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SRNAProfessionalGuide II > MIDTERM REVIEW > Flashcards

MIDTERM REVIEW Flashcards

1
Q

Types of Vaporizers: Variable Bypass Vaporizers

A

•Ohmeda Tec 4 & 5, Drager 19.1, 19.3

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2
Q

Types of Vaporizers: Blender

A

•Ohmeda Tec 6 (Desflurane)

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3
Q

Factors that influence Tec 6 Vaporizer Output

A

Varried Altitudes

Carrier Gas composition

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4
Q

Effects of Varied altitudes of Tec 6

A

Requires manual adjustments of the concentration dial with changes in barometric pressured

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5
Q

Increase in Barometric pressure results in

A

Decrease Vapor administered

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6
Q

Never fill the vaporizer with

A

Dial on the “On” Position

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7
Q

Overfilling can occur

A

if key not tightly on the bottom

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8
Q

If Tipping occurs:

3 things to do

A

• In hardened facilities turn in to maintenance
• Flush for 20-30 minutes with high FGF and set the
vaporizer concentration low
• End-tidal agent monitoring

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9
Q

Pumping effect is Associated with______ or ________
•
• Bypass has diluted vapor and vaporizing chamber is also saturated with vapor
• Causes higher than expected vapor concentrations

A

positive pressure ventilation or oxygen flushing

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10
Q

During Pumping effect, Oxygen flush is at __ psig-

•

A

transmitted back

Occurs during the inspiratory phase - PPV

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11
Q

During Pumping effect there is ______Flow through _________

A

• Reverse flow through the vaporizing chamber back into the bypass chamber

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12
Q

Pumping effect more pronounced with

A 
- Low flow rates
• Low dial settings
• Low levels of agent in the chamber
• Rapid respiratory rates
• High peak inspired pressures
• Rapid drops in pressure during expiration
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13
Q

Dalton’s Law of partial pressure

A

In a mixture of gasses the pressure exerted by each gas is the same as that which it would exert if it alone occupied the container.

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14
Q

Henry’s law

A

At a gas/liquid interface, some of the gas will dissolve

in the liquid.

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15
Q

Measure Flow characteristics (COMMON)

A 
Carrier gas (CG) bubbles through agent
Manual Temp. conversion
Multi-agent
Operator determines CG split
No longer manufactured (but still present on field
machines)
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16
Q

The Ohmeda Tec 6 vaporizer pressurizes the liquid and warms it at

A

39C.

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17
Q

Variable Bypass characteristics

A 
CG flows over agent
Auto adjust for Temp &Pressure
Agent specific
Auto CG split
Higher safety standards
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18
Q

TEC 6 has______alarm

  1. Agent______
  2. Tilt
  3. Power Failure
  4. Internal malfunction

Low Agent
Illuminates with______
Warm-Up

A

No Output Alarm
< 20 ml (1 bar)
> 10 degrees

50cc of agent1

0 minutes to reach operating
temp of 39C

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19
Q

Low pressure system

A

Manifold/Flowmeters
➢Thorpe Tube, Needle Valves, Floats
❖Ohmeda – Link 25 Proportion Limiting Control
System
❖Narkomed - Oxygen Ratio Monitor Controller
(ORMC)
❖Vaporizer Mounting Devices & Vaporizers
❖Common (fresh) Gas Outlet
❖Outlet Check Valve (only on Ohmeda)
❖Pressure Relief Device

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20
Q

HIGH PRESSURE SYSTEM

A 
Size E Cylinders on back of machine
❖Cylinder pressure gauge (Bourdon)
❖Check valves in the hanger yoke
❖Index pins on the hanger yoke
❖Pressure regulator, i.e. First stage
regulator
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21
Q

Intermediate pressure system

A 
Pipeline inlet connections
❖DISS (diameter index safety system)
❖Pipeline check valves
❖Pressure gauges from pipeline
❖Machine piping (usually metal)
❖Gas power outlet for ventilator (outside
the bellows)
❖Master Switch 
Oxygen Pressure Sensor “failsafe” Shut Off Valve (Ohmeda)
❖Oxygen Failure Protection Device “failsafe” (Narkomed)
❖Oxygen Supply Failure Alarm
❖Oxygen Flush valve
❖Second stage regulator
❖Before (Upstream) - Flow control valve
(Sits on the fence)
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22
Q

Five main pathways or functions

A
  1. Powers the ventilator
  2. Oxygen flush valve
  3. Oxygen supply failure alarm
  4. Opens the pressure sensor shutoff valve
  5. Second stage pressure regulator
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23
Q

▪ Bypasses flowmeters etc & goes straight to

Common Gas Outlet

A

O2 flush valve

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24
Q

Flush valve flow rate _____LPM and presssure of _____

A

35-75 LPM at 50 psig

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25
Q

If O2 pressure drops below 20 psi, flow of

A

N20, Air, Helium are stopped by PRESSURE SENSOR SHUT OFF VALVE

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26
Q

2nd stage regulator reduces O2 pressure to

▪ Reduces Nitrous Oxide to

A

14 -16 psi

26 psi

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27
Q

Valve that is part of the 2nd stage regulator

A

Diaphragm

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28
Q

Oxygen SUPPLY FAILURE Alarm is activated when PSI falls below:
▪ Ohmeda:
▪ Narkomed:

A

28 psi

30-37 psi

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29
Q

Oxygen powers vent at ___-psi

A

50

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30
Q

Main component of CO2 absorber is

A 
Calcium Hydroxide (80%) 
Na Hydroxide (4%)
KOH 1%
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31
Q

100 gm of soda lime will absorb

A

approximately 26 L of CO

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32
Q

DO NOT change CO2 absorber midcase just

A

increase fresh gas flow to 5 L/min

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33
Q

CO2 absorber granules sizes

A

4-8 mesh

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34
Q

Purpose of varying Granule size

▪

A

Smaller granules increase surface area
▪ Smaller granules decrease channeling
▪ Larger granules decrease resistance

35
Q

Opening/loosening the knob of APL________ the flow to the scavenging system -____pressure

A

increases; decrease

36
Q

➢ Tightening/closing the knob will

A

Increase ability to give positive pressure ventilation

37
Q 
PISS position
Air
Oxygen
N2O 
Nitrogen
A

1-5
2-5
3-5
1-4

38
Q

Oxygen tank is at _____psig and

A

1900

39
Q

Oxygen tank volume is

A

660L

40
Q

AIr tank volume is

A

625L

41
Q

Air tank pressure is

A

1900

42
Q

N2O tank volume is

A

1590

43
Q

PSI of N2O tank

A

745

44
Q

Oxygen H tank volume

A

6900L

45
Q

Oxygen H tank pressure

A

1900

46
Q

What gas law governs tank pressures?

A

Boyle’s Law

P1V1 = P2V2

47
Q

Formula

A

Actual gauge reading (psi) / (Initial filling pressure X (known liters full) / (total liter flow))(psi)

48
Q

Formula with constant

A

PSI X constant / L/m = minutes before left empty

49
Q

Constant for E cylinder

A

0.30

50
Q

NIOSH for N2O

A

< 25 ppm

51
Q

NIOSH exposure limit for Halogenated Agents

A

< 2 ppm

52
Q

NIOSH Halogenated Agents and N2O

A

< 0.5 ppm

53
Q

Macroshock -

A

gross amounts of shock that will

cause harm or death

54
Q
  1. Microshock -
A

amount of shock that will harm or kill a patient with a conduit to the heart

55
Q

Disruption of electrical function of cells

A

 a. contraction of muscles
 b. alteration of brain function
 c. paralysis of respiration
 d. ventricular fibrillation

56
Q

1st stage and 2nd stage regulator

A

Diaphragm

57
Q

Free floating valve

A

Check valve

58
Q

Ball and spring

A

Ventilator Power Outlet Valve

Oxygen Flush Valve

59
Q

Pin & Spring/Diaphragm

A

Pressure Sensor Shut Off Valve

60
Q

Flow Control Valve

A

Needle valve

61
Q

Adjustable Pressure Limiting (APL)

A

Spring/Diaphragm

62
Q

What is MAC?

A

Alveolar concentration that prevent MOVEMENT in 50% or patients in response to a standardized stimulus

63
Q

MAC mirrors

A

Brian partial pressure

64
Q

Speed induction

ELLI- DHH

A
  • Elimination of rebreathing
  • Low anesthetic-circuit volume
  • Low absorption by the anesthetic circuit
  • Increased ventilation.
  • Decreased solubility
  • High fresh gas flows
  • High cerebral blood flow (CBF)
65
Q

Volatile agents all blunt the

A

Ventilatory stimulation evoked by arterial hypoxemia

66
Q

Vessel rich group

A

75%

67
Q

Nitrous oxide causes on MAP

A

Unchanged

mildly increases

68
Q

HR increase minimally with

A

Desflurane

69
Q

Only FDA approved for induction

A

Sevoflurane

70
Q

VP pressure of isoflurane

A

160

71
Q

VP pressure of Desflurane

A

664

72
Q

VP pressure of Sevoflurane

A

239

73
Q

Blood Gas partition coefficient of isoflurane

A

1.4

74
Q

Blood Gas partition coefficient of Desflurane

A

0.45

75
Q

Blood Gas partition coefficient of NITROUS OXIDE

A

0.47

76
Q

The impact of tissue.

A
  1. the duration of anesthesia

2. Solubility of the anesthesia in various tissue compartments

77
Q

BLOOD gas partition coefficient of Sevoflurane

A

0.65

78
Q

The low solubility of________ in blood and body tissues causes a very rapid induction of and emergence from anesthesia.

A

desflurane

79
Q

Prolonged exposure to anesthetic concentrations of nitrous oxide can result in

A

bone marrow depression (megaloblastic anemia) and even neurological deficiencies (peripheral neuropathies).

80
Q

Halothane lowers

A

MAP by decreasing CO , SVR unchanged

81
Q

Greatest change in SVR by those agents

A

Iso and Des (decrease SVR)

82
Q

Rapid increases in_________ concentration lead to transient but sometimes worrisome_________that are more pronounced than occur with isoflurane, particularly in patients with cardiovascular disease.

A

desflurane elevations in heart rate, blood pressure, and catecholamine levels

83
Q

2.0 MAC of halothane in patients not undergoing surgery results in a

A

50% decrease in blood pressure and cardiac output

SRNAProfessionalGuide II (13 decks)

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