Safety features Flashcards

1
Q

Why is the solution SAGM added to RBC?
{Sodium
Adenine
Glucose
Manitol}

A

It extends the shelf life of RBC up to 42 days of increased functional viability

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2
Q

What size are the connectors for a breathing circuit?

A

15mm and 22mm

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3
Q

Why is a breathing circuit corrugated?

A

Less prone to kinking and increased flexibility

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4
Q

How can you raise concerns of ideas during the crisis?

A

Your input may be crucial

Probe – make observation or ask clarifying question

Alert – suggest problem and offer possible alternative

Challenge – address person using their name, directly question plan or decision

Emergency – get their attention – say you must listen. Give direct order to avoid immediate harm to patient

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5
Q

What should your checks be during any crisis?

A

Oxygen delivery FiO2, FGF, bellows or bag moving

Airway – ETT or LMA patent

Breathing – Sats ETCO2 waveform, tidal volumes and rate

Circulation – Rate, rhythm, ischaemia, BP, Peripheries

Depth – MAC or TIVA value, BIS or entropy

Surgery – ask how is the operation going? Review blood loss

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6
Q

What are the preliminary checks before starting a level 2 machine check?

A

Wash hands

Check bulk gas warning lights and medical gas alarm panel

Turn machine + monitor on

Check machine is plugged into a UPS

Check service dates on machine and patient monitor

Check scavenging is on, and ball float is in the green zone

Depress condenser drain

Check machine moves freely

Attack circuit and gas sampling line

Check sampling line and d-fend are clean and free of defects

Confirm gas analyser registers 21% +/- 3% oxygen

Check low oxygen alarm is set to 21%

Check Aladdin cassettes are full and ports are closed and locked in vaporiser bay and correct agent is identified on the ASD

Check AMBU bag

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7
Q

What does UPS stand for?

A

Uninterruptible power supply

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8
Q

What level should you replace the emergency reserve oxygen cylinder on the back of the anaesthetic machine?

A

<5000 kPa

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9
Q

Residual Current Device

A

An electrical device that monitors current leakage and shuts off if excess, unexpected current is detected

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10
Q

Line insulation Monitor

A

An electrical device that monitors a decrease in electrical resistance and alerts to any change

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11
Q

True or False: a small current may be sufficient to induce ventricular fibrillation

A

True

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12
Q

True or false: body protection is sufficient protection from micro shock

A

False

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13
Q

True or false: micro shock requires a conducting pathway to the heart

A

True

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14
Q

True or false: macro shock cannot cause ventricular fibrillation

A

False

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15
Q

True or false: Cardiac protection is sufficient protection from both micro shock and macro shock

A

True

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16
Q

An operating theatre should be equipped with electrical ________ protection

A

Cardiac

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17
Q

What is the size of the cylinder on our anaesthetic machines?

A

Size A

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18
Q

What is the pin index for medical air

A

1, 5

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19
Q

What is the pin index for oxygen?

A

2, 5

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20
Q

What is the pin index for nitrous oxide?

A

3, 5

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21
Q

What is the pin index for cardon dioxide

A

1, 6

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22
Q

What is the pin index for Entonox?

A

7

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23
Q

What cylinder has blue and white shoulders?

A

Entonox

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24
Q

What cylinder has black and white shoulders?

A

Medical Air

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25
Q

What cylinder has white body and white shoulders?

A

Oxygen

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26
Q

What cylinder has blue body and blue shoulders?

A

Nitrous oxide

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27
Q

What is the name for the combination of nitrous oxide and oxygen?

A

Entonox

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28
Q

What is the Bodox seal made of?

A

Neoprene

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29
Q

True or false – serial number is engraved on the medical gas cylinder BODY

A

True

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30
Q

True or false – owner identification is not engraved on the medical gas cylinder BODY

A

False

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31
Q

True or false – tare weight is engraved on the medical gas cylinder BODY

A

True

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32
Q

True or false – test pressure is on the medical gas cylinder SHOULDER LABEL

A

False

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33
Q

True or false – dangerous goods classification is listed on the medical gas cylinder SHOULDER LABEL

A

True

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34
Q

True or false – the gas content is not listed on the medical gas cylinder SHOULDER LABEL

A

False

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35
Q

True or false – manufacturers perform a visual endoscopic examination of cylinders

A

True

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36
Q

True or false – Manufacturers do not perform impact test on cylinders

A

False

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37
Q

True or false -tensile strength and/or bending tests are performed by the manufacturer

A

True

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38
Q

What are cylinders traditionally made of?

A

Molybenum Steel

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39
Q

After how many years of use must a cylinder be tested?

A

5

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40
Q

True or false – cylinder’s ability to not be flattened will be tested

A

True

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41
Q

What is the micron size range for a blood filter?

A

170-200

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42
Q

Who is the universal blood donor?

A

O Negative

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43
Q

Who is the universal blood recipient?

A

AB positive

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44
Q

What does SAGM stand for?

A

Saline, adenine, glucose and mannitol

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45
Q

Who is the universal plasma recipient?

A

O

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46
Q

In normal use, how many units of blood should be given through a blood filter?

A

4

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47
Q

true or false – in a massive transfusion, it is acceptable to give more units than 4 through a filter

A

True

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48
Q

Can rhesus positive blood be given to rhesus negative patients?

A

No

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49
Q

What blood products should not be given in the same line as RBC’s

A

Platelets

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50
Q

A haemolytic transfusion reaction causes destruction of what?

A

Haemoglobin

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51
Q

What is the energy dose for paediatric defibrillation? J/kg

A

4 J/Kg

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52
Q

What is the energy dose for adult defibrillation?

A

200J

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53
Q

What does DRSABCD stand for?

A

Check for DANGER

Check for a RESPONSE

SEND for help

Check the AIRWAY

Check for BREATHING

Start CPR

DEFIBRILLATION

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54
Q

What does VIE stand for?

A

Vacuum Insulated Evaporator

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55
Q

What are 3 safety features of a Bulk Gas?

A

Colour coded Pipelines

Non-interchangeable screw thread hose

Colour coded wall connectors

Gas pressure and contents visible on the front of the machine

Second stage regulators: control pipeline pressure surges

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56
Q

What are the 4 tests done on a reserve cylinder?

A

Internal endoscopic exam

Impact, Bend, and flattening test

Pressure test at 22000kPa

Tensile test: Strips cut and stretched

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57
Q

What are 5 labels on the reserve cylinder?

A

Name, Chemical and symbol

Substance identification number

Batch number

Hazards warning and safety instructions

Max contents (Litres)

Pressure

Cylinder size code

Storage and Handling

Filing date, shelf life and expiration date

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58
Q

What are 5 safety features of a flowmeter on the anaesthetic machine?

A

Gas knobs are colour coded for each gas

Oxygen knob is positioned on the left and is fluted and larger than the other knobs as it will now be easily recognised.

Oxygen is the last gas to be added to the common gas manifold

One knob for each gas

Each knob is calibrated for that specific gas

Doesn’t allow N2O to be given without O2

O bobbin will rise with N2O: anti-hypoxic device

Does not allow oxygen to have a concentration of less than 25% when giving N2O

59
Q

What are 4 safety features of a vaporiser?

A

Colour coded

Vapour specific

Specific key filling port

Ani-spill/antipollution cap on bottles

Bottles only opens when full inserted into the vaporiser

Content window

Interlock system

Magnetic coding

60
Q

What does MAC stand for?

A

Minimum alveolar concentration

61
Q

What does APL stand for?

A

Adjustable Pressure limiting valve

62
Q

What are 5 safety features of an anaesthetic machine?

A

Anti-static wheels

Colour coded pipeline

Recessed oxygen flush with spring loaded activation

Cover on the on/off switch to prevent accidental on/off

Anti-Hypoxic device

Oxygen failure alarm/nitrous cut off

Universal connectors for a breathing system are 22mm and 15mm

Scavenging has a different connector to breathing system which is 30mm

Back-up power supply

High pressure relief valve which prevents high airway pressure

63
Q

What are the 5 must haves of monitoring during anaesthesia?

A

SpO2

EtCO2

Oxygen analyser

Agent Analyser

Ventilator alarms

64
Q

What are the 10 patient rights?

A

Rightto be treated with respect

Right to fair treatment and freedom from discrimination

Right to dignity and independence

Right to service of an appropriate standard

Right to be listened to and understood

Right to receive information: benefit and risks of treatment

Right to make informed choice

Right to support

Right to teaching and research

Right to complain

65
Q

What is involved in the ‘Sign in’?

A

Confirm surgeon available

Before induction of anaesthesia, confirm with patient: Identity, Site and side, Procedure, Consent

Site marked or not applicable

Does the patient have: Known allergies, Difficult airway or aspiration risk, Risk of >500 ml blood loss recorded.

Anaesthesia safety checklist completed

Check and confirm prothesis/ special equipment to be used

66
Q

What is involved in the ‘Sign out’

A

Verbally confirm with the team after final count:

The name of the procedure recorded

That instrument, needle, sponge, and other counts are correct

How the specimen is labelled (including patient name)

The plan for ongoing VTE prophylaxis

Whether there are any equipment problems to be addressed

Postoperative concerns/plan for recovery and management of this patient

67
Q

What is CO2 measured in?

A

kPa and mmHg

68
Q

What is side stream CO2?

A

Connected to adapter at patient end

Small increase of dead space

Time delay

Moisture trap

69
Q

What is Mainstream CO2?

A

Sample chamber positioned within patient’s gas stream

Increased dead space

Heated to prevent condensation

No time delay

70
Q

What are 7 features of an Endotracheal tube?

A

Radio opaque lines

Single use

Latex free

Sterile

Anatomical shape

Internal diameter on tube

Outer diameter on tube

Pilot balloon with self-seal valve

Low-pressure, high-volume cuff

Depth in CM

Black line to position vocal cords

PVC clear

15mm connector

Murph’s eye

Left bevelled edge

71
Q

Five common causes of anaphylaxis?

A

Latex

Colloid

Antibiotics

Muscle relaxant

Chlorhexidine

Patient blue

sugamadex -[likelihood appears to be dose-related]

72
Q

What is the definition of Decontamination?

A

Process of removal of unwanted matter or infectious tissue on an object or area

73
Q

What is the definition of Disinfection?

A

Process of elimination of all or many micro-organisms not including spores

74
Q

What is the definition of Sterilisation?

A

Process of elimination of all micro-organisms including spores

75
Q

What is the definition of Contact precautions?

A

To prevent transmission of infectious agents which are spread by direct or indirect contact with a patient, their environment, or patient care items

76
Q

What is the definition of Droplet precautions?

A

Prevent transmission of infectious agents which are spread by close respiratory or mucous membrane contact with respiratory secretions

77
Q

What is the definition of Airbourne Precautions?

A

Prevent transmission of infectious agents that remain infectious over long distances when suspended in the air and are transmitted person to person by inhalation of airborne particles

78
Q

What are 4 methods of sterilisation?

A

Autoclaving

Ionising radiation

Dry heat

Ethylene oxide

79
Q

What is Moment 1 in the 5 Moments of Hand Hygiene?

A

Before patient contact

When: before approaching and touching a patient

Why: To protect the patient from harmful germs on your hands

80
Q

What is Moment 2 in the 5 Moments of Hand Hygiene?

A

Before performing a procedure

When: Immediately prior to performing a procedure

Why: To protect the patient from harmful germs, including their own from entering their body

81
Q

What is Moment 3 in the 5 Moments of Hand Hygiene?

A

After procedure or exposure to bodily fluid

When: Immediately are procedure or exposure of bodily fluid and after removal of gloves

Why: to protect you and the health care environment against harmful patient germs

82
Q

What is Moment 4 in the 5 Moments of Hand Hygiene?

A

After patient contact

When: Immediately after touching the patient and touching patient surroundings once leaving the patient’s side

Why: to protect you and the health care environment against harmful patient germs

83
Q

What is Moment 5 in the 5 Moments of Hand Hygiene?

A

After contact with patients’ surroundings

When: immediately after contact with objects that have been in the same area as the patient, even if you have not touched the patient

Why: to protect you and the health care environment against harmful patient germs

84
Q

What does TACO stand for and what is it?

A

Transfusion Related Circulatory Overload

Pulmonary oedema primarily caused by volume excess

Symptoms = acute respiratory distress, cough, pink sputum, decreased SpO2, nausea, pulmonary oedema, raised CVP.

85
Q

What does TRALI stand for and what is it?

A

Transfusion Related Acute Lung Injury

Repaid onset of excess fluid in the lungs.

Symptoms = acute respiratory distress, fever, bilateral infiltrates on chest

86
Q

What is the relationship between standard preacautions and infection control?

A

Universal precautions are in place to prevent infections and contamination

Following standard precautions, we can minimise infection spreading which allows for better infection control

87
Q

Define microshock

A

A small electric current passing directly through the heart and directly sending the patient into ventricular fibrillation

88
Q

Define macroshock

A

Larger electrical current passes through the body

89
Q

What is the formula for estimating the size of both cuffed and uncuffed ETT for a paediatric patient?

A

Cuffed – age/4 + 3.5

Uncuffed age/4 + 4

90
Q

What is sodalime composed of?

A

94% calcium hydroxide

5% sodium hydroxide

1% potassium hydroxide

91
Q

What is the flow rate of a 14g cannula?

A

Just gravity - 250ml/min

Pressurized – 380ml/min

92
Q

What are some examples of colloid substances?

A

RBC

Albumin

FFP

93
Q

What are some examples of crystalloid substances?

A

Heartmans

Sodium Chloride

Plasmalyte

Dextrose saline

manitol

94
Q

What temperature is FFP stored at?

A

-30’C

95
Q

What temperature is RBC stored at?

A

2- 6’C

96
Q

List fractionated blood products available;

A

Plasma

Cryoprecipitate

Platelets

Immunoglobins

Albumin

Irradiated and leuko depleted red blood cells

97
Q

What are leukocytes and what is their main purpose?

A

White blood cells

Main immune system cell

98
Q

What are the 5 R’s of drug administration?

A

Right drug

Right patient

Right dose

Right route

Right time

99
Q

Why are patients in Trendelenburg for an internal jugular central line insertion?

A

To reduce the chance of causeing an air embolism

100
Q

What pressure should a tourniquet be set to?

A

Inflated to above 100mmHg above systolic pressure for lower limbs

Inflated to above 50mmHg for upper limb

101
Q

What are some complications associated with tourniquet use?

A

Nerve damage

Tissue damage

Pain

Overuse can cause limb to become ischemic

102
Q

Define scatter regarding radiation;

A

Radiation that spreads out in different directions from a radiation beam when it encounters an object or tissue

103
Q

What are three methods of radiation protection/

A

Time

Distance

Shielding

104
Q

Expand the acronym LASER

A

Light

Amplification

Stimulated

Emission

Radiation

105
Q

What items can contain latex in operating theatres?

A

Some surgical gloves

Some catheters and other tubing

Sticky tape or electrode pads

106
Q

What items can contain chlorhexidine in operating theatres?

A

Skin antiseptic wipes

Hand gels and hand wash solutions

Surgical skin disinfectants

Pre-surgery wash sponges and wipes

Lubricant preparations

Central venous lines

Surgical dressings and mesh

Mouth wash

107
Q

List four methods of heat loss;

A

Conduction

Convection

Radiation

Evaporation

108
Q

Why do children have a difficult time regulating their temperature?

A

They have thin skin and less body fat

High body surface area to volume ratio and loose heat quicker

They have a high metabolic rate which consumes more oxygen and energy

They are not as developed to develop shivering/vasoconstriction/piloerection/sweating.

109
Q

Outline the guidelines for fluid maintenance relating to body weight in paediatric anaesthesia;

A

0-10kg = 4ml/kg/hr

10-20kg = 2ml/kg/hr

> 20kg = 1ml/kg/hr

4-2-1 rule

110
Q

What are the fasting requirements for children for surgery?

A

6 hours – milk and food

4 hours – breastmilk

2 hours – clear fluids

111
Q

List 5 different places a patient’s temperature can be measured from;

A

Nasal

Oral

Rectal

Catherter

Skin

Ear

112
Q

Explain the advantages and disadvantages of the use of a Jackson Rees modification of a T-Piece;

A

Low resistance with minimal dead space and acts as a manual ventilator

Allows for spontaneous breathing and controlled ventilation

No pressure relief valve

No scavenging

Inaccurate capnograhy

No rebreathing and requires higher fresh gas flow

113
Q

What is the formula for estimating body weight?

A

2 x [age x 4]

114
Q

What is the formula for estimating ET tube depth to both lips and nostril?

A

Lips - [age/2] + 12cm

Nasal - [age/2] + 15cm

115
Q

Define the coroner’s clot

A

Occult hidden clot of blood remaining in the nasopharynx behind the soft palate following surgery or trauma which can cause a fatal airway obstruction following extubation

116
Q

What is the reason for the 15’ left tilt for a LSCS?

A

Reduces aortocaval compression and inferior vena cava compression

117
Q

List equipment required for an intravenous regional block;

A

Double cuff tourniquet

Sterile preperation pack

IV access equipment

Standard monitoring

Local anaesthetic agent [lidocaine or prilocaine]

Fluids primed and ready

Emergency drugs available

Intralipid to treat local anaesthetic toxicity

Syringe and needles

118
Q

Define diagnosis of compartment syndrome;

A

Increased pressure in a confined space that causes significant pain and can decrease blood flow

119
Q

Explain Cushing’s triad;

A

Refers to a set of signs that are indicative of increased intracranial pressure

Consists of bradycardia

Irregular respirations

Widened pulse pressure

Increase between systolic and diastolic pressure

120
Q

Define RCD;

A

Residual control device

121
Q

What is the normal range for CO2?

A

35-45 mmHg

122
Q

What are some components of a VIE?

A

Thermally insulated double walled steel tank with a layer of perlite in a vacuum

Pressure regulators allow gas to enter a pipeline and maintain pressure of 410 Kpa

Safety valve opens at a pressure of 1700kpa

Control valves

123
Q

What size are the gas cylinders in a cylinder manifold?

A

Size J

124
Q

What are some safety features of a bulk gas?

A

Colour coded pipelines

Non-interchangeable screw thread hose

Colour coded wall connectors

Gas pressure and contents visible on the front of the machine

Second stage regulators which controls pipeline pressure surges

125
Q

Why might a pipeline fail?

A

High demand of oxygen

Fault in the Schrader valve connector

Fault in the manifold room

Broken/failure in the pipeline

126
Q

What markings are engraved on a cylinder?

A

Test pressure

Date the test was performed

Chemical symbol and name

Tare weight when empty

127
Q

What are some tests performed on a gas cylinder?

A

Internal endoscopic exam

Impact, bend and flattening test

Pressure test at 22,000 kPa

Tensile test – strips cut and stretched

128
Q

What are some labelling featured on a gas cylinder?

A

Name, chemical symbol

Substance identification number

Batch number

Hazards warning and safety instructions

Max contents in litres

Pressure

Cylinder size code

Storage and handling

Filling date, shelf life and expiration

direction

129
Q

What are some safety features of a flowmeter?

A

Gas knobs are colour coded for each gas

Oxygen knob is always positioned on the left and is larger than the other knobs with a different tactile feel

Oxygen is the last gas to be added to the common gas manifold

Each knob is calibrated for that specific gas

Doesn’t allow N2O to be given without O2

O2 will rise with N2O – anti hypoxic device and ensures no less than 25% oxygen can be delivered when running N2O

130
Q

What are some types of anti-hypoxic devices?

A

Mechanical chain link

Pneumatic pressure sensitive device

Paramagnetic oxygen analyser

131
Q

What are some characteristics of an ideal vaporiser?

A

Performance is not affected by change in FGF

Low resistance to flow

Light weight and economical

132
Q

What are some characteristics of an ideal breathing system?

A

Simple and safe to use

Delivers intended inspired gas mix

Permits spontaneous manual and controlled ventilation

Use low fresh gas flow

Protects patient from barotrauma

Sturdy and light weight

Permits easy removal of gas

133
Q

What are some safety features of a breathing system?

A

High pressure relief valve

Soda lime changes colour when exhausted

Airways pressure gauge present

Breathing circuit 22mm and 15mm

134
Q

What does the acronym HEAMP represent regarding bariatric airway set up?

A

H-hand hygiene

A – anaesthetic type

E - Environment positioning devices e.g. supports

M – level 2 or 3 machine check

P – sniffing the morning air position

135
Q

What does MALES BIT MOA represent?

A

M- mask, Magill’s

A – airway oropharyngeal, nasopharyngeal, Ambu bag, agent

L – laryngoscope, LMA

E – ET tube, emergency drugs

S – Suction under the pillow, syringe, stylet, stethoscope

B – Bag of fluid, bougie

I – IV cannulation

T – tapes, ties

M – Monitoring

O – oxygen cylinder

A – Accessory equipment – air warmers, infusion pumps, fluid warmer

136
Q

Define asepsis;

A

It is a process in which microbial agents on a living surface are either killed or their growth is arrested

137
Q

Define antiseptic;

A

These are the substances applied on the living tissues to reduce the possibility of infection and growth of microorganisms

138
Q

Define aseptic processing;

A

It is defined as the processing and packaging of sterile product into sterilised containers followed by proper sealing with sterilised closure in a manner to control microbiological recontamination

139
Q

Define microorganism;

A

Microscopic organisms which may exist in its single celled form or in a colony of cells

140
Q

Define pathogen;

A

A pathogen is a tiny living organism such as a bacterium or virus that can produce disease in an individual

141
Q

Define disinfection;

A

Antimicrobial process to remove, destroy or deactivate microorganisms on surfaces or in liquids

142
Q

Define decontamination;

A

The process by which a person or a surface is made free from all the agents that contaminate the surface and lead to the surface and lead to the spread of infection

143
Q

Define cleaning;

A

It is the process of removing all forms of foreign material by employing the mechanical action of washing or scrubbing