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Apex Review > Breathing circuits > Flashcards

Breathing circuits Flashcards

1
Q

No rebreathing and no reservoir is considered

A

an open circuit

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2
Q

No rebreathing with a reservoir is considered

A

a semi-open

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3
Q

Partial rebreathing with a reservoir is considered

A

a semi-closed

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4
Q

Complete rebreathing with a reservoir is considered

A

a closed

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5
Q

Breathing circuits are classified into four types:

A

open
semi-open
semi-closed
closed

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6
Q

Open breathing systems do not allow for

A

controlled ventilation, nor do they permit the delivery of precise inspired gas concentrations

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7
Q

Examples of open breathing systems include

A

nasal cannula
insufflation
simple face mask
open drop

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8
Q

Examples of a semi open system include

A

mapleson circuit (FGF dependent on design)
circle system (FGF> minute ventilation)

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9
Q

Examples of a semi closed system include

A

circle system (FGF <minute ventilation)

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10
Q

Examples of a closed system include

A

circle system with very low FGF and APL closed

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11
Q

Advantages of the circle system include

A

less OR pollution
maintenance of heat and humidity of the inspired gas
precise control of inhaled gas concentrations

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12
Q

The circle system can be configured in three ways:

A

semi open: FGF> minute ventilation
semi-closed: FGF < minute ventilation
Closed: FGF only replaces gas consumed by the patient (APL is closed)

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13
Q

_______________ determines how much gas remains in the circuit and how much gas is directed to the scavenger

A

An adjusting pressure limiting valve (APL)

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14
Q

The circle system contains ________________________ that ensure fresh gas travels in one direction.

A

two unidirectional valves (one in the inspiratory limb and one in the expiratory limb)

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15
Q

Malfunction of either unidirectional valve converts the region between the y-piece and the affected valve to

A

apparatus dead space (risk of hypercarbia)

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16
Q

The most common circle system-related causes of rebreathing include an

A

incompetent unidirectional valve
exhausted CO2 absorbent

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17
Q

If a unidirectional valve is stuck open, we will see

A

rebreathing

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18
Q

If a unidirectional valve is stuck closed, we will see

A

airway obstruction

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19
Q

Disadvantages of the circle system include

A

multiple places where disconnection can occur
less portable than non-rebreathing circuits
unidirectional valves can malfunction

20
Q

The reservoir bag provides the following benefits during controlled and assisted ventilation:

A

exhaled gas accumulates inside the bag during exhalation and is returned to the patient on the next inhalation- permits rebreathing and the use of lower fresh gas flows
bag functions as a visual and tactile monitor when patient is spontaneous
allows you to generate positive pressure to deliver assisted or controlled ventilation
most distensible component of the breathing system

21
Q

ASTM requires that the pressure inside an adult-size reservoir bag does not exceed an internal pressure of

A

60 cmH2O if the bag is inflated up to 4 times its size

22
Q

When the unidirectional valves are working properly, dead space begins at

A

the y-piece and ends at the terminal bronchioles of the patient’s lungs

23
Q

The inspiratory valve is open during

A

inspiration and closed during expiration

24
Q

The expiratory valve is closed during

A

inspiration and open during expiration

25
Q

The definitive fix for an incompetent unidirectional valve is to

A

correct the valve; if this cannot be done then a closed or semi-closed system should be converted to a semi-open system

26
Q

What is the BEST Mapleson circuit for a spontaneously ventilating patient?
A. A
B. B.
C. C.
D. D.

A

Mapleson A

27
Q

What are the types of Mapleson circuits?

A

A, B, C, D, E, & F

28
Q

All Mapleson designs are _____________________ circuits

A

semi-open (non-rebreathing)

29
Q

With Mapleson circuits, since inhaled and exhaled gases travel through the same tubing, there’s a risk of

A

rebreathing

30
Q

What Mapleson design is the worst for spontaneous ventilation?

A

Mapleson B

31
Q

What Mapleson design is the best for controlled ventilation?

A

Mapleson D

32
Q

What Mapleson design is the worst for controlled ventilation?

A

Mapleson A

33
Q

What components are present in Mapleson circuits?

A

reservoir bag
fresh gas inlet
corrugated circuit tubing
APL valve
Mask
(Mapleson E does not contain an APL valve or reservoir bag)

34
Q

What components are not present in Mapleson circuits?

A

CO2 absorber
unidirectional valves

35
Q

Describe the Mapleson A circuit?

A

Fresh gas inlet–>bag–>APL valve–>Mask

36
Q

Describe the Mapleson B circuit.

A

bag–> fresh gas inlet–> APL valve–> mask

37
Q

Describe the Mapleson C circuit.

A

Bag–> fresh gas inlet–> APL valve–> mask
same as Mapleson B but no corrugated tubing

38
Q

Describe the Mapleson D circuit.

A

Bag–> APL valve–> fresh gas inlet–> mask

39
Q

Describe the Mapleson E circuit.

A

corrugated tubing–> fresh gas inlet–> mask

40
Q

Describe the Mapleson F circuit.

A

APL valve–> bag–> fresh gas inlet–> mask

41
Q

During expiration, gas containing carbon dioxide

A

enters the corrugated tubing and travels away from the patient

42
Q

With Mapleson circuits, rebreathing is minimized with

A

higher FGF, smaller tidal volume, and longer expiratory time

43
Q

What are advantages to the Mapleson circuit?

A

less airway resistance (good for peds)
convenient
easily scavenged (varies by type of circuit)
Bain circuit prevents heat loss

44
Q

Disadvantages to the Mapleson circuit include

A

increased apparatus dead space
requires high FGF to prevent rebreathing
loss of heat and humidity
inefficient use of inhaled anesthetics
risk of environmental pollution
unrecognized kinking of fresh gas hose in Bain circuit

45
Q

Maples A requires a FGF of __________ during controlled ventilation

A

~20 L/min.

Apex Review (224 decks)

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