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189 Cards in this Set
- Front
- Back
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2 manufacturers of machines
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Drager and Datex-ohmeda
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3 components of pipe line system
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Gas inlets and outlets to final gas composition
Hanger yokes, emergency cylinders Pressure regulators |
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pipeline gas enters machine by
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by way of the DISS and color coded hoses
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The wall pressure of O2 and N2O is
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The wall pressure of O2 and N2O is 45-55 psig.
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pressure regulators are needed to...
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Pressure regulators are needed to reduce the cylinder pressure of 200psig to 45-47 psig to prevent barotrauma.
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in order to comply with the new 2000 ASTM standard, newly manufactured workstations must have monitors that measure the following parameters
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The anesthesia workstation must have a prioritized alarm system that groups the alarms into 3 categories, high, medium, and low priority.
These monitors and alarms may be automatically enabled and made to function by turning on the anesthesia workstation, or the monitors and alarms can be manually enabled and made functional by following a check list before use. |
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The high pressure circuit is confined to the
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cylinders and the cylinders’ primary pressure regulators.
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The intermediate pressure circuit begins at the regulated cylinder supply sources at 45 psig, includes the pipeline sources at 50-55 psig, and extends to the......
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flow control valves
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The low pressure circuit includes the
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The low pressure circuit includes the flow tubes, vaporizers, and one-way check valves which are on the Datex machines.
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The low pressure circuit extends from the flow control valves to the ....
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common gas outlet
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Turning the master switch will activate the .......
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pneumatic system
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...hook up extra equipment to the electric source like a..
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NEVER
bear hugger |
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After the gases have entered the anesthesia machine, all gases except O2 will pass through a.... before proceeding to the flowmeters.
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fail safe valve
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This proportioning system to shut off the n20 and then the o2 is found in the .... In the ... machines, if the O2 fails below 20 psig, all other gases will be shut off.
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drager
datex |
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second state reducing devices just upstream of the N2O and O2 flow valves. These receive gas from either the pipeline or cylinder reducing device and reduce it further to ..psig for N2O and ..psig for O2.
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O2 26
N20 14 |
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The purpose of this second stage reducing device is to eliminate fluctuations in
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pressure supplied to the flow indicator caused by fluctuations in pipeline pressure.
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low pressure alarm PSI
Drager Datex |
Dragers- sound alarm at 30-37 psig
Datex- whistles at 28 psig |
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five pathways oxygen
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Proceeds to the fresh gas flowmeter
Powers the O2 flush Activates fail-safe mechanisms Activates O2 low-pressure alarms Compresses the bellows of mechanical ventilators |
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oxygen flush valve allows for
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Allow direct communication between O2 high-pressure circuit and low-pressure circuit
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oxygen flush valve delivers...
provides.... |
Delivers 100% O2 at a rate of 35-75L/min
High-pressure O2 source for jet ventilation |
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O2 flush valve enters.....of the vaporizers
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dowstream
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hazards of o2 flush valve
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Valve sticks
Awareness barotrauma |
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minimum o2 flow rate
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150 ml/min
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minimal flow resistor
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allows for flow even if operator forgot to turn machine on
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n20/02 ratio is designed to be not more...
w/ o2 concentration at least... |
3:1
25 +-3% |
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hypoxic guard systems only link...therefore the biggest risk for hypoxia is administration of
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N20 and 02
inert third gas like helium |
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flow control valve also know as..
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needle valve
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turning the flow control valve...will increase the flow
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counterclockwise
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components of the flow meter
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Knob
Needle valve Valve stop Flowtube Indicator float Rotating-ball ( Drager) Plumb-bob (Datex) |
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opening the flow control valve allows gas to travel through the space between the float and the flow tube. This space is known as the
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annular space
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the flow rate across a constriction depends on the gas’s .... at low laminar flows and its .... at high turbulent flows.
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viscosity
density |
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fine flow tube is for flows..
coarse flow tube is for flows.. |
200 ml-1L
1L-12L |
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Problems with flowmeters include
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leaks, inaccuracy, and ambiguous scales.
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Flowmeter leaks are s substantial hazard because the flow meters are
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located downstream from all machine safety devices except the oxygen analyzer
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for flow meters it is safer for...to be located downstream.
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o2
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as temperature increase.. vapor pressure
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increases
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The latent heat of vaporization is defined as the number of calories required to
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change 1 g of liquid into vapor without a temperature change
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The specific heat of a substance is the number of calories required
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to increase the temp of 1 g of a substance by 1 degree C
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the specific heat value for an inhaled anesthetic is important because it indicates
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how much must be supplied to the liquid to maintain a constant temperature when heat is lost during vaporization
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manufacturers select vaporizer component metals that have a high specific heat to
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minimize temperature changes associated with vaporizatio
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Vaporizers are constructed of metals that..
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that have relatively high thermal conductivity which helps maintain a uniform temperature.
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Vapor pressure is ... of atmospheric pressure and is contingent only on the temperature and physical characteristics of the liquid.
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independent
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Datex and Drager vaporizers are classified as
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variable bypass, flow over, temperature compensated, agent specific, out of breathing circuit vaporizers.
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copple kettle has a
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bubble through system
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variable bypass vaporizers do not deliver..
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desflourane
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function of the concentration dial
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The function of this dial is to regulate the relative flow rates through the bypass and vaporizing chambers
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All 3 flows, the flow through the bypass chamber, flow through the vaporizing chamber, and flow of the entrained anesthetic, will exit the vaporizer at the.....
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outlet
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The final concentration of the inhaled anesthetic is the ratio of the flow of the inhaled anesthetic
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to the total gas flow.
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the vapor pressure of an inhaled anesthetic depends on
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the ambient temperature
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the VP of isoflourane at 20 C is and at 35 C is
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238, 435
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higher temp results in...anest
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more
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w.an increased temp, the bimetallic strip leans to the
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right
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w decreasing temp, the bimetallic strip
leans to the |
left
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to compensate for increased pressure, there is ....air going through the vaporizing chamber
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less
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In a cold OR , there is ...flow going through the vaporizing chamber
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More
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The Drager vaporizer uses an ..... for temperature compensation.
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expansion element
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flow, less than or greater than...will decrease concentration
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less than 250 mg or greater than 15L
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factors influencing vaporizer output
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Flow rate
Temperature Intermittent backpressure Carrier gas composition |
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Intermittent back pressure results in...
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higher vaporizer output
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a high flow will result in a ....concentration of volitile
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lesser
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higher temp results in...anest
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more
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w.an increased temp, the bimetallic strip leans to the
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right
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w decreasing temp, the bimetallic strip
leans to the |
left
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to compensate for increased pressure, there is ....air going through the vaporizing chamber
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less
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In a cold OR , there is ...flow going through the vaporizing chamber
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More
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The Drager vaporizer uses an ..... for temperature compensation.
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expansion element
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flow, less than or greater than...will decrease concentration
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less than 250 mg or greater than 15L
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factors influencing vaporizer output
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Flow rate
Temperature Intermittent backpressure Carrier gas composition |
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Intermittent back pressure results in...
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higher vaporizer output
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a high flow will result in a ....concentration of volitile
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lesser
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wicks are placed in direct contact w/metal wall to..
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replace heat lost during vaporization
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Intermittent back pressure is associated w/ ..or ..
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o2 flushing and positive pressure
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pumping effect by using o2 flushing is more pronounced w
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the pumping effect and is more pronounced at low flow rates, low dial settings, and low levels of liquid anesthetic in the vaporizing chamber.
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N20 is ...soluble than 02 in halogenated liquid
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more
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Overfilling can cause an overdose because the liquid anesthetic enters the bypass chamber and can deliver up to ....... times more of the intended vapor concentration.
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10
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filler system color for Isoflourane
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purple
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filler system color for sevoflourane
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yellow
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filler system color for halothane
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red
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If the higher vapor pressure agent is placed in a vaporizer of a lower vapor pressure agent, the concentration of the agent delivered will be ...
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higher
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If a lower vapor pressure agent is placed in a higher vapor pressure agent, the concentration of agent delivered to the pt will be ..... than the dial setting.
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lower
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desflourane boils at C
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22.8
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Normal flow through traditional vaporizer= ... of desflurane
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more
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The desflurane vaporizer is a heated, ..
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dual circuit vaporizer
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a unidirectional check valve is located
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Located between the vaporizers and common gas outlet
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If machine has check valve, ..... for leaks in system
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cannot check
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a unidirectional check valve .....from the system
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lessens positive pressure
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The fresh gas tube, which conveys gas to the fresh gas outlet in the breathing system, attaches to the
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common gas outle
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The breathing system is usually regarded as extending from the point of ..... to the point at which gas escapes to the atmosphere or a scavenging system.
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fresh gas inlet
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factors that influence rebreathing...
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Fresh gas flow
Mechanical dead space Design of breathing system backlash |
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the advantages of rebreathing include...
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The advantages of rebreathing include cost reduction, an increase in tracheal warmth and humidity, and a decrease in the potential for exposure of OR staff to trace and waste gases
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The amount of rebreathing will depend on
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The amt of rebreathing will depend on the FGF, mechanical dead space, and the design of the breathing system.
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The amount of rebreathing is increasing as the FGF is ...
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The degree of rebreathing in an anesthesia breathing circuits is increased as the FGF is decreased
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Higher fresh gas flow is associated with..in any circuit
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less rebreathing
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If the vol of FG supplied is equal to or greater than the pt’s minute vol, there will be ...... as long as there is nothing impeding expiration to the atmosphere or scavenging system.
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no rebreathing
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The mechanical dead space is the space in a breathing circuit occupied by gases that are rebreathed without ...
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any change in composition
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increased dead space increases the ..
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possibility of rebreathing co2
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To avoid hypercarbia in the face of an acute increase in dead space, we must increase ...
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the pts minute volume
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Dead space ends where the inspiratory and expiratory gas streams ....
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diverge
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in a circle system, dead space ends at the ..
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Y piece
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use of a face mask is associated with .... ds than ETT
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face mask
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backlash is when , the pt is breathing on his own and the breathing tubes tend to collapse on .. and bulge on .......
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inspiration, expiration
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4 classifications of breathing systems
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Insufflation / Open
Semi-open Semi-closed Closed |
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with the open system, to avoid a build up of Co2 under the drapes, use a ...flow of O2
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HIGH
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examples of opens systems
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Examples = insufflation, open drop, nasal cannula
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A semi open system is one in which a mask is placed over the pt’s face and the pt is able to ..... inhaled anesthetics. Ex:...
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spont breath
mapeleson circuit |
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co2 rebreathing is affected by:
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Fresh gas inflow rate
Minute ventilation Mode of ventilation (spontaneous vs controlled) Tidal volume Respiratory rate Inspiratory to expiratory ratio Duration of expiratory pause Peak inspiratory rate Volume of the reservoir tubing and bag Ventilation through ETT Ventilation by mask Carbon dioxide sampling site |
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mapleson system is classified as five basic types:...
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A to E w/6th F added later
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three functional groups of the mapleson system are
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a, b, cdf
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mapleson A. also known as..
It differs from the other mapleson systems since the FGF doesn’t enter the system near the pt connection,. ,.... |
magill circuit
.. but at the other end of the system |
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For spontaneous ventilation, the APL valve, located at the pt end is kept in the ...
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fully open position
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Excess gas exits through the APL valve during the ...
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end of expiration
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apl valve opens during..
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inspiration
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during spont ventilation the...has the best efficacy in preventing CO rebreathing; but the worst efficiency during controlled ventilation requiring a flow of 20L a/min to prevent rebreathing
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Mapleson A
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A mechanical ventilator ...be used with mapleson A
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should NOT
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the difference b/w B and C mapleson systems is that ......
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C has NO corrugated tubing
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B/C during spont ventilation, the APL is......and excess gas is vented during....
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open completely, excess gas is vented during expiration
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w/controlled ventilation, gas is vented during
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Inspiration
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The FGF must be equal to ... which is normally 20-25 L/min to avoid rebreating when the pt is breathing on their own.
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peak inspiratory flow
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With controlled ventilation, the FGF must be...
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2-2.5X mv
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Mapleson DEF circuit is most efficient during....
requires FGF of |
controlled ventilation, requires FGF of 2.-2.5 x MV
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Most popular of the DEF circuits is the ....
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Bain circuit
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Advantages and FGF of the bain circuit.
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FGF= 2.5 times MV
Lightweight, easily sterilized, reusable scavenging |
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the bain circuit features an inner
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tubing
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hazards of the bain circuit include
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Hazards of this circuit included unrecognized disconnection or kinking of the inner fresh gas hose
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for the bain leak test if the inner tubing is intact the ......will occur at the patients end
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venturi effect
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if there is a leak in the bain system, the reservoir bag will remain
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inflated
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mapleson F is also known as the
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jackson-rees system
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in the circle system; The extent of rebreathing of the other exhaled gases depends on ... and the ...
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component arrangement and FGF
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semi open circle system requires a
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very high FGF rate
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the closed circle system has a feature of ......and a ...valve that remains closed
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complete gas rebreathing, and pop of valve remains closed
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the most popular circle system is the
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semi closed system
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prevention of rebreathing of co2 in the circle system involves (3)
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Unidirectional valves must be located between the patient and reservoir bag on the inspiratory and expiratory limbs of the circuit
Fresh gas inflow cannot enter the circuit between the expiratory valve and patient Pop-off valve cannot be located between the patient and inspiratory valve |
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APL is also called
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pop off valve
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Gas enters the circle system from the ..... by the fresh gas delivery hose
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common gas outlet
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the fresh gas inlet is placed b/w the absorber and the
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inspiratory valve
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a unidirectional valve......
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Unidirectional valve direct the gas flow between the absorber and the pt.
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incompetence of unidirectional valves may occur if
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there is a build up of moisture or foreign material
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The APL valve also known as the pop off valve, is located.... on the absorber mounting block.
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downstream of the PEEP valve
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APL valve only works during...or..
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spont or manually assisted.
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length of breathing tube....effect dead space
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does not
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functions of a reservoir bag are..
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Allows accumulation of gas during exhalation so a reservoir is available for the next inspiration. This permits rebreathing, allows more economical use of gases, and prevents air dilution
Provides means whereby ventilation may be assisted or controlled Serves visual and tactile observation as a monitor of patient’s spontaneous respiration Protects the pt from excessive pressure in the breathing circuit |
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a standard adult reservoir bag is...L
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3
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...is the most commonly used absorbent
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soda lime
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adv. of calcium hydroxide is that it will elliminate
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compound A
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water content of granules is...because...
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essential..because the reactions require water
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small granules=
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more surface area available for absorption
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abs. capacity of co2 per 100 g of absorbent
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26L
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larger granules have the ability to increase ..
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channelling
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channeling can reduce capacity to
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10-12 L
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capacity of calcium hydroxide is..than soda lime
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less
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..and.. are primary indications of exhaustion.
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capnography and indicator color change
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color indicator changes from..to...
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colorless to violet
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...can deactivate the dye
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flourecent lights
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sign of capnograph that the absorber needs to be chagned
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doesnt return to baseline or zero
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when using sevo and barolyme v. soda lime, ....concentrations should be used to prevent increase in compound a
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higher
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use of baralyme v. soda lime results in (3)
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The use of Baralyme rather than soda lime
Higher concentrations of sevo Higher absorbent temperatures Fresh absorbent |
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dried soda lyme and baralyme at high flows can degrade inhaled anes. to ..
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Co
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order of IA production of CO greatest to least
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desflourane>enflourane>isoflourane=halothane>sevolflourane
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....temp increases Co production
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higher
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...GF increases Co production
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low
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SIMV if often used with a pt w a
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LMA
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which bellows are safer ascending or descending
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ascending
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The peak inspiratory pressure is allowed to vary according to the pt’s compliance and ....
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airway resistance
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All ventilators offer controlled mandatory vol(CMV) ventilation. In this mode the vol is kept .... and gas is delivered at a ...
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constant, constant flow
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leading cause of accidents in practiced
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disconnection from circuit
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best monitor to id a disconnect
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co2 detection, very big difference bw end tidal and inspiratory
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set hold pressure alarm should be set w/in .. of..
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5 cm H20 of PEEP
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scavenging is the ....
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collection and removal of vented gases from the OR
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max twa for n20, alone or w/ halogen
max halogen alone or w/N20 |
25 N20 in either case
Halogen 2 alone, .5 wit N20 N20 50 in dental facilities ppm-parts per million |
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transfer tubing in scavenging system must measure
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19-30 mm
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scavenging interface protects the system from
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excessive positive or negative pressure
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The interface Should limit the pressures immediately....... to between -0.5 and +10 cm H2O with normal working conditions.
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downstream from the gas-collecting assembly
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for a passive disposal a..is mandatory
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positive pressure relief valve
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an active system uses a
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reservoir to store gas removed via vacuum
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for an active system....is mandatory
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negative pressure relief valve
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low flows will....humidity
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increase
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heated humidifiers are part of the ..system
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active
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heat moisture exchangers are part of the ..system
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passive
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Unlike the ,mapleson systems, the circle system is able to use
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low gas flow
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in a closed system there is ...of co2 and no air is vented
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complete rebreathing
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in a closed system FGF =
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uptake
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in a closed system induction is accomplished using
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high flows
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recovery using a closed system is ..
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slow
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advantages of closed system anes
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Relative stability of inspired gas concentrations
Conservation of respiratory moisture and heat Prevention of operating room pollution Economical- less gases used Less danger of barotrauma |
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disadvantages of the closed circuit system
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Inability to alter quickly inspired concentrations
Danger of hypercarbia Greater knowledge required Accumulation of undesirable gases in the system Carbon monoxide Metabolites of anesthetic agents nitrogen |
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in closed system anes., ....will decrease any built up concentration of co, co2 absorption
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flushing
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advantages of circle system (4)
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Low fresh gas flows can be used with the physiologic, economic, and environmental advantages of rebreathing
PaCO2 depends only on ventilation, not fresh gas flow Normocarbia can be achieved when a malignant hyperthermia syndrome develops The lengths of tubing can be varied so that the machine can be placed away from the pt to allow optimal surgical exposure in head and neck surgery |
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equipment failure must be reported to the FDA w/in ..days
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10
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safe medical devices act of ..
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1990
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