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Machine Q
SIUE-Kevin's Machine Quiz
| Question | Answer |
|---|---|
| What drugs should you prepare for your induction drugs? | Versed, Fentanyl, Lidocain, Propofol, and Zemuron. |
| What are the emergency drugs that you should prepare? | Atropine, succinylcholine, propofol, lidocaine, ephedrine, neosynepherine. |
| S, C, O, M, in scommladi | suction works and is easily accessible. Circuit passes leak test, ambu bag available. Oxygen line and tank pressure is appropriate. Monitors are functional and alarms are set. |
| M, L, A in scommladi | Machine check has been performed, vaporizers are full, soda lime does not need to be changed. Laryngscope macintosh and miller blades checked and are appropriate for pt. Airways included appropriate ETT, LMA, oral airway, and stylet if necessary. |
| D, I in scommladi | Drugs, all induction and emergency drugs are drawn up and available. IV is functional, of adequate size for surgery, and IV poles are within reach with drape clips available. |
| When does a full machine check need to be performed? A positive pressure test? | Prior to the first anesthetic case of the day. During the first full machine check and before each case. |
| What are the five functions of O2? | 1)Supply the O2 flush valve 2)Supply the low O2 alarm 3)Drive the ventilator 4)Fail safe valve 5)Supply the flowmeters |
| What is the primary gas source for the anesthesia machine? | The hospital gas supply system. |
| When O2 comes in from the hospital gas pipeline what is it's pressure? From the O2 cylinder? What are the two options for O2 to flow to? | 50 psi from the hospital pipeline. 45 psi from the O2 cylinder. Can go to the (spring loaded) O2 flush valve, or the main on/off switch breathing circuit. |
| When O2 is delivered via the cylinder what happens before it reaches the two pathways in which O2 can flow? | O2 1st passes through the hanger yoke check valve where it's cylinder pressure is read by the bourden gauge. It then goes through the 1st pressure regulator where it is converted to a working pressure of 45 psi. |
| What is the purpose of the hanger yoke check valve? | It is a unidirectional valve that prevents backflow of gasses, has an airtight seal and is part of the PISS system. |
| When O2 comes out from the hospital pipeline system what happens before it reaches the two pathways in which O2 can flow? | O2 comes out of the hospital pipelines at 50 psi where it is first read by bourden gauge and then travels through the hanger yoke check valve and is part of the DISS system. |
| What happens when O2 goes through the O2 flush valve? | O2 can only be delivered through the O2 check valve if pressure is applied to the spring loaded valve.O2 bypasses the breathing circuit and is delivered right to the pt at 50 psi or 35-75L/min. |
| If O2 goes through the main breathing circuit what functions can it serve? | O2 goes through the main on/off switch & in it's absence it will alarm the low o2 pressure alarm. Drives the anesthesia circuit (bellows), controls the fail safe valve, & supplies the flowmeters. |
| When O2 is supplying the flowmeters what needs to be done in order for this to occur? | O2 needs to go through the 2nd stage O2 pressure regulator where it is converted from 45-50 psi into a working pressure of 15 psi. |
| What function does O2 have on the fail safe valve? | O2 supplies the fail safe valve (spring loaded valve) with 45-50 psi of pressure which is needed to overcome the tension in the spring. This allows for N2O to enter the system from cylinder or wall. |
| N20 enters the breathing circuit through the cylinders or hospital main gas supply (wall), via the same mechanism as O2, but what is different? | In order for N20 to enter in the breathing circuit, O2 must be flowing at a pressure of 45-50 psi. If not, N2O is not entering the system. After it's in the system it is converted by the 2nd stage pressure regulator to 15 psi to supply the flowmeters. |
| N2O and O2 then go through what after their pressure is converted to 15 psi where they are mixed with only N2O, O2, and Air, no volatile agents. | The common gas manifold |
| Once the gasses mix with the volatile agents it goes through what valves before exiting what? | The gas mixture w/ volatile agents can be released via a one way pressure relief valve if the pressure in the system is too high, and then exits another check valve where it then exits through the common gas outlet. |
| What is the purpose of the 2nd stage O2 pressure regulator? | It converts 45-50 psi to a working pressure for the flowmeters of 15 psi. |
| According to Miller the fail safe valve prevents flow of N2O if the pressure in the O2 supply circuit decreases to less than what psi? | 30 psi or 45 psi according to Kevin |
| Why is O2 always last to be added to the gas mixture? | Prevents hypoxic mixtures |
| According to OSHA in and eight hour time weighted average of less than what ppm for halogenated agents, and if N2O is added what ppm? | Halogenated agents 2ppm. If N20 is added .5 ppm. N20 by itself not more than 25 ppm. |
| What are the four components of the anesthesia machine? | Supply, processing, delivery, and disposal. |
| O2 is stored as a liquid at what temperature? | -150 C |
| What cylinders is N2O contained in? | H cylinders |
| Hoses from the anesthesia machine are connected to the wall outlet via? | Diameter index safety system DISS. |
| What are common sources for leaks in the anesthesia machine? | Quick coupler o rings and faulty springs. At pipeline inlet to machine a filter, a check valve, and a pressure gauge are present. |
| What should you do if you lose your pipeline supply? | Fully open the E cylinder. Disconnect pipeline supply. Use low FGF 1-2l/min. Use manual ventilation. Auxillary O2 flowmeter becomes unavailable. |
| What would you hook your NC up to if the pipeline supply was lost and you were using manual ventilation? | Hook up to the common gas outlet because the auxilliary O2 flowmeter becomes unavailable. |
| Why is it important that when we lose pipeline supply that we disconnect the hoses from the wall? | Cross connection of gases. Could be pulling N2O as opposed to O2. If the pipeline supply is down for thirty minutes & pressure comes back from wall you will be wasting your cylinder O2. |
| If pipeline pressure drops, and gas flows from the cylinder will an alarm notify you if there is no more gas left in the cylinder? | Nope |
| At what psi should the cylinders on the machine be changed out for full ones? | At 1000 psi |
| For patient transport at what psi should the cylinder be changed out? | 250-300 psi |
| What are the three functions of the hanger yoke system? | Orients cylinders. PISS. Provides a gas tight seal. Ensures unidirectional flow. |
| PISS | Pin index safety system. Aids in the prevention of wrong gas cylinder connections. Two 5 mm stainless steel pins on the cylinder yoke connector just below the fitting for the valve outlet port. |
| PISS Air position, Oxygen position, Nitrous Oxide position | Air 1 and 5. Oxygen 2 and 5. Nitrous 3 and 5. |
| What are the types of pressure release valves? | Fusible plug, frangible disc assembly, safety release valve. |
| Woodsmetal that is implanted in the valve assembly of the cylinder. Low melting point which allows for the escape of the gas in the case of fire? | What is a fusible plug? That is the correct answer! |
| Frangible disc assembly | A metal disc that is designed to break when a certain pressure is exceeded. Allows gas to escape from a discharge vent. |
| A spring loaded mechanism that opens a discharge pressure relief valve if pressure becomes too high? | Safety release valve. Remains open until the pressure falls below the valves opening threshold. |
| Cracking the cylinder? | Cylinder should be opened momentarily before use to clear the outlet of possible dust. |
| What must ALWAYS be attached to an outlet valve? | A pressure regulator device. |
| This reads high pressure readings. Will work regardless of the position of the tank and if two tanks are open it will read only the one with the higher pressure? | Bourdon gauge. |
| Pressure regulator | Immediatley distal to the hanger yoke. Converts high cylinder pressure to 45 psi. Intentionally slightly less than pipeline pressure. Decreases cylinder to pressure to a working pressure for the machine. |
| Can you use the ventilator while on back up supply? | No |
| How long do most machines have power back up supply for? | 30 min |
| Why do you not want to use the convenient receptacles on the back of the anesthesia machine. | Because it can blow a circuit. Monitors and ventilator are part of this circuit. |
| What gases pass through the fail safe valve before going to the flowmeters? | All gases besides oxygen |
| What could be the cause of a hypoxic mixture regardless if O2 is being added last? | If the flow meter tube is cracked. |
| Five tasks of oxygen | proceeds to the flowmeter. Powers the oxygen flush valve. Activates fail safe mechanisms. Activates the low O2 pressure alarms. Compresses the bellows for mechanical ventilation. |
| If you are delivering 2% sevo and using the O2 flush multiple times during your case, are you really delivering 2% sevo? | No. You are delivering a dilute anesthetic gas. |
| This system halts the supply of all other gases in the event of O2 supply pressure failure? | The fail safe system. |
| This signals the operator when pressure is lost in the O2 circuit. | Low pressure alarm. |
| The rate of vaporization depends on? | Temperature. Increased temp, increased vapor. vice versa. Vapor pressure of the liquid. Partial pressure of the vapor above the liquid. |
| As vaporization is occurring, is the remaining liquid and its container cooling or warming? | Cooling. Heat is carried away from the liquid with the evaporated molecules. Latent heat of vaporization. |
| What metal is chosen for vaporizers and why? | Copper. Because its high thermal conductivity. Environmental heat is transferred back to the liquid. |
| What are the types of vaporizers? | Variable bypass, measured flow, and injector or tec 6 |
| This vaporizer only allows a small amount of the FGF to come into contact w the liquid to pick up the anesthetic vapor? | Variable bypass vaporizer |
| In the variable bypass vaporizer, full saturation of the carrier gas is ensured by means of what? | Wicks and baffles. The fully datrurated, known concentration of carrier gas is then diluted w the balance of the fresh gas that bypassed the vaporizer to produce the final concentration. |
| Is a variable bypass vaporizer agent specific or not? | Yes it is agent specific. |
| If I am using a high vapor pressure agent meant for a low vapor pressure agent, I am delivering a lower vapor pressure then what I have dialed in. T/F | False. You are delivering a higher vapor pressure then you have dialed in and vice versa. HLH LHL |
| These vaporizers are only used now in the military? | Measured flow vaporizers |
| Measured flow vaporizers | Only a small amount of the FGF to come into contact w the liquid to pick up the anesthetic vapor. Bubble gas through anesthetic agent using a vernitrol/copper kettle. |
| This vaporizer is a heated dual- circuit vaporizer. | Tec 6 vaporizer |
| What vaporizer is specific for des? | Tec 6 |
| In a tec 6 vaporizer does the FGF from the common manifold come into contact w the liquid agent? | No. FGF never flow over or come into contact with the liquid agent. Appropriate amount of vapor is prepared in the 2nd circuit and is added to the FGF on the way out. |
| How does the Tec 6 vaporizer maintain a known vapor pressure in the 2nd circuit for Des? | It is heated to 39 C. This produces a vapor pressure of 1500 mm hg. |
| According the the books can we refill vaporizers while in use, during a case? | No. Only for Tec 6 can we. |
| What is the pumping effect and what helps minimize this? | When vapor output is increased due to intermittent back pressure. Unidirctional valves prevent this phenomenon. |
| Can I still use a vaporizer after it has been tipped over 45 degrees? What do I do if this happens? | No. you have to take it out bc you could deliver a high amount of volatile agent. Consult the operators manual or a field service technician. |
| What is the main purpose of any breathing circuit? | The delivery of O2 and anesthetic gases and the elimination of CO2. |
| How is CO2 eliminated in a breathing circuit? | By adequate FGF or by absorption in soda lime. |
| Increased FGF= more/less rebreathing? | Less |
| What are advantages to rebreathing? | Cost reduction, increase in tracheal warmth and humidity, decrease in potential occupational exposure. |
| Do breathing circuits increase or decrease dead space? What happens as a result of this? | Increase. Not always a good thing. Rebreathing of CO2 produces respiratory acidosis. |
| Why are ventilator TV set higher than the TV of a spontaneous breath? | To prevent rebreathing of CO2. |
| Where does dead space end in a breathing circuit? | Ends where the inspiratory and expiratory gas streams diverge. Y piece. |
| In this breathing system there is no mask on face. Anesthetic to patient by insufflation. Anesthetic diluted by inhalation of RA. No reservoir bag, no valves. pollution and can't positive pressure ventilate. | Open |
| Semi-open | Mask on face/ETT. Reservoir bag; no rebreathing. Room pollution. High gas flow. Unidirectional valve. |
| In this breathing system, you want to use high FGF to prevent any rebreathing? | Semi-open |
| Semi-closed | Mask on face/ETT. No room air inspired. Expired gas exits through scavenging system, CO2 absorber. Partial rebreathing. Unidirectional valves and reservoir bag. Conserves moisture and heat. FGF can be less than pt min volume. |
| In a semi closed breathing system why can FGF be less than patients minute volume? | Because they are recycling some of the gases and also getting FGF's. Together they would equal the patient's minute volume. |
| Closed system | Anesthetic agents are contained in a system & not vented Maintains heat & humidity Complete rebreathing of gases, pop off closed Less pollution CO2 scrubber Unidirectional valves & reservoir bag Flow 150-500ml/mn for phys need, 150-250ml/mn under anesth. |
| This system has no rebreathing and no reservoir bag. We cannot positive pressure ventilate. | Open system |
| These breathing systems all have a reservoir bag and unidirectional valves? Which one of these 3 has NO rebreathing? Complete rebreathing? Partial rebreathing? | Semi-open, semi-closed, and closed. Semi-open-No rebreathing, Semi-closed-PARTIAL rebreathing, Closed-COMPLETE rebreathing. |
| These two breathing systems conserves heat and moisture? | Semi-closed, and closed. |
| In what system is the pop off valve completely closed? | Closed system |
| Circle system | Most commonly used anesthesia circuit, prevents rebreathing of CO2 while allowing rebreathing of all other gases. |
| How does gas enter the circle system? | From the common gas outlet by way of the fresh gas delivery hose. |
| How does gas exit the circle system? | By APL valve or the ventilator relief valve if mechanical ventilation is employed. |
| Where does gas go from the APL valve or ventilator relief valve? | The scavenger system |
| If there are faulty valves in a circle system what does this produce? | Turns the entire corrugated tubing into dead space |
| What are two common reasons for increased inspired EtCO2? | Exhaustion of scrubber or faulty unidirectional valves. |
| What do you do if inspired CO2 rises during a case because of an exhausted CO2 scrubber? | Increase FGF to 5L/min |
| In a circle system, what is the L/min for FGF that provides near total rebreathing? | 0.3-0.5L/min |
| In a circle system, if my FGF are 4-5L/min am I relying on my CO2 scrubber? | No, very little reliance. |
| When scrubbers combine with carbonare ions or CO2, what does it produce? | Water and energy. |
| Fresh absorbents in CO2 scrubbers has what pH? | An alkaline pH. As reactions proceed, the pH decreases. At pH of 10.3 ethyl violet additive changes from colorless to bluish purple. |
| At what pH does ethyl violet change color and what is this in response to? | 10.3 ethy violet changes from colorless to bluish purple and it does this because it is reacting with carbonate ions or CO2 and becoming less alkaline. |
| Size of granules are between what? | 4-8 mesh |
| An 8 mesh would be more efficient because? | More surface area to scrub CO2 from expired gases. |
| Would a 4 or 8 mesh cause more resistance? | An 8 mesh. packs tighter resistance to airflow. |
| What is a byproduct of sevo degradation caused by soda lime? | Compound A |
| What is important to remember when running sevo with a sevo lime? | Don't run your FGF less than 1 L/min for greater than 2 MAC hours. Can cause sevo degradation and compound A formation |
| When is scavenging active? Passive? | Active when suction is applied. Passive when waste gases proceed passively down corrugated tubing through the room ventilation exhaust grill of OR. |
| What are the components of the scavenger system? | Gas collection tubing from APL & relief valve. Transfer tubing-19-30mm. Scavenger interface. Gas disposal tubing-carries gas from interface to disposal assembly. Gas disposal assembly-active or passive. |
| An open scavenger system | Is safer for the patient. Higher risk of occupational exposure. No valves. Use only w active gas disposal system. |
| Closed scavenger system has to have suction? T/F | False. Open scavenger systems have to have suction. |
| In a closed scavenger system? | Gases within the interface may communicate w the atmosphere only through valves. Should adjust vacuum so that reservoir bad neither flat or over distended. |
| T/F CO2 scrubbers need to contain water for reaction? | True. Soda lime contains 14-19% H2O |
| What is the #1 problem with using soda lime? #2 problem? | Causes degradation of most agents. Sevo most, des least. Dry absorbants cause production of carbon monoxide, especially with methyl-ethyl-ethers. |
| In Baralyme what is the activator? What is the primary activator in soda lime? | Baralyme = Barium hydroxide Ba(OH)2-. Soda lime = Calcium hydroxide Ca(OH)2 ~75%. |
| Even though baralyme is slightly less efficient what is an advantage of it? | Less likely to produce dust due to water of crystallization which is chemically bound to the Ba(OH)2 |
| Activator free product eliminates what types of concerns? | Carbon monoxide concerns. |
| Soda Lime chemical formula | CO2+H2O=H2CO3 NaOh+H2CO3=NaHCO3+H2O 2NaHCO3+Ca(OH)2=2NaOH+CaCO3-+H2O. Absorption of 1 mole of CO2 produces 13,000 kcalls of heat energy. |
| Baralyme chemical formula | Ba(OH)2-8 H2O+CO2-->BaCO3+9H2O+energy 9H2O+9CO2-->9H2CO3 9H2CO3=9Ca(OH)2-->CaCO3+18H2O+energy Water and energy are produced w all absorbents. CaCO3 is an insoluble precipitate. |
Created by:
ngawlik
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