AGM Flashcards
(116 cards)
1
Q
What are the 5 tasks of oxygen?
A
- O2 pressure failure alarm
- O2 Failsafe (pressure failure device)
- O2 Flush valve
- O2 Flowmeter
- Ventilator drive gas
2
Q
What does the PISS system do?
A
Prevents connection/installation of the wrong gas cylinder on the gas machine
3
Q
What does the DISS system do?
A
Prevents connection of the wrong gas hose to the gas machine
4
Q
What is the PSI and L volume of an oxygen tank?
A
1900-2200 psi
660L
5
Q
What is the PSI and L volume of a nitrous oxide tank?
A
745 psi
1590 L
6
Q
What is the PSI and L volume of an Air tank?
A
1900 psi
625 L
7
Q
What is the most delicate part of the gas cylnder?
A
Cylinder valve
8
Q
The oxygen pressure failure device is senses and ALARMS when pressure drops below what value?
A
Below 28-30psi
9
Q
The oxygen pressure failure device is ACTIVATED when pressure drops below what value?
A
Below 20psi
10
Q
What is another name for the oxygen pressure failure device?
A
The oxygen failsafe
11
Q
What does the oxygen failsafe do when oxygen pressure drops below 20psi?
A
It stops flow of Nitrous Oxide into the AGM
12
Q
What does the hypoxia prevention device do?
A
Pneumatic or mechanical device that limits the nitrous oxide flow to be only up to 3 times the flow of Oxygen flow
13
Q
What is another name for the hypoxia prevention device?
A
Proportioning device
14
Q
What FiO2 will the proportioning device (hypoxia prevention device) not let you go below?
A
25% (N2O up to 3x the flow of O2 –75%N20:25%O2)
15
Q
What is the annular space?
A
The space between the float and the sides wall of the flowmeter.
16
Q
At what point do you read a skirted float in a flowmeter?
A
At the top
17
Q
At what point do you read a ball float in a flowmeter?
A
The middle of the ball
18
Q
What are the two most critical first steps when a pipeline crossover is suspected?
A
Open oxygen cylinder.
Disconnect pipelines to AGM
19
Q
How much flush does the oxygen flush valve provide?
A
35-75L/min
20
Q
At what pH does ethyl violet change color to purple?
A
10.3 pH
21
Q
What is the maximal CO2 absorbent capacity of Soda Lime?
A
23L of CO2/100g absorbent
22
Q
What is the ideal size of CO2 absorbent material?
A
4-8 mesh which means 4-8 holes per square inch absorbent.
23
Q
Which harmful substance can be created with dessicated soda lime?
A
Carbon monoxide; especially with use of anesthetic gases
24
Q
List two benefits of calcium hydroxide lime over soda lime:
A
No carbon monoxide production.
Less Compound A production
25
List the drawbacks of calcium hydroxide lime compared to soda lime:
Lower CO2 absorbency=more frequent changing required=higher cost
26
What are the four ways you can monitor for circuit disconnect?
Volume.
Pressure.
ETCO2.
Your own vigilance.
27
How are active and passive scavenger systems different?
Active scavengers require suction while a passive scavenger relies on the positive pressure made by fresh gas leaving the interface
28
What happens when the negative pressure relief valve fails?
It is possible for this to create a vacuum which will remove/deplete gas from the breathing circuit.
29
What happens when the positive pressure relief valve fails?
This will cause fresh gas to accumulate in the breathing circuit which will result in high pressures- even barotrauma.
30
Per OSHA, what is the maximum amount of anesthetic gases that can be found in the air of the OR?
Halogenated Gases <2ppm
N20 <25ppm
Halogenated and N20 <0.5ppm&25ppm respectively
31
No rebreathing and no reservoir is an example of what type of breathing circuit?
Open breathing circuit
32
What is an example of an Open breathing circuit?
Nasal cannula.
Insufflation
Open drop technique.
Simple mask
33
Complete rebreathing with a reservoir is an example of what type of breathing circuit?
Closed breathing circuit
34
Partial rebreathing with a reservoir is an example of what type of breathing circuit?
Semi-closed breathing circuit
35
No Rebreathing with a reservoir is an example of what type of breathing circuit?
Semi-open breathing circuit
36
What is an example of a close breathing circuit?
Circle system with very low FGF and APL closed
37
What is an example of a semi-open breathing circuit?
Circle system with >MV FGF
or
Mapleson circuit
38
What is an example of a semi-closed breathing circuit?
Circle system with
39
What three things are produced from chemical neutralization of CO2?
Carbonic Acid.
Heat.
Water
40
Degradation of inhaled anesthetics produces what?
Heat.
Compound A.
Carbon Monoxide
41
How much flow is required to drive bellows?
5L/min
42
SOAP-ME
```
Suction
Oxygen
Airway
Positive Pressure.
Medications
Extra Equipment
```
43
PALMS
```
Positive Pressure.
Airway.
Laryngospasm.
Monitors.
Suction.
```
44
If high pressure alarm goes off and circuit pressure is sustained during manual ventilation what could have happened?
Scavenger Obstruction.
| Scavenger relief valve
45
What are two disadvantages of using an inline HME?
1. Increases dead space.
| 2. Increases resistance
46
What is an example of a Thorp Tube on the AGM?
Flowmeters. Tapered, balls seals it at the bottom.
47
What to do with oxygen pipeline failure...
Trust the alarm until proven inaccurate.
Use Low-flow oxygen.
Shut off vent and bag manually.
Call for help and calculate time remaining in cylinder.
DO NOT reconnect pt to vent until system is checked.
48
What safety feature in the AGM is in place when there is a loss of pipeline supply?
Fail-safe valves will halt all gas delivery.
| Also, low oxygen pressure will alarm.
49
At what PSI is the Intermediate pressure system?
40-50psi.
Basically pipeline pressure/
50
What is the purpose of the Hanger Yoke?
```
Orients the cylinder.
Provides a tight seal.
Ensures unidirectional flow.
Contains a filter.
Minimizes trans-filling (one way valve)
```
51
What is considered the cornerstone of anesthesia?
Airway management
52
What are the 7 Ps?
Prior Preparation Prevents Piss Poor Performance
53
At what spine level is the Softpalate?
C2-C3
54
At what spine level is the hypopharynx?
C5-C6
55
What does damage to the RLN cause?
Hoarseness or stridor
56
Which nerves provides sensory innervation to the nasopharynx?
Trigeminal Nerve
57
What is the reason for such a large surface area within the nose?
To warm and humidify the air going in
58
What are the 3 single cartilages of the larynx?
Epiglottis.
Cricoid.
Thyroid.
59
What are the 3 paired cartilages of the larynx?
Arytenoids
Corniculate
Cuniform
60
What are the 4 main functions of the larynx?
1. Protect lower airway.
2. Patency.
3. Gag and Cough reflex.
4. Phonation.
61
What are the main responsibilities of the intrinsic muscles of the larynx?
Vocal cord movement.
| Epiglottis movement
62
What will stimulation of the carina do?
Induce cough
63
Difficult to ventilate definition:
When signs of inadequate ventilation can not be reversed by mask ventilation or the patient's oxygen saturation can not be maintained above 90% with mask ventilation.
64
Difficult to intubate definition:
A trained anesthesia provider, using conventional laryngoscopy, requires more than 3 attempts or more than 10 minutes to complete tracheal intubation.
65
Difficult airway definition:
A trained anesthesia provider experiences difficulty with facemask ventilation, laryngoscopy, intubation, or all of these.
66
Even with proper evaluation, what percentage of difficult airways are found prior to induction?
15-50%
67
What is the best determinant of a difficult airway?
History of difficult airway
68
What is the LEMON Law?
```
Look externally.
Evaluate the 3-3-2 rule.
Mallampati.
Obstruction or Obesity.
Neck Mobility
```
69
What is the 3-3-2 rule?
3 (fingers) min distance the mouth should open.
3- distance from tip of mandible to the laryngeal cartilage (with neck extended).
2- Distance from floor of the mouth to the prominence of laryngeal cartilage
70
What thyromental distance is considered best for intubation?
>7cm= east intubation
71
When someones uses the term "anterior larynx", in what position is the larynx actually?
Superior
72
What is the A-O Angle?
Atlanto-Occipital angle. A measure of good mobility.
| Always ask if any pain, numbness, tingling, or inability to move further.
73
What tool do we use to know if mask ventilation will be difficult?
BONES
74
What does BONES mean?
```
Beard.
Obesity.
No Teeth.
Elderly.
Snoring.
```
75
What is the #1 reason for difficult mask ventilation?
Having a beard.
| Surgilube will help.
76
What assessment do we use to know if laryngeal visualization will be difficult?
4 D's
77
What are the 4 D's?
1. Disproportion
2. Distortion.
3. Dismobility.
4. Dentition
78
What is the best progression of tasks when experiencing difficulty ventilating?
1. Reposition into good sniffing position.
2. Oral airway/nasal airway.
3. Two Hand technique to bag
4. LMA
5. ETT
6. Cricothyroidotomy.
* NEVER GO BACKWARDS on this progression*
79
What is apneic oxygenation?
Idea that oxygen blown into the lungs will cause alveolar oxygenation
80
Following an airway assessment, the person performing the intubation should be in a position to decide between three possible options. What are they?
1. Awake intubation.
2. Quick look (give a little prop, DL, then give more drugs for intubation).
3. Induction and paralysis
81
What are the two techniques for pre-oxygenating a patient?
1. TV breathing of oxygen for 3-5mins
| 2. Vital capacity breaths x 4 within 30seconds
82
What is the goal of pre-oxygenation?
Replaces nitrogen with oxygen. Increases arterial oxygen tensions (PaO2)
83
With good pre-oxygenation, we can increase the time before desaturation from 2-3min to how long?
8-9mins in a healthy patient
84
What is Jet ventilation?
High flow through a large bore needle
85
Is LMA/SGA considered a "secure" airway?
No
86
LMA size and cuff volume for adults?
LMA size 4 with 30ml or 5 with 40ml.
87
What is another name for an Eschmann Stylet?
Bougie
88
What are 6 things to consider when extubating?
1. Acceptable hemodynamics.
2. Normothermia
3. Ability to maintain patent airway.
4. Adequate muscle strength (enough reversal).
5. Adequate respiratory mechanics.
6. Ability to maintain adequate oxygenation
89
Which complication of airway management is associated with a 1 in 35,000 incidence?
Aspiration
90
What does an increases Alpha angle mean on a capnograph waveform?
Signifies expiratory outflow obstruction
| ex: COPD, Asthma, bronchospasm, or kinked ETT
91
At what point in the capnograph waveform is the Alpha angle measured from?
Point C
92
At what point in the capnograph waveform is the Beta angle measured from?
Point D
93
What does the Beta angle of the capnograph tell us?
Called the Rebreathing angle.
| Should be 90*. If increased, could be sign of rebreathing, Faulty unidirectional valve, or exhausted CO2 absorbent
94
If curare cleft is visible in spontaneously breathing patient, what might this signify?
Suggest inadequate muscle relaxant reversal. Lack of synchronization between diaphragm and intercostal muscles.
95
Pulse oximeter emits 2 light waveforms. What are they?
Infrared=940nm
| Red light=660nm
96
Which light waveform is absorbed by oxygenated hemoglobin (oxyhemoglobin)?
940nm=infrared light
97
Which light waveform is absorbed by de-oxygenated hemoglobin (deoxyhemoglobin)?
660nm= red light
98
Which law is associated with the way the pulse oximeter works?
Beer-Lamberts law
99
What happens to the SBP with a BP cuff that is too large?
Underestimates SBP (lowers)
100
What happens to the SBP with a BP cuff that is too small?
Overestimates SBP (increases)
101
Which method of measurement does an automatic BP cuff use?
Oscillometric method (oscillatory)
102
For every inch above or below the heart, the BP is increased/decreased by how much pressure?
2mmHg
103
If BP location is sampled from above the heart, what will the BP be?
It will be underestimated (decreased reading from the actual pressure)
104
What does the dicrotic notch on an peripheral arterial waveform signify?
Aortic Valve closure
105
What does the "a" wave represent on a CVP/RAP waveform?
Right Atrial Contraction
106
What does the "c" wave represent on a CVP/RAP waveform?
Tricuspid valve closure
107
What does the "v" wave represent on a CVP/RAP waveform?
Passive filling of RA
108
Central venous pressure is a function of what three things?
1. Intravascular volume.
2. Venous tone.
3. Right Ventricular compliance
109
What happens to "a" wave on CVP if pt in atrial fibrillation?
"a" wave will be lost
110
What would happen to "v" wave on CVP if pt has tricuspid regurgitation?
"V" wave will be increased
111
What happens to waveform as catheter tip moves from RV to PA?
Diastolic pressure increases
Systolic pressure stays the same.
Dicrotic notch visible.
Narrower pulse pressure
112
What does the dicrotic notch signify on a Pulmonary artery waveform?
Pulmonic valve closure
113
In which lung zone should the tip of the pulmonary artery catheter be placed for PAWP?
Lung Zone III
114
What two things might cause a falsely elevated PAOP?
Presence of PEEP.
| Diastolic dysfunction
115
What might cause a falsely decreased PAOP?
Aortic valve insufficiency
116
Preload responsiveness is expected to be intact if a 250ml fluid bolus increases stroke volume by at least what percent?
10%
