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Anesthesia Equipment Exam 1 > Anesthesia Machine > Flashcards

Anesthesia Machine Flashcards

1
Q

High pressure system

A

E cylinders: Gas Source: N2O, O2, Air

2000 PSI

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2
Q

Intermediate pressure system

A

Wall supply

50 PSI

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3
Q

Low pressure system

A

Flow meters

6 PSI

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4
Q

Basic Function of anesthesia machine

A
  • deliver gases to keep patient alive and asleep
  • make sure those gases don’t contaminate the air
  • means to provide mechanical ventilation
  • means to monitor the patient and anesthetic gases
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5
Q

Valve/Regulator function

A

regulate flow and pressure

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6
Q

Fail-safe valve/device function

A

prevents hypoxic mixture

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7
Q

Most common type of machine we use at UIHC

A

Draeger

  • Fabius GS: Children’s hosptial
  • Narkomed Apollo
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8
Q

GE healthcare AKA?

A

Datex-Ohmeda

ASC: S5 Aespire
S5 Aysis: Main OR

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9
Q

SPDD Model

A
  1. Supply: how does gases come to machine?
  2. Processing: how does anesthesia gas machine prepare gases before delivery to patient?
  3. Delivery: how is the interaction of gases with the patient controlled and monitored?
  4. Disposal: how are gases disposed of?
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10
Q

2 main components of anesthesia machine?

A
  1. Electrical System

2. Pneumatic system

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11
Q

Electrical System

A
  1. Master switch (turns on electrical and pneumatic system inside machine, does not need to be on for cylinder pressure to be on)
  2. Power failure indicator (visible AND audible)
  3. reserve power (back up battery)
  4. Electrical outlets (convenience)
  5. Data port
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12
Q

Pneumatic system

A
  1. high pressure system
  2. intermediate pressure system
  3. low pressure system
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13
Q

Electrical sources

A
  1. Single power cord
  2. battery backup for 30 minutes
  3. convenience outlets (intended for monitors, may not supply electricity if machine is on battery back up)
    - do NOT use for heat devices (draw a lot of amperage)
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14
Q

Loss of Machine Electric: Devices NOT reliant on electrical power

A

Devices NOT reliant on electrical power

  • spontaneous/manual assist ventilation
  • mechanical flow meters
  • scavenging
  • variable bypass vaporizers
  • aespire: auxiliary flow meters
  • monitor with your 5 senses
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15
Q

Loss of machine electric: Devices which require wall outlet electrical power

A
  • mechanical ventilator (will DRAIN back up battery)
  • electronic monitors
  • digital flowmeter displays for electrical flowmeter
  • vaporizers with electronic controls or injection control (des, Saladin cassettes in s/5 ADU)
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16
Q

Pneumatic System: High Pressure

A

Higher pressure= Cylinder pressure

  • hangar yoke (PISS)
  • cylinder pressure indicator (gauge)
  • pressure regulators
  • gas cylinders (E)
  • check valves
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17
Q

Pneumatic System: Intermediate Pressure

A

Intermediate pressure= 37-55 psig

  • master switch
  • pipeline connections/ pressure indicators
  • second stage pressure regulators
  • piping
  • gas power outlet
  • oxygen pressure failure devices
  • gas selector switch
  • oxygen flush
  • flow adjustment control
  • alternate oxygen flow in case of electrical failure
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18
Q

Pneumatic system: low pressure

A 
Low pressure--- (distal to flowmeter valves)
-flowmeters
-hypoxia prevention safety devices
-unidirectional check valves
-pressure relief device
-low pressure piping
-common (fresh) gas outlet
-Alternate (auxiliary) oxygen flow meter
Protects machine from too much pressure **
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19
Q

Pressure regulators

A
  • down regulate pressure so its technically part of high pressure system*** after this you’re in intermediate
  • reduced high and variable pressures delivered from the cylinder to more constant usable pressures
  • maintains a regular flow rate even as pressure may decrease from the cylinder
  • pressure from cylinders are down regulated to less than 50 psi so the machine will get its supply from wall pressure instead of high pressure tanks
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20
Q

Second Stage Pressure Regulators

A
  • each gas be provided with a separate pressure regulator for providing a constant low pressure suitable of rate machine from the variable high pressure cylinders
  • some machines use 2 regulators whereby the second regulator delivers the gas at slightly above atmospheric pressure to the downstream components (flow meters)
  • helps in providing a smooth constant flow of gas irrespective of fluctuations in pipeline pressure due to peak/trough demands in system
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21
Q

Cylinder Pressure relief valves

A
  • ASTM standards require that all cylinder to have pressure relief devices which vent the contents of the cylinder into the atmosphere should dangerous pressure develop inside the cylinder
  • rupture disk: when a determined pressure is reached, a disc guarding an office rupture releasing contents
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22
Q

Check valves

A
  • One way flow valves or unidirectional flow valves
  • prevent back flow of gas or permit directional flow
  • inspiratory and expiratory valves
  • between cylinder sos they don’t flow into each other ****
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23
Q

Intermediate Pressure System stops where?

A

At flow meters= this is beginning of low pressure system

24
Q

Loss of pipeline (wall) gas

A
  1. Open the emergency oxygen cylinder fully
  2. disconnect the wall pipeline connection
    - something is wrong with the oxygen pipeline (the oxygen alarm will sound)
    - if oxygen analyzer does not warn of the cross over, the pulse oximeter will BUT
  3. ALWAYS ventilate by hand*****
25
Q

Oxygen Safety: Fail safe device

A

AKA: Oxygen pressure failure device

  • WILL NOT let you get hypoxic mixture
  • if you lose oxygen supply, N2O will automatically turn off
  • any gas coming through system less than 50 PSIG it will reduce your N2O
26
Q

Ge Aespire Safety Function

A
  • link system device

- a chain links them— if O2 is turned down then N2O is too

27
Q

Safety feature of flowmeters

A

-each knob has different texture

28
Q

Variable orifice flowmeters

A

Flow is dependent on:
1. Pressure change across construct
2. Magnitude of annular opening
3. Physical properties of gas: changes in temperature and pressure, density governs flow
Low flow= viscosity governs flow more
High flow= flow > turbulence ?* ask heather

29
Q

Reading float types:

A
  1. Floats read at top: non-rotating, plumb-bob, skirted, “H”

2. Floats read at middle: ball

30
Q

Flow meter sequence

A
  1. Oxygen is ALWAYS on the right side- closest to fresh gas outlet
  2. Oxygen leak from the flow tube can produce a hypoxic mixture, regardless of arrangement of flow meters*
31
Q

Aisys Electronic Flowmeters

A
  • all electronic flow meters
    1. gas setup- carrier gas
    2. set up FiO2
    3. Set total FGF
32
Q

Advantages of Machine

A
  • stable inspired concentrations
  • conserve moisture and heat
  • prevention of OR pollution
  • low gas flows and not worry about rebreathing CO2
  • disadvantage: complex design
33
Q

What would you expect to see if an expiratory valve sticks or malfunctions?

A

-CO2 reabsorption (elevated CO2 baseline, will not return to zero between breaths)

34
Q

What would you expect to see if an inspiratory valve sticks or malfunctions?

A
  • Low O2
  • cannot ventilate patient
  • patient cannot inhale
  • lower flows
  • low tidal volumes
35
Q

Reservoir Bag

A
  • be appropriate size for patient: 2-5 X patient’s tidal volume, 22mm female neck fitting
  • ASTM: less than 1.5 L pressure should be less than 30 cm H2O or more than 50 cm when expanded 4X
  • more than 1.5L pressure not less than 35 or greater than 60 cm H2O when expanded 4 times

Purpose:

  1. reservoir
  2. A/C ventilation
  3. visual/tactile monitor
  4. protects from excess pressure
36
Q

Adjustable Pressure Limiting (Pop-off) Valve

A

-adjusts pressure within the circuit
-all the way open= no built up pressure
cannot manually ventilate them because bag will not fill **

37
Q

ADU Caution

A
  • calculated oxygen from dialed flow meters

- NOT FIO2*

38
Q

Vaporizers

A
  • all based on SVPs
  • halogenated agents will vaporize from liquid state to lethal concentrations
  • vaporizers allow precise delivery of useful concentrations (take gas and dilute it down so it can be delivered to patient)
39
Q

Vaporizer placement

A
  • can be in circuit or out of circuit

- most modern day are out of circuit

40
Q

Source of Pollution

A

Major causes:

  1. anesthetic technique:
    - failure to turn off agent at end of case
    - mask fisk
    - flushing circuit (with nothing covering the end)
    - filling vaporizers
    - uncuffed ET tubes
  2. equipment issues:
    - leaks
    - bad scavenging system
41
Q

Types of scavenging: Active or Passive

A

Active: suction supplied. Means to protect patient’s airway from application of suction, or buildup of positive pressure

Passive: waste gases proceed passively down corrugated tubing through the room ventilation exhaust fail of OR. Require that patient be protected from positive pressure buildup only

42
Q

Open vs closed scavenging interface

A

The interface prevents positive pressure or negative pressure from reaching the breathing system

  1. Open: one or more openings to atmosphere, no valves
    - flow meter indicates if vacuum is on and adequate
  2. Closed: connects to atmosphere through positive pressure relief valve
    - if suction (active) is used, it must also have a negative pressure relief valve
43
Q

Interactions with Absorbents

A

Inhalation agents interact with absorbents
1. Trichloroethylene: cerebral neurotoxin
2. Sevo: compound A
3. Carbon monoxide:
Greatest to least= des>en>iso»halo= sevo
-dryness
-type (baralyme worse)
-high temps and agent concentration
-low fresh gas flow rates
-small patient

44
Q

carbon dioxide + water =

A

carbonic acid

45
Q

carbonic acid reacts with hydroxides to form:

A

sodium or potassium carbonate and water

46
Q

calcium hydroxide accepts the carbonate to form:

A

calcium carbonate and sodium or K hydroxide

47
Q

Sevo can interact with absorbent to cause fires:

A
  • baralyme, sevo, high oxygen flows

- possibly with iso and des

48
Q

Semi-Open Circuit

A

-No rebreathing, high fresh gas flow (higher than minute ventilation)

49
Q

Semi-closed Circuit

A

-some rebreathing occurring, FGF and pop-off settings at intermediate values

50
Q

Closed Circuit

A

-fresh gas inflow exactly equal to patient uptake, complete rebreathing after carbon dioxide absorbed and pop off closed

51
Q

Open Systems

A
  • no valves, no tubing
  • example: open drop ether, nasal canal
  • patient has access to atmospheric gases
52
Q 
Numbers of importance:
50 PSI
2000 PSI
45 PSI
35-75L/min
A
  1. 50 PSI= normal working pressure of most anesthesia machines
  2. Cylinders-oxygen supplied at 2000 PSI and regulated down to about 45 PSI after entry
  3. Oxygen flush valve: 35-75 l/min, works if electric fails, works if power off*
53
Q

What system is most susceptible to leaks and breaks?

A

low pressure circuit

  • the LPC is located downstream from ALL safety features except O2 analyzer
  • if negative pressure leak test is performed incorrectly, a leak in LPC will NOT be discovered
  • can result in hypoxic gas mixture being delivered to patient OR awareness
54
Q

How do you detect leak in on the GE (Datex-Ohmeda) machine?

A
  • 1 way check valve in LPC

- negative pressure is the only way to detect a leak in the LPC on these machines

55
Q

Circle system MUST be tested before delivering anesthetic: how?

A
  1. Static test: Set APL to 30 cmH2O and it should hold pressure
  2. Dynamic test: turn ventilator on and use a test lung bag to check for gas flow and valve functions
56
Q

In the event of pipeline cross what should you do?

A
  • DISCONNECT wall oxygen supply

- turn on backup oxygen cylinder

Anesthesia Equipment Exam 1 (9 decks)

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