Lab Quiz 1

endotracheal tubes sizing

-based on the inner diameter

-7.0 for female and 8.0 male

parts of endotracheal tube

-bevel tip on distal tube

-murpheys eye to allow air to still flor through if distal tip is gone

-cuff: inflate with 6-10 cc of air

-inflates to secure airway, makes a seal with the trachea, do not over inflate

-pilot ballon: what we use to inflate the cuff, soft is not infalted

-depth markings in cm

-tube size times 3 for depth from tip to lip

tongue depressor

a thin depressor used to press the tongue down during placement of oral airway

oral airway

-Put in the mouth to keep the tongue falling back on the posterior wall

-Size 100 mm: adult male

-Can be labeled in cm

-Size 90 mm: adult female

-Size 80 mm:

-Berman airway has side channels

-Hold it between the mouth and the angle of the mandible for size

-Between the transition of horizontal to vertical of mandible

-Teeth rest on chanel

-To place it: place tongue anteriorly with tongue depressor and place it in

-Patients don't like this awake

-Gudell has the opening

nasal airway

-Nasal trumpet

-30/32/34 french sizing

-Same sizing as oral but from the nose

-Has a phlanage to keep it from loosing

-Beveled at tip

-Beveled towards the septum

-Lubricate it, more tolerable in awake patient

-Push straight down/back

-Dont use if basilar skull fracture or bleeding issues in nose

laryngoscope handle

-houses battery, provides light source, ensure it works

-hold in left hand, do not hold up high, hold at junction of blade and handle

laryngoscope blade

-Curved blade is Mac blade

-Size 3 is standard for adult female

-Size 4 for adult male, Bigger than size 3 in length

-Miller is a straight blade

-Half sizes in blades

reuseable laryngoscopes

-need to be sterillized

how to intubate

-Use scissoring to open mouth on teeth

-Blade goes in the vallecula: between tongue and epiglottis

-Pull up on tongue

-Right side of mouth and sweep to the left

-Lift blade up to ceiling

-Continuous end tidal CO2 is what we want to see for good intubation of tube in trachea

-Condensation in tube and chest rising for other signs it is in the right place

bag mask ventilating

-Left hand C and E: thumb on top, pointer on opposite like a C

-Pinky under angle of mandible

-Other fingers on mandible

-Only put fingers on bone

-Squeeze twice on bag, and if no chest rising, do something different like oral airway

-Bag mask before intubating

sniffing position

-Cervical flexion: Putting a pillow underneath the head helps with this

-Extension of atlanto-occipital joint: Chin up towards the ceiling

-Want to align all three axes via cervical flexion and extension of A/O joint: Oral, cervical and pharyngeal axes

-Head of the table good and patients head at the xiphoid process, At the end of my sternum

placement of tube

-Properly hold tube like a pencil with right hand

-Introduce tube into right side of mouth

-Advance tube along right side of mouth to not obscure view

-Advance tube until proximal end of cuff is 1 to 2 cm past the vocal cords

-Blade is removed from mouth gently

-Cuff is inflated to create a seal: 6 cc

confirmation tube placement

-Confirmed by clinical assessment and identification of CO2 in the patients exhaled tidal volume using capnometry

-CO2 should be immediate and sustained

-Auscultation with stethoscope at apical and midaxillary areas of chest for lung sounds

-Bilateral breath sounds

-Presence of condensation in the tube itself

main purpose of an anesthesia machine

-oxygen delivery/CO2 elimination

-deliver positive pressure ventilation

-deliver inhalation anesthetics

master switch

activates pneumatic and electrical function

how long can the machine go without AC power?

30 mins

WAGD color

purple

Vacuum color

white

thorpe tubes

-allows precise control of gas exiting the machine to the common gas outlet

-O2 is always the last gas to be added

O2 flush skips

flowmeters and manifold

desflurane

-only vaporizer that can be filled during its use

APL valve

-known as pop off valve

-interface between circuit and the scavenging system

-spontaneous ventilation should be at min, bag mask should be 20

-clockwise closes it

-counterclockwise opens it

ventilator

-compressed downward is inhalation

-upwards during exhalation

-ascending is preferred because bellows won't rise if there is a lak

active scavenge

-requires vacuum to draw wastes out

passive scavenge

-relies on upstream flow of gas coming out of the machine to passively flow out of the system, ie. requires connection to ventilation duct

OSHA standards

-N2O < 25 ppm

-agents

common gas outlet

interface between pneumatic and ventilatory system

auxiliary courtesy flowmeter

-Self-contained flowmeter with its own flow control valve flow indicator and outlet.

-is not effected by computer

-max flow is 10 L/min

-used for NC or facemask

suction

-high for airway

-low for stomach

machine off for what steps of machine checkout

-confirming ambu bag and auxiliary tank

-low pressure system leak check

-vaporizer leak check

-checking vaporizer interlock

-ensureing vaporizers are full and caps tight

check vaporizers

-ensure two gases cannot be. given at same time. via interlock

-ensure they are full and caps tight

Low pressure leak test

-machine off, open ACGO, test suction bulb. with finger first, attach bulb to ACGO and collapse bulb, ensure bulb stays collapsed

-open each vaporizer and check bulb to make sure it collapses

-remove bulb and close ACGO

check low O2 supply alarm

-close O2 tank, disconnect O2 pipeline from wall, press O2 flush, hear it

check o2 cylinder supply

-half full at least (1000 psig)

-close tank after

check O2 fail safe

-close O2 tank, dial in 5L/min of N2O + O2, ensure N2O shuts off by its bulb going down

-remember to reconnect O2 pipeline after and turn N2O flow off

check central pipeline pressures

-should be connected and read 50 psi

remove flow sensors to calibrate no sensor alarm

-where the inspiratory/expiratory limbs are, remove gray thing with knob

-should see no sensor alarm on scree

calibrate O2 analyzer

-remove black O2 sensor, hit setup/calibration, O2 sensor cal -> 21% -> start cal

-once done, reinstall sensor

check O2 alarm

-raise alarm threshold

-hit alarm settings, raise from 21%, turn on air flowmeter

check flowmeters

-adjust flow of all gases through their full range, check for smooth operation of floats and undamaged flow tubes

check link-25

-confirm inability to create hypoxic O2/N2O mixture

-1:3 ratio of O2:N2O

check co2 absorber

-want it to be white, no color

-purple if exhausted, no true way to know

-can tell if patient is rebreathing co2 on end-tidal for FiCO2

test ventilator

-place breathing bag on Y-piece, set approiate ventilator settings for next patient,

-vent mode on, set flows to minimum to not mask any leak, press O2 flush to fill up bellows

-verify tidal volume is being delivered during inspiration

-verify during expiration bellows fill completely, if leak it won't fill up

-verify manometer functioning, should match Pmax, should not go negative

-inspect unidirectional valves

check scavenge

-active: verify ball is. in green range

-closed active: black needle valve open 1.5 turns and oscillates as ventilator delivers breathes, ensures no negative pressure on manomter, press O2 flush and ensure pressure does not exceed 10 cm H2O

circuit leak test

-switch to bag mode, set gas flows to min, close APL completely to 70, bag back on original part

-occlude Y piece, pressure breathing system with O2 flush to 30 cm H2O

-ensure it holds here for 10 seconds

-then decrease to 20 cm H2O by apl at 20 and should hold here

-then slowly open APL to ensure pressure decreases

verify suction

-check with hand/finger

-should stay on finger/hand

-leave suction ON!!!

verify monitors

-asa monitors

final check

-appropriate ventilator settings

-appropriate alarm limits on monitors

-apl to min (open)

-min gas flows

vaporizers off

60% FIO2

1L of air and 1L of O2

order of machine checkout steps

1. confirm ambu bag and auxilliary O2 cylinder

2. check low pressure system leak

3. check vaporizer interlock and each vaporizer leak

4. ensure vaporizers full and caps tight

5. turn on machine

6. check low o2 supply alarm

7. check O2 cylinder supply

8. check O2 fail safe, reconnect O2 pipeline and turn off N2O

9. check pipeline pressures

10. remove flow sensors to calibrate

11. calibrate O2 analyzer

12. check O2 alarm

13. check flowmeters

14. check link 25

15. check co2 absorber

16. test ventilator

17. check scavenging

18. perform circuit leak test

19. ensure suction is adequate

20. verify all required monitors

21. ensure proper final status