miscellaneous anesthesia equipment Flashcards
1
Q
list the components of the SPDD model?
A
supply
processing
delivery
disposal
2
Q
list the 5 tasks of oxygen?
A
02 pressure failure alarm
o2 pressure failure device (failsafe)
o2 flowmeter
02 flush valve
ventilator drive gas
3
Q
what is the location of the supply component of the SPDD model?
A
pipeline to the back of the anesthesia machine
4
Q
what is the location of the processing component of the SPDD model?
A
inside the machine up to the common gas outlet
5
Q
what is the component of the delivery component of the SPDD model?
A
breathing circuit
6
Q
what is the location of the disposal component of the SPDD model?
A
scavenging system
7
Q
1 kPa equals how many mbar?
A
10 mbar
8
Q
1 mbar is equal to how many mm HG?
A
.76 mm Hg
9
Q
100 kPa is equal to how many mBar?
A
1000
10
Q
1000 mbar is equal to how many mmHg?
A
760 mmHg
11
Q
760 mmHg is equal to how may cm H2O?
A
1030 cm H20
12
Q
1030 cm H2O is equal to how many psi?
A
14.7 psi
13
Q
14.7 psi is equal to how many atomsphere?
A
1
14
Q
who is responsible for the purity of the medical gases? and who enforces it?
A
united states pharmacopoeia
food and drug administration (FDA)
15
Q
who has published requirements for the manufacturing, marketing, labeling, filling, qualification, transportation, storage, handling, maintenance, requalification, and disposition of medical gas cylinders and containers?
A
Department of Transportation (DOT)
16
Q
Who is responsible with the regulation of occupational trace gas exposure in the workplace setting?
A
occupational safety health administration (OSHA)
17
Q
what are the components of a medical gas cyclinder?
A
body
valve
port
stem
handle
pressure relief device
conical depression
18
Q
wha tis the most easily damaged portion on the cylinder?
A
the valve
19
Q
what are the two different type of cylinder valves?
A
diaphragm valve
packed valve
20
Q
what type of cylinder should be used for MRI?
A
aluminum
21
Q
cylinders are filled and discharged through a ______.
A
valve
22
Q
the valve on a cylinder attaches to the ______ of the cylinder
A
neck
23
Q
describe a packed valve?
A
stem is sealed by a resilient packing such as teflon, which prevents leaks around the threads
24
Q
packed valves are also called ______ acting, because turning the stem causes the seat to turn.
A
direct
25
what type of pressures is a packed valve meant for?
high pressures
26
what type of pressures is a diaphragm valve mean for?
low pressures
27
describe a diaphragm valve?
closure between the cylinder interior and the atmosphere is accomplished by using a seal usually metal to metal, and a bonnet nut that clamps one or more circular disks in place
28
what are the advantages of a diaphragm valve?
can be opened fully by using a one-half to three quarter turn, compared to the packed valve requires two or three full turns
the seat does not turn and therefore less likely to leak
no stem leakage can occur because of the diagphragm
29
what is the disadvantage of a diaphragm valve?
expensive compared to the packed valve
30
what is the port on a cylinder?
the point of exit for the gas
31
what should happen to the port during transit?
a covering be placed on it
32
what is the purpose of the stem?
is rotated during valve opening or closing
33
to close the valve, the stem seals againt the seat is part of the valve body.
when the valve is opened, the stem moves _____ , allowing gas to flow to the port
upward
34
what is the purpose of the handle on the cylinder?
used to open or close a cylinder valve
35
which way do you turn the handle to open the valve?
turn counterclockwise
36
which way to turn the handle to close the valve?
turn clockwise
37
purpose of the pressure relief device?
purpose is to vent the cylinder's contents to the atmosphere if the pressure of the enclosed gas increases to a dangerous level
38
where is the conical depression found?
found above the safety relief device on small cylinder is the conical depression that recieves the retaining screw of the yoke.
39
if the retaining screw is tightened into the safety relieve device, what may happen?
the device may be damaged and the cylinder contents escape.
40
what is the purpose of the PISS?
inadvertent misconnections of gas cylinders.
41
PISS configuration air?
1,5
42
PISS configurations oxygen?
2,5
43
PISS configurations nitrous oxide?
3,5
44
USA color for oxygen
green
45
international standard color for oxygen
white
46
what is the usa standard color for nitrous oxide
blue
47
what is the international standard color for nitrous oxide
blue
48
what is the usa standard color for carbon dioxide?
grey
49
what is the international standard color for carbon dioxide?
grey
50
what is the usa standard color for air?
yellow
51
what is the international standard color for air?
white and black
52
the presence of more than one washer between the hanger yoke assembly and tem of the tank may do what?
may allow the PISS to be bypassed
53
what is the air capacity in Liters and PSIG for a E cylinder?
625 L
1900 PSIG
54
what is the oxygen capacity in Liters and PSIG for a E cylinder?
660 L
1900 PSIG
55
what is the nitrous oxide capacity in Liters and PSIG for a E cylinder?
1590 L
745 psi
56
name the two gases that come in a liquid or a gas?
nitrous oxide or carbon dioxide
57
when do we typically change the oxygen cylinder?
if the oxygen is less than 500 PSI
58
what percent oxygen is found in 1 liter of air?
21%
59
the only time cylinders on the back of an anesthesia machine should be turned on is?
during the daily machine check or when you are not able to use the pipeline supply.
60
what would happen if you lose pipeline pressure and the oxygen cylinder was left open, what would happen?
you would use the cylinder oxygen without knowing it, by the time the failsafe alarms, your backup oxygen supply would be empty
61
the only way of determining cylinder content is by?
the label not its color
62
what is the weight of a full nitrous oxide cylinder?
20.7 pounds
63
what is the weight of an empty cylinder?
14.1 pounds
64
what is gas volume for nitrous oxide?
250 L to 1590 L
65
list the 15 possible hazards with cylinders
inccorcet cylinder attached
incorrect contents
incorrect valve
incorrect color
incorrect labeling
inoperable valve
damaged valve
contaminated cylinder contents
nitrous oxide theft
asphyxia
fires
explosion
projectile damage
thermal injury
overfilled cylinder
66
oxygen exists as a gas inside the cylinder, because why?
its critical temperature is below room temperature (-119 C).
67
what is the equation to calculate the amount of time left on cylinders?
68
which oxygen analyzer must be calibrated daily
galvanic fuel cell
69
what are the two types of oxygen analyzers
Galvanic Fuel cell
Paramagnetic device
70
which oxygen anayzer increases oxygen tension by creating an increase in magnetic attraction
paramagnetic device
71
which oxygen anayzer increases oxygen tension by creating a current across two electrodes
galvanic fuel cell
72
which oxygen analyzer automatically calibrates itself
paramagnetic device
73
which oxygen analyzer has a quicker response time
paramagnetic over the galvanic fuel cell
74
what do oxygen analyzers monitor
oxygen concentration, not pressure
75
Oxygen analyzers can detect what two things
oxygen pipline crossover
leak in the breathing circuit (tupically Y-piece and CO2 canister)
76
nitrous oxide exists as a liquid inside the cylinder why?
because its critical temperature is above room temperature (36.5 C).
77
\_\_\_\_\_\_ joins two or more similar components
connector
78
\_\_\_ establishes functional continuity between otherwise disparate or incompatible components
adapter
79
The pressure will begin to decrease from 745 psi for nitrous oxide only after what? at this point the cylinder is about _____ empty.
all the liquid is gone and only gas remains.
3/4 empty
80
what are the three disadvantages of connectors and adaptors
increase dead space
increase resistance
increase the number of sites that disconnections can occur
81
when the nitrous cylinder is 3/4 empty approximately ____ L of nitrous oxide remains in the tank.
250 L to 400 L
82
\_\_\_\_\_ are used to protect the patient from microorganisms and airborne particulate mater and to protect anesthsia equpitment and the environement from exhaled components
filters
83
Filters: increase or decrease
\_\_\_\_\_ resistance to gas flow
\_\_\_\_\_ PIP
\_\_\_\_\_\_resistance leading to _____ for spontaneously breathing patients
1. increase
2. increase
3. increased resistance causes problems during spontanous ventilation
84
gas delivered from anesthsia machines is ___ and at ___ remperature
dry and room temperature
85
what are the effects of inhaling dry gases
1. Damages Respiratory tract
2. Body temperature is lowered
3. tracheal tube obstructions may occur
86
what are the damages that occur to the respiratory tract when inhaling dry gases from an anesthsia machine
-- As mucosa dries, the temperature drops, secretions thickens, ciliary function is reduced, surfactant activity is imparied, musoca becomes more susceptible to injury and may result in atelectasis and obstructions
--dry gases can cause bronchospasms
87
what are the four sources of humidity
1. carbon dioxide absorbents
2. exhales gases
3. low fresh gas flow
4. coaxial breathign systems
88
how do carbon dioxide absorbents increase humidity
the reaction of an absorbent and CO2 liberates water
89
In exhales gases, what are ways that humidity is contained
tracheal tube and LMA premits some rebreathing which preserves expired humidity
90
How does fresh gas flow conserve moisture
low FGF will conserve moisture
91
what coaxial breathing system permits humidity
Bain
92
\_\_\_\_\_ conserves some exhaled water and heat and returns them to the patient in the inspired gas
HME (heat and moisture exchanges)
93
what are the two types of HMEs
hydrophobic or hygroscopic
94
what are some contraindications for using an HME
thick, copious, bloody secretions
HEM should be used with caution for weaning patient
\*\*should not be used with an HUMIDIFIER\*\*
95
what are the two types of HMEs
Hydrophobic and Hygroscopic
96
the only reliable method to determine the volume of nitrous oxide that remains in the the tank?
weigh it
97
what is the most delicate part of the cylinder?
the cylinder valve
98
gas cylinders must be stored in the _______ position.
upright
99
the cylinder must be stored in the upright position and \_\_\_\_\_\_.
secured.
100
when changing the cylinder on the anesthesia machine, it is appropriate to temporarily place the old cylinder on it _____ until it can be moved to its appropriate storage receptacle.
side
101
if you do not have cylinder to use as a replacement be sure to insert a ?
yoke plug
102
a yoke plug is inserted to prevent?
if a check valve fails, gas that should be going to the patient will exit the anesthesia machine
103
Failure to remove the plastic cover from the port before installing the cylinder will cause what?
an obstruction of gas flow when the cylinder turned on
104
A hydrophobic membrane consists of _____ pores and the membrane is _____ for ____ surface area
small pores
pleated membrane
increase surface area
105
performance of the hydrophobic HME may be impaired from
high ambient temperatures
106
which HME filter is efficient for bacterial and vital filtering
Hydrophobic
107
which filter allows for the passage of water vapor but not liquid water
hydrophobic
108
which filter is associated with small increases in resistance when wet
hydrophobic
109
\_\_\_\_\_ HME contains a wool, foam or peperlike material coated with moisture retaining chemicals,
hygroscopic
110
Hygroscopic HMEs also contain a thin fiber membrane that has been subjected to electrical field to \_\_\_\_\_
increase its polarity- which improves filtration efficency and hydrophobicity
111
A hygroscopic HME is more efficient at what two things
moisture and temperature conservation
112
in what HME can resistance can increase greatly when HME becomes wet
Hygroscopic
113
what are the factors that affect moisture output
1. types of HME used
2. humidity of fresh gas (increased humidity of gas entering HME will increase inspired humidity)
3. inspiratory and expiraotry flow
4. circuit leaks
114
if you open the cylinder and hear a hissing sound, what does that mean?
what is you first step?
if the first step doesnt work?
if the second step doesnt work, what do you do?
there is a leak
1. tighten the connection
then replace the washer between the cylinder and the hanger yoke assembly
replace the cylinder
115
for factors affecting moisture output, for the inspiratory and expiraotry flow, the faster the gas flows through HME the \_\_\_\_
less time there is to evaporate or deposit moisture so a larger tidal volume may cause humidity of inspired gas to fall
116
if the yoke retaining screw punctures the safety relief valve, what can happen?
it may damage the cylinder causing it to leak
117
an mri cylinder will have two colors which are?
majority of the tank will be silver, and only the top is the color that signifies the gas it contains.
118
what are the advantages of HMEs
inexpensive, easy to use, reliable, low resistance when dry, no danger in overhydration
119
what are the disadvantages of using HMEs
limited humidification
contribution to temperature preservations is not significant
increases dead space (needs to be as close to patient as possible)
120
list some of the hazards of HMEs
-- heavy, viscous secretions can greatly increase resistance of HME use
-- do not use with external heated humidifier
-- nebulized medication can increase resistance with hygroscopic HMEs
-- HME can become obstructed with blood, fluid, secretions
-- liquid can break through hygroscopic HME, causing poor filtration
-- HMEs can contribute to rebreathing (pediatric patients)
121
ionic reactions take place on the surface of granuales in
aqueous medium
122
\_\_\_\_\_ granules becomes exhaused more quickly than ___ granuels which indicates what % of water needs to be present
dry granules quicker than moist
10-20% of water
123
when beginning an anesthetic using the anesthesia machine, a provider must check for the presence of what supply components?
full E cylinder and alternative means of ventilation (ambu bag).
124
KOH is used less frequently as an activator due to
the ability to produce Compound A and Carbon monoxide
125
if the pipeline pressure fials or fraction of inspired oxygen drops what are the steps a provider should take?
1. do not attempt to fix the oxygen analyzer- it must be trusted until it can be proven wrong
2. turn on backup oxygen cylinder on machine fully, and disconnect pipeline. Ensure that the measured fraction of inspired oxygen (FIO2) begins to rise. If the FIO2 does not increase (with fresh gas flow adequate to wash in the O2 quickly), ventilate the patient by Ambu bag with room air.
3. use low flows of oxygen. maintain anesthesia with a volatile agent. ensure that FIO2 and agent concentration are appropriate
4. turn off the ventilator and ventilate manually through the circle system.
5. call for help if needed; calculate the time remaining for the current cylinder; call for additional oxygen cylinders, and install them on the machine if needed.
6. find out how long the problem is expected to last; participate in the hospital disaster plan, which may require prioritzing oxygen for those pateitns who need it most
7. do not reconnect the patient to pipeline gas until the gas supply is tested
8. if unable to use the circle, ventilate with an oxygen source (freestanding cylinder) or with room air via a bag-valve-mask device, adn institute toal intravenous anesthesia.
126
1 mole of CO2 produces
13,000 kcal of heat energy
127
absorbents contain _____ as an indicator of absorbent pH
ethyl violet
128
\_\_\_\_\_\_\_ does not regenerate to any extent, indicating it does not regain capacity to absorb CO2 during period that it is not in use
soda lime
129
During a rest period, soda lime changes from ____ to \_\_\_\_\_
from purple to white during a rest period
130
what is the first step in the reaction of CO2 with soda lime
Carbon dioxide + water - - carbonic acid
131
what is the second step for CO2 reaction with soda lime
Carbonic acid + 2 sodium Hydroxide --- sodium carbonate + 2 water + heat
132
what is the third step for CO2 and soda lime reaction
sodium carbonate + calcium Hydroxide - - - calcium carbonate + 2 sodium hydroxide
133
what are the pipeline components?
base block
primary and secondary valve
gas specific connection point
quick connectors
face plate
134
why are indicators added to absorbents
to signify when the absorbents ability to absorb CO2 is exhausted
135
describe the function of a primary valve for the pipeline component?
opens and allows the gas to flow when the male probe is inserted and closes automatically when the connection is broken.
136
137
what is the purpose of the secondary valve for the pipeline component?
designed so that when the primary valve is removed, the gas flow is shut off. When the primary valve is in place, the secondary valve stays open
138
what is the purpose of the DISS system?
prevents inadvertent misconnections of gas hoses. Each gas hose and connector are sized and threaded for each individual gas.
139
what is the purpose of quick connectors for pipeline components?
allow apparatuses to be connected or disconnected by a single action
140
does a quick connector or a DISS fitting leak more?
quick Connector
141
what is the purpose of the face plate?
permanently marked with the name and/or symbol of the gas that it conveys
142
hoses used to connect anesthesia machines and other apparatus to terminal units, must have a permanently attached?
noninterchangeable connector
143
the hoses used for a pipeline system must be ____ coded.
color
144
hoses should be kept off the _____ and away from \_\_\_\_
floor
heat
145
pipeline system problems (6)?
pressure loss - most frequent problem
cross connection of gases - most common between nitrous and oxygen
contamination - from particles, bacteria, and liquid water
leaks
theft of nitrous oxide
excessive pressure- regulator failure
146
what component fo a circle system makes rebreathing of exhaled gases?
carbon dioxide absorbers
147
what are the benefits of the carbon dioxide absorber?
conserve agent, oxygen, nitrous oxide, heat, and humidity
preventing respiratory acidosis that would result from rebreathing CO2
148
FGF of ______ provides near-total rebreathing, and full reliance on absorbent for prevention of rebreathing carbon dioxide
0.3 to 0.5 L/min
149
FGF of ____ is associated with little if any reliance on absorbent granules because exhaled carbon dioxide is rapidly diluted and sent to the scavenger with such high fresh gas inflows.
greater than 5-8 L/min
150
what do you do if your carbon dioxide absorber goes out what do you do?
increases fresh gas flow
151
how many canisters can you have for a carbon dioxide absorber?
2
152
double canisters advantages are?
permit more complete carbon dioxide absorption
less frequent changes
lower gas flow resistances
153
the 2 canisters you date when the absorbent was last changed where?
on the lower canister
154
do indicators affect absorption
no
155
What is an additive that serves as an indicator of absorbent pH
Ehtyl Violet
156
Fresh CO2 absorbent has a caustic ______ pH due to sodium hydroxide
alkaline
157
to ensure complete absorption, a patient's tidal volume should not exceed what?
air space b/t absorbent granules (50% absorber's capacity)
158
when the pH reaches \_\_\_\_, the ethyl violet changes from what color to what color
10.3
white to purple
159
what does a baffle system do?
directs gas flow throught the center
160
what does color change indicate in ehtyl blue
exhausted soda lime
161
first absorption on a carbon dioxide canister occurs where?
at the inlet and along the canister sides.
162
does Ehtyl Violet regain capability to reabsorb
no
163
name the three different types of oxygen analyzers?
paramagnetic oxygen analyser
electrochemical oxygen analysis
piezoelectric analysis
164
what is the common absorbent known as
soda lime
165
describe piezoelectric analysis?
uses vibrating crystals that are coated with a layer of lipid to measure volatile anesthetic agents.
When exposed to a volatile anesthetic agent the vapor is absorbed into the lipid
The resulting change in the mass of the lipid alters the vibration frequency.
By using an electronic system consisting of two oscillating circuits, one of which has an uncoated crystal and the other a coated crystal, and electric signal that is proportional to the vapor concentration is generated.
166
explain the importance of mesh size and granules
size of the granule must strike a balance btw surface area (absorptive capacity) and airflow resistance (work of breathing)
Small granule= higher surface area with high resistance
large granule= low surface area with low resistance
167
fragmented soda lime granules produce
dust hardener
168
describe electrochemical oxygen analysis?
consists of a sensor, which is exposed to the gas being analyzed, and the analyzer box, which contains the elctronic circuitry, display, and alarms.
The sensor contains a cathode and anode surrounded by electrolyte.
The gel is held in place by a membrane that is non permeable to ions proteins, and toher such materials, yet is permeable to oxygen.
Sensor is placed in the inspiratory limb of the breathing system.
169
size 4 or 8 mesh size signifies?
less resistance with the greatest amount of absorbent
the holes determine the size of particles allowed to get through soda lime resulting in Compoud A and Carbon Monoxide
170
after limited use of CO2 absorption canister, absorption has occured primarily at the ___ and lesser at the \_\_\_
inlet and lesser along the sides
171
where is the least resistance in a CO2 absorption canister
loosely packed granules or smooth inner walls
172
describe paramagnetic oxygen analysers?
when introduced into a magnetic field, some substances locate themselves in the strongest portion of the field, gaining themselves the name paramagnetic.
oxygen is the only paramagnetic gas important in anesthesia.
When a gas that contains oxygen is passed through a switched magnetic field the gas will expand and contract, causing a pressure wave that is proportional to the oxygen partial pressure.
To ensure accuracy, the pressure is compared to pressure of air or oxygen.
173
Volitle anesthetics can be further broken down into ___ and _____ when a drier absorber is used
compoud A or carbon monixide and not scavenged
174
what are the two ways to respond to a hypercarbia patient with an exhausted absorber
1. increase Fresh Gas Flow (do not increase Minute Ventilation)
2. change the canister (dont throw away the old canister in case there is something wrong with the new one, you will not be able to ventilate your patient)
175
what are the 2 main problems that can occur with carbon dioxide absorbent
1. exhausted absorbent (no longer able to neutralize CO2)
2. desiccated absorbent (too dry)
176
177
\_\_\_\_\_\_ may disturbe the paramagnetic oxygen sensor so that it reads higher than expected
desflurane
178
list the early signs of carbon dioxide absorber exhaustion
increase in partial pressure of end-tidal carbon dioxide, may be accompanied by an increase in inspired carbon dioxid
respiratory acidosis
hyperventilation
signs of SNS activation (flushed, cardiac irregularities, sweating)
increased bleeding at surgical site
color of indicator
179
what is the benefit of adding Silica to absorbent granules
provides hardness and minimizes the creation of dusts (less dust means less bronchial irritation and less risk bronchospasms)
180
what are the late signs of carbon dioxide absorber exhaustion?
increased (and then later decrease) in heart rate and blood pressure
dysrhythmia
181
you should use carbon dioxide absorbents with lower amounts of strong \_\_\_\_\_\_\_\_, such as?
bases
potassium hydroxide
182
a good recommendation is to change the absorbent regularly, such as _____ mornings. why?
monday
incase the absorbent was exhausted due to FGF left on all weekend
183
if you have a double canister, do you have to change both at the same time?
yes
184
if you are unsure of an abosrbent state of hydration, such as when the FGF has been left on, what should you do?
change the absorbent
