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
