Week 1 Handout

Question 1

What is a key responsibility of a CRNA?

Answer 1

Administering anesthesia and ensuring patient safety

Question 2

When was anesthesia first publicly demonstrated?

Answer 2

1846 at Massachusetts General Hospital

Question 3

What were the early anesthetic agents mentioned?

Answer 3

• Ether
• Chloroform

Question 4

What role did nurses take on in the 19th century concerning anesthesia?

Answer 4

They became anesthetists due to a lack of interest from physicians

Question 5

What advancements have been made in modern anesthesia practice?

Answer 5

Advancements in drugs, techniques, and safety protocols

Question 6

In what settings do nurse anesthetists work?

Answer 6

• Hospitals
• Surgical centers
• Military contexts

Question 7

Who was Catherine S. Lawrence?

Answer 7

A nurse who played a crucial role in administering anesthesia during the Civil War

Question 8

What significant organization was founded by Agatha Hodgins?

Answer 8

National Association of Nurse Anesthetists (NANA)

Question 9

What is Alice Magaw known for?

Answer 9

Being referred to as the ‘Mother of Anesthesia’ and her meticulous documentation of techniques

Question 10

What contributions did Helen Lamb make to nurse anesthesia?

Answer 10

Developing and enhancing educational standards and curricula

Question 11

What is the significance of the American Association of Nurse Anesthetists (AANA)?

Answer 11

It represents the professional organization for nurse anesthetists established in 1931

Question 12

Fill in the blank: Medical gases used in operating rooms include oxygen, nitrous oxide, air, and _______.

Answer 12

Nitrogen

Question 13

What is critical for patient safety regarding medical gas systems?

Answer 13

Correct configuration and functionality

Question 14

What determines the medical gas supply system design in hospitals?

Answer 14

Peak demand estimates

Question 15

How is medical grade oxygen produced?

Answer 15

By fractional distillation of liquefied air

Question 16

What type of cylinder do small hospitals typically use for oxygen storage?

Answer 16

High-pressure cylinders (H-cylinders)

Question 17

What safety feature do oxygen E-cylinders have?

Answer 17

A plug made from Wood’s metal that ruptures at 3300 psig

Question 18

What is the critical temperature of nitrous oxide?

Answer 18

36.5°C

Question 19

What is a notable safety feature of nitrous oxide E-cylinders?

Answer 19

They are equipped with a Wood’s metal plug to prevent explosion

Question 20

True or False: The transition of nitrous oxide to a gaseous phase causes a significant rise in tank pressure.

Answer 20

False

Question 21

What is the primary function of woods metal in anesthesia machines?

Answer 21

To prevent explosion under high gas pressure conditions.

This includes unintentional overfilling or during a fire.

Question 22

What is the constant pressure in reserve nitrous oxide E-cylinders at 20°C?

Answer 22

745 psig

This pressure remains constant until the liquid nitrous oxide is exhausted.

Question 23

How is the residual volume of nitrous oxide in a cylinder best determined?

Answer 23

By weighing it.

The tare weight (TW) is often stamped on the cylinder.

Question 24

What is the growing trend in anesthesiology regarding gas usage?

Answer 24

Increasing use of medical air.

This is due to the decline in nitrous oxide popularity and reduction in high concentrations of oxygen use.

Question 25

What is the composition of medical-grade cylinder air?

Answer 25

A blend of oxygen and nitrogen.

Question 26

What is the critical temperature of air?

Answer 26

-140.6°C.

Question 27

What is the purpose of nitrogen in hospitals?

Answer 27

To power operating room equipment like saws, drills, and surgical handpieces.

Question 28

What is the function of the central vacuum system in hospitals?

Answer 28

To prevent contamination and may be used for waste anesthetic gas disposal (WAGD).

Question 29

What color coding is used for medical vacuum receptacles?

Answer 29

Typically black with white lettering.

Question 30

What is carbon dioxide used for in surgeries?

Answer 30

Insufflation of body cavities during laparoscopic or robotic-assisted surgeries.

Question 31

What are the characteristics of carbon dioxide?

Answer 31

Odorless, colorless, nonflammable, and slightly acidic.

Question 32

What is a risk associated with carbon dioxide cylinders?

Answer 32

They share the same size orifice and thread with oxygen cylinders.

Question 33

What are the three main anesthesia gas sources?

Answer 33

* Oxygen * Nitrous oxide * Air

Question 34

What are the wall outlet color codes in the operating room for gas delivery?

Answer 34

* Green for oxygen * Blue for nitrous oxide * Yellow for air

Question 35

What is the purpose of the Diameter Index Safety System (DISS)?

Answer 35

To prevent misconnections in gas delivery systems.

Question 36

What is the approximate pipeline pressure for gases delivered to the anesthesia machine?

Answer 36

50 psig.

Question 37

What is the role of safety devices in gas delivery systems?

Answer 37

To ensure that other gases can only flow if there is sufficient oxygen pressure.

Question 38

What does the high-pressure system in anesthesia machines manage?

Answer 38

High-pressure gas from the anesthesia machine's cylinders.

Question 39

What is the pressure range typically found in the high-pressure system?

Answer 39

2000 to 2200 psi.

Question 40

What is the function of the intermediate pressure system?

Answer 40

To ensure a constant and safe pressure for gas delivery.

Question 41

What pressure range is typical for the low-pressure system?

Answer 41

Close to atmospheric pressure, typically between - psi.

Question 42

What is the purpose of the low-pressure system?

Answer 42

To accurately deliver and regulate the anesthetic agent to the patient.

Question 43

What is the method for determining nitrous oxide cylinder depletion?

Answer 43

Assumed when the pressure gauge begins to decrease.

Question 44

What does a full E size nitrous oxide cylinder contain in liters?

Answer 44

1590 L.

Question 45

What is the function of the Pin Index Safety System (PISS)?

Answer 45

To prevent misconnections in gas cylinders.

Question 46

What color is the oxygen tank in the USA?

Answer 46

Green.

Question 47

What is the pressure gauge reading for a full E size oxygen tank?

Answer 47

2000 psi.

Question 48

What is the function of the pressure gauges on anesthesia machines?

Answer 48

To indicate the pressure of the gas in the corresponding cylinder.

Question 49

What is the storage requirement for air in hospitals?

Answer 49

Dehumidified but unsterile air through pipeline systems powered by compression pumps.

Question 50

What must be avoided with the inlets for compression pumps?

Answer 50

Contamination from vacuum exhaust vents and machinery.

Question 51

What is the relationship between pressure and volume in an oxygen cylinder?

Answer 51

Directly proportional.

Question 52

What is the assumption about remaining gas when the pressure gauge for nitrous oxide decreases?

Answer 52

About 75% of the contents are exhausted.

Question 53

What is the purpose of the high-pressure leak test on an anesthesia machine?

Answer 53

To ensure the integrity and safety of the high-pressure components of the machine ## Footnote Leaks in the high-pressure system can lead to failure in gas delivery, compromising patient safety.

Question 54

What should be done during the preparation phase of a high-pressure leak test?

Answer 54

Turn off the anesthesia machine, disconnect from power, close flow control valves, turn off vaporizers, and remove the breathing circuit ## Footnote Proper preparation is crucial for an effective leak test.

Question 55

How is the high-pressure system pressurized during the leak test?

Answer 55

By opening the valve of one gas cylinder at a time ## Footnote Typically, the pressure level corresponds to a full cylinder, around 2000 to 2200 psi for oxygen.

Question 56

What indicates a leak in the high-pressure system during testing?

Answer 56

A drop in pressure on the gauge after closing the cylinder valve ## Footnote The rate of pressure drop can help determine the severity of the leak.

Question 57

Where should common leak points be checked in the high-pressure system?

Answer 57

* Cylinder valve * Connection between the cylinder and the yoke * High-pressure hoses * Regulators ## Footnote A soap solution can be used to visually identify leaks.

Question 58

What is the purpose of the low-pressure leak test on an anesthesia machine?

Answer 58

To ensure the integrity and safety of the anesthesia delivery system, particularly in the low-pressure circuit ## Footnote This test checks for leaks that could lead to inadequate anesthesia delivery.

Question 59

What components are checked during the low-pressure leak test?

Answer 59

* Vaporizers * Flowmeters * Common gas outlet * O-ring seals * Breathing circuit connections * CO2 absorber canister * Ventilator bellows and hoses * Pressure relief devices * Check valves ## Footnote Each component plays a crucial role in preventing leaks.

Question 60

What should be done during the preparation phase of a low-pressure leak test?

Answer 60

Connect the machine to the gas supply, ensure gas cylinders are turned off, close flowmeters, turn off vaporizers, and attach a test lung or occlusion device ## Footnote Proper setup is essential for accurate leak detection.

Question 61

How is the low-pressure system pressurized during the leak test?

Answer 61

By squeezing the reservoir bag or using the oxygen flush until a pressure of about 30 cm H2O is achieved ## Footnote This pressure should remain stable if the system is intact.

Question 62

What indicates a leak in the low-pressure system during testing?

Answer 62

A drop in pressure ## Footnote The rate of pressure drop can indicate the severity of the leak.

Question 63

What should be done if a leak is detected in the system?

Answer 63

Check each component systematically to identify the source of the leak and repair or replace the faulty component ## Footnote Repeating the test after repairs is necessary to ensure all leaks have been addressed.