2/14Exam 1 Reading N.Ch16 Flashcards
1
Q
P: According to the Occupational Safety and Health Administration (OSHA), operating room personnel should not be exposed to more than how many parts per million of a halogenated agent if nitrous oxide is also used?
A
0.5
2
Q
If nitrous oxide is not used, then the maximum exposure is
A
2 ppm.
3
Q
The maximum exposure to nitrous alone is
A
25 ppm.
4
Q
The hanger yoke assembly orients the
A
gas cylinder, provides for uni-directional gas flow, and provides an air-tight seal.
5
Q
The pipeline inlet connections on the anesthesia machine are fitted with_______To prevent__________ . What kind of valve do they have?
A
diameter index safety system fittings to prevent connection of a gas line to the wrong connector on the machine. They also have a unidirectional check valve.
6
Q
Which of the following is an advantage of a piston-driven ventilator?
A
It does not require an oxygen supply to drive mechanical ventilation
7
Q
Piston-driven ventilators like the Apollo ventilator use an
A
electric motor to power the ventilator. They do not use driving gas and can mechanically ventilate the patient without depleting a backup oxygen cylinder.
8
Q
A piston-driven ventilator does not use what?
A
bellows.
9
Q
3 Other advantages to a piston-driven ventilator are :
A
- Quiet
- Does not produce the 2-3 cm H2O PEEP caused by the relief valve of a gas-driven ventilator
- less loss of tidal volume because the piston-design is less compliant than a bellows design.
10
Q
Which of the following would be an example of an open circuit?
A
Nasal cannula
11
Q
2 factors that Anesthesia circuits are classified based on
A
a. whether or not they have a reservoir bag
b. the degree to which rebreathing of gases occurs.
12
Q
The four major classes of circuits are
A
open
semi-open
semi-closed
closed.
13
Q
What is an open system? and examples?
A
Open systems allow the patient open access to the atmosphere.
Examples include open drop anesthesia, nasal cannula, or simple face masks.
14
Q
The semi-open, semi-closed, and closed classes of circuits all have
A
reservoirs.
15
Q
Because E-cylinder nitrous oxide tanks contain nitrous oxide in both the liquid and gas state, the only accurate way to determine the amount of gas left in the tank is by
A
weighing it.
16
Q
A full E-cylinder tank of N2O will hold
A
1590 Lof nitrous oxide.
17
Q
When the nitrous tank pressure drops what does it indicate?
A
When the pressure gauge drops below 745 psig, the liquid form has been consumed.
18
Q
When the nitrous tank pressure drops, what it the approximate left?
A
The amount of nitrous oxide in the gas phase at that point is about a quarter of the tank or around 400 liters. At 2 liters per minute, you would have approximately 200 minutes of nitrous oxide left.
19
Q
Unlike a variable bypass vaporizer, the fresh gas flow
A
the fresh gas flow does not come into contact with the liquid desflurane.
20
Q
The Tec-6 vaporizer is heated because
A
desflurane has a high vapor pressure
21
Q
Because of its high vapor pressure, the Tec-6 vaporizer is heated to _____why?
A
39 degrees Celsius to produce a controlled vapor output.
22
Q
The mechanical deadspace of a circle system breathing circuit effectively ends at the
A
Y-piece
23
Q
The mechanical deadspace of a circle system breathing circuit ends where the
A
inspiratory and expiratory streams diverge, which is at the y-piece.
24
Q
Although increasing the length of the corrugated inspiratory and expiratory limbs of the circuit may
A
increase the loss of tidal volume due to compliance, it does not increase deadspace.
25
You are administering anesthesia using a circle system. The fresh gas flow rate is 2 liters per minute and the patient's minute volume is 4 liters per minute. This would be an example of
Semi-closed circuit
26
For example, in both the non-rebreathing circuits and circle system, the circuit is considered semi-open if.
the fresh gas flow rate is greater than the minute ventilation
27
If the fresh gas flow rate is less than the minute ventilation, then the patient
must be rebreathing some of the exhaled gases and the circuit class is considered semi-closed.
28
When the bag/vent selector is set to Vent Mode, what components are eliminated from the breathing circuit? (select two)
RESERVOIR bag and
| the APL valve are eliminated from the breathing circuit.
29
All of the following are final products in the chemical reaction between soda lime and carbon dioxide except:
H2CO3
30
Final products in the chemical reaction between soda lime and carbon dioxide are
Na2CO3
H2O
Heat
31
The reaction that occurs within the CO2 absorber between soda lime and carbon dioxide occurs in two steps. The first is ______
The second portion of the reaction is _______
CO2 + H2O --> H2CO3.
| H2CO3 + 2NaOH --> Na2CO3 + 2H2O + heat.
32
Soda lime reaction, What is an intermediate product of the reaction?
H2CO3
33
A hospital's pipeline delivers oxygen to the anesthesia machine at
50 psig
34
The pressure gauge on your oxygen E-cylinder shows that it is at exactly half of the full service pressure. How many minutes will the tank last if you are using 10 liters of oxygen a minute? (Calculate your answer to the nearest whole number)
33 minutes
35
A full E-cylinder oxygen tank holds______L at a pressure of _____Psig
660 liters; 1900 psig.
36
Because the pressure in an oxygen tank is proportional to____what is the significance of that ?
its contents, if the pressure falls by half, then the number of liters falls by half as well. Using
37
Copper is often used in the construction of anesthetic vaporizers because it exhibits
High Thermal Conductivity
The high thermal conductivity of copper helps stabilize the temperature of the volatile anesthetic liquid and maintains a more constant vaporization rate.
38
Increasing the mechanical deadspace in an anesthesia circuit will
Make rebreathing CO2 more likely
39
The introduction of tubing or some other respiratory apparatus between the patient and the y-piece of the circuit will
increase the deadspace.
40
Which of the following statements regarding the Tec 6 vaporizer is true? (select two)
Pressurized to 2 atmospheres.
| No fresh gas flows through the sump.
41
Is the TEC 6 Vaporizer a variable bypass
NO
42
The gases from the anesthesia flowmeters are first mixed in the
Common Manifold
43
Oxygen should be positioned where in the flowmeters? why?
last in the flowmeters.That way, in case there is a crack in the flowmeter, it decreases the chance that a hypoxic gas mixture will be administered since it is added to the common manifold last.
44
The gases first mixed in the common manifold, after what happens?
The gases then enter a vaporizer if it is turned on and then pass into the common gas outlet. From the common gas outlet, the gases then enter the breathing circuit that is connected to the patient. Gases leave the breathing circuit through the scavenging interface and are disposed of through the hospital ventilation system.
45
Mnemonic of flow
CoMani
VapoCoGa
Breathe
Scave
46
Which of the following statements regarding the gas flowmeters found on an anesthesia machine is FALSE?
The diameter of the flowmeter tube is smaller at the top than at the bottom
47
The diameter of the flowtube description
tapered, but it is smaller at the bottom than at the top
48
At lower gas flows, it takes less pressure to support the bobbin and the diameter
is smaller.
49
At higher gas flows, the diameter is
larger and more gas is allowed to pass around the bobbin.
50
The oxygen low-pressure alarm on your anesthesia machine begins sounding. What is the first step you should take?
Switch on the backup oxygen cylinder
51
If the pipeline pressure is lost, the first step is to
open the backup oxygen cylinder,
reduce oxygen flows to conserve the backup gas supply, and consider switching to manual ventilation since many ventilators use the oxygen supply to drive the ventilator bellows.
52
Your patient is being mechanically ventilated with a pneumatically-driven anesthesia machine. Because of a loss of your pipeline medical gas supply, you have switched your anesthesia machine to your backup oxygen cylinders. What action could you take to prolong the amount of time you have before your oxygen cylinders are exhausted?
Switch to manual ventilation
53
PNEUMATICALLY-DRIVEN anesthesia machine: The ventilator is driven by
oxygen and requires a significant amount of oxygen to power it (sometimes as much as your minute ventilation).
54
With pneumatically driven anesthesia machine: Your oxygen cylinder can become ______What should you do to prevent that from happening?
depleted quickly when using the ventilator. Switching to manual ventilation will dramatically prolong the amount of time you can administer oxygen through the backup cylinders.
55
The phenomenon of channeling in a carbon dioxide absorber cannister can be minimized by
shaking the CO2 cannister prior to use
56
Channeling occurs when_____. How can channeling be prevented?
gases flow through passages of lower resistance in the CO2 cannister. When this occurs, most of the CO2 absorbent granules are bypassed and the efficiency of the absorber decreases. It can be minimized by gently shaking the cannister prior to use.
57
When the anesthesia machine is connected to a pipeline gas supply, the backup gas cylinder valves should be kept in the____Position
closed position so that
58
When the anesthesia machine is connected to a pipeline gas supply, the backup gas cylinder valves should be kept in the closed position so that
pipeline pressure failure would be detected earlier and to prevent pressure variations in the pipeline from draining oxygen from the cylinders.
59
Which monitors reliably detect a disconnection in the breathing system? (select two)
End-tidal CO2 monitor
| Respirometer
60
What are the 3 monitors with the ability to detect a disconnect in the breathing circuit?
end-tidal CO2 monitor
respirometer, and
airway pressure monitor
61
What do you see when there is a disconnection in the breathing system?
The end-tidal CO2 monitor will fall abruptly to baseline on a disconnect and the respirometer indicator will stop moving.
62
What is the proportioning system used for?
The proportioning system is used to link the nitrous oxide and oxygen flow dials together to prevent the administration of a hypoxic gas mixture.
63
If the breathing circuit is disconnected, WHAT HAPPENS to the oxygen analyzer?
The oxygen analyzer would continue to detect oxygen entrained from ambient air and would not necessarily indicate that a disconnection has occurred.
64
The variable-bypass vaporizer you were about to install and use on your next case gets tilted onto its side. What should you do before this vaporizer can be used? (select two)
drain the anesthetic from the vaporizer
| run fresh gas flow through the vaporizer for a period of time
65
If a traditional vaporizer is tilted, what can happen? B
Liquid agent could get into the control assembly and produce a potential overdose of the anesthetic.
66
Tilted vaporizer, Because it varies from model to model, you should consult the
manufacturer's operational manual for the vaporizer to obtain the recommended gas flow rate and duration.
67
The most common critical incidents in anesthesia are due to
The most common critical incident in anesthesia is due to breathing circuit disconnections, which most commonly occur at the y-piece.
68
As the partial pressure of the vapor above a liquid in a closed container increases
the rate of vaporization will slow.
69
The rate at which a liquid evaporates relies on only three factors:
Vapor pressure of the substance
the partial pressure of the vapor in the container above the liquid,
Temperature.
70
As the temperature or the vapor pressure increase
so does the rate of vaporization.
71
Which of the following is true regarding the common gas outlet?
outer diameter of 22 mm.
72
Inner and outer diameter of common gas outlet
15mm , outer 22mm
73
Role of The common gas outlet is designed to
help prevent accidental disconnection.
74
E-size tank reads 475 psig, how many L of O2 are left in the tank?
165L
75
When using a circle anesthesia circuit, the inspired carbon dioxide level should be
0 torr
76
When using a circle anesthesia circuit, the inspired CO2 should be 0 why?
A circle circuit incorporates the carbon dioxide absorbers which will absorb any exhaled CO2. The amount the patient will inspire with each breath should be zero.
77
What primarily determines the resistance to gas flow in an anesthesia circuit?
Circuit diameter and length
78
All of the following are tasks that oxygen performs in the anesthesia machine except
pressurize the variable-bypass vaporizers to 2 atmospheres
79
Cite the 5 functions of the oxygen valve\
| 2 P 2S 1 A
```
Power the fail-safe valve
Power the ventilator bellows
Supply the oxygen flush valve
Supply the fresh gas flowmeter
Activate the OXYGEN LOW PRESSURE alarm
```
80
Oxygen passes through the variable-bypass vaporizers but does not
when they are turned on, but it does not increase the pressure within them.
81
The most widely used anesthesia circuit in the United States is the
Circle system
82
The circle system allows
for the rebreathing of all exhaled gases except for carbon dioxide, which is removed by the CO2 absorber.
83
The Bain circuit is a modification of the
Mapleson D circuit that has the fresh gas tubing inside the circuit tubing.
84
What would happen if an oxygen cylinder is left open and the pipeline pressure drops below 45 psi?
Gas will flow from the cylinder
85
Normal pipeline pressure is___ psi.
50
86
If the PIPELINE pressure drops below 45 psi is there an alarm for that situation? What would happen?
There is no alarm to alert of this condition. The low oxygen supply failure alarm does not sound until the emergency supply is exhausted.
87
You are using a circle anesthetic circuit and realize that the carbon dioxide absorbent has become exhausted. You decide to convert the circuit to an open configuration. What is the easiest way to do this during the case?
Increase the fresh gas flow rate above the patient's minute ventilation
88
An open circuit implies that the patient Increasing the fresh gas flows above the patient's minute ventilation will convert a circle system to an open configuration.
is not rebreathing any of the exhaled gases.
89
Open circuit, Although this is wasteful, it can also be useful in the event the
CO2 absorbent becomes exhausted during a case and you need to prevent the patient from rebreathing exhaled carbon dioxide.
90
What can convert a circle system to an open configuration.
Increasing the fresh gas flows above the patient's minute ventilation
91
What anesthesia machine alarms are based on the circuit pressure? (select two)
The disconnect alarm
| The high pressure alarm
92
What component in a gas-driven ventilator is responsible for producing the 2-3 cm H2O of PEEP seen when mechanical ventilation is applied?
Ventilator relief valve
93
During inspiration what happens to the ventilator relief valve?
the pressure from the driving gas closes the ventilator relief valve so that the circuit can pressurize and inflate the patient's lungs.
94
During the early part of expiration, what happens to the ventilatory relief valve?
a weight in the ventilatory relief valve holds the valve open until the bellows have filled.This weight against the patient's expiration creates a PEEP of 2-3 cm H2O.
95
Both eliminated from the circuit when the ventilator is in mechanical ventilation mode.
The APL valve and the breathing bag
96
You are checking the oxygen cylinders connected to your anesthesia machine and notice that tank A has two washers in the hanger yoke connection and tank B only has one. You should
remove the second washer from tank A
97
Doing this could potentially bypass the pin index safety system and allow the connection of the wrong gas.
Use more than one washer
98
Which of the following ventilation modes allows for spontaneous ventilation? (select two)
Pressure support ventilation
| synchronized Intermittent Mandatory ventilation
99
4 Types of ventilation modes that allow for spontaneous breathing?
Pressure support ventilation
synchronized intermittent mandatory ventilation,
continuous positive airway pressure
airway pressure release ventilation
100
2 types of ventilation modes that DO NOT ALLOW for spontaneous ventilation ?
Pressure controlled ventilation and volume controlled ventilation do not.
101
You are transporting a patient on oxygen by face mask at 3 L/min. The pressure gauge on the E-cylinder oxygen tank you are using shows that 1/2 of the tank remains. How many minutes do you have before the tank is empty? Calculate your answer to the nearest whole number.
First: calculate how many L left in the tank
[( 950psig x 660L) / 1900psig} = 330L
for 3L =1 min , 330 L = 110min
