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principals test 1

anesthesia machine

capnography provides information about co2 production pulmonary perfusion alveolar ventilation respiratory patterns and elimination of co2 from the circuit and ventilator
capnography has been shown to be effective in the early detection of adverse respiratory events, malposition of ET tubes circulatory failure and defective breathing systems
capnography capnography and pulse oximetry together could have helped in the prevention of 93% of avoidable anesthisia mishaps according to closed ASA claim studies
capnography ASA has adopted the use of capnography as a standard of care for patients undergoing a general anesthetic
capnography ETCO2 is the best method to confirm correct placement of the ETT
capnography severe hypotension will cause and increase in co2
capnography the cold standard for ETT placement is ETCO2
capnography there is continuous sampling from the patients airway to the analyzer
what are the three pressure systems within the machine high intermediate and low pressure systems
the high pressure system parts which recieve gas at cylinder pressure- hanger yoke (including filter and unidirectional valve) yoke block (with check valves) cylinder pressure guage cylinder pressure regulators
intermediate pressure system recieves gases at low, relatively constant pressures (37-55psi=pipeline pressure
intermediate system pipeline inlets and pressure guages, ventilator power inlet, o2 pressure failure device (fail safe) and alarm, flowmeter valves, o2 second stage regulator, o2 flush valve
o2 pressure failure device a failsafe valve is controlled by o2 pressure it shuts off or proportionally decreases and or interrupts the supply of nitrous oxide or air if the o2 supply pressure decreases below 12-30psi sensor is placed inline between the n2o supply and flowmeter
omeda vs drager fail safe systems ohmeda- all or nothing principle, when o2 supply pressure falls below 20-25 psi flow of all other gases to their flowmeters is interrupted
drager called an o2 failure protection device OFPD as o2 supply pressure falls OFPD proportionately reduces the supply pressure of all other gases. if the o2 pressure fails completely the nitrous flow
vaporizer interlocking system safety mechanism which allows only one vapor at a time to be open
TEC 6 vaporizer desflurane, this vaporizer differs from the others in that it actively heats (39 degrees and pressurizes the liquid agent. the vaporizer is a gas/vapor blender rather than variable bypass heat produces vapor which is injected into the fresh gas flow
tec 6 vaporizer desfluranes vapor pressure in 680 torr at room temperature which is close to atmospheric pressure. there ar electronic alarms for low agent no agent output and low battery
what is the purpose of anesthesia breathing systems to deliver anesthetic gases and o2, offer a means to deliver anesthesia without significant increase in airway resistance, to offer a convenient and sage method of delivering inhaled anesthetic agents
anesthesia breathing systems basic principles- all anesth breathing systems have 2 fundamental purposes 1- delivery of o2 /anesthetic gases 2 elimination of co2 all breathing circuits create some degree of resistance to flow
clasifications of anesthesia breathing systems open, semiopen, closed, semi closed
open breathing systems no reservour, no rebreathing no neutralization of co2, no unidirectional valves, examples include: nasal cannula, open drop ether, exhaled gases are released into atmosphere
semi open systems gas reservour bag present, no rebreathing, no neutralization of co2, no unidirectional valves,fresh gas flow needed exceeds minute ventilation(2-3 times minute ventilatio to prevent rebreathing) min FGF 5Lmin examples mapleson A B C D bain, jackson rees
non rebreathing circuits all NRBs circuits lack unidirectional valves (insp and exp) soda lime co2 absorption, amount of rebreathing is highly dependent on FGF, work of breathing is low (no unidirectional valves or soda lime granules to create resistance
Anesthesia breathing systems are classified on location of the fresh gas inlet and the APL valve and the present or absence of a reservoir bag
required fresh gas flow mapleson A and E 3 times the minute ventilation mapleson B,C,D,and F are 2 times the minute ventilation, mapleson E used for spontaneous resp only, bain (version of maple D 200-300cc/kg/min for spon 70cc/kg/min for controlled
what are the end products of co2 absorbents heat, water and carbonate
when does the low pressure alarm go off when pressure in the breathing system fails to exceed a certain level
what is happening if the low pressure alarm signifywhat is happening disconnects, major air leaks, leaking tracheal cuff, failure of ventilator to cycle
what does a high pressure alarm detect airway obstructions like larengospasm, decreased lung compliance such as bronchospasms, kinked or occluded ETT, patient coughing against ETT occlusion of expiratory limb
what causes a sub-ambient alarm detect patient attempting to inhale against an empty reservoir bag, blocked inspiratory limb, malfunctioning of an active scavenging system, NG tube placed in the trachea
what is the best way to oxygenate your patient fresh gas flow 8-10 liters, APL valve open, tight mask fit and observe a good co2 vaveform, dont rush the process 3-5 min of ventilation is good
breathing pressure wave forms should (see page 18 for graph) the horizontal dotted line represents the threshold pressure alarm limit, if the breathing pressure remains below the threshold pressure limit for greater thatn 15 sec alarm will sound, the pressure alarm limit should be close to pts PIP w/o exceeding it
which devices do not rely on wall outlet electrip power manual assisted ventilation, mechanical flowmeters, scavenging, variable bypass vaporizers
devices that require wall outlet power mechanical ventilators, elictronic monitors, digital flowmeters, gas/vapor blender vaporizers (desflurane)
what are the minimum machine check requirements in an emergency high pressure test of the breathing circuit, check suction, observe/palpate breathing bag during preoxygenation
who are the regulatory agencies for medical gas cylinders FDA, DOT, OSHA, NFPA
Created by: lmcatee36