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NU 568
Exam 2 - Anesthesia Machine - Lecture 2
| Question | Answer |
|---|---|
| What is the color for nitrous for both U.S. and international standards? | Blue |
| How is nitrous stored? | liquid form |
| What is the vapor pressure of N2O at room temperature? | 745 psi |
| Cylinder pressure of N2O is (the same/different) compared to its vapor pressure at room temperature. | the same |
| Why does the cylinder gauge of N2O remain constant at 745 psi until almost all of the liquid is gone? | More gas is generated in the cylinder as gas is being used |
| The cylinder pressure gauge will read 745 psi for N2O until the volume is at what level? | 400L |
| How can you tell whether a nitrous tank is getting empty? | Weigh the cylinder |
| What is the reason that rapid N2O removal from a cylinder will form frost or freeze the cylinder valve? | Loss of latent heat of vaporization from the liquid N2O |
| Touching the frost outside of an N2O cylinder may cause _____________. | Frostbite |
| Compressed air composition is (identical/variable) between samples. | variable |
| Newer AM have backup batteries that will keep the AM running for how long? | 30-45min |
| Where are convenience receptacles located and what do they allow? | Back of the AM and allow for monitors and other equipment to be plugged in |
| What feature protects convenience receptacles? | circuit breakers or fuses |
| What should not be plugged into a convenience receptacle? | Electrical devices that generate heat |
| Give examples of electrically powered devices that generate heat. | Air or water warming blankets, IVF warmers |
| What are two reasons that a heat generating device should not be plugged into the convenience receptacle? | 1)more likely to open the circuit breaker 2)circuit breakers are in non-standard locations, making it difficult to reset once open |
| What are the problems that occur with an open circuit breaker connected to a convenience receptacle? | All the devices plugged into the receptacle will lose power, will lose valuable time trying to locate the circuit breaker |
| What are two important things to consider about convenience receptacles and circuit breakers. | Do not plug heat-generating devices into the receptacle and know the location of the circuit breaker that protects the receptacle that is being used |
| What are 7 devices that do not rely on wall outlet electrical power? | 1)spontaneous and manually assisted ventilation 2)mechanical flow meters 3)scavenger system 4)flashlights 5)IV bolus or infusion pumps 6)peripheral nerve stimulators 7)variable bypass vaporizers |
| What are 5 devices that require electrical power? | Mechanical ventilator, physiologic monitors, room and surgical field illuminators, digital flowmeter displays, warming blankets |
| What is important to know about backup generators? | Not completely reliable in the event of a power loss |
| What were the principle problems for anesthesia machines in a power loss? | Loss of room illumination, failure of mechanical ventilators and electronic patient monitoring |
| Name the 6 anesthesia machines covered in lecture. | Drager Apollo, Drager Fabius, Narkomed 6000/6400, GE Aestiva, GE Aisys, GE ADU |
| What is similar about the path of gases through the AM? | Each passes from a supply point to a flowmeter |
| Which gas does not flow through a fail-safe valve on its way to the flowmeter? | Oxygen |
| What holds the fail-safe valve open? | Pressure in the O2 circuitry in the AM |
| Where are gases first joined together? | After passing through flowmeters in the common manifold |
| Where is oxygen added in the common manifold and why is it added in this area? | Downstream so that delivering a hypoxic mixture is less likely |
| From the common manifold, where do the combined gases go? | Any vaporizer that's turned on |
| After entering the vaporizer, where do gases flow? | Common gas outlet |
| What connects the common gas outlet to the breathing circuit? | Delivery hose with a locking connection |
| Give the pathway of gases in the AM from supply to the delivery hose. | Supply point -> fail-safe valve (except O2) -> flowmeter -> common manifold (O2 downstream) -> vaporizer -> commong gas outlet -> delivery hose w/locking connection |
| What is the destination of gases after the delivery hose? | Breathing circuit and ventilator |
| Identify the remaining path of gases from the breathing circuit and ventilator. | Breathing circuit & ventilator -> patient -> scavenger interface -> disposal in hospital ventilation or suction system |
| Name the 5 tasks/pathways of oxygen in listed order. | 1)Proceed to the flowmeter 2)power the flush valve 3)activate fail-safe mechanisms 4)activate the O2 low pressure alarm 5)compress bellows |
| How many pathways do N2O and air have to the patient after passing their flowmeters. | One: flowmeter -> breathing circuit -> patient |
| What can newer AMs use to drive the bellows in an oxygen pressure loss scenario? | Air |
| What is the 1st task of O2? | Proceed to flowmeter and then to patient as life-sustaining gas |
| In reference to FGF, all current gas machines use ______________ and some have ______________ as well. | mechanical needle valves, digital display |
| FGF control knobs are uniform in color and form. | False -- each knob is distinct for visual and tactile terms |
| What is the classic way to capture and display FGF? | Glass tube with indicator float |
| How are flowtubes shaped? | Tapered with narrowing at the bottom |
| What other name can flowtubes be referred to as? | Variable orifice flowmeter (Thorpe tube) |
| What is standard positioning for the O2 flowmeter in the U.S.? | To the right of other gases |
| What is the most fragile part of an anesthesia machine? | flowtubes |
| A Thorpe Tube is also called a/an _____________. | Variable orifice flowmeter |
| What is unique about the Fabius flowmeters? | Vertically arranged |
| What are the 5 components of the flowmeter? | control knob, needle valve, valve stop, flowtube, indicator float |
| Needle valves are mechanical on all machines except for which two systems? | Avance and Aisys (electronic) |
| Flowtubes are (identical/specific) for each gas and therefore (can/cannot) be interchanged. | specific, cannot |
| What is the indicator float for Drager machines? | Rotating ball |
| What is the indicator float for GE machines? | Plumb bob |
| See Slide 33 for the flowtube diagram | |
| What is an older term for "flowmeter" or "flowtube"? | Thorpe Tube (variable orifice) |
| What are three ways to decrease the chance of fire in sedated patients undergoing head and neck surgery? | decrease FiO2, scavenge the O2, tent the drapes |
| Which law governs flow through a tube? | Poiseuille's Law |
| Gas flow a flowmeter is governed by what characteristic at low flow? High flow? | Low flow=viscosity, High flow=density |
| According to Poiseuille's Law, what has the most dramatic on flow in a tube? | Radius |
| According to Poiseuille's Law, flow through a tube is proportional to what power of the tube's radius? | Flow is proportional to the 4th power of the radius |
| How much does flow increase when the diameter is doubled? | 16x |
| How much does flow increase when the diameter is tripled? | 81x |
| What are the first 5 steps in the care of flowmeters? | 1)turn off the flowmeter before the machine is turned on 2)never adjust the flowmeter without looking at it 3)ball-type indicators are read in the center 4)plumb-bob indicators are read at the top 5)don't leave flowmeters on |
| Why should flowmeters be turned off prior to turning on the AM? | If open, the float will shoot to the top of the flowtube and may cause damage |
| What are 4 problems that can arise from leaving flowmeters on after a case ends? | Premature drying of CO2 absorbers, increase degradation of VAA, CO generation in canisters, canister fires |
| What types of machines use auxiliary oxygen flowmeters? | All anesthesia machines |
| What are three benefits of the auxiliary O2 flowmeter? | Delivers supplemental O2 while leaving breathing circuit and delivery hose intact, instantaneous switch from NC to circle system, readily available O2 source for the Ambu bag for manual ventilations |
| What are two drawbacks to the auxiliary O2 flowmeter? | Depends solely on pipeline supply, FiO2 cannot be adjusted (fire hazard in head/neck surgeries) |
| What is the supply source for auxiliary O2 flowmeters? | Pipeline supply |
| Besides mechanical and auxiliary flowmeters, what are 2 other locations of flowmeters? | common gas outlet, scavenging system |
| What is the purpose of the common gas outlet flowmeter? | Serves as a backup on machines with electronic capture and display of FGF on computer screens |
| What is the purpose of scavenging system flowmeters? | Indicates that suction is adequate so exposure to anesthetic waste gases is avoided |
| What is the 2nd task of oxygen? | supply the O2 flush valve |
| What is the purpose O2 flush valve? At what rate does it achieve this? | Quick fill of the breathing circuit w/O2; 35-75L/min |
| What are drawbacks of the O2 flush valve? | barotrauma if used on inspiration, dilution of other gases b/c it bypasses the vaporizer |
| If flushing is necessary for filling bellows, in what phase of respiration should it be activated? | Expiration and with caution and in short bursts |
| Normal delivery of O2 to the AM is _________ L/min. | 50 |
| Where does the O2 flush valve insert O2? | Directly into the common gas outlet (after the vaporizer and just prior to the breathing circuit) |
| What is the 3rd task of oxygen? | activation of the fail-safe system |
| A hypoxic mixture of gas is a mixture that delivers less than ____________ % O2. | 21 |
| Fail-safe valves work like __________. | Gates |
| What are two types of fail-safe valves? | Gate-like and proportional |
| Which machines use gate-like fail-safe valves? | Avance, Fabius |
| Which machines use proportioning systems as fail-safe measures? | Aestiva, AISYS, ADU |
| What is the drawback to the fail-safe system? | Does not analyze the gas content, only pressure (cross-connect error could still allow for a hypoxic delivery of gas) |
| Most machines have fail-safe devices placed on which gas line? | N2O |
| True/False: It is possible to deliver a hypoxic mixture of air. | False |
| What is the 4th task of O2? | activate low pressure alarm |
| What does activation of the low pressure alarm signify? | pressure loss in the oxygen circuitry |
| What is the difference between older and newer O2 pressure loss alarms? | older machines utilized a whistle that would go off with low pressure or when turning off the AM; new models use a variety of visual and auditory alarms |
| What is the 5th task of O2? | power the bellows (ventilator driving gas) |
| Which AM manufacturer uses O2 to drive its bellows? | GE |
| Which AM manufacturer used oxygen to drive a Venturi device in older models? | Drager |
| How was the driving gas augmented with the Venturi device in older Drager models? | Augmented with entrained room air |
| Give the location where entrained air enters and augments driving gas for the bellows? Which machine was this found on? | RA enters through a chrome or steel cylindrical muffler. Found on the back of some Narkomed AM |
| Which AM models utilize piston ventilators run by electric motors? | Narkomed 6000/6400, Fabius, Apollo |
| Which AM is capable of driving the bellows with air or O2? | ADU |
| What types of machines incorporate a hypoxic guard? | All current AMs. |
| The hypoxic guard could also be referred to as a _______________. | Proportioning system |
| What is the function of a proportioning system? | Prevent the delivery of a hypoxic mixture of N2O and O2. |
| The delivery of N2O:O2 never exceeds what ratio? | 3:1 |
| Proportioning systems gaurantee an FiO2 of at least ____________ % | 25% (+/- 4) |
| Which model AM utilizes a mechanical proportioning system? | Aestiva, Aespire |
| Describe the proportioning system of the GE Ohmeda. | Flowmeter control knobs are linked by a chain so that N2O:O2 ratio remains at a safe constant |
| Name the Make and model of the link system for proportioning N2O and O2. | Datex Ohmeda Link 25 |
| What is the name of the electronic hypoxic guard system? | Sensitive Oxygen Ratio Control (S-ORC) |
| At what % does the S-ORC maintain FiO2 above and how is this achieved? | Maintained at least 23% by limiting N2O supply |
| Name the AMs that use an S-ORC system for proportioning. | Narkomed 6000, Apollo, Fabius |
| What are the 4 circumstances under which a hypoxic guard system can permit a hypoxic delivery of gases? | wrong supply gas in pipeline or cylinder, defective pneumatics/mechanics, leaks downstream of flow control valves, inert gas administration (i.e. helium as a 3rd gas) |
| Of the 4 ways a hypoxic guard can fail, which reason is the most harmful and why? | administration of a 3rd gas b/c hypoxic guards link only N2O and O2 and does not account for any extra driving gases |
| To prevent a hypoxic delivery, proper use of what device in each general anesthetic is of vital importance? | O2 analyzer |
| Name 3 different types of vaporizers. | Variable, measured, Tec 6 |
| How does the variable flow vaporizer work? | Increasing the vaporizer dial allows more fresh gas into the vaporizer |
| How does the measured flow vaporizer work? | Operator determines how much gas is bubbled through the anesthetic liquid by a formula |
| After calculating the amount of gas to be bubbled into anesthetic liquid, what does the operator set? | Operator sets the amount of calculated gas on a second O2 flowmeter marked "Oxygen for Vernitrol" |
| What type of vaporizer is no longer manufactured in the U.S.? | Measured-flow vaporizer |
| What does the Tec 6 injector utilize in its process? | Heated, dual-circuit vaporizer |
| In a Tec 6 vaporizer, the fresh gas (does/does not) come in contact with the vaporizer liquid. | Does not |
| Which vaporizer system utilizes a heating system and separates the fresh gas flow from the liquid anesthetic agent? | Tec 6 |
| The first circuit in the Tec 6 consists of the _____________. The second circuit in the Tec 6 consists of the __________. | Fresh gas; anesthetic agent |
| How many control points does the second circuit in a Tec 6 have? How are these control points controlled | 2; controlled by the operator to set concentration, controlled by the amount of FGF |
| To what temperature does the Tec 6 heat the second circuit? | 39 degrees celsius |
| When using desflurane, heating the second circuit to 39 deg C creates a vapor pressure of __________ mmHg. _________ kPa | 1500mmHg; 200kPa |
| Why does desflurane need a specialized vaporizer? | Its near boiling vapor pressure at room temperature would result in a hypoxic breathing mixture |
| True/False: Variable-bypass and Tec 6 vaporizers are filled in (different/similar) ways. | similar |
| What are the methods by which variable-bypass and Tec 6 vaporizers are filled? | funnel-type and keyed-filler type |
| Which method of filling vaporizers is preferred and why is it preferred? | Keyed-filler b/c they decrease the chances of filling with the wrong agent |
| Which vaporizer allows for filling while in operation and which gas does operate with? | Tec 6; desflurane |
| True/False: All variable-bypass vaporizers must be turned off while being filled. | True |
| What do standards require in relation to filling vaporizers? | Overfilling be prevented in normal operating position; liquid level indicators be visible to the operator |
| What can occur with overfilling? | discharge of liquid anesthetic from the vaporizer outlet |
| How is the flow of gases to and from the patient controlled and monitored? | Through the breathing circuits |
| What are the functions of the breathing circuit? | Deliver anesthetic gas, deliver oxygen, eliminate CO2 |
| How is CO2 eliminated from the breathing circuit? | Washout with adequate FGF or absorption in soda lime |
| Give two reasons why resistance to airflow should be minimized. | Resistance is uncomfortable for the conscious patient; unconscious patient may hypoventilate |
| What are 5 methods to decrease resistance of gas flow in the AM. | reduce circuit length, increase circuit diameter, avoid using sharp bends, eliminate valves, maintain laminar flow |
| Which creates more resistance to breathing, the AM or the ETT? | ETT |
| T/F: Rebreathing of exhaled gases occurs in both anesthesia and ICU type ventilators. | False -- it is unique to anesthesia |
| What are the purposes of using a rebreathing system in anesthesia? | cost reduction, tracheal warmth and humidity, decrease staff exposure to trace and waste gases |
| T/F: Rebreathing exhaled O2 has no ill effects. | True |
| How does rebreathing exhaled nitrogen affect induction? | Slows induction |
| How does increasing mechanical dead space affect rebreathing? | Rebreathing of CO2 is more likely (leading to respiratory acidosis) |
| Why are are dry gases used in the AM? | Avoids internal corrosion and bacterial colonization |
| Why is active humidification less common? | Less effective at preventing hypothermia than heated-air warming blankets, added moisture can clog gas-analysis lines and soda lime granules, can obstruct unidirectional valves |
| What are the two gases used to compress mechanical bellows? | air, O2 |
| Besides driving gases, what other gases are present in mechanical bellows? | gases inspired and expired by the patient |
| What device prevents the potential buildup of volume and pressure in the breathing circuit from the constant influx of FGF? | ventilator relief valve |
| What are other names for the ventilator relief valve? | spill or overflow valve |
| What is the position of the ventilator relief valve on inspiration and what does this do? | closed - prevents release of gas from bellows to the scavenger system until bellows are compressed |
| What is the position of the ventilator relief valve on expiration? | opened - opens to scaving system |
| Most modern ventilators are classified under what 4 categories? | Multimode, double circuit, electronically controlled, volume and pressure limited |
| Observation of bellows during ___________ identifies it as ascending or descending. | expiration |
| Why are ascending bellows safer? | Will not fill in the event of a disconnect and will remain flat |
| What are the disadvantages of descending bellows? | May not immediately detect a disconnect (may fill with RA in a disconnect), bellows sometimes reach below the writing surface of the AM, may gather water |
| Inspiration in the AM is (mechanical/passive). | Mechanical |
| Identify the 7 different types of ventilator alarms. | high press, press below threshold 15-30sec, continuing high press, subatmospheric press, low TV or MV, high RR, reverse flow |
| What does a reverse flow alarm indicate? | Incompetence of expiratory unidirectional valve in the breathing circuit >> moisture in the system may prevent valves from opening and closing |
| What are the 4 different modes of ventilation? | Controlled mandatory (CMV, VCV), pressure controlled (PCV), synchronized intermittent mandatory (SIMV), manual-spontaneous |
| Which mode of ventilation do all AM offer? | VCV |
| Volume and gas are delivered at (variable/constant) flows in VCV mode. | constant |
| When is inspiration determined in VCV mode? | When the desired TV is delivered or an excess of pressure is reached |
| How is PIP controlled in VCV mode? | patient's lung compliance |
| How is EtCO2 controlled in VCV mode? | RR and TV |
| What are typical settings for VCV mode? | TV 10cc/kg, RR 6-12, PEEP 0, I:E 1:2 |
| What does PSV require of the patient? | Spontaneous breathing |
| What is the difference b/w PCV and PSV? | RR is set to 0 in PSV |
| When is PSV used? | End of surgery during emergence and with spontaneous breathing |
| Breathing is assisted in PSV mode with a present _______________ pressure. | inspiratory |
| What is the default assisted pressure in PSV for the ADU? | 12 cmH20 |
| In PCV mode, what which is variable and which is controlled for both volume and pressure? | Volume is variable, pressure is controlled |
| What causes changes in inspiratory volume? | changes in compliance and airway resistance |
| How does pressure get delivered to the patient in PCV mode? | High flow at first to reach target pressure, then lower flows to maintain that pressure throughout inspiration |
| In what two scenarios will TV drop in PCV mode? | pulmonary compliance drops (pneumperitoneum) or airway resistance increases (bronchospasm, kinked ETT) |
| How is the target pressure determined in PCV mode? | adjusted based on the desired TV |
| What are indications for PCV mode? | pt's where high PIP is dangerous, pt's who need higher TV over what VCV can deliver, leaks around the breathing tube, one-lung ventilation |
| What are typical settings for PCV? | Pressure limit 20 cm H20, RR 6-12, PEEP 0, I:E 1:2 |
| How is SIMV similar to VCV? How is it different? | Similarity=it is volume-controlled ventilation, Difference=intermittent breaths are delivered synchronously and triggered with spontaneous efforts |
| Besides volume and rate, what other variable set by the operator in SIMV? | Trigger window percent and sensitivity |
| What does the trigger window control? | Amount of time, or percentage, during each expiratory cycle that the ventilator is sensitive to negative pressure generated by the patient's diaphragm |
| What does sensitivity in SIMV mode control? | How much negative pressure the patient needs to produce to trigger a breath |
| How do newer machines operate the bellows? | Electronically with pistons |
| What are the advantages of piston driven bellows? | Quiet, no autopeep, accurate TV, does not require O2 cylinder supply in the event of O2 pipeline failure, patient will not receive extra gas that drives bellows |
| What are three machines that utilize piston driven bellows? | Fabius, Apollo, Narkomed 6000/6400 |
| What are 3 reasons why TV is more precise with piston bellows? | compliance and leak compensation, fresh gas decoupling, rigid piston design |
| What are the disadvantages of piston driven ventilators? | familiar visual behavior of the standing bellows is lost during disconnection or with spontaneous breathing, less audible cycle, does not easily accomodate NRB circuits |
| What are the disadvantages of the older gas driven ventilators? | Set TV changes with increases in FGF, 1/3 of FGF is inspiration, |
| What are 3 ways that PEEP can be added? | add-on adapters, devices built into the system, electronically |
| What is the safest way to add PEEP? | electronically |
| Where are PEEP adapter add-ons situated in the AM? | between the expiratory limb of the circuit and expiratory unidirectional valve |
| What can occur if a PEEP adapter is placed on the inspiratory limb of the breathing circuit? | Obstruction |
| How does a fresh gas decoupling system works? | Fresh gas is diverted by a decoupling valve to the manual breathing bag, and is thus not added to the delivered tidal volume |
| What device closes the decoupling (one-way) valve? | the piston |
| The FGF decoupling system diverts FGF from the patient to the manual breathing bag on (inspiration/expiration). | inspiration |
| Give two examples of the unusual visual appearance of fresh gas decoupling systems. | breathing bag inflates with each breath, even with mechanical ventilation (normally quiescent in mechanical mode); moves opposite the bellows (inflates w/inspiration) |
| Which AMs use a fresh gas decoupling system? | Apollo, Fabius, Narkomed 6000 |
| Besides decoupling, how else can delivered TV account for FGF? | fresh gas compensation |
| How does fresh gas compensation work? | Volume and flow sensors provide feedback so the ventilator can adjust the delivered TV to match the set TV, in spite of changes in FGF |
| Which machines utilize fresh gas compensation? | Aestiva, Aisys, ADU |
| How much waste gas must be eliminated per minute? | An amount equal to the delivered gas per minute |
| What does the scavenging system do? | Collects waste anesthetic gases from the breathing circuit and ventilator and removes them from the OR |
| What determines the amount of scavenged gas? | FGF |
| What are the 5 components of the scavenging system? | Gas collection assembly, transfer tubing, scavenging interface, gas disposal tubing, gas disposal assembly |
| What organization sets standards for exposure to waste anesthetic gases? | Occupational Safety and Health Administration (OSHA) |
| Where is the gas collection assembly located in the scavenging system? | At the APL and ventilator relief valve |
| What is the length of transfer tubing and how is it coded in the scavenging system? | 19mm and 30mm; sometimes color coded yellow |
| Scavenging systems are either ________ or ______ while the scavenging interface is either _________ or _______. | Active, passive, closed, open |
| What 2 things does an active scavenging system require? | Suction apparatus, both positive and negative pressure relief valves |
| How does a passive scavenging system work? | Waste gases proceed passively down corrugated tubing through the room ventilation exhaust grill of the OR |
| How does the anesthetist know that the suction apparatus in an active scavenging system is attached to the scavenging interface? | Distinct "whoosh" sound means suction is attached |
| Older AMs utilize a/an (closed/open) scavenging interface. | closed |
| How does a closed interface scavenging system communicate with the atmosphere? | Only through valves |
| What does a closed interface scavenging system require in order to work with a passive system? | positive pressure relief |
| What does a closed interface scavenging system require in order to work with an active system? | both positive and negative pressure relief valves |
| What is the most important component of the scavenger system and why? | The interface b/c it protects the patient from excessive buildup of positive pressure and from exposure to suction |
| What device is mandatory for all closed scavenging systems? | means for relief of positive pressure |
| When do positive pressure relief valves operate and where do they transmit anesthetic waste gases? | operate before the pressure buildup in the scavenging system is transmitted to the breathing circuit and lungs; releases waste gases into the operating room air |
| Newer AM utilize a/an (open/closed) scavenger interface. | open |
| If it is utilized, why does suction need to be adjusted in a closed scavenging system? | should be adjusted with changes in FGF so that the scavenger reservoir bag is neither flat nor overdistended |
| What does the open scavenging system lack that is present in closed systems? | valves |
| What safety features are built into the open scavenging interface? | both negative and positive pressure relief |
| In the open scavenging interface, where does each patient exhalation lead to? | bottom of the open interface reservoir, where a second tube tube withdraws it by suction before the next exhalation |
| What is critical for the open scavenging interface to function properly? | appropriate suction |
| What is the difference between the hissing sounds heard in the closed and open scavenging interfaces? | soft intermittent hiss heard in closed means gas is leaking into the room through the positive press relief valve; open interface should hiss continuously when properly adjusted |
| Open interfaces should only be used with (active/passive) systems. | active |
| Why is an open interface safer for patients? | no chance of relief valve failure, which can cause barotrauma or suction to the breathing circuit |
| What is the threshold for smelling volatile agents? | 5-300 ppm |
| T/F: It is ok per OSHA standards for minimal amounts of volatile gas to be smelled. | F - any agent that is smelled indicates excessive concentration |
| OSHA dictates that exposure to halogenated agents should not exceed _______ ppm or ______ ppm if used with nitrous oxide. | 2, 0.5 |
| OSHA dictates that exposure to nitrous oxide should not exceed ________ ppm. | 25 - based on a time weight of 8hrs |
| What do all open interface scavenging systems require? | Reservoir |
| Which interface is less safe for caregivers? | open - if used improperly |
| When is a closed interface useful? | where passive scavenging is used (no dedicated suction line for the scavenger, and waste gases flow passively along with room ventilation exhaust) |
| What are 3 hazards of the scavenger system? | obstruction distal to the interface (barotrauma or excessive negative pressure), occupational exposure, barotrauma w/inability to ventilate |
| What should the operator do if there as an obstruction distal to the scavenging interface? | disconnect the gas collection from the back of the APL valve or turn off suction |
| What are the levels of anesthetic gases around unscavenged anesthetic locations? | 85 ppm of halogenated agent, 7000 ppm of N2O |
| The health effects of chronic exposure to volatile agents is (proven/unproven). | unproven |
| The strongest relationship of harm from exposure to gaseous agents is between _________ and __________. | N2O, reproductive difficulties |
| T/F: The scavening system does not have to be included in the anesthesia checklist. | False |
| Name the first 5 techniques to decrease exposure to anesthetic gases. | good mask fit, avoid unscavengeable techniques (i.e. open drop, insufflation), prevent flow from the breathing circuit into RA, turn on the agent only when the mask is in use, wash out anesthetics into the scavenging system at the end of a case |
| Name the last 4 techniques to decrease exposure to anesthetic gases. | Used a cuffed ETT whenever possible, check for machine leaks, TIVA, avoid nitrous |
| What is the 1st step in the AM checklist? | Verify backup ventilation equipment is available and functioning |
| What is the 2nd step in the AM checklist and how is it performed? | check O2 cylinder supply: verify at least half full (1000 psi) and close the cylinder |
| Identify and describe the 3rd step in the AM checklist. | Check pipeline supply: check that hoses are connected and gauges read 50 psi |
| Identify and describe the 4th step in the AM checklist. | Check initial status of low pressure system: close flow control valves and turn off vaporizers, check fill level and tighten vaporizer filler caps |
| What is the 5th step in the AM machine checklist? | Perform leak check of low pressure system |
| What are the first steps in performing a leak check of low pressure systems? | a)verify that the master switch and flow control valves are off b)attach "suction bulb" to the common gas outlet c)squeeze the bulb repeatedly until fully collapsed |
| What are the last three steps in performing a leak check of low pressure systems? | d)verify the bulb stays fully collapsed for at least 10sec e)open one vaporizer at a time and repeat steps "c" and "d" f)remove the suction bulb and reconnect the fresh gas hose |
| What is the 6th step in the AM checklist? | Turn on the AM master switch and all other necessary electrical equipment |
| What is the 7th step in the AM checklist? | Test flowmeters |
| What are the two steps in testing a flowmeter? | a)adjust flow of gases through their full range and check for smooth operation of floats and undamaged flow tubes b)attempt to create a hypoxic N2O/O2 mix and verify correct changes in flow and/or alarm |
| What is the 8th step of the anesthesia machine check? | Adjust and check scavenging system |
| What are the first 3 steps in checking the scavenging system? | a)ensure proper connections between the scavenging system and both APL (popoff) and ventilator relief valves b)adjust waste gas vacuum (if possible) c)fully open APL valve and occlude Y-piece |
| What is the 4th step in checking the scavenging system? | d)with minimum O2 flow, allow scavenger reservoir bag to collapse completely and verify that absorber pressure gauge reads ~0 |
| What is the 5th and final step in checking the scavenger system? | e)with the O2 flush activated, allow the scavenger reservoir to fully distend, then verifyt hat absorber pressure gauge reads <10 cm H2O |
| What does the 9th step in the AM check calibrate? | O2 monitor |
| What are the steps involved with calibrating the O2 monitor? | 1)ensure monitor reads 21% in RA 2)verify low O2 alarm is enabled and functioning 3)reinstall sensor in circuit and flush breathing system w/O2 4)verify that monitor now reads >90% |
| What is the 10th step in the AM checklist? | Check initial status of breathing system |
| What are the 4 steps involved with checking the initial status of the breathing system? | a)set selector switch to "bag" mode b)check that breathing circuit is complete, undamaged, unobstructed c)verify adequacy of CO2 absorbers d)install breathing circuit accessories |
| What are different types of breathing circuit accessories? | humidifier, PEEP valve |
| What is the 11th step in the AM checklist? | Perform leak check of the breathing system |
| What are the first three steps to check for leaks in the breathing system? | a)set all gas flows to zero (or minimum) b)close the APL valve and occlude the Y-piece c)pressurize the breathing system to about 30 cmH20 with the O2 flush valve |
| What are the last two steps to check for leaks in the breathing systems? | d)ensure that pressure remains fixed for at least 10sec e)open APL valve and ensure pressure decreases |
| What is the 12th test in the AM check? | Test ventilation system and unidirectional valves |
| What are the first 3 steps in checking the ventilation system and unidirectional valves? | a)place a 2nd breathing bag on the Y-piece b)set appropriate ventilator parameters for the next patient 3)switch to automatic, or Ventilator, mode |
| What are the next 3 steps in checking the ventilation system and unidirectional valves? | 4)fill bellows and breathing bag with O2 flush then turn ventilator on 5)set O2 flow to minimum, other gas flows to zero 6)verify that during inspiration, bellows delivers appropriate TV and that bellows completely fill on expiration |
| What are the 7th, 8th, and 9th steps for checking the ventilation system and unidirectional valves? | 7)set FGF to 5L/min 8)verify that bellows and simulated lungs fill and empty appropriately w/o sustained end-expiratory pressure 9)check for proper action of unidirectional valves |
| What are the 10th and 11th steps to check the ventilation system and unidirectional valves? | 10)exercise breathing circuit accessories to ensure proper function 11)turn ventilator OFF and switch to manual ventilations (bag/APL) mode |
| What are the 12th and 13th steps to check the ventilation system and unidirectional valves? | 12)ventilate manually and assure inflation and deflation of artificial lungs and appropriate feel of system resistance and compliance 13)remove 2nd breathing bag from Y-piece |
| What is the 13th step in the AM check? | Check, calibrate, and set alarm limits of monitors |
| What are the different types of monitors that need to be checked? | capnometer, pulse oximeter, O2 analyzer, respiratory volume (spirometer), pressure monitor w/high and low airway alarms |
| Identify the last step (14th) of the AM check and describe the 6 different parts. | Check final status of AM: 1)vaporizers off 2)AFL valve open 3)selector switch to "Bag" 4)all flowmeters to zero 5)Patient suction adequate 6)Breathing system ready to use |
| T/F: The complete 14 step anesthesia machine check needs to be performed after every case. | False - can be abbreviated if the same machine is used in successive cases |
| What does the first step in the AM check look for? | Emergency ventilation equipment |
| What do the 2nd and 3rd steps in the AM check test? | High pressure system components |
| What do the 4th-7th steps in the AM check test? | Low pressure system components |
| What does the 8th step in the AM check? | Scavenging system |
| What do the 9th-11th steps in the AM check? | Breathing system |
| What does the 12th step in the AM check test? | The manual and automatic ventilation systems |
| What does the 13th step in the AM check test? | Monitors |
| What does the 14th step in the AM check test? | Final status of the machine |
Created by:
philip.truong
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