Exam 2 (Breathing systems) Flashcards
(83 cards)
1
Q
What is an open cicuit?
A
No reservoir bag & no rebreathing
2
Q
What is a semi-open circuit?
A
Reservoir bag but no rebreathing
3
Q
what is a semi-closed circuit?
A
Reservoir bag & partial rebreathing
4
Q
What is a closed circuit?
A
Reservoir bag & complete rebreathing
5
Q
Where does the circuit mask fit on the face?
A
Between interpupillary line & groove between the mental process & alveolar ridge
6
Q
What is the size of the Y-piece connector?
A
22mm
7
Q
What are the benefits (3) of connectors/adapters?
A
- Extend distance between Pt & breathing system
- Change connection angle
- Allows more flexibility/less kinking
8
Q
What are the disadvantages (3) of connectors/adapters?
A
- Increased resistance
- increased dead space (distal to the Y-piece)
- Additional locations for disconnects
9
Q
What is the length of the breathing tubing & what is its internal volume?
A
- 1 meter
- 400 - 500mL/m
10
Q
The breathing tubing has ___ resistance & is somewhat ___?
A
- low
- distensible
11
Q
Circuit breathing tubing flow is ___ due to the ____?
A
- turbulent
- corrugation
12
Q
Circuit pressure checks are done at ___ cm ____
A
- 30
- H₂O
13
Q
In what case do unidirectional valves contribute to dead space?
A
When the valve does not close rapidly & all the way
14
Q
Where are the unidirectional valves located?
A
Near the CO2 absorber, fresh gas inflow site & pop-off valve
15
Q
What are the 5 requirements for unidirectional valves?
A
- Arrows or directional words
- Hydrophobic
- Must open & close appropriately
- Clear dome
- Must be placed between Pt & reservoir bag
16
Q
Traditional adult reservoir bags hold how much air?
A
3L
17
Q
What is the max pressure for rubber reservoir bags?
A
40 - 60 cm H₂O
18
Q
Do plastic reservoir bags have a higher or lower distending pressure than rubber?
A
2x that if rubber bags
19
Q
What are the reservoir bag functions (5)?
A
- Reservoir for anesthetic gases or O₂
- Means of manual ventilation
- Assistance with spontaneous ventilation
- Visual/tactile monitor of ventilation
- Protection from excessive positive pressure
20
Q
What is the preferred location for the gas inflow site?
A
Between CO₂ absorbent & inspiratory valve
21
Q
What does the APL valve control?
A
Pressure in the breathing system
22
Q
The APL valve releases gases to the?
A
Scavenging system
23
Q
What are the 3 APL valve requirements?
A
- Clockwise= increase pressure
- 1-2 clockwise turns from fully open to fully closed
- Arrow must indicate direction to close valve
24
Q
What is the purpose of the side or center tube in the absorber canister?
A
Returns the gas to the Pt
25
When the absorbent canister is all purple the contents are?
All carbonates & NO hydroxides
26
What are the 2 fast reaction hydroxides?
- NaOH
- KOH
27
What is the full product after CO₂ reacts with Soda Lime?
CaCO₃ + H₂O + heat
28
What are the 3 strong bases used in absorbents?
- Ca(OH)₂
- NaOH
- KOH
29
100g of absorbent can absorb how much CO2?
~ 26L CO₂
30
What are the 3 advantages of Ensorb?
- Produces NO Compund A
- Reduced CO production
- Destruction of inhaled gases
------------------------------------------------------------------
- Ensorb is also called Calcium hydroxide lime
31
Which 2 absorbents do not contain NaOH?
- Spiralith
- Litholyme
- Sodasorb
Spiralith & Litholym
32
Which absorbent does not contain H₂O?
Spiralith
33
Which 2 absorbents do not contain LiCl?
- Spiralith
- Litholyme
- Sodasorb
Sodasorb & Spiralith
34
Spiralith is mostly made up of?
LiOH
35
Which 2 absorbents do not contain NaOH & KOH?
Litholyme & Spiralith
36
Which absorbent does not regenerate?
Litholyme
37
Which absorbent does not produce compound A & CO?
Litholyme
38
Which absorbents have lower exothermic reactions?
Litholyme & Spira-lith
39
Which absorbent does not change colors?
Spira-Lith
40
Which absorbent has a larger surface area for reactions?
Spira-Lith
41
What decreases surface area & CO₂ absorption efficiency?
- Excess liquid water within the canister
- Channeling
42
What 4 things can contribute to Compound A formation?
- Low FGF (1 - 2L)
- Increased absorbent temperature
- High Sevo Mac values
- Dehydrated absorbent
43
What 2 gases result in the highest CO production?
- Desflurane
- Enflurane
44
Sevoflurane combined with which absorbent can lead to high heat production & ultimately combustion.
Strong base absorbents like anhydrous LiOH (Spiralith)
45
What is missing with Mapleson circuits?
- CO₂ absorber
- Unidirectional valves
- separate inspiratory & expiratory limbs
46
Which Mapleson circuit is the best for spontaneous breathing?
Mapleson A (Magill's system)
47
Which circuit is the worst for controlled ventilation?
Mapleson A (Magill's system)
48
Which circuit does not contain corrugated tubing?
- Mapleson C
- C ya later corrugated tubing
49
Which circuit is the best for controlled ventilation?
Mapleson D
50
What does the FGF need to be with the Mapleson D circuit?
2 -2.5x minute ventilation
51
What makes the Bain circuit unique?
- It creates inspiratory & expiratory limbs
- Also, the FGF is moved away from the Pt
52
Which circuit does not have an APL valve?
Mapleson E & F
53
What is the Mapleson E used for?
In spontaneously breathing Pt's to deliver O2
54
What is the Jackson Rees circuit?
Adding a Reservoir bag, with a hole at the end, to the Mapleson E circuit
55
Which Mapleson circuits have the APL valve close to the Pt's mouth?
Mapleson A, B & C
56
Which Mapleson circuits waste a lot of FGF at the end of expiration?
- B & C
- A (if using for controlled ventilation)
57
Which 2 Mapleson circuits are least likely to be used for spontaneous ventilation?
B & C
58
How is the resistance to gas flow in Mapleson circuits?
Low resistance to gas flow
59
What are the disadvantages to Mapleson circuits?
- Need high FGF
- Do not conserve heat & humidity
- No scavenging system (Except D)
- Not suitable for MH Pt's (as FGF might not go high enough to blow off CO₂)
60
How much expired gas is rebreathed with Low flow anesthesia?
~ 50% after CO₂ removal
61
What are the 3 advantages of Low-flow anesthesia?
- Decreased use of VA's
- Improved temp & humidity control
- Reduced environmental pollution
62
What are the 3 disadvantages of Low-flow anesthesia?
- Difficult in rapidly adjusting anesthesia depth
- Possibility of accumulating unwanted exhaled gases
- VA degradation byproducts
63
What are advantages of Circle systems?
- Can use Low-flow anesthesia
- CO₂ elimination
- Stable inspired gas concentration
- Conservation of moisture, heat & gases
- Prevents OR pollution
64
What are the disadvantages of Circle systems?
- Complex design
- CO or Compound A
- May compromise Vt during controlled ventilation
- Increased law suits (D/t misconnections/disconnections)
65
What are the hazards for Ambu bags?
- Barotrauma due to Breath stacking
- Significant variation in Vt, PIP, PEEP
- Non-rebreathing valves generate resistance
66
What are the concerns with bacterial filters?
- Create high airflow resistance
- Prevent water penetration leading to increased resistance & efficiency
- Obstructions
- Leakage in housing of gas line filter
67
When is a Inspiratory filter placed?
When machine has previously been contaminated
68
What Pt's need a Airway filter at the Y-piece?
- Covid Pt's
- PUI Pt's
69
What is relative humidity?
Percent saturation; amount of water at certain temperature
70
What is absolute humidity?
What is the value covered in class?
- Mass of water vapor in gas in mg H₂O/L
- 44 mg H₂O/L
71
Where is the isothermic saturation boundary?
Just below the carina
72
Cool inspired air can lead to what?
Bronchospasms
73
What can happen with underhumidification?
- Secretions thicken
- Ciliary function decreases
- Impairs surfactant activity
- Mucosa susceptible to injury
- Body heat loss
- ETT obstruction
- increased resistance & work of breathing
74
What can happen with overhumidification?
- Water intoxication
- inefficient mucociliary transport
- Obstruction to sensors
- Increased risk for pulmonary infection
- surfactant dilution
- atelectasis
75
What do Heat & moisture exchangers do?
Where are they placed?
- They conserve some exhaled heat & water & returns them to Pt
- They are placed between Y-piece & ETT
76
HME's can cause what issues?
- Low EtCO₂ readings
- Increase resistance & dead space
- Reduced efficiency with large tidal volumes
77
Hygroscopic HME's are most efficient for?
- Retaining heat & moisture
- H for heat
78
Hydrophobic HME's are more efficient for?
Filtering of pathogens
79
What is the downside to Hygroscopic HME's?
- Prone to becoming saturated
- Increased inspiratory & expiratory resistance
80
When are humidifiers used?
- Neonates
- Pt's with difficult respiratory secretions
- hypothermic Pt's
81
Condensation can lead to what?
Decreased tidal volumes
82
Where are humidifiers placed in a circle system?
On the inspiratory limb between the unidirectional valve and Y-piece
83
What devices has a higher chance for water aspiration?
Humidifiers
