Physics, measurement and equipment

“Candidates should have a good understanding of the principles of physics and clinical measurement with an emphasis on the function of monitoring equipment safety and measurement techniques”.

Physics and measurement

Elements from both competency documents relating to Physics and Measurement are listed in the following section mapped to the chapter headings in Basic Physics and Measurement in Anaesthesia, by Davis, Parbrook and Kenny. Terms included in the chapter headings therefore may not appear in the College Syllabus

Chapter 1 – Pressure

Simple Mechanics: mass, force.
Absolute and relative pressure
Measurement and units of pressure.
Principles of surface tension.

Chapter 2 – Fluid flow

Density and viscosity of gases
Laminar and turbulent flow; Poiseuille’s equation, the Bernoulli principle

Chapter 3 – Volume and flow measurement

Measurement of volume and flow in gases and liquids
The pneumotachograph and other respirometers
The Fick Principle

Chapter 4 – The gas laws

Physics of gases and vapours
The gas laws; triple point; critical temperature and pressure
Vapour pressure: saturated vapour pressure

Chapter 5 – Natural exponential functions

Concepts only of exponential functions and logarithms: wash-in, wash-out and tear away
Measurement of Cardiac output by thermodilution

Chapter 7 – Diffusion and Osmosis

Colligative properties
Osmometry

Chapter 8 – Work, energy and power

Work and power

Chapter 9 – Temperature

Heat: freezing point, melting point
Conduction, convection, radiation
Measurement of temperature

Chapter 10 – Heat capacity and latent heat

Concept of latent heat
Mechanical equivalent of heat: laws of thermodynamics

Chapter 12 – Humidification

Measurement of humidity

Chapter 13 – The sine wave and wave patterns

Basic principles of ultrasound and the Doppler effect

Chapter 14 – Electricity

Basic concepts of electricity and magnetism
Capacitance, inductance and impedance
Bridge circuits
Sources of electrical interference
Diathermy and its safe use
Principles of defibrillators
Principles of pressure transducers

Chapter 15 – Biological electrical potentials: their display and recording

Basic measurement concepts: linearity, drift, hysteresis, signal: noise ratio, static and dynamic response
Amplifiers: band width, filters
Amplification of biological potentials: ECG, EMG, EEG
Processing, storage and display of physiological measurements
Principles of cardiac pacemakers
Measurement of neuromuscular blockade

Chapter 16 – Electrical safety

Electricity and electrocution
Electrical hazards: causes and prevention

Chapter 17 – Blood pressure measurement

Resonance and damping, frequency response
Direct and indirect methods of blood pressure measurement
Principles of pulmonary artery and wedge pressure measurement

Chapters 18, 19 and 20 – Oxygen, (H+) and co2 measurement, gas chromatography and mass spectrometry

Pulse oximetry
Measurement of gas and vapour concentrations, (oxygen, carbon dioxide, nitrous oxide, and volatile anaesthetic agents) using infra-red, paramagnetic, fuel cell, oxygen electrode and mass spectrometry methods
Measurement of pH, pCO2 , pO2
Capnography, including interpretation of the capnography trace
Interpretation and errors of capnography, oximetry and ventilatory gas analysis

Chapter 23 – Fires and explosions

Fires and explosions

Chapter 24 – Isotopes and radiation

Basic principles and safety of lasers

Chapter 25 – Presenation and handling of data

Mathematical concepts: relationships and graphs

Appendix

SI units: fundamental and derived units
Other systems of units where relevant to anaesthesia (e.g. mmHg, bar, atmospheres)

Clinical Measurement (CCT III)

“The Final examination assumes knowledge of the Primary FRCA examination syllabus, with the addition of more sophisticated measurements. There is an emphasis on clinical applications of clinical measurement, such as indications, practical techniques and interpretation of acquired data. Candidates will be expected to understand the sources of error and the limitations of individual measurements”.

Anaesthesia, HDU and ICU equipment: monitoring and safety

Physical principles underlying the function of:
The anaesthetic machine
Pressure regulators
Flowmeters
Vaporizers
Breathing systems
Care, cleaning, disinfection, sterilization (particularly airway equipment)
Potential defects and problems
Basis for pre-use checks of anaesthetic machine, breathing systems and monitoring apparatus
Safety precautions and checking.
Manufacture and storage of oxygen, nitrous oxide, carbon dioxide, compressed air
Pipeline gas supplies and suction systems
Gas cylinders
Airways, tracheal tubes, emergency airways, laryngeal masks, fixed and variable performance oxygen therapy equipment, self-inflating bags (including the use of)
Other laryngoscopy blades and bougies
Specialised tubes
Tracheostomy tubes, types, fixation and care
Principles of lung ventilators, disconnection monitors
Humidification devices
Filters
Chemistry of absorption of carbon dioxide
An understanding of the uses and limitations of monitoring equipment
Understanding portable monitoring systems
Characteristics of intravenous cannulae, spinal and epidural needles
peripheral nerve stimulators
Peripheral nerve locators
Function and use of resuscitation equipment, transfusion devices
The content of an anaesthetic record
Diathermy
Principles of underwater seals on chest drains
Environmental control of the operating theatre including temperature, humidity, air changes and scavenging systems for waste anaesthetic gases and vapours

Skills listed in CCT ii: Equipment

Checking the anaesthetic machine
Checking pipelines
Changing and checking cylinders
Connecting up breathing systems
Checking breathing systems
Setting up/checking/monitoring lung ventilators
Setting up/checking alarm limits for monitoring equipment
Collecting data from monitors
Record keeping
Checking resuscitation equipment
Assembling resuscitation equipment
Selecting defibrillator settings
Recognizing machine, breathing system and equipment errors: miss-assembly and disconnections
Composing equipment checklists for: resuscitation equipment
Difficult and failed intubation
CVP monitoring
Arterial pressure monitoring
Epidural/spinal packs
Paediatric intubation set

CEACCP 2004: JUNE
Stephen Keay and Chris Callander
The safe use of infusion devices

CEACCP 2006: APRIL
Colin M Sinclair, Muthu K Thadsad, and Ian Barker
Modern anaesthetic machines

CEACCP 2001: FEBRUARY
William Wellesley Mapleson
Anaesthetic breathing systems – semi-closed systems

CEACCP 2004: AUGUST
Nadeem Sabir and Vino Ramachandra
Decontamination of anaesthetic equipment

CEACCP 2001: JUNE
David A Gabbott
Recent advances in airway technology

CEACCP 2003: APRIL
Julia Ely and Michael Clapham
Delivering oxygen to patients

CEACCP 2002: OCTOBER
Antony R. Wilkes
Breathing system filters

CEACCP 2006: FEBRUARY
Phil Dalrymple and Subbiah Chelliah
Electrical nerve locators

CEACCP 2006: OCTOBER
Ian Thomas and John Anthony Carter
Occupational hazards of anaesthesia

CEACCP 2001: APRIL
A R Wilkes
Humidification: its importance and delivery

CEACCP 2003: FEBRUARY
Steve Boumphrey and Jeremy A Langton
Electrical safety in the operating theatre

CEACCP 2003: OCTOBER
Andrew John Kitching and Christopher J Edge
Lasers and surgery

Matt J Simpson MBChB FRCA
Consultant Anaesthetist at St. James’s University Hospital.
Lead anaesthetist in Obstetric anaesthesia and advanced vascular access. Chairs the Clinical Information and Outcomes Group. He is an Innovation champion for West Yorkshire and Humber and inventor of a new regional anaesthesia delivery system as well as having interests in thoracic and ophthalmic anaesthesia. Recently taken Leeds Crammer to Hong Kong to assist the Society of Anaesthetists of Hong Kong with exam training.

Philip J Antill MBChB (Hons) BSc (Hons) MRCP FRCA FFICM

Consultant in Anaesthesia and Intensive Care Medicine. Experienced ATLS and ALS instructor, with additional faculty roles in trauma and intensive care simulation. He has previously received the Yorkshire Society of Anaesthetists Critical Care ODN Registrar’s Prize and the Final Examination Chair’s Commendation for overall performance in the Final FRCA.

Rebecca K. Lathey MBChB FRCA

Dual Anaesthesia and Intensive Care Medicine trainee heavily involved in undergraduate teaching programmes, national research networks, multicentre research and recent Royal College National Audit Project applications. Guest speaker at RCoA events and holds a life citizenship award from Leeds for contributions towards health and wellbeing.

Michael Carrick MBChB FRCA

Consultant Anaesthetist in Leeds Teaching Hospitals Trust, specialising in thoracic and HPB anaesthesia with additional interests in advanced vascular access. Organised regional anaesthetic registrar teaching for Yorkshire and runs a training forum.
Visiting Faculty
John P Adams MA MBChB MRCP FRCA FFICM

John Adams is a Consultant Anaesthetist and Associate Medical Director at the Leeds Teaching Hospitals NHS Trust. He has an interest in Neuroanaesthesia and Intensive Care having completed an assistant Professorship at the Oregon Health and Science University, Portland USA. He was the principle organiser of the West Yorkshire and Humberside Final Fellowship Preparation (FFP) course and is now an examiner for the Royal College of Anaesthetists. John has a Master’s Degree in Healthcare Law and Ethics from the University of Manchester and he worked as a Medicolegal Adviser to the Medical Protection Society for over three years.

Andrew Lindley FRCA MMedSci FFICM
Consultant Anaesthetist in Neuroanaesthesia and Regional Anaesthesia. Completed an Assistant Professorship at Harbor View Medical Centre, Seattle. Experienced instructor in medical education. Andy is now a Royal College examiner for the primary component of the FRCA.