-
What equipment is needed to use the anesthesia machine?
- endotracheal tubes
- stylets
- IV catheter
- administration set
- IV fluid bag
- KY jelly
- lidocaine spray
- ophthalmic ointment
- face mask
- inhalation anesthesia machine
- emergency drugs
- monitoring equipment
- scavenger system
-
What is the goal of anesthesia?
to deliver a precise amount of anesthetic vapor and O2 to patient
-
Why do we use the anesthesia machine?
increases safety and convenience of inhalation anesthesia
-
What type of volatile inhalation anesthetic gases do we use?
- halothane
- isoflurane
- sevoflurane
- methoxyflurane
-
What are carrier gases?
volatile anesthetic gas is mixed with carrier gas for delivery?
-
What carrier gases do we use?
- oxygen
- oxygen + nitrous oxide
-
What is the function of the anesthesia machine?
- deliver oxygen
- vaporize anesthetic
- mix anesthesic with oxygen
- deliver mixture to patient
- remove exhaled gases
-
How is inhalation anesthetic supplied?
as a liquid
-
Vaporize anesthetic must be _____.
evaporated
-
Vaporize anesthetic must be delivered at a specific _____.
concentration
-
How is exhaled gas removed?
through the scavenger system and may recirculate to patient after removing CO2
-
Should oxygen be continuously supplied to the patient?
yes
-
What color tank is the oxygen tank?
- green in USA
- white everywhere else
-
What is the O2 pressure gauge?
direct relationship between amount of O2 in tank and it's pressure
-
Where is the O2 pressure gauge located?
near top of tank
-
What will the O2 pressure gauge say if it is a full tank?
2000 psi
-
What will the O2 pressure gauge say if the tank is half full?
1000 psi
-
What will the O2 pressure gauge say if the tank is considered empty?
100 psi
-
What is the atm pressure?
15 psi
-
What are the cautions about oxygen?
- oxygen supports combustion
- keep away from flames
- no smoking or sparks near equipment
-
What color are N2O tanks?
blue
-
What does the N2O pressure gauge say if it is full?
770 psi
-
What is N2O?
a combination of liquid and gas at a certain pressure (770 psi)
-
When does the N2O pressure drop?
when the tank is almost empty
-
When is the N2O tank considered empty?
500 psi
-
What can happen to the patient as a result of N2O not used correctly?
asphyxiation
-
How do you keep track of the N2O pressure?
weigh the tank
-
What size tank is the little size?
E
-
What size tank is the bigger sizes?
G, H, M
-
How do you open the tank valve?
turn counterclockwise
-
How do you close the tank?
turn clockwise
-
What does the pressure gauge read on the tank when it is turned off?
zero
-
How do you evacuate the pressure in the tank?
- turn off tank
- leave flowmeter on until it reads zero
- then turn off flowmeter
- OR
- turn off tank
- push the oxygen flush valve until pressure is gone
-
What are the different attachments for the tank?
- gas line (for free standing tanks)
- yoke (for small tanks attached directly to the machine)
- safety systems
-
What is the purpose of the safety system on the tanks?
prevents the wrong tank from being attached
-
What are the different safety systems for the tanks?
- pin-index saftey system (for yokes)
- special outlets (for gas lines)
- color coding
-
What is the pressure regulator valve?
- on O2 and N2O tanks
- reduces pressure down to 50 psi
- prevents damage ot patient and machine
-
Are there separate flowmeters for oxygen and nitrous oxide?
yes
-
What must be turned on in order for O2 to be delievered to the patient?
O2 tank and flowmeter
-
What is the flowmeter?
allows rate of gas flow to be set
-
How is the flowmeter set?
- rate is set according to patient's size and need
- expressed in L/min
-
What does the flowmeter look like?
graduated narrow glass tube with loose ball inside
-
How do you turn the flowmeter on?
turn dial to the left
-
Where do you read the flowmeter?
at the center of the ball
-
Gas enters the flowmeter at the _____ at _____.
-
Gas leave the flowmeter at the _____ at _____.
-
How can the flowmeter be damaged?
- not handling carefully
- over tightening the dial
- not turning it off after use
-
What is fresh gas?
gas that has not been exhaled from the patient and which is not mixed with gas exhaled from the patient
-
What does the fresh gas include?
- O2
- N2O (if being used)
- anesthetic vapor if using VOC
-
Where is the fresh gas inlet?
where the fresh gas enters the patient breathing circuit
-
What is another name for the patient breating circuit?
patient ciruit or anesthetic circuit
-
What does the patient circuit include?
- one way flutter valves
- breathing hoses
- CO2 absorber
- pop-off valve
- reservoir bag
-
What is the reservoir bag?
- rebreathing bag
- adjusts to the changing gas volume within the breathing circuit
-
When a patient inhales what happens to the reservoir bag?
deflates
-
When a patient exhales what happens to the reservoir bag?
inflates
-
What goes in the reservoir bag?
fresh gas
-
What happens when the reservoir bag is too small?
- not enough gas is available and patient can not breathe easily
- bag can fill up too fast
-
What happens when the reservoir bag is too large?
difficult to monitor the bag - there is little volume change between inspiration and expiration
-
What are the functions of the reservoir bag?
- easier for patient to breath from bag than from gas flow in tube
- allows observation of rate, depth, and rhythm of respiration
- movement of bag from breathing confirms placement of endotracheal tube into trachea
- allows the anethetist to "bag" the patient's lungs
-
What are the advantages of bagging the patient?
- helps prevent atelectasis (no exchange through collapsed alveoli)
- flushes airways and alveoli with fresh air
- can ventilate patient who can't breathe on his own
- life-saving
-
How full should the bag be?
about 1/2 - 3/4 full
-
How do fill the reservoir bag just right?
adjust flowmeter, pop-off valve, and scavenger
-
Should we use the oxygen flush to keep refilling the bag? Why or why not?
- no
- delivers 100% oxygen and no anesthetic
- dilutes - patient lightens
-
Whats another name for the one-way valve?
flutter valve or unidirectional valve
-
What is the purpose of one-way valves?
allows orderly circulation
-
What is the inhalation valve?
allows gas flow towards patient in the inspiratory or inhalation breathing tube
-
What is the exhalation valve?
allows gas flow away from patient in the expiratory or exhalation breathing tube
-
What is the importance of one-way valves?
forces exhaled gas to pass through CO2 absorber for the most efficient delivery
-
What is the purpose of the y-piece?
attaches together the inhalation and exhalation tubes
-
What is the purpose of the oxygen flush valve?
allows O2 to bypass flowmeter and vaporizer to deliver 100% O2 into breathign circuit
-
When can the O2 flush valve be good?
when the patient is too deep because it dilutes the anesthetic gas
-
When can the O2 flush valve be bad?
when the patient is too light because it dilute the anesthetic gas
-
What is the purpose of the pop-off valve?
- prevents pressure from building up in patient breathing circuit
- controls patient ventilation (able to bag the patient)
- can keep fully or partly open during most anesthetic procedures
-
When is the pop-off valve fully closed?
- when bagging the patient
- when using closed or total rebreathing system
-
What is the scavenger system?
- removal of waste gases
- can either be physically removed from building or can pass through an activated charcoal cartridge
-
How is the waste gas physically removed from the building using the scavenger system?
- active suction: fan or pump
- passive: pressure or gravity
-
What does the carbon dioxide absorber canister contain?
soda lime
-
What is the purpose of the carbon dioxide absorber canister?
remove exhaled CO2 from breathing circuit and prevents acidosis
-
What is the active ingredient in the soda lime or barium hydroxide granules?
calcium hydroxide
-
What chemical reaction takes place in the carbon dioxide absorber canister? And what does it produce?
- takes place between CO2 and calcium hydroxide
- heat and water
-
How do you know when the carbon dioxide granules are good?
- canister is warm while in use
- stay normal color when in use
- feel soft and crumbly
-
How do you know when the carbon dioxide granules are bad?
- no warmth when in use
- change color in use
- feel hard and brittle
-
When replacing the carbon dioxide granules, how much space should you leave at the top?
2 cm
-
What is another name for the pressure manometer?
ventilation pressure gauge
-
What is the purpose of the pressure manometer?
measures pressure inside breathing circuit and patient
-
Where is the pressure manometer located?
on top of CO2 absorber
-
Manometer pressure should not exceed _____ during non-bagging use?
15 cm H2O
-
Manometer pressure should not exceed _____ during bagging use?
20 cm H2O
-
When does barotrauma occur?
when the manometer pressure exceeds 60 cm H2O
-
What does barotrauma cause?
- pneumothorax
- subcutaneous emphysema
- air embolism
-
What is the purpose of the negative pressure relief valve?
to prevent negative pressure or a vaccum from developing inside the breathing circuit
-
Where is the negative pressure relief valve located?
on top of the inhalation flutter valve
-
When does a vaccum occur?
- when the oxygen tank becomes empty
- reservoir bag is flat
-
What are the different ways to check for leaks in the system?
- turn on O2 and close pop-off valve
- hold off trach tube opening of y-piece
- fill reservoir bag with oxygen and squeeze bag
-
If leaks are detected...
- minor: tape up
- major: replace parts
- really major: send of for repairs
|
|