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NURG 7017 > Breathing Systems Blueprint > Flashcards

Breathing Systems Blueprint Flashcards

1
Q

what are the 4 general principles of breathing systems

A

Resistance
Rebreathing
Compliance
Common Components

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2
Q

what are the two types of resistance

A

laminar

turbulent

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3
Q

what is the significance of resistance

A

it imposes strain and work of breathing (especially in patients that are independently breathing)

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4
Q

changes in breathing are proportional to

A

changes in work of breathing

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5
Q

what is the greater source of resistance in the breathing system

A

Tracheal tube

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6
Q

is regards to resistance, what should the anesthesia provider aim to do

A

minimize resistance such as minimize

  • CONNECTIONS
  • Connectors
  • kinks
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7
Q

what is poiseulles law

A

the relationship between airway resistance and the diameter of the tube (viscosity flow rate / rate 4th)

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8
Q

in laminar flow, where is flow the highest

A

middle/center of the tube, due to less friction

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9
Q

in poiseulles law, airway resistance is

A

airway resistance is inversely proportionate to the radius to the 4th power

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10
Q

with resistance, a change in pressure will

A

signify the resistance

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11
Q

define turbulent flow

A

can be either GENERALIZED or LOCALIZED

–flow is going in multiple directions

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12
Q

define laminar flow

A

flow is smooth and parallel to the walls of the tube (the more resistance, the slower gas delivery and less efficient)

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13
Q

changes in direction such as sharp turns/bends will result in

A

increase resistance

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14
Q

describe generalized turbulent flow

A

when the flow of gas through a tube exceeds a certain value called a CRITICAL FLOW RATE (basically the flow is bouncing completely around in the tube)

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15
Q

describe localized turbulent flow

A

when gas flow is below the critical flow rate but encounters constrictions, curves, valves or an area of localized turbulence (basically the flow meets resistance d/t kink or connectors causing turbulence)

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16
Q

turbulent flow will need _____ due to resistance

A

more PRESSURE

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17
Q

what is the one factor that is more import in the formulas for laminar and turbulent

A

laminar: viscosity of gas
turbulent: gas density

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18
Q

when considering resistance and the size of an ETT, the anesthesia provider should

A

use the minimal length with the maximal internal diameter

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19
Q

give examples of how anesthesia providers can minimize resistance

A
  • shorten circuit length
  • minimize kinks, turns
  • shorten length of tube and wider diameter
  • minimize connections
  • minimize the amount of VALVES
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20
Q

when does resistance become excessive

A

when the patient cannot overcome it (you will not be able to deliver gas and more invasive ventilator modes will be have be implemented)

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21
Q

what is compliance

A
  • the measure of the change in volume / the change in pressure
  • MEASURE OF DISTENSIBILITY (the amount of pressure needed to generate that volume to distend lungs)
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22
Q

what are the most distensible components of the breathing system

A

> reservoir bag

>breathing tubes

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23
Q

compliance plays a role in the determination of

A

TIDAL VOLUME (bc its an inverse relation, more compliance more volume and less compliance less volume)

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24
Q

less compliance, ____ resistance and ___ volume

more compliance, _____ resistance

A
  • more resistance and lesser volume
  • less resistance and higher volume
  • *inverse relationship**
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25
Q

what is rebreathing

A

inhale previously respired gases from which CO2 MAY or MAY NOT have been removed

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26
Q

rebreathing has a ______ relationship with fresh gas flow

A

inverse

  • low FGF = more rebreathing
  • high FGF = less rebreathing
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27
Q

rebreathing will ____ and the fresh gas flow _____

A
  • increases

- decreases

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28
Q

what are the three factors affecting rebreathing

A
  1. Fresh gas flow
  2. mechanical dead space
  3. breathing system design
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29
Q

the volume in a breathing system that is occupied by gases that are rebreathed without any change in composition

A

mechanical dead space (ventilation without perfusion)

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30
Q

How can mechanical dead space be minimized

A

separating the inspiratory and expiratory gas streams as close to the patient as possible

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31
Q

anatomical dead space plus the alveolar dead space

A

physiological dead space

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32
Q

consists of the patients conducting airway down to the alveoli

A

anatomical dead space

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33
Q

the volume of the alveoli ventilated but not perfused

A

alveolar dead space

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34
Q

why do we want to decrease dead space

A

we cannot effectively change the composition of inhaled gas composition

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35
Q

if dead space is increased without exchange of gases what occurs

A

rebreathing will be increased b/c increase dead space will decrease oxygen amount, increase CO2, and decrease volatile agents

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36
Q

with no rebreathing, the composition of inspired gas is ______ to that of the fresh gas delivered

A

identical

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37
Q

what are the benefits of rebreathing

A
  • heat and moisture retention
  • altered inspired gas tensions
  • decreases costs
  • decrease risk of exposure to OR personnel
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38
Q

what may patients under anesthesia rebreathe

A

oxygen, nitrous, CO2, volatile agents

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39
Q

oxygen rebreathing alveolar gas will have a _____ inspired oxygen tension

A

reduced

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40
Q

what are the common components of the breathing system

A
  1. connectors and adaptors
  2. reservoir bag
  3. breathing tubes- long circuits
  4. ALP Valve “pop off valve”
  5. PEEP
  6. filters
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41
Q

connectors will increase _____

A

dead space

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42
Q

fitting intended to joint together two or more similar components

A

connectors

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43
Q

a specialized connector that establishes functional continuity between otherwise incompatible components

A

adaptors

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44
Q

Connectors and adaptors can be differentiated by

A

shape, component attached to, added feature (nipple), size and type of fitting

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45
Q

______ increase the number of areas disconnections can occur

A

connectors

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46
Q

Connectors add ______ if positioned between the breathing system and the patient

A

dead space

47
Q

describe the shape and size of the connector of the reservoir bag

A

ellipsoidal

22mm female

48
Q

what are the 2 purposes of a reservoir bag

A
  1. to allow gas to accumulate during exhalation permitting rebreathing
  2. to protect the patient from excessive pressure
49
Q

the reservoir bag serves as a visual or tactile observation to monitor _____

A

spontaneous respirations

50
Q

the reservoir bag is the most ____

A

distendible, it will protect the patient from EXCESS PRESSURE

51
Q

what is the standard set by the American society for testing and material (ASTM) for reservoir bags

A

<>1.5L bag (the pressure should 30-50 cm H2O)
<>bags larger than 1.5L (pressure should be 35-60 cm H2O)
<> typically a 3L is used in adults

52
Q

the reservoir bag must be able to distend how many times its normal capacity

A

4X

assess bags compliance when performing machine checkout

53
Q

breathing tubes are large bore _____ tubing, which provides ____ and _____

A

CORREGATED

flexibility and low resistance

54
Q

what is the purpose of corrugated tubing in breathing tubes

A

prevents kinking and increases flexibility

55
Q

_____ is an adjustable valve used to release gases to a scavenging system

A

APL valve “spill valve” “pop off valve” “pressure relief valve”

56
Q

what is the purpose of the APL valve

A

to control the pressure in the breathing system

57
Q

PEEP valves can be

A

unidirectional or bidirectional

58
Q

what type of PEEP valves are primarily used today

A

BIDIRECTIONAL (these valves have a second flow channel with its own one way valve)

59
Q

where should the PEEP valve be located

A

between the ventilator and breathing system

60
Q

PEEP valves are marked with an arrow to display

A

the proper direction of gas flow (can also be marked with inlet and outlet arrow)

61
Q

using PEEP in a spontaneously breathing patient will cause

A

an increase in work of breathing

62
Q

what will occur if the PEEP valve is occluded

A

barotrauma

63
Q

_____ is used to protect the patient from microorganisms and airborne particulate

A

filters

64
Q

what are the benefits and downfalls of using a filter

A

Benefits: increases inspired humidity, increase rebreathing
Downfall: increases dead space, increase ETCO2

65
Q

list the 4 classifications of breathing circuits

A
  1. open
  2. semi open
  3. semi closed
  4. closed
66
Q

breathing circuits are classified by what two things

A

reservoir and rebreathing

the only one that does not have a reservoir is open

67
Q

give examples of an open breathing circuit and the classification

A

no reservoir and no rebreathing

insufflation, open drop, NASAL CANULA or SIMPLE FACE MASK

68
Q

give examples of an semi-open breathing circuit and the classification

A

has a reservoir and no rebreathing

Mapleson (FGF > Minute Ventilation

69
Q

give examples of an semi-closed breathing circuit and the classification

A

Has a reservoir and partial rebreathing
Circle system (FGF, APL)
( FGF < minute ventilation)

70
Q

give examples of an closed breathing circuit and the classification

A

has a reservoir and complete rebreathing
CIRCLE SYSTEM (APL will be closed in this system)
( FGF VERY LOW)

71
Q

what are the downfalls of using insufflation

A
  1. ventilation is not well controlled d/t mask lacking direct contact with patients face
  2. takes longer time to put child to sleep
  3. entrained room air is breathed in rather than just gas
72
Q

what open system is not utilized in anesthesia today

A

open drop (chloroform and either)

73
Q

in the draw over technique, what is the carrier gas that would carry anesthetic agent to the patient through the cloth

A

ambient air

74
Q

for a draw over open system, what is used at the carrier gas

A

ambient air

75
Q

in a draw over system, spontaneous breathing room air is drawn over a vaporizer by

A

negative pressure while inhaling

76
Q

in a draw over, the _____ bag encompasses a valve preventing retrograde flow which is then delivered to the patient via

A

self inflating bag (NOT THE SAME AS A RESERVOIR)

via nonrebreathing valve (AMBU)

77
Q

in an open system, what happens to the CO2 the patient exhales

A

vented out to the room

78
Q

what are the advantages and disadvantages of open systems

A

advantage:
- -simple, easy to use, not expensive
disadvantage:
- -cannot control inspired concentration b/c of entrained room air
- -cannot ASSIST ventilate patient b/c no reservoir bag
- -will not be able to conserve heat humidity (heat loss)
- -increases OR pollution

79
Q

describe the characteristics of the mapelson systems

A
  1. Absence of UNIDIRECTIONAL valves
  2. No means to absorb exhales CO2 (fresh gas flow washes out the excess CO2)
  3. not able to separate inspired and exhaled gases
  4. monitoring CO2 is the best method to determine optimal FGF
80
Q

what are the advantages of using a mapelson system

A
  1. lightweight, simple, inexpensive

2. work of breathing is low and resistance is low d/t no valves being present)

81
Q

in mapelsons, the lower FGF _____ and the higher FGF ______

A

lower (higher rebreathing)

higher (lower rebreathing)

82
Q

list the components of the mapelson system

A
  1. FGF-inlet
  2. APL
  3. Reservoir bag
  4. breathing tubes (Corrugated tubing)
  5. face mask
83
Q

list the ranking from best to worse (spontaneous)

A

A > DEF > CB

84
Q

list the ranking from best to worse (controlled)

A

DEF > BC > A

85
Q

what size is the breathing tube (corrugated) for mapelsons

A

22MM

86
Q

in mapelsons, what is the biggest determinant of tidal volume

A

breathing tube (corrugated tubing)

87
Q

what is the purpose of the APL valve in mapelsons

A

a spring/disk/valve

    • controls the flow of gas and allows for adjustment of pressure in circuit and system
    • can be used for manual or assisted breaths
88
Q

when the ventilator is used, the APL valve is bypassed resorting to a

A

spill valve

89
Q

what is the range for the APL valve

A

0 to 70 (totally open to totally closed)

90
Q

as the APL valve is open or closed, what is exiting the breathing system

A

ONLY GAS

91
Q

is the APL valve a unidirectional valve

A

NO - - it is an adjustable valve

92
Q

since the reservoir bag is the most distensible, this can cause

A

volu or barotrauma

93
Q

what is the ceiling effect for a reservior bag

A

2-3L bag options
if the bag is too full due to it being closed, it will divert gas and oxygen to scavenging system once it has reached this effect

94
Q

what mapelsons can you not scavenge with

A

E (Arye T piece) because there is no reservoir bag present

95
Q

what are the two components not present in mapelsons

A

no CO2 absorber and no unidirectional valves

96
Q

_____ is the best method to determining the amount of FGF required to prevent rebreathing

A

ETCO2

97
Q

list the advantages and disadvantages of mapelsons

A

Advantages:

    • less airway resistance
    • convenient
    • EASILY SCAVENGED
    • bain prevents heat loss

Disadvantages:

    • increases dead space and high FGF to prevent rebreathing
    • loss heat and humidity
    • inefficient use of inhaled agents
    • environmental pollution
    • unrecognized kinking in Bain Circuit
98
Q

what is the primary benefit of Bain circuit

A

warms inhaled air (coaxial adjustment, which provided tubing inserted in the back of corrugated but ends close to the patient where FGF is released

99
Q

what is the downfall of using bain

A
  • kinking

- at risk for hypercarbia

100
Q

list the components of a circle system

A
  1. Fresh Gas inlet
  2. unidirectional Valves (inspiratory and expiratory)
  3. Y-piece connector
  4. APL valve
  5. Reservoir bag
  6. canister containing carbon dioxide absorbent
  7. bag/vent selector switch
  8. mechanical anesthesia ventilator
  9. breathing tubes
101
Q

if unidirectional valves become incompetent or jammed what will occur

A

incompetent: less resistance resulting in rebreathing
jammed: obstruction

102
Q

the Y-piece connector is what size

A

15mm ETT and 22mm breathing tube

dead space ends at y-piece

103
Q

When is the APL valve open and closed

A

open: spontaneous breathing
closed: controlled ventilation

104
Q

used to turn on when bagging a patient or off when the ventilator is in use

A

bag/vent selector switch

105
Q

where is the most common area for disconnections to occur in the circle system

A

y-piece

106
Q

list the arrangements of components for the circle system (9)

A
  1. minimize absorbent desiccation (place FGF after your absorber to prevent wearing out absorber) leads to carbon monoxide formation
  2. maximize FGF in the inspired mixture and maximum venting of alveolar gas
  3. minimal consumption of absorbent (do not want to absorb the gases being vented through APL valve)
  4. accurate reading from respirometer placed in the system
  5. maximal humidification of inspired gas
  6. minimal dead space
  7. low resistance
  8. minimal pull on ETT, LMA
  9. convenience (tubes and wires should be organized)
107
Q

what is the goal of the circle system

A

to minimize DEAD SPACE and MINIMIZE RESISTANCE

NOT REBREATHING!

108
Q

list the advantages of the circle system

A
    • Decreases OR pollution
  • -heat moisture conserved
  • -less FGF
  • -LESS RESISTANCE
  • -inspired concentration is fixed and constant
  • -can be used in semi-open, semi-closed and closed system
109
Q

list the disadvantages of the circle system

A

–INCREASES DEAD SPACE
–complex and not portable
–MISSED CONNECTIONS!
–malfunctioning unidirectional valves
stuck Open: rebreathing. stuck Closed: obstruction

110
Q

the circle system prevents _____ rebreathing but permits rebreathing of _____

A

CO2 rebreathing

permits anesthetic gases and oxygen rebreathing

111
Q

in a closed breathing system, APL is _____ and what must the FG Flow be

A

APL closed

–FGF must meet metabolic demand (150-250 ml/minute under anesthesia)

112
Q

what is one Main benefit of a closed breathing system

A

Uses LOW FGF (d/t total rebreathing)

113
Q

in a closed breathing system, during inspiration and expiration, where is the gas/O2 coming from

A

inspiration: FGF and some recycled gases from reservoir
expiration: fills reservoir and ALP then absorber

NURG 7017 (7 decks)

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