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NU 568

Exam 2 - Anesthesia Machine - Lecture 2

What is the color for nitrous for both U.S. and international standards? Blue
How is nitrous stored? liquid form
What is the vapor pressure of N2O at room temperature? 745 psi
Cylinder pressure of N2O is (the same/different) compared to its vapor pressure at room temperature. the same
Why does the cylinder gauge of N2O remain constant at 745 psi until almost all of the liquid is gone? More gas is generated in the cylinder as gas is being used
The cylinder pressure gauge will read 745 psi for N2O until the volume is at what level? 400L
How can you tell whether a nitrous tank is getting empty? Weigh the cylinder
What is the reason that rapid N2O removal from a cylinder will form frost or freeze the cylinder valve? Loss of latent heat of vaporization from the liquid N2O
Touching the frost outside of an N2O cylinder may cause _____________. Frostbite
Compressed air composition is (identical/variable) between samples. variable
Newer AM have backup batteries that will keep the AM running for how long? 30-45min
Where are convenience receptacles located and what do they allow? Back of the AM and allow for monitors and other equipment to be plugged in
What feature protects convenience receptacles? circuit breakers or fuses
What should not be plugged into a convenience receptacle? Electrical devices that generate heat
Give examples of electrically powered devices that generate heat. Air or water warming blankets, IVF warmers
What are two reasons that a heat generating device should not be plugged into the convenience receptacle? 1)more likely to open the circuit breaker 2)circuit breakers are in non-standard locations, making it difficult to reset once open
What are the problems that occur with an open circuit breaker connected to a convenience receptacle? All the devices plugged into the receptacle will lose power, will lose valuable time trying to locate the circuit breaker
What are two important things to consider about convenience receptacles and circuit breakers. Do not plug heat-generating devices into the receptacle and know the location of the circuit breaker that protects the receptacle that is being used
What are 7 devices that do not rely on wall outlet electrical power? 1)spontaneous and manually assisted ventilation 2)mechanical flow meters 3)scavenger system 4)flashlights 5)IV bolus or infusion pumps 6)peripheral nerve stimulators 7)variable bypass vaporizers
What are 5 devices that require electrical power? Mechanical ventilator, physiologic monitors, room and surgical field illuminators, digital flowmeter displays, warming blankets
What is important to know about backup generators? Not completely reliable in the event of a power loss
What were the principle problems for anesthesia machines in a power loss? Loss of room illumination, failure of mechanical ventilators and electronic patient monitoring
Name the 6 anesthesia machines covered in lecture. Drager Apollo, Drager Fabius, Narkomed 6000/6400, GE Aestiva, GE Aisys, GE ADU
What is similar about the path of gases through the AM? Each passes from a supply point to a flowmeter
Which gas does not flow through a fail-safe valve on its way to the flowmeter? Oxygen
What holds the fail-safe valve open? Pressure in the O2 circuitry in the AM
Where are gases first joined together? After passing through flowmeters in the common manifold
Where is oxygen added in the common manifold and why is it added in this area? Downstream so that delivering a hypoxic mixture is less likely
From the common manifold, where do the combined gases go? Any vaporizer that's turned on
After entering the vaporizer, where do gases flow? Common gas outlet
What connects the common gas outlet to the breathing circuit? Delivery hose with a locking connection
Give the pathway of gases in the AM from supply to the delivery hose. Supply point -> fail-safe valve (except O2) -> flowmeter -> common manifold (O2 downstream) -> vaporizer -> commong gas outlet -> delivery hose w/locking connection
What is the destination of gases after the delivery hose? Breathing circuit and ventilator
Identify the remaining path of gases from the breathing circuit and ventilator. Breathing circuit & ventilator -> patient -> scavenger interface -> disposal in hospital ventilation or suction system
Name the 5 tasks/pathways of oxygen in listed order. 1)Proceed to the flowmeter 2)power the flush valve 3)activate fail-safe mechanisms 4)activate the O2 low pressure alarm 5)compress bellows
How many pathways do N2O and air have to the patient after passing their flowmeters. One: flowmeter -> breathing circuit -> patient
What can newer AMs use to drive the bellows in an oxygen pressure loss scenario? Air
What is the 1st task of O2? Proceed to flowmeter and then to patient as life-sustaining gas
In reference to FGF, all current gas machines use ______________ and some have ______________ as well. mechanical needle valves, digital display
FGF control knobs are uniform in color and form. False -- each knob is distinct for visual and tactile terms
What is the classic way to capture and display FGF? Glass tube with indicator float
How are flowtubes shaped? Tapered with narrowing at the bottom
What other name can flowtubes be referred to as? Variable orifice flowmeter (Thorpe tube)
What is standard positioning for the O2 flowmeter in the U.S.? To the right of other gases
What is the most fragile part of an anesthesia machine? flowtubes
A Thorpe Tube is also called a/an _____________. Variable orifice flowmeter
What is unique about the Fabius flowmeters? Vertically arranged
What are the 5 components of the flowmeter? control knob, needle valve, valve stop, flowtube, indicator float
Needle valves are mechanical on all machines except for which two systems? Avance and Aisys (electronic)
Flowtubes are (identical/specific) for each gas and therefore (can/cannot) be interchanged. specific, cannot
What is the indicator float for Drager machines? Rotating ball
What is the indicator float for GE machines? Plumb bob
See Slide 33 for the flowtube diagram
What is an older term for "flowmeter" or "flowtube"? Thorpe Tube (variable orifice)
What are three ways to decrease the chance of fire in sedated patients undergoing head and neck surgery? decrease FiO2, scavenge the O2, tent the drapes
Which law governs flow through a tube? Poiseuille's Law
Gas flow a flowmeter is governed by what characteristic at low flow? High flow? Low flow=viscosity, High flow=density
According to Poiseuille's Law, what has the most dramatic on flow in a tube? Radius
According to Poiseuille's Law, flow through a tube is proportional to what power of the tube's radius? Flow is proportional to the 4th power of the radius
How much does flow increase when the diameter is doubled? 16x
How much does flow increase when the diameter is tripled? 81x
What are the first 5 steps in the care of flowmeters? 1)turn off the flowmeter before the machine is turned on 2)never adjust the flowmeter without looking at it 3)ball-type indicators are read in the center 4)plumb-bob indicators are read at the top 5)don't leave flowmeters on
Why should flowmeters be turned off prior to turning on the AM? If open, the float will shoot to the top of the flowtube and may cause damage
What are 4 problems that can arise from leaving flowmeters on after a case ends? Premature drying of CO2 absorbers, increase degradation of VAA, CO generation in canisters, canister fires
What types of machines use auxiliary oxygen flowmeters? All anesthesia machines
What are three benefits of the auxiliary O2 flowmeter? Delivers supplemental O2 while leaving breathing circuit and delivery hose intact, instantaneous switch from NC to circle system, readily available O2 source for the Ambu bag for manual ventilations
What are two drawbacks to the auxiliary O2 flowmeter? Depends solely on pipeline supply, FiO2 cannot be adjusted (fire hazard in head/neck surgeries)
What is the supply source for auxiliary O2 flowmeters? Pipeline supply
Besides mechanical and auxiliary flowmeters, what are 2 other locations of flowmeters? common gas outlet, scavenging system
What is the purpose of the common gas outlet flowmeter? Serves as a backup on machines with electronic capture and display of FGF on computer screens
What is the purpose of scavenging system flowmeters? Indicates that suction is adequate so exposure to anesthetic waste gases is avoided
What is the 2nd task of oxygen? supply the O2 flush valve
What is the purpose O2 flush valve? At what rate does it achieve this? Quick fill of the breathing circuit w/O2; 35-75L/min
What are drawbacks of the O2 flush valve? barotrauma if used on inspiration, dilution of other gases b/c it bypasses the vaporizer
If flushing is necessary for filling bellows, in what phase of respiration should it be activated? Expiration and with caution and in short bursts
Normal delivery of O2 to the AM is _________ L/min. 50
Where does the O2 flush valve insert O2? Directly into the common gas outlet (after the vaporizer and just prior to the breathing circuit)
What is the 3rd task of oxygen? activation of the fail-safe system
A hypoxic mixture of gas is a mixture that delivers less than ____________ % O2. 21
Fail-safe valves work like __________. Gates
What are two types of fail-safe valves? Gate-like and proportional
Which machines use gate-like fail-safe valves? Avance, Fabius
Which machines use proportioning systems as fail-safe measures? Aestiva, AISYS, ADU
What is the drawback to the fail-safe system? Does not analyze the gas content, only pressure (cross-connect error could still allow for a hypoxic delivery of gas)
Most machines have fail-safe devices placed on which gas line? N2O
True/False: It is possible to deliver a hypoxic mixture of air. False
What is the 4th task of O2? activate low pressure alarm
What does activation of the low pressure alarm signify? pressure loss in the oxygen circuitry
What is the difference between older and newer O2 pressure loss alarms? older machines utilized a whistle that would go off with low pressure or when turning off the AM; new models use a variety of visual and auditory alarms
What is the 5th task of O2? power the bellows (ventilator driving gas)
Which AM manufacturer uses O2 to drive its bellows? GE
Which AM manufacturer used oxygen to drive a Venturi device in older models? Drager
How was the driving gas augmented with the Venturi device in older Drager models? Augmented with entrained room air
Give the location where entrained air enters and augments driving gas for the bellows? Which machine was this found on? RA enters through a chrome or steel cylindrical muffler. Found on the back of some Narkomed AM
Which AM models utilize piston ventilators run by electric motors? Narkomed 6000/6400, Fabius, Apollo
Which AM is capable of driving the bellows with air or O2? ADU
What types of machines incorporate a hypoxic guard? All current AMs.
The hypoxic guard could also be referred to as a _______________. Proportioning system
What is the function of a proportioning system? Prevent the delivery of a hypoxic mixture of N2O and O2.
The delivery of N2O:O2 never exceeds what ratio? 3:1
Proportioning systems gaurantee an FiO2 of at least ____________ % 25% (+/- 4)
Which model AM utilizes a mechanical proportioning system? Aestiva, Aespire
Describe the proportioning system of the GE Ohmeda. Flowmeter control knobs are linked by a chain so that N2O:O2 ratio remains at a safe constant
Name the Make and model of the link system for proportioning N2O and O2. Datex Ohmeda Link 25
What is the name of the electronic hypoxic guard system? Sensitive Oxygen Ratio Control (S-ORC)
At what % does the S-ORC maintain FiO2 above and how is this achieved? Maintained at least 23% by limiting N2O supply
Name the AMs that use an S-ORC system for proportioning. Narkomed 6000, Apollo, Fabius
What are the 4 circumstances under which a hypoxic guard system can permit a hypoxic delivery of gases? wrong supply gas in pipeline or cylinder, defective pneumatics/mechanics, leaks downstream of flow control valves, inert gas administration (i.e. helium as a 3rd gas)
Of the 4 ways a hypoxic guard can fail, which reason is the most harmful and why? administration of a 3rd gas b/c hypoxic guards link only N2O and O2 and does not account for any extra driving gases
To prevent a hypoxic delivery, proper use of what device in each general anesthetic is of vital importance? O2 analyzer
Name 3 different types of vaporizers. Variable, measured, Tec 6
How does the variable flow vaporizer work? Increasing the vaporizer dial allows more fresh gas into the vaporizer
How does the measured flow vaporizer work? Operator determines how much gas is bubbled through the anesthetic liquid by a formula
After calculating the amount of gas to be bubbled into anesthetic liquid, what does the operator set? Operator sets the amount of calculated gas on a second O2 flowmeter marked "Oxygen for Vernitrol"
What type of vaporizer is no longer manufactured in the U.S.? Measured-flow vaporizer
What does the Tec 6 injector utilize in its process? Heated, dual-circuit vaporizer
In a Tec 6 vaporizer, the fresh gas (does/does not) come in contact with the vaporizer liquid. Does not
Which vaporizer system utilizes a heating system and separates the fresh gas flow from the liquid anesthetic agent? Tec 6
The first circuit in the Tec 6 consists of the _____________. The second circuit in the Tec 6 consists of the __________. Fresh gas; anesthetic agent
How many control points does the second circuit in a Tec 6 have? How are these control points controlled 2; controlled by the operator to set concentration, controlled by the amount of FGF
To what temperature does the Tec 6 heat the second circuit? 39 degrees celsius
When using desflurane, heating the second circuit to 39 deg C creates a vapor pressure of __________ mmHg. _________ kPa 1500mmHg; 200kPa
Why does desflurane need a specialized vaporizer? Its near boiling vapor pressure at room temperature would result in a hypoxic breathing mixture
True/False: Variable-bypass and Tec 6 vaporizers are filled in (different/similar) ways. similar
What are the methods by which variable-bypass and Tec 6 vaporizers are filled? funnel-type and keyed-filler type
Which method of filling vaporizers is preferred and why is it preferred? Keyed-filler b/c they decrease the chances of filling with the wrong agent
Which vaporizer allows for filling while in operation and which gas does operate with? Tec 6; desflurane
True/False: All variable-bypass vaporizers must be turned off while being filled. True
What do standards require in relation to filling vaporizers? Overfilling be prevented in normal operating position; liquid level indicators be visible to the operator
What can occur with overfilling? discharge of liquid anesthetic from the vaporizer outlet
How is the flow of gases to and from the patient controlled and monitored? Through the breathing circuits
What are the functions of the breathing circuit? Deliver anesthetic gas, deliver oxygen, eliminate CO2
How is CO2 eliminated from the breathing circuit? Washout with adequate FGF or absorption in soda lime
Give two reasons why resistance to airflow should be minimized. Resistance is uncomfortable for the conscious patient; unconscious patient may hypoventilate
What are 5 methods to decrease resistance of gas flow in the AM. reduce circuit length, increase circuit diameter, avoid using sharp bends, eliminate valves, maintain laminar flow
Which creates more resistance to breathing, the AM or the ETT? ETT
T/F: Rebreathing of exhaled gases occurs in both anesthesia and ICU type ventilators. False -- it is unique to anesthesia
What are the purposes of using a rebreathing system in anesthesia? cost reduction, tracheal warmth and humidity, decrease staff exposure to trace and waste gases
T/F: Rebreathing exhaled O2 has no ill effects. True
How does rebreathing exhaled nitrogen affect induction? Slows induction
How does increasing mechanical dead space affect rebreathing? Rebreathing of CO2 is more likely (leading to respiratory acidosis)
Why are are dry gases used in the AM? Avoids internal corrosion and bacterial colonization
Why is active humidification less common? Less effective at preventing hypothermia than heated-air warming blankets, added moisture can clog gas-analysis lines and soda lime granules, can obstruct unidirectional valves
What are the two gases used to compress mechanical bellows? air, O2
Besides driving gases, what other gases are present in mechanical bellows? gases inspired and expired by the patient
What device prevents the potential buildup of volume and pressure in the breathing circuit from the constant influx of FGF? ventilator relief valve
What are other names for the ventilator relief valve? spill or overflow valve
What is the position of the ventilator relief valve on inspiration and what does this do? closed - prevents release of gas from bellows to the scavenger system until bellows are compressed
What is the position of the ventilator relief valve on expiration? opened - opens to scaving system
Most modern ventilators are classified under what 4 categories? Multimode, double circuit, electronically controlled, volume and pressure limited
Observation of bellows during ___________ identifies it as ascending or descending. expiration
Why are ascending bellows safer? Will not fill in the event of a disconnect and will remain flat
What are the disadvantages of descending bellows? May not immediately detect a disconnect (may fill with RA in a disconnect), bellows sometimes reach below the writing surface of the AM, may gather water
Inspiration in the AM is (mechanical/passive). Mechanical
Identify the 7 different types of ventilator alarms. high press, press below threshold 15-30sec, continuing high press, subatmospheric press, low TV or MV, high RR, reverse flow
What does a reverse flow alarm indicate? Incompetence of expiratory unidirectional valve in the breathing circuit >> moisture in the system may prevent valves from opening and closing
What are the 4 different modes of ventilation? Controlled mandatory (CMV, VCV), pressure controlled (PCV), synchronized intermittent mandatory (SIMV), manual-spontaneous
Which mode of ventilation do all AM offer? VCV
Volume and gas are delivered at (variable/constant) flows in VCV mode. constant
When is inspiration determined in VCV mode? When the desired TV is delivered or an excess of pressure is reached
How is PIP controlled in VCV mode? patient's lung compliance
How is EtCO2 controlled in VCV mode? RR and TV
What are typical settings for VCV mode? TV 10cc/kg, RR 6-12, PEEP 0, I:E 1:2
What does PSV require of the patient? Spontaneous breathing
What is the difference b/w PCV and PSV? RR is set to 0 in PSV
When is PSV used? End of surgery during emergence and with spontaneous breathing
Breathing is assisted in PSV mode with a present _______________ pressure. inspiratory
What is the default assisted pressure in PSV for the ADU? 12 cmH20
In PCV mode, what which is variable and which is controlled for both volume and pressure? Volume is variable, pressure is controlled
What causes changes in inspiratory volume? changes in compliance and airway resistance
How does pressure get delivered to the patient in PCV mode? High flow at first to reach target pressure, then lower flows to maintain that pressure throughout inspiration
In what two scenarios will TV drop in PCV mode? pulmonary compliance drops (pneumperitoneum) or airway resistance increases (bronchospasm, kinked ETT)
How is the target pressure determined in PCV mode? adjusted based on the desired TV
What are indications for PCV mode? pt's where high PIP is dangerous, pt's who need higher TV over what VCV can deliver, leaks around the breathing tube, one-lung ventilation
What are typical settings for PCV? Pressure limit 20 cm H20, RR 6-12, PEEP 0, I:E 1:2
How is SIMV similar to VCV? How is it different? Similarity=it is volume-controlled ventilation, Difference=intermittent breaths are delivered synchronously and triggered with spontaneous efforts
Besides volume and rate, what other variable set by the operator in SIMV? Trigger window percent and sensitivity
What does the trigger window control? Amount of time, or percentage, during each expiratory cycle that the ventilator is sensitive to negative pressure generated by the patient's diaphragm
What does sensitivity in SIMV mode control? How much negative pressure the patient needs to produce to trigger a breath
How do newer machines operate the bellows? Electronically with pistons
What are the advantages of piston driven bellows? Quiet, no autopeep, accurate TV, does not require O2 cylinder supply in the event of O2 pipeline failure, patient will not receive extra gas that drives bellows
What are three machines that utilize piston driven bellows? Fabius, Apollo, Narkomed 6000/6400
What are 3 reasons why TV is more precise with piston bellows? compliance and leak compensation, fresh gas decoupling, rigid piston design
What are the disadvantages of piston driven ventilators? familiar visual behavior of the standing bellows is lost during disconnection or with spontaneous breathing, less audible cycle, does not easily accomodate NRB circuits
What are the disadvantages of the older gas driven ventilators? Set TV changes with increases in FGF, 1/3 of FGF is inspiration,
What are 3 ways that PEEP can be added? add-on adapters, devices built into the system, electronically
What is the safest way to add PEEP? electronically
Where are PEEP adapter add-ons situated in the AM? between the expiratory limb of the circuit and expiratory unidirectional valve
What can occur if a PEEP adapter is placed on the inspiratory limb of the breathing circuit? Obstruction
How does a fresh gas decoupling system works? Fresh gas is diverted by a decoupling valve to the manual breathing bag, and is thus not added to the delivered tidal volume
What device closes the decoupling (one-way) valve? the piston
The FGF decoupling system diverts FGF from the patient to the manual breathing bag on (inspiration/expiration). inspiration
Give two examples of the unusual visual appearance of fresh gas decoupling systems. breathing bag inflates with each breath, even with mechanical ventilation (normally quiescent in mechanical mode); moves opposite the bellows (inflates w/inspiration)
Which AMs use a fresh gas decoupling system? Apollo, Fabius, Narkomed 6000
Besides decoupling, how else can delivered TV account for FGF? fresh gas compensation
How does fresh gas compensation work? Volume and flow sensors provide feedback so the ventilator can adjust the delivered TV to match the set TV, in spite of changes in FGF
Which machines utilize fresh gas compensation? Aestiva, Aisys, ADU
How much waste gas must be eliminated per minute? An amount equal to the delivered gas per minute
What does the scavenging system do? Collects waste anesthetic gases from the breathing circuit and ventilator and removes them from the OR
What determines the amount of scavenged gas? FGF
What are the 5 components of the scavenging system? Gas collection assembly, transfer tubing, scavenging interface, gas disposal tubing, gas disposal assembly
What organization sets standards for exposure to waste anesthetic gases? Occupational Safety and Health Administration (OSHA)
Where is the gas collection assembly located in the scavenging system? At the APL and ventilator relief valve
What is the length of transfer tubing and how is it coded in the scavenging system? 19mm and 30mm; sometimes color coded yellow
Scavenging systems are either ________ or ______ while the scavenging interface is either _________ or _______. Active, passive, closed, open
What 2 things does an active scavenging system require? Suction apparatus, both positive and negative pressure relief valves
How does a passive scavenging system work? Waste gases proceed passively down corrugated tubing through the room ventilation exhaust grill of the OR
How does the anesthetist know that the suction apparatus in an active scavenging system is attached to the scavenging interface? Distinct "whoosh" sound means suction is attached
Older AMs utilize a/an (closed/open) scavenging interface. closed
How does a closed interface scavenging system communicate with the atmosphere? Only through valves
What does a closed interface scavenging system require in order to work with a passive system? positive pressure relief
What does a closed interface scavenging system require in order to work with an active system? both positive and negative pressure relief valves
What is the most important component of the scavenger system and why? The interface b/c it protects the patient from excessive buildup of positive pressure and from exposure to suction
What device is mandatory for all closed scavenging systems? means for relief of positive pressure
When do positive pressure relief valves operate and where do they transmit anesthetic waste gases? operate before the pressure buildup in the scavenging system is transmitted to the breathing circuit and lungs; releases waste gases into the operating room air
Newer AM utilize a/an (open/closed) scavenger interface. open
If it is utilized, why does suction need to be adjusted in a closed scavenging system? should be adjusted with changes in FGF so that the scavenger reservoir bag is neither flat nor overdistended
What does the open scavenging system lack that is present in closed systems? valves
What safety features are built into the open scavenging interface? both negative and positive pressure relief
In the open scavenging interface, where does each patient exhalation lead to? bottom of the open interface reservoir, where a second tube tube withdraws it by suction before the next exhalation
What is critical for the open scavenging interface to function properly? appropriate suction
What is the difference between the hissing sounds heard in the closed and open scavenging interfaces? soft intermittent hiss heard in closed means gas is leaking into the room through the positive press relief valve; open interface should hiss continuously when properly adjusted
Open interfaces should only be used with (active/passive) systems. active
Why is an open interface safer for patients? no chance of relief valve failure, which can cause barotrauma or suction to the breathing circuit
What is the threshold for smelling volatile agents? 5-300 ppm
T/F: It is ok per OSHA standards for minimal amounts of volatile gas to be smelled. F - any agent that is smelled indicates excessive concentration
OSHA dictates that exposure to halogenated agents should not exceed _______ ppm or ______ ppm if used with nitrous oxide. 2, 0.5
OSHA dictates that exposure to nitrous oxide should not exceed ________ ppm. 25 - based on a time weight of 8hrs
What do all open interface scavenging systems require? Reservoir
Which interface is less safe for caregivers? open - if used improperly
When is a closed interface useful? where passive scavenging is used (no dedicated suction line for the scavenger, and waste gases flow passively along with room ventilation exhaust)
What are 3 hazards of the scavenger system? obstruction distal to the interface (barotrauma or excessive negative pressure), occupational exposure, barotrauma w/inability to ventilate
What should the operator do if there as an obstruction distal to the scavenging interface? disconnect the gas collection from the back of the APL valve or turn off suction
What are the levels of anesthetic gases around unscavenged anesthetic locations? 85 ppm of halogenated agent, 7000 ppm of N2O
The health effects of chronic exposure to volatile agents is (proven/unproven). unproven
The strongest relationship of harm from exposure to gaseous agents is between _________ and __________. N2O, reproductive difficulties
T/F: The scavening system does not have to be included in the anesthesia checklist. False
Name the first 5 techniques to decrease exposure to anesthetic gases. good mask fit, avoid unscavengeable techniques (i.e. open drop, insufflation), prevent flow from the breathing circuit into RA, turn on the agent only when the mask is in use, wash out anesthetics into the scavenging system at the end of a case
Name the last 4 techniques to decrease exposure to anesthetic gases. Used a cuffed ETT whenever possible, check for machine leaks, TIVA, avoid nitrous
What is the 1st step in the AM checklist? Verify backup ventilation equipment is available and functioning
What is the 2nd step in the AM checklist and how is it performed? check O2 cylinder supply: verify at least half full (1000 psi) and close the cylinder
Identify and describe the 3rd step in the AM checklist. Check pipeline supply: check that hoses are connected and gauges read 50 psi
Identify and describe the 4th step in the AM checklist. Check initial status of low pressure system: close flow control valves and turn off vaporizers, check fill level and tighten vaporizer filler caps
What is the 5th step in the AM machine checklist? Perform leak check of low pressure system
What are the first steps in performing a leak check of low pressure systems? a)verify that the master switch and flow control valves are off b)attach "suction bulb" to the common gas outlet c)squeeze the bulb repeatedly until fully collapsed
What are the last three steps in performing a leak check of low pressure systems? d)verify the bulb stays fully collapsed for at least 10sec e)open one vaporizer at a time and repeat steps "c" and "d" f)remove the suction bulb and reconnect the fresh gas hose
What is the 6th step in the AM checklist? Turn on the AM master switch and all other necessary electrical equipment
What is the 7th step in the AM checklist? Test flowmeters
What are the two steps in testing a flowmeter? a)adjust flow of gases through their full range and check for smooth operation of floats and undamaged flow tubes b)attempt to create a hypoxic N2O/O2 mix and verify correct changes in flow and/or alarm
What is the 8th step of the anesthesia machine check? Adjust and check scavenging system
What are the first 3 steps in checking the scavenging system? a)ensure proper connections between the scavenging system and both APL (popoff) and ventilator relief valves b)adjust waste gas vacuum (if possible) c)fully open APL valve and occlude Y-piece
What is the 4th step in checking the scavenging system? d)with minimum O2 flow, allow scavenger reservoir bag to collapse completely and verify that absorber pressure gauge reads ~0
What is the 5th and final step in checking the scavenger system? e)with the O2 flush activated, allow the scavenger reservoir to fully distend, then verifyt hat absorber pressure gauge reads <10 cm H2O
What does the 9th step in the AM check calibrate? O2 monitor
What are the steps involved with calibrating the O2 monitor? 1)ensure monitor reads 21% in RA 2)verify low O2 alarm is enabled and functioning 3)reinstall sensor in circuit and flush breathing system w/O2 4)verify that monitor now reads >90%
What is the 10th step in the AM checklist? Check initial status of breathing system
What are the 4 steps involved with checking the initial status of the breathing system? a)set selector switch to "bag" mode b)check that breathing circuit is complete, undamaged, unobstructed c)verify adequacy of CO2 absorbers d)install breathing circuit accessories
What are different types of breathing circuit accessories? humidifier, PEEP valve
What is the 11th step in the AM checklist? Perform leak check of the breathing system
What are the first three steps to check for leaks in the breathing system? a)set all gas flows to zero (or minimum) b)close the APL valve and occlude the Y-piece c)pressurize the breathing system to about 30 cmH20 with the O2 flush valve
What are the last two steps to check for leaks in the breathing systems? d)ensure that pressure remains fixed for at least 10sec e)open APL valve and ensure pressure decreases
What is the 12th test in the AM check? Test ventilation system and unidirectional valves
What are the first 3 steps in checking the ventilation system and unidirectional valves? a)place a 2nd breathing bag on the Y-piece b)set appropriate ventilator parameters for the next patient 3)switch to automatic, or Ventilator, mode
What are the next 3 steps in checking the ventilation system and unidirectional valves? 4)fill bellows and breathing bag with O2 flush then turn ventilator on 5)set O2 flow to minimum, other gas flows to zero 6)verify that during inspiration, bellows delivers appropriate TV and that bellows completely fill on expiration
What are the 7th, 8th, and 9th steps for checking the ventilation system and unidirectional valves? 7)set FGF to 5L/min 8)verify that bellows and simulated lungs fill and empty appropriately w/o sustained end-expiratory pressure 9)check for proper action of unidirectional valves
What are the 10th and 11th steps to check the ventilation system and unidirectional valves? 10)exercise breathing circuit accessories to ensure proper function 11)turn ventilator OFF and switch to manual ventilations (bag/APL) mode
What are the 12th and 13th steps to check the ventilation system and unidirectional valves? 12)ventilate manually and assure inflation and deflation of artificial lungs and appropriate feel of system resistance and compliance 13)remove 2nd breathing bag from Y-piece
What is the 13th step in the AM check? Check, calibrate, and set alarm limits of monitors
What are the different types of monitors that need to be checked? capnometer, pulse oximeter, O2 analyzer, respiratory volume (spirometer), pressure monitor w/high and low airway alarms
Identify the last step (14th) of the AM check and describe the 6 different parts. Check final status of AM: 1)vaporizers off 2)AFL valve open 3)selector switch to "Bag" 4)all flowmeters to zero 5)Patient suction adequate 6)Breathing system ready to use
T/F: The complete 14 step anesthesia machine check needs to be performed after every case. False - can be abbreviated if the same machine is used in successive cases
What does the first step in the AM check look for? Emergency ventilation equipment
What do the 2nd and 3rd steps in the AM check test? High pressure system components
What do the 4th-7th steps in the AM check test? Low pressure system components
What does the 8th step in the AM check? Scavenging system
What do the 9th-11th steps in the AM check? Breathing system
What does the 12th step in the AM check test? The manual and automatic ventilation systems
What does the 13th step in the AM check test? Monitors
What does the 14th step in the AM check test? Final status of the machine
Created by: philip.truong
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