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54 Cards in this Set

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Anesthesia machine purpose
- receives medical gas
- controls the flow of gas
- vaporizes volatile anesthetics
- delivers gases to a breathing circuit connected to patient
American National Standards Institute (1979)
ANSI
defined design, performance and safety requirements for all anesthesia machines
American Society for testing materials (1988)
ASTM
superseded ANSI; all machines to date must conform w/ ASTM standards
Dept of Transportation (DOT)
requirements for design, construction, testing, making, labeling, filling, etc. of compressed gas cylinders

All cylinders must be marked according to Commerce COmmissions Regulations
Compressed Gas Association (CGA)
Sets standards for safe practice, the JCHAO of anesthetic gases
National Fire Prevention Association (NFPA)
recommends location, construction and installation of bulk oxygen systems
National Occupation & Health Act (NOHA)
protect the healthcare worker, i.e. those in the OR exposed to volatile agents
FDA
standards for medical devices and gases
Phamacopeia of the US & National Formulary
develop purity specification for medical gas
5 tasks of Oxygen
1.) ventilator driving gas
2.) flush valve
3.) oxygen pressure failure alarm
4.) oxygen pressure sensor shut off valve
5.) flowmeters
Oxygen cylinders
2000psi
660L capacity as E-cylinder/ 6000-8000L as H-cylinder
Green (white)
2,5 pin position
Gas

**replace at 1/2 to 1/3 full**
Air cylinders
2000psi
625L capacity as E-cylinder/ 6000-8000L as H-cylinder
Yellow (white & black)
1,5 pin
Gas
Nitrous oxide cylinders
745psi
1590L capacity as E-cylinder / 15,900L as H-cylinder
Blue (blue)
3,5 pin
liquid

**Measure by weight**
Hanger yoke
(3 functions)
- orients cylinder
- provides gas-tight seal
- ensures unidirectional flow

**check valve within yoke**
**Uses PISS system**
**contains 100um filter**
Pressure regulating device
(diaphram valve)
First stage: cylinder pressure decr to 40-50psi

Second stage: further reduces O2 cylinder pressure, or reduces O2 pipeline pressure, to 16psi *eliminates fluctuations in pressure supplied to the flow*
Check valve
prevents transfilling and ensures unidirectional flow
Safety mechanisms on anesthesia machine
Color coded cylinders/pipelines
DISS/PISS
Check valves
Fail-safe valve & alarm
Oxygen analyzer
Vaporizer interlock mechanism
Proportioning system
Pipeline inlet
Connection from H-cylinder housing unit in hospital to OR; uses DISS system; 100um filter
Three types of valves
Free floating (check valve)
Ball and spring (O2 flush valve)
Diaphragm (pressure regulators)
Fail-safe valve function
prevents the delivery of hypoxic gas mixtures in the event of failure of the O2 supply

Valve shuts off or proportionally decr the flow of ALL gases when the pressure in the O2 delivery line decr to <30psi
Fail safe alarm
activated by the fail-safe valve
Oxygen analyzer - what it does
analyzes what gas is present in the pipeline and if crossover of gases/mislabeling of contents has occured
Flush valve
delivers 35-75L/min unanesthetized O2

high pressure O2 (40-50psi from wall/cylinder)

may cause barotrauma

use only in case of an emergency
Is the flowmeter valve for of the intermediate or low pressure system?
Intermediate
A device that delivers gas to the distal circut in L/min?
flowmeter
Allows for the connection of O2 devices when the anesthesia machine is off?
Auxillary O2 flowmeter
Volatile anesthetics are _____ at room temp & atmospheric pressure.
liquids
______ is the conversion of a liquid to a vapor. This occurs from an increase in _______.
Vaporization
Temperature
The concentration control valve o a vaporizer controls what?
it regulates the amount of O2 flow through the bypass and vaporizing chambers.
Describe the proportioning system of the anesthesia machine.
aka the hypoxic guard system

it links the NO and O2 flows, so that NO cannot flow without O2; mechanically or pneumatically prevents final inspired O2 concentration less than 30%.
The most common location for a possible leak is the ______.
Common gas outlet.
Anesthesia machine check categories
- Emergency equipment
- High/low pressure system
- Scavenging system
- Breathing system
- Manual/Auto ventilation system
- Monitors
- Check final status of machine
Where does the circle system start?
The common gas outlet
How does gas "exit" the circle system? how does pressure "exit" the circle system?
the scavenging system; the APL valve
What is the APL valve?
The adjustable pressure limit valve that helps control excess pressure buildup within the system and prevents harm to the patient's lungs.

**the pop-off valve**
What are two ways CO2 leaves the circle system?
- the atmosphere (open/semi-open systems)
- chemical neutralization (semi-open/closed systems)
Two types of CO2 neutralizers
Soda Lime & Bara lime
S/S of hypercarbia
- Elevated HR & BP
- Hypercapnea
- Resp Acidosis
- Dysrhythmias
- SNS activation (flushing, sweathing, cardiac irreg)
- Incr bleeding @ surg site
Signs on your circle system that CO2 is elevated.
Cool CO2 cannister
The ____ is used to prevent misconnection of gases in the pipeline.
DISS
The ____ prevents the misconnection of a cylinder to the wrong yoke.
PISS
What happens if the check valve is from the pipeline is stuck open?
Retrograde flow
What happens if the check valve from the E-cylinder is stuck open?
If cylinder P < pipeline pressure, nothing serious; but if pipeline pressure drops, the E-cylinder will flow until empty (with no warning) and you'll only know when the O2 low supply alarm goes off and you're out of gas.
The fail-safe valve is only connected to these gases?
Nitrous Oxide & Air
What would you do in a suspected crossover? for loss of O2 pipeline pressure?
Open your E & D/C your P
When would you WANT to hit your O2 flush valve?
Inspiration
Flowmeters are designed for each individual gas according to...
Density and viscosity
Splitting ratio = ...
flow through the vaporizing chamber / flow through the bypass chamber
The hypoxic guard system will not safeguard against hypoxic breathing in these four extraneous circumstances:
1.) wrong supply of gas in pipeline/cylinder
2.) defective pneumatic or mechanics
3.) leaks downstream of control valves
4.) inert gas is present (i.e. helium)
The resistance of circle systems is .... (cm H2O)
less than 3cm H2O
Dead space is increased by all respiratory apparatus (true/false)?
True
Mechanical dead space ends where?
Y-connector, the point where inspired and expired gas streams diverge
Indications of increased airway circuit pressure:
- decreased lung compliance
- increased Tv
- obstruction in circut/tube/airway
Indication of decreased airway circuit pressure:
- increased lung complaince
- decrease Tv
- air leak