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Chem/Phys > Breathing Sys/CO2 absorbent/Scaveging > Flashcards

Breathing Sys/CO2 absorbent/Scaveging Flashcards

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1
Q

What is dead space?

A

The space occupied by gases that are rebreathed without any change in composition - area of no gas exchange

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2
Q

What 2 things make up anatomical dead space?

A
  • patient’s conducting airways
  • conducting zone of respiration
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3
Q

What structures are included in the conducting airways?

A

nose
mouth

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4
Q

What structures are included in the conducting zone of respiration?

A

nose
trachea
bronchi

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5
Q

How to approximate anatomical dead space using IBW?

A

2 ml/kg

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6
Q

Is anatomical dead space the majority of physiologic dead space?

A

Yes

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7
Q

What is alveolar dead space?

A

The alveoli are ventilated with little or no perfusion - ventilation with no perfusion

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8
Q

What structures is alveolar dead space comprised of?

A

Alveoli

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9
Q

What is physiologic dead space?

A

Anatomical dead space + Alveolar dead space

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10
Q

What is mechanical/apparatus deadspace?

A

dead space created by the patient circuit

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11
Q

What increases mechanical dead space?

A
  • masks
  • ETT
  • adding items between ETT and Y piece
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12
Q

What things could be added between ETT and Y piece to increase dead space?

A
  • gooseneck extenders
  • humidifier filter
  • straight connector
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13
Q

What accounts for a majority of physioligc dead space DURING anesthesia?

A

mechanical dead space

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14
Q

What decreases mechanical dead space?

A

tracheostomy

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15
Q

Do ETT increase or decrease mechanical dead space?

A

They decrease because the entire Vt enters the dead as opposed to the mouth

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16
Q

What does VT stand for?

A

Tidal volume

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17
Q

What does VA stand for?

A

Alveolar volume

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18
Q

What does VD stand for?

A

Dead space volume

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19
Q

What 2 components make up VT?

A

VT = VA + VD

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20
Q

With each breath, tidal volume (VT) is made up of ______ + gas that is ______

A

With each breath, tidal volume (VT) is made up of ALVEOLAR VENTILATION (VA) + gas that is DEAD SPACE (VD)

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21
Q

What is the normal alveolar:dead space ratio? How would you see this ratio written?

A
  • 2:1
  • VA/VD
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22
Q

What is the approximate dead space:tidal volume ratio? How would you see this ratio written?

A
  • 1:3
  • VD/VT
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23
Q

For each breath, 1 ml/lb (lean body weight) becomes ___, 2 mlxlb-1 becomes ____, 3 mlxlb-1 constitutes the ____

A

For each breath, 1 ml/lb (lean body weight) becomes VD, 2 mlxlb-1 becomes VA, 3 mlxlb-1 constitutes the VT

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24
Q

What is minute ventilation?

A

The total flow expired over 1 min

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25
Q

What is the algebraic expression for minute ventilation?

A

VT x f
- where f is RR

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26
Q

VE is synonymous with what?

A
  • minute ventilation
  • VT x f
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27
Q

What are the 2 equations for VE?

A

VE = VT x f
VE = VA + VD

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28
Q

When is rebreathing DESIRED? Why?

A
  • when the patient is breathing previously ehaled gases and agents (O2, N2O, Air, sevo..)
  • prevents waste
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29
Q

When is rebreathing NOT DESIRED? Why?

A
  • when the patient is breathing previously exhaled CO2.
  • Causes CO2 retention & dilutes gases/agents
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30
Q

What are 2 ways that CO2 is removed?

A

CO2 absorber/scrubber
Scavenger system

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31
Q

Does rebreathing CO2 dilute gases & agents? What does this do to speed of induction and emergence?

A

Yes, it can delay the speed of induction & emergence

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32
Q

What 3 factors influence rebreathing?

A
  • FGF
  • Mechanical dead space
  • Design of breathing system (circle v mapleson)
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33
Q

If the volume of FGF is equal to or greater than patient’s minute volume, is there rebreathing/CO2 retention?

A

No

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34
Q

If the volume of FGF is equal to or greater than patient’s minute volume, must there be unobstructed expiration to atmosphere or a scavenging system?

A

Yes

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35
Q

In regards to apparatus dead space, increasing or decreasing the dead space decreases or increases the risk of rebreathing CO2?

A

In regards to apparatus dead space, INCREASING the dead space INCREASES the risk of rebreathing CO2?

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36
Q

At what 2 points during the case do we want higher flows?

A
  • On induction during denitrogenation
  • on emergence to blow off CO2
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37
Q

Do you want your flows higher or lower during maintaence phase of the case?

A

lower

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38
Q

Circle circuits are also known as what 2 names?

A

semi closed systems
closed systems

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39
Q

In a circle circuit, is rebreathing expected or not expected?

A

Rebreathing of inhaled agents/gase is expected, not CO2

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40
Q

Non rebreathing circuits are also known as what 3 names?

A
  • semi opened system
  • Bain
  • mapleson D
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41
Q

In a non rebreathing circuit, is rebreathing desreable?

A

No, rebreathing is not

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42
Q

How is CO2 eliminated in circle circuits?

A

CO2 absorbent that scrubs exhaled CO2

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43
Q

In non rebreathing circuits, calculating _____ may be necessary to prevent rebreathing CO2

A

In non rebreathing circuits, calculating VE (MINUTE VENTILATION) may be necessary to prevent rebreathing CO2 - provided on circuit

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44
Q

Does rebreathing CO2 raise CO2 blood levels?

A

Yes

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45
Q

What are the 5 goals of the circle system?

A
  • Deliver gas
  • Remove co2
  • Ace humidity
  • Condition temperature
  • Exclude room air
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46
Q

What are the 2 unidrectional resp valves in a circle system?

A
  • inspiratory
  • expiratory
47
Q

What are the 2 overall purposes of the unidirectional resp valves?

A
  • direct gas flow
  • decrease dead space
48
Q

When does the inspiratory valve open? When does it close?

A
  • opens during inspiration
  • closes during expiration
49
Q

When does the expiratory valve open? When does it close?

A
  • opens during expiration
  • closes during inspiration
50
Q

What size connecters is circle circuit tubing?

A

22 mm connecters

51
Q

Is the scavenger system tubing the same as the circuit tubing? Does it have the same connector sizes?

A

No, different tubing, different connector sizing

52
Q

What size connecters is the scavenging system tubing? What color?

A
  • 30 or 19 mm connecters
  • black or yellow
53
Q

Why are the connecter for the circuit and scavenger different size/colors?

A

For safety, to prevent accidental inappropriate connections - leading to patient breathing CO2 and other gases out to scavenger

54
Q

How would you describe the circle tubing appearnace?

A

It is corrugated.

55
Q

What does corrugated mean?

A

flexible and prevents kinking

56
Q

Approximately how long is the inspiratory and expiratory limbs of the circle circuit?

A

1 meter

57
Q

Is dual limb circle tubing frequently used today? Which is type is considered standard?

A

No, universal F (single limb) is standard

58
Q

What volumes are associated with dual limn circle tubing? What adult size connecters?

A
  • 400-500ml
  • 22 mm
59
Q

What is a universal F or single limb tubing?

A
  • breathing limb where there is a divider or tube inside a tube - both limbs in one
60
Q

Which has higher volumes, single or dual limb?

A

dual limb

61
Q

With 20 cmh20, which expand more, single limb or dual limb?

A

Dual

62
Q

In the single limb, which is insp? Which is exp?

A

inner most is insp
outer most is exp

63
Q

What does co-axial mean?

A

dual insp & exp limbs within 1 single corrugated tubing

64
Q

Are inspired gases still warmed and humidified if using universal F tubing?

A

yes

65
Q

What are 2 disadvantages to universal F circuits?

A
  • increased insp resistance to breathing
  • difficult to recognize if the inner tube/wall is intact
66
Q

What 2 connectors are considered standard by ISO - all things related to airway

A

15 mm
22 mm

67
Q

What are 3 types of airway filters that have 99.99% viral filtering efficiency between Y & ETT?

A
  • HMEF w/ gas sampling port
  • Airway filter with no humidification
  • COVID/TB filters
68
Q

Do airway filters between the Y and ETT add dead space? Which patient population should you be cognizant of with this?

A

Yes, peds patients

69
Q

Should airway filters between the Y and ETT be used with a filter on the exp limb?

A

Yes

70
Q

On which limb is it recommended you put the breathing circuit filter? Is placing one on insp and exp better than just exp?

A
  • expiratory
  • no
71
Q

In what 2 circumstances might we see the use of electronically heated humidifiers in anesthesia?

A
  • HFJV
  • HFNC
72
Q

What are the 2 names for the anesthesia breathing bags?

A
  • reservoir bag
  • rebreathing bag
73
Q

What material is the reservoir bag made of?

A

Neoprene

74
Q

What are the 3 main purposes of the reservoir bag?

A
  • reservoir for anesthesia gases/agents
  • means of manual/assisted ventilation
  • visual assessment of spont ventilation (helps approx. volumes)
75
Q

What are the 3 optimal sizes of reservoirs bags? Which is used for adults?

A
  • 1, 2, 3 L
  • 3 L
75
Q

Should the vol of the reservoir bag exceed that of the insp capacity?

A

Yes

76
Q

What is the max pressure of the reservoir bag?

A

60 cmH2O or 4x their stated capacity

77
Q

What does APL valve stand for? What is it also known as?

A
  • Adjustable pressure limiting valve
  • Pop off valve
78
Q

What is the purpose of the APL valve? What is it measured in?

A
  • Permits excess volume of gas to exit circuit and on to scavenging system
  • cmH2O
79
Q

APL Valve: Which direction is open? Does that provide minimum or maximum pressure?

A
  • counterclockwise
  • minimum pressure
80
Q

APL Valve: Which direction is closed? Does that provide minimum or maximum pressure?

A
  • clockwise
  • maximum (pressure remains in circuit)
81
Q

APL Valve: While closing, when do you feel a click? At what pressure is the valve fully closed?

A
  • above 30 cm h2o
  • at 70 cm h2o
82
Q

APL Valve: What does the term “adjusted” mean?

A

When the valve is in ANY position above open/minimum

83
Q

What are the 2 types of APL valves? Which type are most APL valves?

A
  • spring loaded (pressure regulated) and stem & seat (needle valve)
  • most are spring loaded (pressure regulated)
84
Q

What is manual mode of the APL?

A

Adjusted position where the pressure from the circuit needs to be high enough to lift valve open or forceful exhalation by patient to permit gases to exit to scavenger

85
Q

What is spontaneous mode of the APL?

A

The valve is in the fully open position & gases easily go to scavenger - only taking 1cm h2o from exhalation of FGF

86
Q

During spont breathing, is the APL open, adjusted or closed?

A

open

87
Q

During Machine checkout - scavenger system check - and
after morning check of machine, is the APL open, adjusted or closed?

A

open

88
Q

While placing mask on an awake and spontaneously breathing patient for induction and during emergence emergence, is the APL open, adjusted or closed?

A

open

89
Q

During assisted ventilation, is the APL open, adjusted or closed?

A

adjusted

90
Q

During machine check, is the APL open, adjusted or closed?

A

adjusted

91
Q

During valsalva – brief positive pressure to lungs during case, is the APL open, adjusted or closed?

A

adjusted

92
Q

During Machine check- circuit positive pressure check, is the APL open, adjusted or closed?

A

closed

93
Q

During very, very brief positive pressure to lungs during case, is the APL open, adjusted or closed?

A

closed

94
Q

What happens to the APL valve when the bag/ventilator switch is flipped?

A

Switching to Vent mode automatically isolates APL in traditional circle systems (Piston vents are different)

95
Q

What can a manual PEEP valve on the inspiratory limb result in

A

Negative pressure pulmonary edema

96
Q

What do oxygen analyzers measure? Where are oxygen analyzers found?

A
  • inspired O2 concentration
  • at the inlet to circle before insp valve
97
Q

Where are flow and pressure sensors located?

A

on insp & exp limbs

98
Q

Are CO2 absorbent canisters only found in circle systems?

A

Yes

99
Q

What breathing system is most commonly used in anesthesia today?

A

circle/closed circuit systems

100
Q

In open systems, is there a resevoir/rebreathing?

A

No

101
Q

In semi opened systems is there a reservoir? Is there rebreathing?

A
  • Yes, there is a resevoir
  • No there is no re breathing
102
Q

In open and semi opened systems, is there inspiration from atmosphere?

A

Yes

103
Q

In open and semi opened systems, is there expiration to atmosphere?

A

Yes

104
Q

In semi closed and closed systems, is there a reservoir?

A

yes

105
Q

In semi closed systems, is there rebreathing? Can there be partial rebreathing?

A
  • No there is no rebreathing but there can be partial at times
106
Q

In semi closed systems, is there inspiration from atmosphere? Is there expiration to atmosphere?

A
  • No, there is not inspiration to atmosphere
  • Yes, there is expiration to atmosphere
107
Q

In closed systems, is there a reservoir? Is there rebreathing?

A

Yes
Yes, complete rebreathing

108
Q

In closed systems, is there inspiration from the atmosphere? Is there expiration to the atmosphere?

A

No

109
Q

Is HFNC considered an open system? Is it a circle or non circle system?

A

It is considered an open, non circle system

110
Q

Does HFNC cause minimal dead space, little resistance, use RA or O2, and not have rebreathing?

A

Yes

111
Q

Does HFNC waste gas/increase pollution, have unpredicatable gas concetrations, cause a loss of heat/moisture, cause corneal abrasions, and have the inabilty to assist ventillation?

A

Yes

112
Q
A

Chem/Phys (1 decks)

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