This document provides an overview of the history and components of an anesthesia machine. It describes the machine's pneumatic system including high, intermediate, and low pressure systems. Key safety features are outlined such as oxygen failure protections, monitors, and alarms. The document concludes with instructions for checking the various parts of the anesthesia machine prior to use.
The anaesthetic machine (UK English) or anesthesia machine (US English) or Boyle's machine is used by anaesthesiologists, nurse anaesthetists, and anaesthesiologist assistants to support the administration of anaesthesia. The most common type of anaesthetic machine in use in the developed world is the continuous-flow anaesthetic machine, which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour (such as isoflurane), and deliver this to the patient at a safe pressure and flow. Modern machines incorporate a ventilator, suction unit, and patient monitoring devices.
• Medical gas supply system in hospitals and
other healthcare facilities are utilized to supply
specialized gases and gas mixtures to various
parts of the facility .
Supply of Medical Gases:
• From:
• Cylinders (Manifold)
• PIPED gas system
• Medical gases commonly
used:
• Oxygen
• Nitrous oxide
• Air
• Nitrogen
• Carbon Dioxide
The anaesthetic machine (UK English) or anesthesia machine (US English) or Boyle's machine is used by anaesthesiologists, nurse anaesthetists, and anaesthesiologist assistants to support the administration of anaesthesia. The most common type of anaesthetic machine in use in the developed world is the continuous-flow anaesthetic machine, which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour (such as isoflurane), and deliver this to the patient at a safe pressure and flow. Modern machines incorporate a ventilator, suction unit, and patient monitoring devices.
• Medical gas supply system in hospitals and
other healthcare facilities are utilized to supply
specialized gases and gas mixtures to various
parts of the facility .
Supply of Medical Gases:
• From:
• Cylinders (Manifold)
• PIPED gas system
• Medical gases commonly
used:
• Oxygen
• Nitrous oxide
• Air
• Nitrogen
• Carbon Dioxide
The anaesthesia gas machine is a device which delivers a preciselyknown but variable gas mixture, including anesthetizing and lifesustaining gases.
• Original Boyle was made by the firm COXTERS.
• There are several differences between newer and older anesthesia
machines.
• Advanced ventilators are the biggest difference between newer and
older gas machines.
Types Of Anaesthesia Machine
• Intermittent Anaesthesia Machine
-Gas flows only during inspiration
• Ex:-
• Entonox apparatus ,
• Mackessons apparatus
• Continuous Anaesthesia Machine
-Gas flows both during inspiration
and expiration.
• Ex:-
• Boyle Machine
• Forregar
• Dragger
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. CONTENTS
▪ History
▪ Introduction
▪ Essential safety features
▪ Pneumatic system
▪ High pressure system
▪ Intermediate pressure system
▪ Low pressure system
▪ Anaesthesia machine checkup
3. HISTORY
▪ 1846: Public demonstration of ether
anaesthesia, WTG Morton
▪ 1917: Boyle’s machine, Henry Edmund
Gaskin Boyle
▪ 1921: Waters to and fro absorption
apparatus
▪ 1927: Flowmeter for CO2
4. ▪ 1930: Plunger of vaporizer; circle
absorption system, Brian Sword
▪ 1933: Dry bobbin flow meters
▪ 1952: PISS by Woodbridge
5. THE ANAESTHESIA MACHINE
▪ Receives medical gases from a gas supply
▪ Controls the flow and reduces the pressure
of gases to a safe level
▪ Vaporizes volatile anesthetics into final gas
mixture
▪ Delivers gases to a breathing circuit
connected to the patient’s airway
6. 1. Gas-specific connections to pipeline inlets (DISS)
with pressure gauges, filter, and check valve
2. PISS for cylinders with pressure gauges, and at
least one oxygen cylinder
3. Low oxygen pressure alarm
4. Minimum O2:N2O ratio controller device
5. Oxygen failure safety device
ESSENTIAL SAFETY FEATURES
7. 6. O2 enters common manifold downstream to other
gases
7. O2 concentration monitor and alarm
8. Automatically enabled essential alarms and
monitors (eg, oxygen concentration)
9. Vaporizer interlock device
10.Capnography and anesthetic gas measurement
11.O2 flush mechanism
10. HIGH PRESSURE SYSTEM
▪ Receives gases from high pressure E
cylinders
▪ 2000 psig for O2 and air, 745 psig for N2O
▪ Handy in case of failure of hospital pipeline
supply source
11. Hanger Yoke
▪ Orients and supports the cylinder
▪ Provides gas tight seal
▪ Ensures unidirectional gas flow
▪ Parts
▪ Body
▪ Retaining screw
▪ PISS pins
▪ Washer
▪ Filter
12. Pressure regulator
▪ Reduces high/ variable pressure from
cylinder
▪ To lower/ constant pressure for use in
anesthesia machine (40-45psig)
▪ Pressure at regulator outlet: set lower than
pipeline pressure
13. Check valve
▪ Allows gas from cylinder to enter machine
▪ Minimizes transfer of gas from a cylinder at high
pressure to one with lower pressure
▪ Helps exchange of empty cylinder with a full one
▪ Minimizes leakage from an open cylinder to the
atmosphere if one cylinder is absent
17. Pneumatic safety systems
O2 failure protection device
▪ When O2 pressure is normal->push the
diaphragm and stem downward
→opening valve
▪ When O2 pressure falls→Fail-safe valves
shut off or proportionally decrease the
flow of the other breathing gases
▪ If a gas other than O2 adequately
pressurizes the O2 circuit as a result of
hospital pipeline contamination, fail-safe
valves will remain open. In such a case,
only the inspired oxygen concentration
monitor will help
18. O2 supply failure alarm
▪ Sensor with an audible and visual warning if
O2 pressure drops below a minimum
▪ Cannot be silenced until the pressure is
restored to the minimum value
▪ Dräger Fabius series machines are set to
alarm at 20 psig
19. Oxygen flush valve
▪ Provides manual delivery of a high flow rate of
100% O2
▪ High (35 to 75 L/m) flow directly to CGO
▪ Flow bypasses the anesthetic vaporizers
▪ Available even when machine is not turned on
▪ Pressure: 50 psig
20. Auxiliary O2 flowmeter
▪ Administer O2 in case of electric failure
▪ Allows the use of low-flow oxygen for devices
independent of the patient’s breathing circuit
▪ Accessible even when the machine is not
turned on
21. Second stage pressure regulator
▪ Located downstream from the gas supply
sources
▪ Constant pressure to the flow control valves
regardless of potential fluctuations in hospital
pipeline pressures
▪ Lower levels than the pipeline supply, usually
between 14 and 35 psig
22. LOW PRESSURE SYSTEM
▪ Begins at flow control valves and ends at
machine outlet
▪ Flow control valves, flowmeters or flow
sensors, vaporizer manifold, and anesthetic
vaporizers
▪ Most vulnerable section to leaks within the gas
supply system
23. Flow adjustment control
▪ Regulates flow of gases to flowmeter
▪ Clockwise: decrease gas flow
▪ Anticlock wise: increase gas flow
▪ Inlet pressure is determined by pressure
characteristics of intermediate-pressure segment
▪ Flow control knob
▪ Different texture, diameter, color coded, name of gas
engraved
▪ O2: fluted, larger
24. Flowmeter
▪ Variable orifice vertical glass tube with
indicator (Thorpe’s tube)
▪ Upward force resulting from gas flow equals
the downward force on the float resulting
from gravity at a given flow rate
▪ Height of indicator: measure of gas flow
▪ Widest diameter : flow to be read
25.
26. ▪ Flow rate depend on
▪ Pressure drop across the constriction
▪ Size of annular opening
▪ Physical properties of gas
▪ Calibrated at atmospheric
pressure, room temperature
27. Flow indicator sequence
▪ Where O2 and other gases are delivered
by their respective flow indicators into a
common manifold, the O2 should be
delivered downstream of all other gases.
▪ In the event of a flowmeter leak, a
potentially dangerous arrangement exists
when N2O located in downstream
position (A and B).
▪ A safer configuration exists when O2
located in downstream position (C & D).
▪ Hypoxic mixture less likely because all O2
flow is advanced by N2O (the principle
known as the Eger flow sequence)
28. Proportioning system
▪ No matter how high N2O is turned up, or how low
the O2 flow is made when N2O is running
▪ The machine will automatically limit the amount of
N2O flow→ hypoxemic gas will not be delivered
▪ Protects against delivery of a mixture with an oxygen
concentration below 21% oxygen (v/v%)
29. Outlet check valve
▪ One way check valve located between
vaporizer and CGO
▪ Prevent backflow into the vaporizer during
positive-pressure ventilation
30. Common Gas Outlet
▪ Receives gas mixture from machine and
delivers to breathing circuit
▪ Fresh gas outlet, critical role in adding new
gas of fixed and known composition to the
circle system
32. Waste gas scavengers
▪ Dispose gases that have been vented from
breathing circuit by APL valve
▪ Safe level
▪ Room concentration of N2O:25ppm
▪ Halogenated agents:2ppm
35. High pressure system
▪ Check O2 cylinder supply
▪ Open cylinder, verify at least half full (1000 psig)
▪ Close cylinder
▪ Check central pipeline supplies
▪ Check hoses are connected
▪ Pipeline gauge: 50psig
36. Low pressure system
▪ Close flow control valves, turn off vaporizers
▪ Check fill level, tighten filler caps
▪ Perform leak check
▪ Test flowmeters
37. Breathing system
▪ Calibrate O2 monitor
▪ Check initial status breathing system
▪ Leak check
▪ Set all gas flows to zero
▪ Close APL valve , occlude Y piece
▪ Pressurize to about 30cm of H2O
▪ Ensure pressure remains fixed (at least 10 second)
▪ Open APL valve: pressure decrease