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october exam > anesthesia machine > Flashcards

anesthesia machine Flashcards

1
Q

where does the high pressure system begin and end

A

begins at cylinder and ends at cylinder regulators

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2
Q

components of high pressure

A

hanger yoke, yoke block with check valves, cylinger pressure gague, cylinder pressure regulators

gas pressure= cylinder pressure

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3
Q

where does intermediate pressure system begin and end

A

begins: pipeline
ends: flowmeter valve

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4
Q

components of intemediate

A

pipeline inlets, pressure gagues, ventilator power inlet, oxygen pressure failure system, oxygen second stage regulator, oxygen flush valve, flowmeter valve

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5
Q

gas pressure if using pipeline vs tank

A

50 psi if pipeline
45 psi if tank

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6
Q

where does low pressure begin and end

A

beggins at flow meter tubes and ends at common gas inlet

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7
Q

components of low pressure

A

flowmeter tubes, vaporizers, check valves, common gas outlet

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8
Q

5 tasks of oxygen in anesthesia machine

A

o2 pressure failure alarm, o2 pressure failure device, o2 flowmeter, o2 flush valve, ventilator drive gas (if pneumatic bellows)

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9
Q

pin index safety system

A

PISS- prevents inadvertent misconnections of gas cylinders

on each hanger yoke

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10
Q

what could lead to bypass of PISS

A

presence of more than one washer between hanger yoke and tank

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11
Q

diameter index safety system

A

DISS- prevents inadvertent misconnectios of gas hoses- each hose and connector are sized and threaded for each individual gas

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12
Q

max pressure and volume for o2 tank

A

1900 psi
2, 5 pin
660 L

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13
Q

air tank

A

625 L
1900 psi
pin 1, 5

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14
Q

n2o tank

A

1590 L
745 psi
pin 3,5

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15
Q

what does n2o tank weigh empty

A

14.1 lb (about 20 lb full)

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16
Q

how do you know if a cylinder is mri safe

A

most of it will be silver- only the top will be colored so you know what gas it is

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17
Q

gas cylinders should neber be exposed to temperatures above

A

130 F

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18
Q

if a gas cylinder is exposed to a temperature too high what can happen

A

a fire or explosion

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19
Q

how may the oxygen pressure failure device permit the delvery of a hypoxic mixture

A

the failsafe device responds to pressure NOT flow- if there is a pipeline crossover- the pressure of the second gas produces pressure to defeat the failsafe device- the patient gets exposed to a hypoxic mixture

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20
Q

what situation devices will hypoxia prevention safety devices not allow delivery of hypoxic mixture

A

oxygen pipeline crossover, leaks distal to flowmeter valves, administration of 3rd gas, defective mechanic or pneumatic components

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21
Q

whats the difference between oxygen pressure failure device and hypoxic prevention safety device

A

oxygen pressure failure device: fail safe device- shuts off and reduces n2o flow is o2 pressure drops below 20 psi

hypoxia prevention safety device: proportioning device- prevents you from setting hypoxic mixture with flow control valves- limits n2o flow to 3x o2 flow

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22
Q

where should o2 flowmeter be positioned

A

always furthest right

made of glass- most delicate part of the machine!!! - a leak can cause hypoxic mixture- oxygen should be closest to manifold so leak in any of the others will not reduce fio2 delivered to the patient

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23
Q

what is the vaporizer splitting ratio

A

modern variable bypass vaporizers split fresh gas into 2 parts

  1. some fresh gas enters the vaporizing chamber and becomes 100% saturated with a volatile agent
  2. the rest of the gas bypasses the vaporizing chamber and does not pick up any volatile agent

before leaving, they mix and this determines the final anesthetic concentration enxiting the vaporizer

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24
Q

what is the pumping effect

A

it can increase vaporizer output.

basically anything causing gas that has already left the vaporizer to re enter the chamber causes the pumping effect. generally due to pos pressure ventiilation or oxygen flush valve

not a risk in modern machines

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25
what is an injector type vaporizer
desflurane
26
what temp is des vaporizer heated to
39 C
27
are vaporizers in circuit or out of circuit
out
28
what does the oxygen analyzer monitor
oxygen concentration (not pressure) it is the only device downstream of flowmeters that can detect a hypoxic mixture
29
what system do leaks most often occur in the machine
low pressure system
30
what do you do if there is an oxygen supply line crossover
1. turn ON oxygen cylinder 2. disconnect pipeline oxygen supply - KEY STEP turning on cylinder will not save pressure b/c it will still pull from pipeline if pressure is fine regardless of the gas inside
31
2 risks of pressing oxygen flush valve
barotrauma and awareness the gas from here does not flow through vaporizers so no anesthesia in it
32
what is volume controlled ventilation
delivers a preset tidal volume over predetermined time- volume is fixed so inspiratory pressure will vary as patients compliance changes. the inspiratory flow is held constant during inspiration
33
what is pressure control ventilation
delivers preset inspiratory pressure. pressure and time fixed tidal volume and inspiratory flow varies- depends on pt lung mechanics if resistance rises or lung compliance decreases- vt suffers and higher inspiratory flow is needed to achieve preset airway pressure
34
what do you do if you notice soda lime has been exhausted in the middle of the surgical procedure
increase fresh gas flow to convert it into a semi open configuration increasing minute ventilation will not help
35
what is dessication
when absorbent is devoid of water ethyl violet tells you about exhaustion but it does not tell you about the water content
36
what does a dessicated soda lime cause
carbon monoxide-> carboxyhemoglobinemia compound a-> renal dysfunction
37
7 ways to monitor for disconnection of breathing circuit
precordial, visual inspection of chest rise, capnography, resp volume monitors, low expired volume alarm, low peak pressure alarm, failure of bellows to rise with ascending bellows (not with descending)
38
what is the purpose of unidirectional valves
ensure gas moves in one direction
39
what happens if a valve becomes incompetent
patient rebreathes exhaled gas- if you cannot fix the valve- increase FGF
40
what is decreased pulmonary compliance due to
a reduction in static compliance (PIP and PP increase) -endobronchial intubation, pulmonary edema, pleural effusion, tension pneumo, atelectasis, chest wall trauma, abdominal insufflation, ascites, trend, inadequate muscle relaxation
41
what conditions increase pulmonary resistance
usually due to reduction in dynamic compliance kinked ett, endotracheal tube cuff herniation, bronchospasm, bronchial secretions, compression of the airway, foreign body aspiration
42
what are the 4 phases of a normal capnograph
phase 1: (first flatline) exhalation of anatomic dead space phase 2: (upstroke) exhalation of anatomic dead space and alveolar gas phase 3: (top flatline): exhalation of alveolar gas phase 4: inspiration of fresh gas not containing co2
43
what happens if the alpha angle increases
alpha angle is the angle on the capnography on the left- indicates expiratory airflow obstruction copd, bronchospasm or kinked ett
44
what does an increased beta angle mean
rebreathing faulty unidirectional valve
45
list some reasons that cause increased etco2
increased BMR, malignant hyperthermia, thyroxicosis, fever, sepsis, seizures, laproscopy, tourniquet/ vascular clamp removal, na bicarb administration, anxiety, pain, shivering, increased muscle tone (after nmb reversal), med side effect
46
list some reasons of decreased etco2
decreased bmr, increased anesthetic depth, hypothermia, decreased pulmonary blood flow, decreased co, hotn, pulmonary embolism, v/q mismatch, med side effect
47
what are some equipment causes of increased etco2
rebreathing, co2 absorbent exhaustion, unidirectional valve malfunction, leak in breathing circuit, increased apparatus dead space
48
what are some equipment malfunction causes of decreased etco2
ventilator disconnection, esophogeal disconnect, esophogeal intubation, poor seal with ett or LMA, sample line leak, airway obstruction, apnea
49
what law is the pulse ox based on
beer lambert law
50
explain beer lambert law
relates intensity of light transmitted through a solution and the concentration of the solute within the solution
51
what 2 wavelengths of light does the pulse ox emit
red light (660 nm) - preferentially absorbed by deoxyhemoglobin (higher in venous blood near infrared light (940 nm) - preferentially absorbed by oxyhemoglobin - higher in arterial blood
52
what will impair the reliability of the pulse ox
1. decreased perfusion- vasoconstriction, hypothermia, raynauds 2. dysfunction hgb- carboxyhemoglobin, methemoglobin, nOT hgbS or hgbBF 3. altered optical characteristics: methylene blue, indocyanine green, indigo carmine, NOT fluroscein 4. non pulsatile flow- CBP, LVAD 5. shivering/ movement 6. electrocautery, dark skin, venous pulsation, NOT jaundice or polycythemia
53
what is the ideal bladder length of BP cuff
80% of extremity
54
what is the ideal bladder width of BP cuff
40%
55
as pulse moves from aortic root to periphery what changes with SBP and DBP
at aortic root SBP is lowest, DBP is highest, PP is narrowest dorsalis pedis SBP is highest, DBP lowest and PP is widest
56
if bp cuff is above heart bp reading will be false
decreased (less hydrostatic pressure)
57
what does it mean to be optimally damped
baseline is re-established after 1 oscillation
58
what does it mean to be under damped
the baseline is re-established after several oscillations (SBP is overestimated, DBP is underestimated, and MAP is accurate)
59
what does it mean to be over damped
the baseline is re established with no oscillations (SBP is underestimated, DBP is overestimated and MAP is accurate) causes: air bubble, clot in pressure tubing or low flush bag pressure
60
what does a mean on cvp waveform
rA contraction
61
what does c mean on cvp waveform
tricuspid valve elevation into RA
62
what does x mean on cvp waveform
downward movement of contracting RV
63
what does v mean on cvp waveform
RA passive filling
64
what does y mean on cvp waveform
RA empties through open tricuspid valve
65
what increases cvp value
transducer below phlebostatic axis, hypervolemia, RV failure, tricuspid stenosis or regurg, pulmonic stenosis, peep, vsd, constructive pericarditis, cardiac tamponade
66
factors that decrease CVP
transducer above phlebostatic axis, hypovolemia
67
what conditions cause loss of a wave on CVP waveform
when synchronized contraction fo RA is lost -a fib -v pacing (if underlying rhythm is asystole)
68
what causes an increased a wave on cvp waveform
tricuspid stenosis, diastolic dysfunction, myocardial ischemia, chronic lung dz rv hypertrophy, av dissociation, junctional rhythm, v pacing asyn, pvs
69
69
what causes large v waves
tricuspid regurg, acute increase in intravascular volume, RV papillary muscle ischemia
70
what does the pressure and waveform of PA look like in RA
1-10 (flat wave)
71
what does the pressure and waveform of PA look like in RV
15-30/ 0-8 tall!
72
what does the pressure and waveform of PA look like in PA
you see the dicrotic notch 15-30/ 5-15
73
what does the pressure and waveform of PA look like in PAOP
lvedp still see notch but it gets short (can see a, c, v) 5-15
74
the tip of the PAC should be in what west zone
3
75
what causes decreased svo2
increased o2 consumption: stress, pain, thyroid storm, shivering, fever decreased o2 delivery: decreased pao2, decreased hgb, decreased CO
76
what causes increased svo2
decreased o2 consumption: hypothermia, cyanide toxicity increased o2 delivery: increased pao2, increased hgb, increased CO
77
what are the bipolar leads
I, II, III
78
what are the limb leads
avl, avr, avf
79
what are the precordial leads
v1-v6
80
causes of R axis deviation
copd, acute bronchospasm, cor pulmonale, pulmonary htn, pulmonary embolus
81
causes of L axis deviation
chronic htn, LBBB, aortic stenosis, aortic insufficiency, mitral regurg
82
class 1 antiarrhythmic
Na channel blockers depresses phase 0; prolongs phase 3
83
class 2 antiarrhythmics
beta blockers slows phase 4- depol in sa node
84
class III MOA
K channel blockers prolongs phase 3 repolarization- ex: amiodarone
85
class IV antiarrhythmic
ca channel blockers- decreases conduction velocity through AV node (verapamil and diltiazem)
86
what ekg findings are consistent with wolff parkinson white syndrome
delta wave caused by ventricular preexcitation short PR interval <0.12 seconds wide QRS complex possible T wave inversion
87
what increases risk of torsades de pointes
POINTES phenothiazines other meds (methadone, droperidol, amiodarone w/ hypokalemia) intracranial bleed no known cause t1 antiarrhtyhmic electrolyte (low K, ca, mag) syndromes (timothy, romano-ward)
88
treatment for torsades
mag cardiac pacing to increase HR - reduce AP duration and QT interval
89
what conditions increase the risk of failure to capture
- high and low K -hypocapnia -hypothermia -MI -fibrotic tissue buildup around the pacing leads -antiarrhtyhmic meds
90
how does the cerebral oximetry work
utilizes NIRS (near infrared sectroscopy)- to measure cerebral oxygenation
91
how do brain waves change during GA
-indution of GA is associated with increased beta wave acitvity -light anesthesia is associated with increased beta wave activity -theta and delta waves predominate during GA -deep anesthesia produce burst suppression -at 1.5- 2.0 MAC GA cause complete suppression or isoelectricity
92
name 2 drugs that are most likely to reduce the reliability of the BIS
-nitrous oxide - increases amplitude of high frequency activity and reduces the amplitude of low frequency ativity. does not affect the BIS value -ketamine- increases high frequency activity- can produce a higher BIS than the level of sedation/ anesthesia
93
what is the difference between macro and microshock
macroshock: comparatively lg amount of current that is applied to the external surface of the body. the skins impedance offers a high ersistance so it takes a larger current to induce v fib microshock: comparatively smaller amount of current that is applied directly to the myocardium- high resistance to skin is bypassed- takes a significantly smaller amount of current to induce v fib
94
what is the role of the line isolation monitor
line isolation monitor assess the integrity of the underground power system in the OR tells you how much current could potentially flow through you or the pt if a second fault occurs
95
what is the main purpose of the LIM (line isolation monitor)
alert the OR staff at first fault
96
can the LIM protect you or the patient from macro or micro shock
no- not by itself
97
when will the LIM alarm
when 2-5 mA of leak current is detected
98
if the alarm sounds what do you do
last piece of equipment that was plugged in should be unplugged

october exam (12 decks)

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