Bb Anesthesia Machines

Front 1

What's unique about using sevoflurane with CO2 absorbers?

Back 1

Sevo used with dessicated CO2 absorbents(especially baralyme) can lead to spontaneous fires in the cannister

Front 2

What is the main benefit of using CaOH absorbent compared to soda lime or baralyme?

Back 2

lack of NaOH, and KOH which eliminates the production of both carbon monoxide and compound A

Front 3

What is the maximum absorbent capacity of soda lime and calcium hydroxide?

Back 3

soda lime-26L CO2/100g absorbent
CaOH-10/100

Front 4

What inhaled anesthetics have the greatest risk of generation of carbon monoxide from CO2 absorbent?

Back 4

Des>iso>halo=sevo

Front 5

What CO2 absorbent has the highest risk of developing carbon monoxitde?

Back 5

baralyme>sodalime

Front 6

How can you decrease carbon monoxide production during general anesthesia?

Back 6

turn off machines after last case of the day; add water to CO2 absorbent to rehydrate dessicated absorbent; use calcium hydroxide absorbent

Front 7

What are the 4 types of disconnect alarms?

Back 7

pressure alarms: triggered is set pressure is not reached; volume alarms:triggered if preset volume, rate, or direction is not reached; CO2 alarm; other disconnect alarms: SaO2, esophageal stethescope

Front 8

What is the first machine alarms to detect a circuit disconnect?

Back 8

Low pressure alarm, mass spectrometer is a close second

Front 9

If you're given the pressure in psi of Nitrous or oxygen e cylinder how do you determine the volume left in the cylinder?

Back 9

multiple the pressure by 0.3

Front 10

What are the steps to make sure that a hypoxic gas mixture is not given to the patient?

Back 10

Fail Safe system: if O2 supply pressure decreases below a critical value the supply of other gases are shut off and an alarm sounds; on the machine a proportioning system can make sure that other gases are not given without sufficient O2(not on every machine); O2 analyzer on inspiratory limb is needed

Front 11

How are flowmeters checked?

Back 11

drager relies on a positive pressure check, ohmeda uses a negative pressure check due to the presence of a check valve

Front 12

What can cause inaccuracies in flowmeters?

Back 12

large temperature fluctuations; barometric pressure decreases result in inaccuracies at high flows(density of gas decreases and delivered flow is greater than the flowmeter reports); the greater the flow the more error in actual flow delivered; float must be properly aligned the tube needs to be straight up and down(length of tube does not affect accuracy)

Front 13

How does gas flow vary at low and high gas flows?

Back 13

low flow gas flow varies according to viscosity; at high flow gas flow varies according to density

Front 14

What is the best monitor to detect a flowmeter leak?

Back 14

oxygen analyzer in inspiratory limb

Front 15

What should you do if the reverse flow indicator alarms?

Back 15

consider spontaneous respiration; is it at the right location(should be on expiratory limb); check for nonfunctional inspiratory or expiratory valve

Front 16

What is the high pressure system and how is it checked?

Back 16

wall to the flowmeters; opening and checking the pressure of O2 and N20 tanks; this checks from the tanks to the regulator and indirectly from the wall to the flow meters

Front 17

What is the low pressure system and how is it checked?

Back 17

extends from the flowmeters to the patient; leak test(occluding circuit)

Front 18

What is the negative pressure check test?

Back 18

checks for leaks between comon gas outlet and regulators, checks regulators, flowmeters, vaporizers, and common gas outlet, detects smaller leaks than the low pressure check test,

Front 19

When do you use high frequency ventilation?

Back 19

bronchopleural fistula, TE fistula, barotrauma, bronchoscopy, laryngoscopy

Front 20

How can you improve oxygenation in the setting of ARDS?

Back 20

increase FiO2, institute PEEP, institute HFV, diuretics, digitalis, and afterload reduction if heart failure is present

Front 21

If a patient becomes hypotensive with institution of PEEP what should you consider?

Back 21

has the patient's been adequately volume loaded

Front 22

What are physiological effects of hypoventilation/hypercarbia?

Back 22

A RIPE; Acidosis, arrhythmias, Right shift of oxyhemoblobin curve, Intracerebral steal, PA pressure increase, Epi-norepi release

Front 23

What are the physiological effects of hyperventilation/hypocarbia?

Back 23

AVCO; Apnea, alkalosis, airway constriction; V/Q mismatch, decrease CO, cerebral blood flow, coronary blood flow, ca, oxy hgb curve shift to left

Front 24

What are the effects of oxygen toxicity?

Back 24

atelectasis, pulmonary edema, alveolar hemorrhage, thickened alveolar capillary membranes

Front 25

What is the cause of oxygen toxicity?

Back 25

oxygen partial pressure(>0.5atm), duration of exposure(can tolerate 1atm for 24hr), and inherent susceptibility

Front 26

How do Ohmeda machines regulate gas pressure?

Back 26

1st stage pressure regulator(2200 to 45psi, 750 to around 26psi); 2nd stage regulator(line pressure from 50 to 14psi), pressure relief valve opens if pressure downstream from 2nd stage regulator > 120mm Hg

Front 27

How do Drager machines regulate gas pressure?

Back 27

1st stage pressure regulator but not a second stage pressure regulator, pressure relief valve set to open if pressure downstream from 1st stream regulator exceeds 15psi

Front 28

What do you need to do when a pipeline supply source crossover has occured?

Back 28

disconnect pipeline supply and then turn on backup O2 source

Front 29

How does vapor pressure influence how much anesthetic gas is delivered?

Back 29

the percent of anesthetic delivered increases with increased vapor pressure

Front 30

If the machine is calibrated at sea level and we take it to higher elevation what happens to VP/BP?

Back 30

VP remains the same, barometric pressure decreases so the ratio increases