Objectives: Physics I—Physical Laws Upon completion of the lecture, the learner will have a working knowledge of: 1. Ideal gas laws a) Boyle's law b) Charles' Law c) Gay-Lussac's Law d) Combined Gas Law e) Avogadro's Hypothesis 2. Diffusion laws a) Pick's Law b) Graham's Law c) Henry's Law d) Dalton's Law 3. Units of Measure a) Metric system b) temperature conversion 4. Solubility coefficients a) blood-gas b) oil-gas c) tissue-gas 5. Physics of the circulatory system a) Ohm's Law b) Hagan-Pouseille equation c) La Place equation Objectives: Physics II—Medical Gases Upon completion of the lecture, the learner will have a working knowledge of: 1. Compressed gas cylinders a)E b) H 2. Oxygen tanks a) capacities b) pressures 3. Nitrous oxide tanks a) capacities b) pressures 4. Air Tanks a) composition b) pressures 5. Pressure relief valves 6. Connectors a) pin index safety system (PISS) 7. Yoke assembly a) contents 8. Proper storage/handling of tanks 9. Central supply of medical gases a) oxygen b) nitrous oxide c) central vacuum system Objectives: Physics III—The Anesthesia Machine Upon completion of the lecture, the learner will have a working knowledge of: 1. The general schematic of the anesthesia machine a) oxygen supply a. tank b. central pipeline i. diameter index safety system (DISS) ii. gauges 1. Bourden principle iii. pressure regulators iv. flush valve v. oxygen supply failure alarm vi. fail-safe valve vii. flow meters 1. construction 2. low and high flows a. gas viscosity vs. density 3. effect of barometric pressure b) Nitrous oxide and air 2. Oxygen ratio monitoring and proportioning systems 3. Common gas outlets/check valves 4. FDA (1993) recommendations for apparatus checkout 5. Vaporizers a) general principles b) vapor, evaporation, and vapor pressure c) minimum alveolar concentration (MAC) d) regulation of output e) variable bypass vaporizers f) effects of changes in barometric pressure g) vaporizer arrangement h) the pumping effect i) the desflurane vaporizer 6. Anesthesia breathing systems a) the circle system i. advantages and disadvantages ii. components a. CO2 absorber 1) chemical reaction b. APL valve c. inspiratory and expiratory valves d. reservoir bag e. circuit hoses f. fresh gas supply b) The Mapleson circuits a. A b. D Objectives: Physics IV—Waste Anesthetic Gases Upon completion of the lecture, the learner will have a working knowledge of: 1. The history and standards of measurement of waste anesthetic gases a) OSHAActof 1970 b) NIOSH recommendations i. halogenated agents ii. nitrous oxide 2. Sources of anesthetic gas spillage a) techniques to reduce OR pollution 3. OR ventilation systems 4. waste scavenging systems a) closed vs. open reservoir i. hoses ii. disposal routes 1. active vs. passive Objectives: Physics V—Ventilators Upon completion of the lecture, the learner will have a working knowledge of: 1. Intermittent positive pressure ventilation (IPPV) a. physiologic dead space b. CO2 production c. O2 consumption d. lung function under IPPV e. types of ventilation i. spontaneous ii. controlled iii. assisted iv. IMV 1. assisted v. airway pressure release ventilation vi. jet ventilation f. machine compliance g. classifications of ventilators i. volume limited ii. pressure limited h. controlled ventilation variables i. minute volume ii. tidal volume iii. inspiratory flow and plateau i. volume ventilators i. bellows ii. control box 1. rate 2. minute volume 3. VT 4. I:E ratio 5. sigh 6. alarma 7. manual cycle j. the ventilatory cycle k. limitations of PPV I. subclasses of ventilators on various anesthesia machines Objectives: Physics VI—Capnography Upon completion of the lecture, the learner will have a working knowledge of: a. types of capnographs i. side stream vs. main stream b. measurement techniques i. infrared vs. mass spectrometry c. the normal capnogram i. 4 phases 1. inspiratory baseline 2. expiratory upstroke 3. expiratory plateau 4. inspiratory downstroke d. the abnormal capnogram i. COPD ii. increased inspiratory resistance iii. rebreathing iv. cardiac oscillations v. "Curare Clefts" e. differences between PaCO2 and PeCO2 Objectives: Physics VII—Oximetry Upon completion of the lecture, the learner will have a working knowledge of: 1. Modes of oxygen transport a) functional saturation (SaO2) b) oxyhemoglobin (O2Hb) c) oxygen content (CaO2) d) oxyhemoglobin dissociation curve 1. Pso e) O2 delivery f) O2 consumption (VO2) 1. Pick equation 2. Physics of the pulse oximeter a) light wavelengths b) blood pulsations c) ratio of O2Hb and RHb 3. Sources of error a) dyes b) COHb and MetHb c) wavelength uncertainty d) signal to noise ratio 1. weak pulses 2. Penumbra effect 3. patient movement 4. venous blood pulsations 5. Bovie interference 4. Accuracy Objectives: Physics VIII—Blood Pressure Monitoring Upon completion of the lecture, the learner will have a working knowledge of: 1. Definition of CO 2. modes of invasive BP monitoring a) waveforms 3. manual BP monitoring 4. oscillometric BP monitoring 5. Penaz technique of BP monitoring 6. Arterial tonometric BP monitoring 7. Pulse transit technique of BP monitoring Objectives: Physics IX—Hazards of the Delivery System Upon completion of the lecture, the learner will have a working knowledge of: 1. causative factors of anesthetic mishaps 2. definition of hypoxia a) causative factors 3. measurement of FiO2 b) O2 analyzers i. O2 galvanic cell ii. polarographic sensors iii. paramagnetic analyzers 4. causes of O2 failure in the anesthesia machine a) upstream b) within the machine or circuit 5. definition of hyperoxia 6. definition of hypercarbia a. causative factors 7. definition of hypocarbia a. causative factors 8. circuit pressure and volume problems 9. anesthetic overdose and underdose 10. electrical failure Objectives: Physics X—Lasers Upon completion of the lecture, the learner will have a working knowledge of: 1. definition of laser 2. medical lasers a. CO2 b. Nd:YAG c. Argon d. KTP e. Dye 3. laser hazards a. ANSI classifications i. ranges 1-4 b. eye damage from lasers 4. considerations during laser surgery of the airway a. ventilation b. ET tubes c. selection of airway gases d. management of airway fires Objectives: Physics XI—Electrical Safety Upon completion of the lecture, the learner will have a working knowledge of: 1. Principles of electricity a. Ohm's law b. power c. electrical work d. impedance e. capacitance f. inductance 2. electrical shock hazards 3. grounded electrical power 4. ungrounded power a. line isolation monitor i. conditions for alarms ii. equipment ground wire iii. ground fault circuit interrupter (GFCI) 5. microshock 6. electrosurgery.