Exam 2 whiteboard and study guide flahcards Flashcards
(97 cards)
1
Q
OSHA recommendations halogenated agents alone
A
<2ppm
2
Q
OSAH recommendations Nitrous oxide alone
A
<25 pm
3
Q
OSHA recommendations halogenated agents + nitrous oxide
A
<0.5 ppm + 25 ppm
4
Q
Full tank of oxyen (L and psi)
A
660 L, 1900 psi
5
Q
Full tank air (L and psi)
A
625 L and 1900 psi
6
Q
Full tank N2O (L and psi)
A
1590 L and 745 psi
7
Q
Venous blood pulse ox light
A
near-infared light
940 nm
8
Q
Arterial blood pulse ox
A
Red light 660nm
9
Q
Five tasks of oxygen
A
- Flush the fresh gas flowmeter
- Powers the oxygen flush
- Activates fail safe mechanism
- Activates oxygen low pressure alarm
- compresses the bellows of mechanical ventilators
10
Q
SPDD stands for
A
Supply
Processing
Delivery
Disposal
11
Q
pipeline psi
A
50
12
Q
oxygen cylinder supply (psi and L)
A
1900 psi
660L
13
Q
Oxygen pressure failure device/failsafe
A
Proportioning system (hypoxic guard)
14
Q
How does the hypoxia prevention proportioning system work?
A
Nitrous - oxygen proportioning
all final breathing mixtures must be 23-25% oxygen
ratio of NO2: O2 must not exceed 3:1
15
Q
High pressure system location
A
Cylinder—> cylinder regulators
16
Q
High pressure system components
A
Yoke things
cylinder things
17
Q
Intermediate pressure system pressure
A
pipeline=50 psi
tank=45 psi
18
Q
Low pressure system pressure
A
slightly above atmospheric but variable (14.7 or 16 psi)
19
Q
Intermediate pressure system location
A
Pipelines—>flowmeter valves
20
Q
Low pressure items
A
Flowmeter tubes
Vaporizers
Check valve (if present)
Common gas outlet
Manifold
21
Q
Low pressure system pressure
A
slightly above atmospheric pressure but variable
22
Q
Low pressure system location
A
Flowmeter tubes –>common gas outlet
23
Q
Low pressure system components
A
Flowmeter tubes
Vaporizers
Check valves
Common gas outlet
24
Q
If oxygen pressure falls below ____psi, the failsafe (hypoxia) will trigger an alarm
A
30 psi
25
If oxygen pressure falls below ____ psi, failsafe will stop N2O flow or reduce it proportionately
20
26
Failsafe device senses _________ NOT ______
senses pressure, not gas concentration
27
Reynold's number
Density x Diameter x Velocity
_______________________________
Viscosity
28
Reynolds number tells us if:
Turbulent flow in flowmeter is
Laminar
Turbulent
Transitional
29
Reynold's number <2000
Laminar
Flow is dependent on gas's viscosity
30
Reynold's number >4000
Turbulent flow
31
Reynold's number 2000-4000
Transitional
32
First stage regulator system and pressure
Reduce high/variable pressure in a cylinder to lower (intermediate) pressure (40-50 psi) via diaphragm valve
33
Second stage regulator system and pressure
Reduces pressure from 40-50 psi (first stage) to 16-24 psi via diaphragm
=keeps flow more constant in flowmeter
34
Safe tank handling: ALWAYS
Protect a cylinder when carrying, it is the most fragile part
35
Safe tank handling: NEVER
-Stand a cylinder upright without support -lay on side instead
-Leave empty cylinder on the machine
-Leave plastic cover on the port while installing
-Use more than one washer between cylinder port and yoke
-Rely only on a cylinder's color- READ LABEL
-Oil valves
-Remove a cylinder form a yoke without filling the space with a yoke plug (back up strategy for guarding against check valve failure(
36
Supply and examples
How gas enter pipeline: cylinders
37
gas enters pipeline at
50 psi,
38
Processing and examples
How the machine prepares the gas: vaporizers
39
Delivery and examples
How gases are brought to the patient: breathing circuit
40
Disposal and examples
How the gases are removed: scavenger
41
Proportioning device is a
hypoxic guard that ensures nitrous-oxygen proportioning
42
Even with hypoxic guard, hypoxic mixture can occur if (4):
1. wrong supply of gas in oxygen pipeline (gas crossover)
2. defective pneumatics or mechanics
3. Leak downstream of flow control valves
4. intert gas administration
43
Low O2 pressure:
Halts the supply of all other gasses in the event of supply failure
44
Fail safe low O2 pressure:
Gate is held open by pressure (NOT concentration) in oxygen line and will close if pressure is not met
45
In a power failure situation:
Manually ventilate your patient, TIVA
46
What powers the low pressure alarms?
Oxygen
47
Check on machine everyday (6):
See cardflow
48
Check machine before ever case
see cardflow
49
Desflurane and altitude
Higher = lower barometric pressure
requires higher setting on dial. DES because you are pressurized to 2
50
Potency of Sevo
always the same no matter the output concentration
51
concentration of sevo below sea level
is greater below sea level than is set on dial
but potency is the same
52
Concentration of sevo above sea level
is less above sea level than is set on dial
but potency is the same
53
Most common type of breathing circuit in US
circle system (semi closed very common)
54
In a circle system gas enters and exits via:
enters from CGO by way of fresh gas delivery hose
exits in circle to scavenger via the APL valve
55
Circuit leak parameters high pressure
occlude circuit and pressurize system to 30 cm H2O min
56
Circuit leak parameters low pressure leak test
inflate the bulb in CGO, should stay deflated for 10 seconds
57
What harm can O2 flush do(2)?
Cause barotrauma, especially during inspiratory phase. Do during expiratory it at all
Can dilute inhaled gasses because it adds 100% O2 to the circuit, can less depth of anesthesia
58
O2 flush purpose:
to quickly fill the breathing circuit with oxygenO
59
O2 flush volume
35-75 L/min
60
O2 flush psi
50 psi (same as pipeline pressure)
61
Which ventilator can be used for longest time and why?
Piston because they do not consume oxygen to drive the bellows (use electric)
62
Which ventilator can be used for least amount of time and why
Pneumatic because it is driven on oxygen flow and can consume a whole cylinder in 30 minutes
63
Pressure control vs volume control ventilation
see cardflow
64
What type of ventilation is this
Control/mandatory
machine triggered and machine cycles
65
What type of ventilation is this
Assisted /PSV
Patient triggered but machine cycled
66
What type of ventilation is this?
Spontaneous
patient tripped and cycled
67
5 components of scavenging system:
1. gas collecting assemply
2. Transfer tubing
3. Interface (open or closed)
4. Gas disposal tubing
5. Gas disposal system
68
The most important component of the scavenging system is the
scavenging interface
69
Why is the scavenging interface important?
Removal of too much case would create negative pressure in circuit
Removal of too little gas could increase risk of barotrauma
70
Function of the scavenging system(2):
1.remove excess gas from the anesthesia circuit
2. minimize environmental exposure to waste anesthetic gas
71
What controls gas ---> scavenger in spontaneous ventilation?
APL valve
72
Mapleson circuit
see notability doc
73
What controls gas---->scavenger in mechanical ventilation?
Ventilator spill valve
74
ABG guidlines for determining respiratory failure: Arterial PaO2:
<55-60 mm Hg (on O2)
75
AGB guideline for determining respiratory failure: Arterial CO2
<7.32
76
Evidence of increased work of breathing indicating resp support need: RR and Vt
RR >35/min
Vt < 5 mL/kg
77
Evidence of increased WOB need support: Vital capacity
<10-15 mL/kg
vital capacity: the greatest volume of air that can be expelled from the lungs after taking the deepest possible breath.
78
Initiation of ventilatory support: Max inspiratory pressure/negative inspiratory force
<25 cm H2O
79
Indications for initiating adult ventilatory support physical exam (3)
Retractions
nasal flaring
paradoxical/divergent chest motion
80
Compliance definition
As air flows into the lungs, gas molecules encounter resistance when the strike the walls of the airway
compliance is the pressure needed to deliver a specific volume
81
Effects airway resistance:
diameter of the airway
82
Airflow is _____ related to resistance
inversely
as resistance decreases, airflow increases
83
Compliance definition
A measure of the distensibility of a chamber expressed as a change in volume per unit of measure
84
Compliance is the (equation)
change in volume/
change in pressure
85
Dynamic compliance equation
TV
-----------
PIP-PEEP
86
Static compliance equation
TV
--------
Pplat - PEEP
87
Resistance vs compliance
cardflow lab game
88
Pressure-volume loop looks at
compliance
89
Boyles law
pressure of gas in inversely proportional to to volume of its container
90
Plateau pressure is applied to
small airways and alveoli
91
Plateau pressure is measured during
inspiratory pause on ventilator
92
In normal lungs PIP is ______ than Pplat
slightly higher
93
Increased Peak pressure, no change in Pplat indications (2)
increased resistance
Inspiratory flow rate as increased
94
Increased peak pressure and Pplat (2)
Total compliance has decreased
Tidal volume has increased
95
Calculating FiO2
(air flow rate x 21) + (Oxygen flow rate x 100)
-----------------------------------------------------------------
total flow rate
96
The only reliable way to measure how much is left in a nitrous tank is to
Weigh it because it exists as a liquid
97
Change nitrous tank when pressure drops below
745 psi
