the PaO2 remains the same but the SpO2 becomes lower

94
Q

Reasons a pulse oximeter could not read accurately

A

poor perfusion, dark skin, nail polish, ambient light, motion artifact, dyes, anemia

95
Q

How much hemoglobin is available for oxygen transport

A

15%

96
Q

Things to consider when picking a site for pulse oximeter to go on

A

warm, clean, dry, thin, well perfused, and a relatively still area

97
Q

Types of probes for pulse oximeter

A

disposable vs. nondisposable, finger, ear, wrap, reflective

98
Q

Advantages to pulse oximeter

A

continuous, instant results, non invasive, comfortable, simple and portable

99
Q

Disadvantages to pulse oximeter

A

false high readings, only oxygenation assessed, cross contamination, potential tissue injury

100
Q

Signs and symptoms of acute hypoxemia

A

tachycardia, tachynpea, cyanosis, paleness, poor perfusion, hypertension, restlessness, dyspnea, disorientation, lethargy, labored breathing, coma

101
Q

Signs and symptoms of chronic hypoxemia

A

same as acute plus loss of coordination, sleepyness, headaches, clubbing of digits

102
Q

What are some conditions or diseases requiring oxygen

A

heart attack, trauma, congestive heart failure, respiratory disease, anaphylaxis, surgical procedures, labor and delivery

103
Q

What are some signs of good or improving oxygenation?

A

normal vital signs, good skin color, capillary refill <2 secs, good pulses, good skin temp, normal urine output, normal CNS status

104
Q

What does A+O x 3 mean?

A

patient knows name, date, and place

105
Q

Low flow devices definition

A

concentration or percent O2 varies with patients breathing pattern

106
Q

Factors that will affect the percentage of oxygen the patient receives from low flow equipment are?

A

Tidal volume, rate, inspiratory flowrate, anatomic reservoir, and respiratory pattern

107
Q

Nasal catheter

A

low flow, not used much anymore, flowrates 6-10 LPM, 22-44% oxygen

108
Q

Nasal cannula

A

low flow, most common device, Adults 0.5-6 LPM, Peds 0.1-2 LMP, convenient and easy to use, 22-44% oxygen

109
Q

Simple mask

A

Mask is less comfortable, 5-10 LPM, 35-50% oxygen

110
Q

Partial rebreather

A

6-10 LPM, 40-70% oxygen

111
Q

Non rebreather

A

10 LPM and up (usually 15) 60-80% oxygen

112
Q

Trans tracheal oxygen

A

Used for patients on long term oxygen, surgically placed, ..25-4 LPM, 22-50% oxygen

113
Q

Rounding of patients

A

Usually done every 4 hours, checks orders, observe patients, check equipment

114
Q

High flow definition

A

Fixed performance, can predict patients oxygen percentages that’s provided to them of all inspired gas. Exceeds patients inspiratory flow rate

115
Q

Bernoulli effect

A

As gas flow thru a tube the lateral pressure is inversely proportional to the velocity

116
Q

Venturi effect

A

Sucking theory, addition of a tube of gradually increasing diameter in the direction of flow near a restriction (jet orifice) will restore the lateral pressure to it’s pre-restriction pressure

117
Q

Viscous shearing force

A

Dragging force, as moving fluid or gas encounters a stationary fluid or gas, the friction between the two will cause the moving fluid to accelerate the stationary fluid.

118
Q

Entrainment principles

A
  1. The tighter the restriction:
    - greater inc. in velocity
    - greater dec. in lateral pressure
    - greater pressure gradient between pre and post restrictions
  2. If entrainment port size is held constant more of the second gas will be entrained with a smaller jet than a larger one
  3. If entrainment port size is increased and the jet size is held constant more of the second gas will be entrained
  4. Any restriction to flow at distal end of tube will cause back pressure which can decrease entrainment
119
Q

Venturi mask

A

High flow, suppose to deliver a pre mixed concentration of oxygen at a flow rate that exceeds the patients inspiratory flow rate

120
Q

What is the typical flow rate for adults?

A

25-30 LPM at rest

121
Q

What do we try to keep the flow rates at?

A

Greater than 40 LPM

122
Q

Ratio for 24 LPM

A

25:1

123
Q

ration for 28 LPM

A

10:1

124
Q

Ratio for 30 LPM

A

8:1

125
Q

Ratio for 31 LPM

A

7:1

126
Q

Ratio for 35 LPM

A

5:1

127
Q

Ratio for 40 LPM

A

3:1

128
Q

Ratio for 50 LPM

A

2:1

129
Q

Construction of small version bulk liquid reservoirs

A
  • insulation to maintain lower temp
  • pressure relief valve
  • vaporizing coils
  • usually large reservoir and a smaller portable unit
130
Q

Portable units provides how many hours of oxygen depending on flow rate and temp?

A

8-12 hours

131
Q

Examples of small bulk liquid reservoirs

A
  • linde walker
  • companion
  • liberator/spirit
  • Helios (Puritan Bennett)
132
Q

What are some benefits to liquid oxygen respiratory systems?

A
  • promotes patient ambulation
  • improved quality of life
  • 100% pure medical oxygen
  • saves $$
  • lower dealer maintenance
133
Q

Handling recommendations liquid oxygen systems

A
  • do not store in enclosed space
  • keep upright
  • keep away from heat
  • let spills evaporate
  • no smoking
134
Q

Purpose of concentrators

A

Separates oxygen from environmental air and delivers to patient as supplemental oxygen

135
Q

Molecular sieve concentrators is what?

A

Most common method used

136
Q

How does molecular sieve concentrator work?

A

Draws in and compresses room air, zeolite crystals absorb nitrogen, oxygen is collected and held for patient

137
Q

Membrane concentrator

A

Provides humidity and moderate amounts of oxygen using a semi permeable membrane

138
Q

FIO2 for membrane concentrators

A

Approx. 30-40%

139
Q

Advantages to concentrators

A
  • patient less dependent on home care company
  • less expensive
  • less high pressure risks
  • less fire hazard risk
140
Q

Disadvantages to concentrators

A
  • less portable
  • requires electricity
  • must have tanks for emergencies
  • higher flows=lower purity of oxygen
141
Q

Air compressor purpose

A

Compressed room air to provide medical devices such as nebs, vents, or hospital piped in air

142
Q

What are the 3 styles of compressors?

A

Piston
Diaphragm
Rotary

143
Q

Piston style compressor

A

More common, used for large systems like hospital

144
Q

Diaphragm style compressor

A

Close to design as piston, used for small compressors like nebs

145
Q

Rotary style compressor

A

More commonly used in mechanical vents. Very noisy

146
Q

What are air compressors powered by?

A

Electricity or battery

147
Q

Oxygen blender purpose

A

Provide a pre mixed concentrating of oxygen to patient

148
Q

Oxygen blender provides how much oxygen?

A

21-100%

149
Q

Oxygen blenders are usually already on what piece of equipment?

A

Mechanical ventilators

150
Q

Operation of oxygen blender

A

Requires 50 psi air and oxygen source gases and mixed by a proportioning valve

General Respiratory Care (1 decks)

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