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120 Cards in this Set

  • Front
  • Back
Anesthesia machine
7 components
-Pipeline & cyclinder gas supp
-Vaporizers
-CO2 Absorber & gas mang. sys
-Ventilator
-Monitors/display
Anesthesia System
What the machine does in respect to the patient.
-Supplies set mix of gas & anesthetic vapor
-Controls pt RR, vol,pressures
-Monitor gas conc from mach.
(EtCo2, O2,
-Monitors pt
-safety features protect pt
-removes excess gas from breathing sys.
Safety Standards (Boards)
-1979 standards set for all mach in US.
-ANSI (American Natl' Standards Inst.)
-Released 1979 standards
-ASTM (Am. Soc. testing & materials)
ASTM F 1850 -Current gas mach standard
Gas Supplies
Gas cyclinders connected directly to anesth mach
-usually 2nd or emergency
-Central pipeline sys connect to wall & ceiling outlet
Gas Cylinders
-Compressed gas, high press gas or liquid
-Gauge (psig or kPa)
psig (pounds per sq in. should have min of 1000 psig)
-Tested q 5yrs at 1.66 capacity/over pressure
Cyclinders
-Regulators (reduce press)
-Cyclinder pres/vol E tank
(E= 2200 PSI)
-stored securely
-support violent burning flammable materials
Central Pipeline Sys.
-Primary gas supply for anest sys
-Tanks of liquid gas or large cylinders supply gas to central sys.
Central Pipeline Sys. Standards psig for O2
45--55
Central Pipeline Sys.
-Manifold automactically switches when
one bank is empty
Central Pipeline Sys.
What is the safety mech of the sys
includes sensors wired to alarm sys
Safety sys
Color Coding Pin indexing
for tanks
O2 (Color & Pin #)
Green 2-5
Safety sys
Color Coding/Pin indexing for tanks
NO2 (Color & Pin #)
Blue 3,5
Safety sys
Color Coding/Pin indexing for tanks
Air (Color & Pin #)
Yellow 1,5
Safety sys
Diameter indexing - Pipeline
Fitting for each gas has diff diameter
Anest Systems
When O2 wall supply is connect to pipline inlet or cyclinder
Where is O2 always avail ?
pneumatic outlets
Oxygen flush valve
5 Pathways of Oxygen
-Flowmetes
-Oxygen flush
-Fail-Safe system
-Low pressure alarms
-Vent driving gas
On/Off Settings
ON
Oxygen press connects to
low oxygen supply alarm & shutoff valves
On/Off Settings
ON
O2 press opens shutoff valves
-
premits flow of other gases to their flow control assemblies
On/Off Settings
ON
O2 & secondary gases flow through
flowmeters at the set flow rates
On/Off Settings
ON
Mixed gas flows through vaporizer manifold
Where does it go?
thru the vaporizer that is on and to common gas outlet.
On/Off Settings
System Off
-Remaining gas vents downstream thru.
exhaust blk
On/Off Settings
System Off
Low oxygen supply
alarm is activated
On/Off Settings
System Off
All shutoff valves are
closed
On/Off Settings
System Off
Cuts off elec power to
monitors & vent
O2 Flush can deliver how much O2?
35-70L of 100% O2
Ventilator is driven by?
Flow of O2
Gas Supply module
enters on what section of the machine
High press.
Gas Supply module
A gas supply module includes
Pipeline branch
Cyclinder Branch
Press Gauges for pipeln & cyclinder supplies
Pipeline gases go thru
Pipeline Inlet (gas in)
Inlet filter
Pressure gauge (prevent leak backward)
Check valve
Cyclinder Gas goes thru
-Cyclinder yoke
-inlet filter
-press gauge
-check valve
-high press regulator
Cyclinder Gas goes thru
A pressure relief valve vents to atmosphere if pipln press or reg cyclinder is
too high
The pipeline PSI =
50 psi
Pipeline & cyclinder gauges
-Two supply pressures
-located after the inlet (O2, Air, N2O) filters/bef check valves
-color coded
Bourdon Pressure gauges
Press inc. tube straightens if you up cyclinder too fast it can
Break
Primary Regulator
Cyclinders (psig)
40-47 psig
Primary Regulator
Pipeline psig
45-55 psig
Primary Regulator
What is the purpose
Ensures check valve connect to higher pipeline supply
Pipeline relief valve
IF press >
>75psig
Pipeline relief valve
IF press > 75psig
What happens?
P relief valve opens & vents gas to atomsphere
oxygen flush button
How much O2 does it deliver
45-75 L/min 100% FiO2
-Flows direct to common gas outlet
-Works even when mach. off
When might you want to use O2 flush button
Prior to turning Pt for back surg. (Pt disconnected) can dilute anesth and inc chance of recall can occur
Low oxygen supply alarm
-What areas does it include
Warns low press. O2 press
-reservoir
-regulator
-reed
-adjustable flow regulator
Shut off valve
Where is it located?
-Between an additionl gas supply & a flow control valve
Shut off valve
When is gases other O2 able to flow
IF there is sufficient oxygen pressure present at valve (25 psi)
Shut off valve
What happens if oxygen supply is too low
the valve closes & blks the flow of any additional gas
Flow control assembly
Manages mixture of gases (flowmeters) Includes
-2nd regulators
-flow cont knobs
-flow cont needle valves
-link 25 proportion limiting cont sys
-flow tubes (thrope tubes, constant press variable vol tubes)
Link 25 proportion limiting control system
The N2O gear has a __ pin
the O2 has a ___ pin Why?
N20 = 14
O2= 29
This does not allow you to give hypoxic mix (3:1 = 25% usual = 30%)
Link 25 proportion limiting control sys
Flow controls for O2 & N2O linked by link 25 system changes N2O:O2 flow 3:1
Maintains what % O2
25% Oxygen
Flowtube assembly
Low & High flow tubes
-low flow measured
-placed @ right (o2 always downstream from other gases)
Flowtube assembly
-When flow control valve on gas flow through the flow tube into
the gas distribution manifold
(least chance of leak, this is why O2 is far right)
Flowtube assembly
Where to read a Ball &
Float
Center
Float is read at the top
When doing a high pressure test what should be off
gas flows
Air, gases mix @ top of the
manifold
Vaporizer manifold
Gas flows from gas distribution manifold into
vaporizer manifold to the right of the flow meter module
Vaporizer manifold
Vaporizer manifold & connection sys form an interlock, what is the purpose
Only allows having one vaporizer on at a time
A bar slides over to prevent other vaporizers from being on.
-Hold 3 vaporizers
Vaporizer manifold
When the vaporizer is off each port valve is closed by a
ball pressed against its seat
Vaporizer manifold
Turned on
Port valves pressed open by
pins on the vaporizer
Vaporizer manifold
What prevents leaks in the vaporizer
O-ring prevents leaks
Vaporizer manifold
Turned on
Fresh gas flows into vaporizer
agent is added
mix flow from vaporizer thru outlet port valve to common gas outlet
Tec 4 Vaporizer
holds, specifics about vaporizer
125 ml
-Glass tube volume
-one for each agent
-color coded by agent
-safety lock lever
Tec 6 Vaporizer
Used for desflurane
-holds 400ml
-0-18%
Tec 6 Vaporizer
-maintains agent vapor from control valve & fresh gas at the same pressure when they are
mixed in the rotary control valve
Tec 6 Vaporizer
What measures pressures
transducers
-adjust control valve to regulate downstream vapor pressure
Problem solving
-Incorrect filling
(service, run 5L O2 until no vapor detected)
-agent reuse (don't)
-tipping vaporizer (overdose when re-connected)
agent is in central mechanism not regulated
-Vent excess gas from the patient breathing circuit
Pressure & volume
Control Modes
Volume controlled Mode
-TV delivered
-Most common in OR
-Compliance changes (poss dec TV
-High pressure alarms (barotrauma)
Pressure & volume
Control Modes
Pressure controlled Mode
Breath delivered to set peak pressure
Pressure controlled Mode
What population is used for
Obese
Lap Cases
Pressure controlled Mode
Lap Cases
Inc to 40cm while abd inflated, because abd press is at 20cm, when trocars are out dec. to 20cm.
Other Variables
Insipratory Flow (6sec breaths I:E 3sec)
Peep (peep valve or on vent)
Insp sigh
Insipratory Flow
-Rate effects distribution of gas in lung
-Effects of exp times
Ventilators
Power source
compressed gas elec
Ventilators
Drive Mech.
-Double circuit
-pneumatically driven (air)
-compresses bellow
-empties contents
Bellows
Ascending
-expiration, easy detection of disconnect
Bellows
Descending (hanging) (older)
-decsend w/ exhale
-look full
-barotrauma poss if leaks
-drive gas into lungs
Ventilator Cycle
Inhalation phase
-bellows inflate w/ fresh gas
-recirc exhale gas (circuit)
-drive gas pressurizes bellows (pushes dn, forces gas mix into lungs
Ventilator Cycle
Exhalation phase
-Control module drive gas from bellow to exhaust port

-Allows gas to flow from lungs
- I:E ratio
Control Module
-select, vol. rate pressure limits
-Control components that allow inhale or exhale
-Display FIO2, Exp vol
-Display sound/alarms
Control Module
-Alt adjust
-Mech vent
-Set up
-TV
-RR
-Flow
-Press limit
-Insp pause
TV = How much per kg
6-8kg/ml
Pressure monitoring
-Cont. monitor airway press
-press sens inside vent cont module (flex tube to sensing port in breathing circ)
Circuit press monitored at inhale port of GMS absorber
Alarms
-Low press
-Sub atmosph press (too much scavenger)
-High press (cough, bronch, biting)
Sustained Press (one way valve obst)
Volume monitor
TV
Exp minute vol (Ve)
Reverse Flow Alarm
Warns of rev flow
-stick exhal valve
Position
-Distal pos of exp limb
Trigger
-Depends on TV setting
Apnea alarm
-depends on TV set
-initiated after first pos press breath
Oxygen monitor
-fuel cell to measure FIO2
-Calibrate at 21% daily (assure it gets to 90%, air alts calib.)
-100% monthly
Bellows are all latex free and the same bellow can be used w/ ped as with adult
T/F
True
Carbon Dioxide absorption
-Makes rebreathe imposs
-conserve gas/agents
-remove CO2
-Dec CO2
Types of CO2 absorp
Soda lime
Baralyme
Amsorb
CO2 Absp
Soda lime
-94% Ca+ hydroxide
-5% Na+ hydroxide
-1% K+ hydroxide
-Silca to harden granules
-ethyl violet as an indicator
CO2 Absp
Baralime
80% Ca+ hydroxide
20% Barium hydroxide
ethyl violet as an indicator
CO2 absp
-pH extreme high
-granule size
-4-8 mesh
-Water is required for chem rxn to occur (from circ)
-
CO2 Absp
-Dessicate absorb
Precautions
-Inc flow can dry out
-Airway fire
-rebreath CO2
CO2 Absp
Incompatible
Trichlorethylene
-dichloracetylene (neurotox)

Phosgene
-pulm irrt

Sevo
-degrades absorb
-Comp A (renal tox)
What is the recc. flow with Sevo
At least 2L
Chem of Soda Lime
Step 1 Rxn (1st neutralization rxn)
CO2 + H2O -> H2CO3
Chem of Soda Lime
Step 2 Rxn
H2CO3 + 2NaOH (or KOH) -> Na2CO3 (or K2CO3) + 2 H2O + Energy
Chem of Soda Lime
Step 3 Rxn
(2nd neutralization rxn)
Regen activator take place CaCO3 is an insoluble precipitate
Na2CO3 +(or K2CO3) +
Ca(OH)2 -> CaCO3 + 2 NaOH (or KOH)
Chem of Barium hydroxide lime (Baralyme)
1
Ba(OH)2-8H2O + CO2 -> BaCO3 + 9H2O + energy
Chem of Barium hydroxide lime (Baralyme)
2
9 H20 + 9 CO2 -> 9 H2CO3
(direct rxn and by NaOH, KOH if present)
Chem of Barium hydroxide lime (Baralyme)
3
9 H2CO3 + 9 Ca(OH)2 -> CaCO3 + 18H2O + energy
CaCO3 is an insol precp.
Changing Absorb
-Wear gloves
-loosen clamp
-remove discard top canister
-promote bottom canister to top, fresh canister on bot.
-Check circ for leaks
-Always remove wrap (if not no flow)
- Don't change mid case
What if absorb change color in middle of case
Inc flows to bypass the absorb.
Clincial signs of Co2 exhaust
-rise in HR & BP
- hyperpnea
-resp acid
-dysrhy
-SS of sns activiation
Flush, cardiac irreg, sweating
-inc bleed
-elev. CO2
Anest circ
-link mach to pt
-eliminate CO2
-Mapleson classification
- many diff in use
-mod maple still in use
-know current apps for mod mapleson
Delivery System
-Connection to Pt
-Breathing tubing
-Unidirectional valves
-breathing bags
-pop off valve (adj press limit valve)
-CO2 absorp
-Bact filter
Circle system
-Allows rebreathing of anesth gases
-lower FGF rates
-less pollution
-Requires CO2 absorp
-Conserv heat & humidity
Components of Circle Sys
-Fresh inlet gas
-Inhal check valve
-Inspiratory limb
-Y-Piece
-Expiratory limb
-Exhalation check valve
-APL valve (adj press limit)
-Bag/Vent selector switch
-CO2 cannister
Four Basic Circuits
Open
Semi-Open
Semi Closed
Closed
Open Systems (open drop ether)
-Insuffllation
-blow anest gas over face
-no direct contact
-no rebreath of gases
-vent cannot be control
-unkn amt delivered
Open systems
Open drop anesth
-gauze covered wire mask
-anesth dripped
-inhale air passes thru gauze & picks up anesth
-conc varies
-re-breath poss
-environ pollution
Semi open sys
-breathing sys which entrains room air
-self inflating resuscitatior sys
-Mapleson ABCDEF
-Bain
Semi closed sys
-gas enters from mach (part leaves via scavenger
-Circle sys
Closed sys
- only enough gas enters to meet metablolic need
-Scavenger is closed
-closed circle sys
(saves money, agent O2 supply)
Closed Sys Anesth
-Tech not commonly used
-APL is closed & only enough O2 is added to meet metabolic needs
-Anesth added based on sq root of time
-Conserves anesth gas & eliminates time
Scavenger Sys
OSHA Fact sheet on Waste Anest Gases (WAGS)
-Gives NIOSH recc to OHSA
-Occ exposure limited to
2ppm (halogenated agent)
25 ppm N20
Scavenger Sys
-Releases excess press from sys
-prevents OR pollution
-Gases leave thru APL
-May put too much neg press on sys (suction sys)
(Part of mach chk make sure it does not go below zero)
Scavenging connections
waste gas from circ
-vented thru APL valve when in bag
-pop off valve in bellows assembl when vent
-flows thru hoses connect to 19 or 30mm intake ports of the waste gas manifold
-Vented
Scavenging sys
Two types
Active
Passive
Scavenging sys
Active
vented thru hosp vaccuum sys (used mostly)
Scavenging sys
Passive
vented thru hosp vent duct
(tube has to be 18in high)