Nce side note

what range of psi is high pressure ?

750-2000 psi

where is high pressure coming from ?

the cylinders

which cylinders on the high pressure system is proportional to each other?

nitrous oxide and oxygen

which subjects on the high pressure system correlate with it?

yoke, PISS, gauges, regulator, and check valves

check valve

is a valve that makes the flow from the cylinder to patient go one way and does not backflow and prevents leakage

yoke

this is a equipment piece that has specific holes to attach to a specific cylinder .

gauges

this checks the pressure on the cyclinders to know what psi they are falling under

first regulator

this is the first regulator that will decrease the pressure when it gets to the second stage from cylinder to anesthesia gas machine

PISS

pin index safety system that is a system where specialized yokes are for certain cylinders

colors of oxygen, nitrous oxide, and air

green , blue , yellow

what pressure is intermediate system and what system is it coming from ?

50 psi and coming from pipelines in hospital

what range is the oxygen flush at ?

35-75 liters per min

auxiliary flow meter

is a direct line of oxygen needed for patient during anytime in surgery that the machine does not need to be on.

oxygen safety alarm

is to alarm if oxygen is below 30 psi

fail save valve

this is a safety alert to prevent hypoxia of mixed gases to patient and will shut off immediately and the link 25 system

DISS

diameter safety system is specific hoses in hospital pipeline that connect to anesthesia gas machine

second regulator

this will be lowered even more to 30 psi to now go to patient

what pressure is low system at?

30 psi

what type of bobs for a flow meter

square , circle, and flat top

what type of system does a flow meter have to prevent hypoxia?

they have a 25 link system to not flow mixed gases to

patient without oxygen reaching at least 25%

what design is the flow meter ?

thorpe tube being tapered

what is the common manifold?

where all of the gases mix

what does the flow meter valves do?

they open and close unidirectionally to deliver gases and air to patient .

what is a definition for vaporizers?

they are a volitale gas that needs continuos heat to change it from a liquid to a vapor

desaflourane (blue)

is the highest agent of 660 mmgh that needs constant heat to stay a vapor and is the longest to supply.

isoflourane (purple)

this is a pressure of 238 mmhg that does not need heat but can be a liquid at room temperature

sevoflourane (yellow)

pressure running at 160 mmgh

what is a bypass?

it is where gases and fresh gas flow run through to than meet to mix and deliver to the patient at whatever fixed number is needed.

what type of circuit is used during ventilation?

a closed circuit system

what is a blood gas coefficient

it is stating how fast a gas will go to brain by being less soluable

solubility of nitrous oxide ?

less solvable of .43 and goes to brain faster and leaves body quick

soluablity of halothane ?

high solubility of 2.3 meaning it does not go to brain as quick and patient sleeps longer

MAC

minimal alevolr concentration measured by potency of 50%

the less mac the higher the potency

false

mac of nitrous oxide, desa , iso, sevo, halo

104

6.6

1.7

1.8

0.75

what is oil gas partition

the more lipid soluble a gas is the more potent

halothane , iso, sevo, desa, nitrous oxide oil gas partition

220, 91, 47, 19, 1.4

what is the difference between manual and mechanical ventilation

mechanical you let machine breathe for them and manual you breathe for them

APL VALVE

it controls the amount of positive pressure to breathe during a manual or spontaneous ventilation

open apl valve

turned to the left and patient breathing

close app valve

turned to the right and patient ventilated

bellows

they are a mechanical squeezing fresh air apparatus that fives air and gases to patient lungs and the excess goes to scavenger

co2 absorber

exhaled gases and air will be sent to a canister to remove it from patient

what are granules called on absorber

hydroxides

exothermic reaction needs?

heat and water

accumulation of ethyl dye in absorber for a long time can do what?

it can turn back to white causing re breathing on co2 to patient that than can hyperventilate , cause sweating, and acidosis imbalances.

fresh gas flow to absorber for a long time can cause what?

it can cause desaflourane to produce carbon monoxide and sevo to produce compound A and kidney issues

what electrical power should the anesthesia machine be on

115-120 AC to 60 hz

what is the elbow on the circuit

it is a equipment to connect to the tube of patient to link co2 sampliny with a diameter of 15 mm ID

HME

is a filter to retains the patients exhaled gases and moisture and to prevent drying out mouth and to create a barrier for bacteria from entering

scavenger ID is

19 mm

volume control

garuentee air that gives stable co2 , sets tidal volume , inspirations flow, respiratory rate.

cons of volume control

can give barotrauma, PIP varies

pressure control

needs to meet a certain pressure to target inspiration pressure

cons of pressure control

hypoventalation, increased co2, and lungs are stiff

rigid fiber optic

it is a straight metal with light source to directly ventilate vocal cords

flexible fiber optic

360 degree scope that can flex the tip anyway that is ideal for difficult airways, trauma, spine , sleep or awake intubations with lidocaine, nasal intubations,

what are fiber optics used for?

The are ideal for awake intubations and difficult airways

what type of medication is used for fiberoptic

topical lidocaine to numb the throat.

rigid layrngoscope

a direct view of vocal cords to intubate

glidescope

a indirect view of the throat using a clear view to intubate a difficult airway

what is a cuffed ETT?

it is a low pressure high volume that is oval shaped that blocks the trachea windpipe to avoid any leakage

what is a uncuffed ETT?

this is a ETT that is not cuffed and used mostly for children under eight years old due to there narrow cricoid cartilage

what is the calculation for ETT size?

4 + age/4

difference between rigid stylet and regular ?

rigid stylet has a strong shape to it to give the ETT a stiff curve and shape for the glidescope and a regular stylet is a flexible tool that is used to help shape the tool for regular intubation

reinforced ett

metal coiled to prevent kinking , strengthen, and flexibility that is used for head/neck surgeries to be able to compress and have full range of motion

Laser ETT

used in laser surgeries tp prevent fire from happening. It is protected by a elastomer shaft, filled with saline and Methylane blue

what type of double lumen tubes

Robert Shaw, DLT, and Univent

what is the goal for for DLT?

to help collapse a lung or lobe to be able to work on the other lung. provides ventilation while the other lung is collapse.

what is a brocnhial blocker?

it is a tool to help isolate the lobe through a ETT that will require fiberoptic.

oral rae

towards the feet “south” that are for ENT surgeries

Nasal Rae

towards the head “north” that are for mouth/manidable surgies that require Magil Foreceps.

LMA

delivers positive pressure ventilation to relieve obstruction in the airway of the oropharynx. It sits right on top of the vocal cords giving spontaneous ventilation and is a rescue device.

Jet ventilation

gives shots of burst of high pressure of oxygen through a catheter to keep patient breathing while inflating the lungs while leaving the airway completley open

what anesthesia for jet ventilation ?

TIVA due to not risking gases releasing in the air.

what psi can jet ventilation exceed?

25 psi

retrograde wire

is a guidewire introduced in the neck to create a pathway for ETT to allow a quick intubation for a failed one

what technique is used for central line, retrograde wire, PCA?

selingers technique

Boujie

a eschman catheter for helping with difficult airways

combitube

is a blind insertion device to use for emergency situations to secure a airway through the esophagus to than put air through trachea

cook exchanger catheter

replaces the ETT without loosing the ETT itself rthat will deliver oxygen with a rapid tip (15mm).

Mac vs a miller

mac is a curved blade that does not pick up the epiglottis directly but will pick up the valecum and the miller is a straight blade used mostly for children

OPA

purpose is to open the airway and relieve the tongue from obstructing the airway

dopplers

are specilaized ultrasound devices that monitor blood flow, verify iv placements, and cardiac emergencies that work by bouncing high friequency soound waves off of moving RBC

3 lead EKG

basic monitoring that tracks heart activity for abnormalities or arrhythmia and the colors are white on right arm, black on left arm, and red on left leg

what leads on a five ecg are most important ?

ll and v

Pulse oximeter

measures the oxygen saturation in blood that is based off of LED lights of plethosymography and spectrophotoenergy

what two wave length numbers rely on pulse oximetery?

660-940 mm

what type of contradictions can happen with measuring pulse oximetery ?

nail polise, genetic disorders, cold hands, methyline dyes, movement

non invasive BP

operates ona oscillatory technique that measures blood flow to heart.

small cuff …


big cuff….

large arm - high BP

Small arm - low BP

what device measures accurate BP reading beat to beat?

arterial blood pressure

what other things can be done for a arterial line?

blood samples, accurate BP readings

Central line

indirect measuring of volume in heart of the vena cava on top of the right atrium that measures 2-8 mmgh

what can we use a CVP for?

fluid resuscitation, medication delivery, and monitor accurate hemodynamic status .

what are cons for central line?

arterial puncture, pneumothorax, infection, and embolism .

pulmonary arterial catheter

continuos monitoring of the heart through the right atrium, right ventricle, pulmonary arterial till you hit wedge to measure both sides of the heart. we use it for drastic changes in fluid shift, hypotension, and shock

cons for using a PVC?

dysrythmias, right bundle block, valve damage, thrombus formation, catheter tangle.

when using cricoid pressure, when should you let go?

when the provider tells you too

how many lobes does each side have?

right has 3 and left has 2.