Term
| What 2 things should you do before replacing a cylinder on the yoke? |
|
Definition
| FIRST: wash hands, then check to make sure the 2 pins of the PISS are present on the yoke. |
|
|
Term
| What comes in contact with the retaining screw of the yoke? |
|
Definition
|
|
Term
| What is the first step in placing a cylinder in the yoke? |
|
Definition
| Retract the retaining screw. |
|
|
Term
| The retaining screw pushes the valve of the cylinder over the _____ and ______. |
|
Definition
|
|
Term
| What is the most common cause for a leak of a cylinder on the anesthesia machine? |
|
Definition
|
|
Term
| For high pressure system, the O2 pressure range is? |
|
Definition
|
|
Term
| FOr high pressure system, N2O pressure range is? |
|
Definition
|
|
Term
| 2 components of the high pressure system. |
|
Definition
| Cylinders and ends at the cylinder's PRIMARY pressure regulators |
|
|
Term
| What is the numeric value of the regulated cylinder pressure? |
|
Definition
|
|
Term
| Name 4 main things modern anesthesia machines incorporate (VVSM). |
|
Definition
| Ventilators, Vaporizers, suction and monitors |
|
|
Term
| What % range of anesthesia errors are caused by human error? |
|
Definition
|
|
Term
| What % of total errors are caused by human airway mismanagement? |
|
Definition
| 50% of 70-80%...so 35-40% |
|
|
Term
| The breathing circuit is involved in what % of human error management? |
|
Definition
|
|
Term
| Vaporizers contribute to what % of human errors? |
|
Definition
| 21%. But if you wanted to know what % vaporizers contribute to the total error, it would be 21% of 70-80% (There is 70-80% human error. Airway mgt consists of 50% of 70-80%. Vaporizers contribute to 21% of airway errors) |
|
|
Term
| Ventilators attribute to what % of airway mismanagement? |
|
Definition
|
|
Term
| What % of cardiac deaths are caused by hypoxia, secondary to human error? |
|
Definition
|
|
Term
| What % range is caused by equipment failure? |
|
Definition
|
|
Term
| What are 3 ways the equipment failures have been reduced? |
|
Definition
| 1. By the manufacturer, 2. by doing a consistent machine check first thing in the am, 3. By being a watchful (vigilant, alert) operator |
|
|
Term
| Name 3 GE (Datex-Ohmeda) anesthesia machines currently in production |
|
Definition
| S/5 (AS/3, system 5) 2. Aestiva, 3. Aespire |
|
|
Term
| Which anesthesia machine can you take into the MRI room...the Aestiva or the Aespire? |
|
Definition
|
|
Term
| Which machine is the only one that employs "tippable" vaporizers (ie, the Aladin) |
|
Definition
|
|
Term
| What anesthesia machine do we have in lab? |
|
Definition
|
|
Term
| Name 5 Drager machines currently in production. |
|
Definition
| 1. Narkomed 6000, 2. Fabius GS, 3.Narkomed GS, 4.Narkomed MRI, 5.Julian |
|
|
Term
| The 1979 American National Standards Institute applies to machines built before what date? |
|
Definition
|
|
Term
| The 2000 revision of the American Society for Testing and Materials (ASTM F1850) specifies what? |
|
Definition
| What is needed for an anesthesia work station (not just a machine). Also states what components may need to be added to older machines. |
|
|
Term
| The American Society for Testing and Materials 1850 (2000) specifies that anesthesia machines must monitor what 9 things? |
|
Definition
| Breathing (7 things): FiO2, CO2 concentration, O2 pressure, SaO2, exhaled TV, anesthetic vapor, and the continuous breathing system pressure. Hemodynamics (2): Continuous ECG and arterial BP |
|
|
Term
| How do you automatically enable anesthesia alarms? |
|
Definition
|
|
Term
| How do you manually enable alarms on the machine? |
|
Definition
| Do the 1993 FDA checklist |
|
|
Term
| Name 3 main causes for high priority pressure alarms to sound. |
|
Definition
| 1. User-adjustable limits are exceeded, 2.prolonged high pressure is sensed, 3. Negative pressure is sensed (disconnect) |
|
|
Term
| A disconnect (high priority) alarm may be based on by what 3 things the machine may sense? |
|
Definition
| 1.Low pressure, 2.Exhaled volume, 3.CO2 |
|
|
Term
| What is the most common disconnect and what are 2 steps to decrease it's incidence? |
|
Definition
| ETT from breathing circuit. Use an elbow adapter and/or tape |
|
|
Term
| Pressure in the breathing circuit is limited to what? |
|
Definition
|
|
Term
| A high priority alarm will sound if the FiO2 drops to what % for how long? |
|
Definition
| 18% (or a limit set by the user), for 30 seconds or greater |
|
|
Term
| A hypoxic guard does what? |
|
Definition
| It prevents a hypoxic mixture when N2O is being used...this is a ASTM 1850 regulation. |
|
|
Term
| The O2 flush is part of the intermediate pressure sytem, but what about when you use the O2 flush? |
|
Definition
| It can generate high pressures. Also note that the O2 flush bypasses the vaporizers and goes directly to the common gas outlet. |
|
|
Term
| The O2 flush can deliver what range of O2 in L/min? |
|
Definition
|
|
Term
| When is the O2 flush active? |
|
Definition
|
|
Term
| An anesthesia machine may be considered obsolete due to changes in _______, changes in ______ and changes in ________. |
|
Definition
| anesthesia practice, training and experience, safey |
|
|
Term
| T/F Anesthesia machines with measured flow vaporizers are currently in use in the US |
|
Definition
| F. This is an unacceptable feature and is illustrated by the copper kettle. |
|
|
Term
| Intermediate pressure system receives gases at what psig? |
|
Definition
|
|
Term
| 2nd stage pressure regulators reduce gas pressures to what? |
|
Definition
|
|
Term
| Gases are piped in at what psig? |
|
Definition
|
|
Term
| What is the "working pressure" of the anesthesia machine? |
|
Definition
|
|
Term
| The low pressure system extends from where to where? |
|
Definition
| from the flow control valves to the common gas outlet |
|
|
Term
| The low pressure system includes what 4 components? |
|
Definition
| flow control valves, vaporizers, one-way check valves (when present), and flow meter tubes (thorpe tubes). |
|
|
Term
| Drager or GE has the one-way check valve in its low pressure system? |
|
Definition
|
|
Term
| In what 3 ways do anesthesia machines differ? |
|
Definition
| 1. Approaches to safety alarm systems (Drager...nice, GE...loud) 2.Physical placement of parts 3.Physical appearance |
|
|
Term
| What model and make has a digital flow meter? |
|
Definition
|
|
Term
| This is shut off or decreases the N2O and other gases if low O2 pressure is sensed. |
|
Definition
|
|
Term
| Where is the fail safe valve located? |
|
Definition
| Downstream of the N2O supply |
|
|
Term
| What is the purpose of having a second stage pressure regulator? |
|
Definition
| To decrease damage to the O2 flow control valve (caused by pressure). It's usually set at 14 psig to the oxygen flow control valve and is on the GE machines. |
|
|
Term
| What is the purpose of the one-way check valves? On what machines is it located and in what pressure system? |
|
Definition
| To prevent intermittent backpressure into the vaporizer, on GE systems in the low pressure system. |
|
|
Term
| What is the most common problem with the pipeline? What is the second most common problem? |
|
Definition
| 1.Inadequate pressure, 2.Too much pressure |
|
|
Term
| From the pipeline, gas enters the anesthesia machine via the DISS or the PISS? |
|
Definition
| DISS. Gas-specific, threaded fittings |
|
|
Term
| If you suspect a crossover of gas piping, what should you do? |
|
Definition
| FIRST!!! Turn on the cylinder supply then disconnect the pipeline source. (Note: the machine checkoff would help detect this in advance) |
|
|
Term
| Pipeline inlet connections is where gas enters _______. |
|
Definition
| the anesthesia machine via the DISS. |
|
|
Term
| A check valve located downstream of the inlet to the pipeline supply prevents __________. |
|
Definition
| Backflow of gas from anesthesia machine to the pipeline. |
|
|
Term
| O2 enters the ______ downstream/upstream from other gases. |
|
Definition
| common manifold, downstream |
|
|
Term
| The pipeline O2 has 6 tasks. They are: Powers ventilator, supplies O2 to ______ valve, Powers safety devices that sense O2 ______, travels through _______ (if present) to flowmeter, triggers _____and _____ alarms that warn of O2 pressure decrease, and (on newer machines), may travel to a secondary O2 flow meter. |
|
Definition
| O2 flush, pressure, second regulator, auditory and visual |
|
|
Term
| E cylinders are attached to anesthesia machines via a ______. |
|
Definition
|
|
Term
| Name 3 functions of the hanger yoke. |
|
Definition
| 1. Orients and supports the cylinder, 2.Tight seal, 3.Unidirectional flow of gases. |
|
|
Term
| Name the 4 parts of the check valve assembly (part of the hanger yoke) |
|
Definition
| 1.Nipple, 2.Washer, 3. Index pins, 4.Retaining screw |
|
|
Term
| A pressure gauge indicator is needed for each gas, and is usually on the front of anesthesia machines, but where might you find the cylinder pressure gauge indicator? |
|
Definition
| Near the cylinder on the back. |
|
|
Term
| What is a synonym for the pressure gauge indicator for either the pipeline or cylinder? |
|
Definition
|
|
Term
| The Bourdon tube is calibrated with what on the outside and what on the inside? |
|
Definition
|
|
Term
| The scale of the Bourdon tube must be what % greater than the max filling pressure of the cylinder? |
|
Definition
|
|
Term
| Cylinder pressure regulators regulate what? |
|
Definition
| Reduces pressures from high and variable (ie, 2200 or 200 psig) down to 45 psig. This is set at the factory. |
|
|
Term
| Standard requires flow from a cylinder not to exceed _____ L/min when the pipeline supply is _____. |
|
Definition
|
|
Term
| Pressure delivered from the regulator is greater than/less than the pressure delivered from the pipeline. |
|
Definition
|
|
Term
| The cylinder check valve is located upstream/downstream of the cylinder, and prevents high pressure gas flowing ________. |
|
Definition
| Downstream, into a cylinder of low pressure. |
|
|
Term
| The cylinder check valve allows for _______ while gas flows from another cylinder and minimizes gas leaking into ______ if another cylinder is absent. |
|
Definition
| changing an empty cylinder, the atmosphere |
|
|
Term
| Give a synonym for a cylinder pressure reducing valve. |
|
Definition
| Cylinder pressure regulator |
|
|
Term
| A high/medium/low priority alarm sounds within 3/5/10/30 seconds of O2 pressure is decreased below 18/30 psig. |
|
Definition
|
|
Term
| A "fail safe" valve is present in O2/non-O2 gas lines and is controlled by O2/non-O2 gas pressure. |
|
Definition
|
|
Term
| What is the term for the "fail safe" valve on a GE machine? |
|
Definition
| Pressure sensor shut off (open vs. closed) |
|
|
Term
| What is the term for the "fail safe" valve on a Drager machine? |
|
Definition
| Oxygen Failure Protection Device (OFPD) (proportional decrease in other gases) |
|
|
Term
| Machines without a flow ______ system can deliver a hypoxic mixture of gases even with a "fail-safe" valve. This can happen if the O2 flow valve is open/closed and the O2 pressure keeps other gas valves open, allowing them to flow. |
|
Definition
|
|
Term
| GE machines have second stage pressure regulators located in the high/intermediate/low pressure system and reduces pipeline and cylinder regulator pressures to _____psig going to the very delicate ______. |
|
Definition
| intermediate, 14 psig, flow meter |
|
|
Term
| Flow meters and flow control valves allows for precise control of gases to the ______. |
|
Definition
|
|
Term
| The flow control valve regulates gas flow into a ______. |
|
Definition
| Thorpe tube (conventional flow meter) |
|
|
Term
| A thorpe tube has the smallest diameter at the top/bottom. |
|
Definition
|
|
Term
| What does the "stop" do for a thorpe tube? |
|
Definition
| Prevents the float from plugging the outlet. |
|
|
Term
| Both O2 and N2O have double thorpe tubes. What scales are used? |
|
Definition
|
|
Term
| Rate of flow through a flow meter is dependent on 3 things: Pressure ________, frictional resistance encountered between the _____ and the _____ and the __________. |
|
Definition
| Pressure drop across the constriction, float and wall of tube, size of the annular space. |
|
|
Term
| At low flows, flow is a function of density/viscosity, and is dependent/independent of atm pressure. |
|
Definition
|
|
Term
| At high flows, flow is a function of density/viscosity and is dependent/independent on atm pressure. |
|
Definition
|
|
Term
| High flow is governed by what law? |
|
Definition
|
|
Term
| Low flow is governed by what law? |
|
Definition
|
|
Term
| At high flows and high altitudes, what will happen to the flow of gas? |
|
Definition
| It will increase, due to the decrease in density of molecules in the air |
|
|
Term
| In a hyperbaric chamber at high flows, the flow will be greater than/less than what is indicated on the meter. |
|
Definition
| less than, due to the increase in density of the gas molecules |
|
|
Term
| In other countries, what side is the flow meter on? |
|
Definition
| The left...but I'm sure that the O2 is still downstream of the other gases to prevent O2 dilution. |
|
|
Term
| Name the 3 possible problems with flow meters. |
|
Definition
1.Inaccuracy
2.Indicator problems
3.Leaks |
|
|
Term
| How could you damage the flow indicator? |
|
Definition
| If you left the flow control valve open to 10L/min and turned the machine off. Someone could turn the machine on and the flow meter would shoot up to greater than 10 L/min and damage the indicator. |
|
|
Term
| How might a leak in the flow meter occur? |
|
Definition
| If the flow control valve is open without a cylinder or with a cylinder plug on hanger yoke. |
|
|
Term
| To turn up the flow with an electric flow meter, what way must you turn the flow control valve? |
|
Definition
| Clockwise (this is opposite of the usual) |
|
|
Term
| When the anesthesia machine is not in use, the gas source should be _____ or _____. The flow control valve should be opened until gas pressure is _______, then closed. |
|
Definition
| closed, disconnected, bled to zero |
|
|
Term
| On the flow meter, the flow control knob is joined to the ______. |
|
Definition
|
|
Term
| The N2O knob is fluted/knurled. |
|
Definition
|
|
Term
| How many flow indicators are there on electronic flow meters? |
|
Definition
| Only one that shows the total gas flow of fresh gas |
|
|
Term
| What is the factory-set range of minimum O2 flow? Will this prevent a hypoxic mixture at low flows? |
|
Definition
|
|
Term
| GE machines link the control valves mechanically/pneumatically to prevent the delivery of O2 of less than what %? |
|
Definition
|
|
Term
| What is the outer and inner diameter for the common gas outlet? What is the purpose of these diameters? |
|
Definition
| 22mm and 15 mm. To prevent accidental disconnection |
|
|
Term
| The common (fresh) gas outlet receives all of the gases and vapors from the machine to the ______, and must have a ______ device. |
|
Definition
| breathing system, retaining |
|
|
Term
| The O2 flush can receive O2 from either the _______ or the __________ and discharges it directly to the _______. |
|
Definition
| pipeline, cylinder pressure regulator, common gas outlet |
|
|
Term
| What is the pressure range of the O2 flush, and in what phase of the respiratory cycle must you use it on a pt? |
|
Definition
| 40-50 psig, during expiration or will cause barotrauma |
|
|
Term
| A complication of using the O2 flush with regard to your gases is________. |
|
Definition
| It will dilute your anesthetic agents. This is mostly a problem with the insoluble gases. |
|
|
Term
| The master or the main power switch activates both the ______ and the ______ power. |
|
Definition
|
|
Term
| In the "off position", what 2 electrical components are active? |
|
Definition
| The battery charger and electrical outlets |
|
|
Term
| Computer-driven machines should be turned off and restarted with a full (self) checkout every _____ hours. |
|
Definition
|
|
Term
| In an emergency, can electronic machines bypass the checkout? |
|
Definition
| Yes, but there's a limit, and is logged for legal purposes. |
|
|
Term
| What could happen if you plug in a bair hugger into the electrical outlet of the anesthesia machine? |
|
Definition
| It could activate the circuit breaker and you may lose all power. ...It's probably a good idea to locate the circuit breakers on every anesthesia machine you work with. |
|
|
Term
Pt breathing system:Ether
Mode =
Reservoir bag = Y/N
Rebreathing = Y/N
Example = |
|
Definition
Pt breathing system: Ether
Mode = Open
Reservoir bag = N
Rebreathing = N
Example = Open drop |
|
|
Term
Pt breathing system: Semi-open mode
Reservoir bag = Y/N
Rebreathing = Y/N
Example = |
|
Definition
Pt breathing system: Semi-open mode
Reservoir bag = Y
Rebreathing = N
Example = Beginning and end of case, high flows, non-rebreathing circuit |
|
|
Term
Pt breathing system: semi-closed
Reservoir bag = Y/N
Rebreathing = Y/N
Example = |
|
Definition
Pt breathing system:Semi-closed mode
Reservoir bag = Y/N
Rebreathing = Y, partial
Example = Maintenance FGF< VE |
|
|
Term
Pt breathing system: closed
Reservoir bag = Y/N
Rebreathing = Y/N
Example = |
|
Definition
Pt breathing system: Closed
Reservoir bag = Y
Rebreathing = Y, complete
Example = Circle with APL closed |
|
|
Term
| This is a high moisture (wet type) of CO2 absorbant. |
|
Definition
|
|
Term
| CO2 absorption uses the principle of a _____ neutralizing an _____. ______ combines with _____ or _____ in soda lime, yeilding _____ and H2O |
|
Definition
| base, acid. H2CO3, NaOH, KOH, carbonate |
|
|
Term
| What is the most abundant element of soda lime and baralyme? |
|
Definition
|
|
Term
| What will happen if the soda lime dries out? |
|
Definition
|
|
Term
| What do Medisorb and Dragersorb 800 Plus both have in common? |
|
Definition
| They are the new CO2 absorbants |
|
|
Term
| Why was the Dragersorb 800 Plus developed? |
|
Definition
| To reduce the production of Compound A from Sevoflurane by eliminating NaOH and KOH |
|
|
Term
| 100 GM of CO2 absorbant can absorb how many L of CO2? |
|
Definition
|
|
Term
| The name of the pH indicator added to CO2 absorbants is _______. If you turn off the machine on Friday, then come back on Monday, the canister may look new again, but then change back to violet within 10 minutes of use. That is "peaking" or "regeneration". Now, describe what can deactivate the pH indicator. |
|
Definition
| Ethyl violet, florescent lights |
|
|
Term
| What is the granular size of the CO2 absorbants? This provides optimal ______ capacity with negligable ______. |
|
Definition
| 4-8 mesh, absorptive, airway resistance |
|
|
Term
| A filled CO2 canister is approximately what % of air? |
|
Definition
|
|
Term
| Trace gas levels are expressed in ppm. What is 100%? 1%? |
|
Definition
|
|
Term
| Trace gas levels depend on ______, OR ______ and anesthetic _________. |
|
Definition
| Fresh gas flow, ventilation system, time |
|
|
Term
| What has been determined about the evidence of harm of trace gas levels? |
|
Definition
| It is suggestive, but not conclusive. However, Dorsch and Dorsch state that it may cause spontaneous abortion and fetal injuries. |
|
|
Term
| The gas collecting assembly consists of what 2 things? |
|
Definition
| Tubes connected to the APL valve and the ventilator relief valve |
|
|
Term
| The gas-collecting assembly collects ____ gas and delivers them to a _______ means. The outlet connection is usually 30 mm, but might also be 19 mm. Note that it is not the same size as the breathing circuit (15 mm and 22 mm) |
|
Definition
| gases, transport means, 30 mm |
|
|
Term
| The _____ collects gas from the gas collecting assembly and delivers the excess gas to the _______. |
|
Definition
| transfer means, scavaging interface |
|
|
Term
| The interface prevents ________ changes from being transmitted to the ______ or the ______. |
|
Definition
| pressure, breathing system, ventilator |
|
|
Term
| Name the 3 basic elements to the scavenging interface |
|
Definition
Positive pressure relief
Negative pressure relief
Reservoir capacity |
|
|
Term
| An open scavenging interface requires a reservoir and _____ piping. |
|
Definition
| vacuum. This is what is found in most modern ORs |
|
|
Term
| A closed scavenging interface requires both a ______ and a _______. |
|
Definition
| positive pressure relief VALVE, negative pressure relief VALVE |
|
|
