Breathing Systems Part 1 (Ericksen) Exam 2 Flashcards
Breathing Systems are defined as ____________ the gas mixture from the machine.
A) Delivering
B) Receiving
C) Removing
D) Allowing
B) Receives gas mixture from the machine
*Delivery of something via the circle system to the patient *
Breathing Systems are defined as the process of ________ gas to the patient.
A) Monitoring
B) Recieving
C) Delivering
D) Removing
C) Delivering gas to the patient
A primary function of the component of breathing systems is that it removes __________.
A) CO2
B) O2
C) CO
D) HCO3-
A) It removes CO2
____________ and humidifying the gas mixture is a function of the breathing system.
A) Cooling
B) Conducts
C) Heating
D) Evaporating
C) Heating and humidifying of the gas mixture thats being delivered to the patient
The functionality of a breathing system allows for spontaneous, ____________, or controlled respirations.
A) assisted
B) humidified
C) filtered
D) measured
A) assisted
Breathing systems provide gas sampling, measure airway pressure, and __________ volume.
A) resist
B) increase
C) monitor
D) absorb
C) monitor
When gas passes through a tube, the pressure at the outlet ( P1 ) will be ____________ than at the inlet (P2).
A) higher
B) the same
C) lower
D) fluctuating
C) lower
Outlet or P1 is where the tube is connected to the patient
The drop in pressure (P2-P1) when gas passes through a tube is a measure of the __________ that must be overcome.
A) volume
B) temperature
C) resistance
D) velocity
C) resistance (R)
Resistance (R) varies with the __________ of gas passing through per unit of time.
A) temperature
B) volume
C) pressure
D) composition
B) volume
If you add an extra tube, you add volume and increase resistance
Which type of flow is described as smooth and orderly?
A) Turbulent
B) Laminar
C) Irregular
D) Mixed
B) Laminar
Which type of flow is described as rough?
A) Turbulent
B) Laminar
C) Irregular
D) Mixed
A) Turbulent
Flow types can change __________.
A) temperature
B) resistance
C) volume
D) pressure
B) resistance
In laminar flow, particles move __________ to the tube walls.
A) perpendicular
B) randomly
C) parallel
D) prostrate
C) parallel
They move in the same direction, orderly, don’t bump into anything
In laminar flow, the flow is fastest in the __________ of the tube where there is less friction.
A) center
B) near the walls
C) at the inlet
D) at the outlet
A) center
Which law describes the relationship between pressure, flow, and resistance in laminar flow?
A) Newton’s Law
B) Boyle’s Law
C) Poiseuille’s Law
D) Ohm’s Law
C) Poiseuille’s Law
Parallel
Laminar
We don’t have to calculate this
What letter(s) are considered Laminar flow?
A.
What letters is considered Generalized Turbulent flow?
B.
Particles are bouncing against each other
What letters correspond to Localized Turbulent flow?
C,D,E,F
Any difference in diameter, getting more narrow, bend or curve, another connection.
Laminar –> turbulent –> laminar
Which of the following statements are true about turbulent flow? (Select 3)
A) Flow lines are parallel.
B) Flow lines are not parallel.
C) “Eddies” are composed of particles moving across the general direction of flow.
D) “Eddies” are composed of particles moving opposite the general direction of flow.
E) The flow rate is different across the diameter of the tube.
B) Flow lines are not parallel
C) “Eddies” are composed of particles moving across the general direction of flow
D) “Eddies” are composed of particles moving opposite the general direction of flow.
Which of the following conditions can cause generalized turbulent flow?
A) When the flow of gas through a tube exceeds the critical flow rate.
B) When the flow of gas through a tube is below the critical flow rate.
C) The presence of constrictions, curves, or valves.
D) When the flow rate is different across the diameter of a tube
A) When the flow of gas through a tube exceeds the critical flow rate
Localized turbulent flow can occur under which of the following conditions? (Select 2)
A) Gas flow rate below the critical flow rate
B) When the flow of gas through a tube exceeds the critical flow rate.
C) Gas-conducting pathways are different across diameter of tube
D) Flow lines are parallel.
E) Gas flow rate encounters constrictions, curves, or valves.
A) Gas flow rate below the critical flow rate
E) Gas flow rate encounters constrictions, curves, or valves
To minimize resistance in gas-conducting pathways, which of the following should be considered? (Select 3)
A) Maximal internal diameter of the tube.
B) Minimal internal diameter of the tube.
C) Pathways should be have sharp curves
D) Pathways should have minimal length.
E) Pathways should have maximal length
F) Pathways should be without sharp curves.
A) Maximal internal diameter
D) Minimal length
F) Without sharp curves
Ericksen-Minimize resistance in the system- ideal to have short, straight, wide and no curves
Like an Old Fashion drink glass :p
Resistance imposes a strain with ventilatory modes where the patient must do part or all of the __________.
A) expiration
B) moving
C) work
D) inspiration
C) Work (inspiration and expiration)
If we are adding more things that the patient has to initiate breaths through, it makes it harder to breath through, increasing resistance
Changes in resistance ____________changes in the work of breathing.
A) subdivide
B) separate
C) diverge
D) parallel
D) parallel
Increased WOB = Increased resistance
The endotracheal tube (ETT) probably causes __________ resistance than the breathing system.
A) more
B) less
C) the same
D) no
A) more!
*It is one of the most narrow things going into the patient. Do not try to intubate yourself.. *
How can you tell how much resistance is considered too much? (Select 2)
A) There is no common agreement
B) It is universally agreed upon
C) Watching flow-volume loops
D) Watching spirometry
A) There is no common agreement people just know if you keep adding things, it increases resistance
C) Watching flow-volume loops can help determine too much resistance
Looking at your system and looking at how your pt is breathing and the pressures will let you know how much resistance is there
Compliance is the ratio of __________ to __________.
A) change in pressure; change in volume
B) change in volume; change in pressure
C) pressure; volume
D) volume; pressure
B) change in volume; change in pressure
How something easily expands and contracts
Compliance measures __________.
A) resistance
B) distensibility
C) elasticity
D) viscosity
B) distensibility (mL/cmH20)
Compliance helps determine __________.
A) respiratory rate
B) tidal volume (Vᵗ)
C) inspiratory time
D) expiratory time
B) tidal volume (Vᵗ)
Some components can stretch more to allow larger tidal volumes to be delivered to patient, like the resevoir bags and corrugated tubes.
Which components are considered the most distensible in a breathing system?
A) Valves and connectors
B) Filters and humidifiers
C) Tubes and bags
D) Sensors and monitors
C) Breathing tubes and Reservoir bags
Breathing tubes that are corrugating
Rebreathing is defined as the process of inhaling __________.
A) fresh gases only
B) previously inspired gases from which CO₂ may have been removed
C) previously inspired gases from which CO₂ may or may not have been removed
D) gases with increased oxygen concentration
C) previously inspired gases from which CO₂ may or may not have been removed
*Does not necessarliy mean CO2, can be any inhaled anesthetic gasses
If the CO2 scrubber/absorbant is exhausted then there is a higher chance of rebreathing CO2 d/t it not being removed*
Which of the following factors influence rebreathing? (Select 3)
A) Fresh gas flow
B) Dead space
C) Type of anesthetic used
D) Breathing system design
E) Tidal volume
A) Fresh gas flow - high vs low flos
B) Dead space
D) Breathing system design - is it semi-closed/open, open or closed system
The amount of rebreathing varies __________ with the total fresh gas flow (FGF).
A) directly
B) inversely
C) proportionally
D) exponentially
B) inversely
If the volume of FGF supplied per minute is equal to or greater than the patient’s minute volume, __________ occurs.
A) rebreathing
B) no rebreathing
C) partial rebreathing
D) increased rebreathing
B) no rebreathing
Minute volume is the amount of gas inhaled or exhaled from a person’s lungs in one minute. Normal minute volume is 4-6L/min
**This is true as long as exhaled gas is VENTED, its leaving into the scavenging system. **
Rebreathing occurs when the volume of FGF supplied per minute is __________ than the patient’s minute volume.
A) more
B) equal to
C) less
D) twice as much
C) less
Rebreathing occurs at low flows of air/oxygen at normal tidal volumes. Some of the inhaled gasses must be rebreathed to make up required volume
Match the Dead Space to their definitions
1 - A
2 - C
3 - D
4 - B
How can apparatus dead space be decreased?
A) By increasing the length of the breathing circuit
B) By adding more connectors to the breathing system
C) By having inspiratory and expiratory limb separation as close to the patient as possible
D) By having inspiratory and expiratory limb separation as further from the patient as possible
C) By having inspiratory and expiratory limb separation as close to the patient as possible apparatus dead space is decrease
**Apparatus dead space is ETT, facemask, anything distal from Y-piece. NOT insp/exp limbs.
What is the composition of inspired gas during no rebreathing?
A) Identical to the fresh gas
B) Part fresh gas and part rebreathed gas
C) Entirely rebreathed gas
D) Mixed with atmospheric air
A) Identical to the fresh gas delivered by the anesthesia machine
*Anything that the patient is getting from the vent, nitrous, o2, oxygen, volatiles.. *
What happens to the composition of inspired gas during rebreathing?
A) It is identical to the fresh gas
B) It is part fresh gas and part rebreathed gas
C) It is entirely rebreathed gas
D) It is mixed with atmospheric air
B) It is part fresh gas and part rebreathed gas
Which of the following are effects of rebreathing? (Select 2)
A) Reduces heat loss from the patient
B) Reduces moisture loss from the patient
C) Increases heat loss from the patient
D) Increases moisture loss from the patient
A) Reduces heat loss from the patient
B) Reduces moisture loss from the patient
Rebreathing can alter inspired gas tensions (partial pressures) by __________.
A) Increasing the inspired oxygen tension
B) Reducing the inspired oxygen tension
C) Reducing the inspired carbon dioxide tension
D) Increasing the inspired nitrogen tension
B) Reducing the inspired oxygen tension
*Think of a leak in the system, what we are putting in is not equaling what is coming out. There could be a leak and the machine and it isn’t alarming.
How does altered inspired gas tensions affect the concentration of inhaled anesthetic agents?
A) It affects the concentration during induction and maintenance
B) It affects the concentration during induction and emergence
C) It has no effect on the concentration
D) It only affects concentrations during induction
B) It affects the concentration during induction and emergence
*During induction you want to see the same amount going in and coming out
During emergence, when you turn off the gas, you don’t want to see high numbers still with high flows, they should be blowing off the gas.*
How does rebreathing affect the inspired carbon dioxide tension?
A) It decreases the inspired carbon dioxide tension
B) It has no effect on the inspired carbon dioxide tension
C) It increases the inspired carbon dioxide tension
D) It stabilizes the inspired carbon dioxide tension
C) It increases the inspired carbon dioxide tension
*Any rebreathing increases carbon dioxide. Alveolar dead space continuously increases, they are ventilating but not perfusing, the PaCO2 would increase and you will see a decrease in ETCO2.
What contributes to the volume of airflow of inspired and expired gas? (Select 3)
A) Nitrous
B) Oxygen
C) Air
D) Volatile Gasses
A) Nitrous
B) Oxygen
C) Air
Ericksen- Volatiles do not contribute to the volume, they are just partial pressures
Desirable characteristics of breathing circuit
A desirable characteristic of a breathing circuit is to have low __________ to gas flow.
A) resistance
B) pressure
C) volume
D) humidity
A) resistance
Desirable characteristics of breathing circuit
Minimal __________ is important to prevent the patient from inhaling previously exhaled gases.
A) pressure
B) rebreathing
C) humidity
D) resistance
B) rebreathing
Desirable characteristics of breathing circuit
The breathing circuit should ensure the removal of CO₂ at the rate of __________.
A) absorption
B) inhalation
C) production
D) exhalation
C) production
Desirable characteristics of breathing circuit
The ability to make ________changes in delivered gas when required is a desirable characteristic.
A) secondary
B) rapid
C) undesirable
D) critical
B) Rapid
*Ericksen - we want to see these changes immediately. *
Warmed __________ of inspired gas helps to maintain patient comfort and prevent respiratory complications.
A) filtration
B) ventilation
C) humidification
D) condensation
C) humidification
Safe disposal of __________ gases is essential for maintaining a safe environment in the operating room.
A) inhaled
B) waste
C) fresh
D) mixed
B) waste
CO2 canisters and to the scavenging system, to reduce the amount of rebreathing going on
Matching Classifications of Circuits to their definition
1 - b.
2 - a.
3 - c.
4 - d.
Which type of circuit has no rebreathing or a reservoir bag and is open to atmosphere like a nasal cannula?
A) Open
B) Semi-open
C) Semi-closed
D) Closed
A) Open
No valves, open to atmosphere, no tubing. Patient is breathing in mixture of oxygen and RA, no rebreathing
Open drop ether, Ericksen is not that old
In which type of circuit does partial rebreathing occur?
A) Open
B) Semi-open
C) Semi-closed
D) Closed
C) Semi-closed
*MOST commonly used, has a reservoir bag, tubing, circle system, APL valve.
Partial re-breathing, gasses have a way to escape. *
Which type of circuit includes a reservoir bag but does not allow rebreathing?
A) Open
B) Semi-open
C) Semi-closed
D) Closed
B) Semi-open
Ericksen - resevoir bag and no rebreathing, HIGH fresh gas flow, higher than minute ventilation
“If our FGF is 6 and the minute ventilation 4L/min, then we have a semi-open system.”
In a closed circuit, the presence of complete rebreathing depends on __________.
A) the type of gas used
B) the flow rate of fresh gas (FGF)
C) the size of the reservoir bag
D) the length of the circuit
B) the flow rate of fresh gas (FGF)
*Whatever is coming in is circulating and the patient is rebreathing it. LOW flow anesthesia, metabolic rate to the patient or lower.
If your FGF is equal or less than minute ventilation there is going to be rebreathing of insp/exp gasses.
What if our CO2 is exausted? Then yes, there is rebreathing.*
Components of Anesthesia
A __________, LMA, or ETT is used to provide a secure airway for the patient.
A) facemask
B) reservoir bag
C) fresh gas inflow site
D) Y-piece
A) Facemask
Components
__________ are used to deliver gas to and from the patient in the breathing circuit.
A) Respiratory valves
B) Carbon dioxide absorption canisters
C) Breathing tubing
D) Fresh gas inflow sites
C) Breathing tubing
Components
__________ control the direction of gas flow within the breathing circuit.
A) Reservoir bags
B) Respiratory valves
C) Facemasks
D) Y-pieces
B) Respiratory valves
Components
A __________ is used to store excess gas in the breathing circuit.
A) Y-piece
B) pop-off valve
C) reservoir bag
D) carbon dioxide absorption canister
C) reservoir bag
Components
A __________ leading to scavenging helps to remove excess gases from the breathing circuit to maintain safety.
A) facemask
B) pop-off valve
C) Y-piece
D) fresh gas inflow site
B) pop-off valve
Components
A __________ is used to remove carbon dioxide from the exhaled gases before they are rebreathed.
A) Y-piece
B) facemask
C) reservoir bag
D) carbon dioxide absorption canister
D) carbon dioxide absorption canister
Components
A __________ with mask/tube connectors is used to connect the various components of the breathing circuit.
A) facemask
B) Y-piece
C) pop-off valve
D) fresh gas inflow site
B) Y-piece
*Tube connectors - Elbows, accordians like with trachs *
An anesthesia mask is typically __________ to allow observation of the patient’s face and condition.
A) clear
B) opaque
C) colored
D) black
A) clear
They use to be black.
The purpose of the pneumatic cushion in the mask’s cuff is to __________.
A) provide structural support
B) seal to the face
C) hold additional gas
D) attach other devices
B) seal to the face
*Inflatable or inflated cuff you can add or take away air to.
The mask fits between the interpupillary line and in the groove between the __________ and the alveolar ridge.
A) nasal bridge
B) zygomatic arch
C) jawline
D) mental process
D) mental process
Should be between the interpupillary line and grooves of the mental process and alveolar ridges.. shouldn’t engulf the whole face
Prongs on the anesthesia mask are used for attachment to __________.
A) the breathing tube
B) a rubber mask holder
C) the reservoir bag
D) the fresh gas inflow site
B) a rubber mask holder or head strap
An anesthesia mask connects to the Y-piece or connector using a __________.
A) 15 mm male connection
B) 15 mm female connection
C) 22 mm male connection
D) 22 mm female connection
D) 22 mm female connection
What is the primary purpose of connectors/adapters in a breathing circuit?
A) To monitor patient vitals
B) To join together two or more components
C) To increase the flow rate of gases
D) To measure gas composition
B) To join together two or more components
One of the benefits of using connectors/adapters is that they __________.
A) extend the distance between the patient and the breathing system
B) decrease the flexibility of the breathing circuit
C) reduce the resistance in the circuit
D) increase the dead space in the circuit
A) extend the distance between the patient and the breathing system
Ericksen - if you need to turn the bed 90 or 180 for surgical positioning, allows you to add more length but it does increase deadspace
Which of the following are disadvantages of using connectors/adapters? (Select 3)
A) Extends distance btween patient and breathing system
B) Increased dead space
C) Additional locations for disconnections
D) Reduced gas flow
E) Increased resistance
B) Increased dead space
C) Additional locations for disconnections
E) Increased resistance
Which of the following are benefits of using connectors/adapters? (Select 4)
A) Extend the distance between patient and breathing system
B) Increase the resistance in the breathing circuit
C) Allow more flexibility
D) Change the angle of connection
E) Less kinking
F) Decreases resistance
A) Extend the distance between patient and breathing system
C) Allow more flexibility and less kinking
D) Change the angle of connection
E) less kinking
Breathing tubing is typically __________ in length.
A) 0.5 meters
B) 1 meter
C) 1.5 meters
D) 2 meters
B) 1 meter
The internal volume of breathing tubing is Large bore and typically __________ mL/m of length.
A) 100-200
B) 200-300
C) 400-500
D) 500-600
C) 400-500
The flow through breathing tubing is always __________ due to corrugation.
A) laminar
B) turbulent
C) intermittent
D) steady
B) turbulent
Breathing tubing is usually made of __________.
A) metal
B) rubber
C) plastic
D) glass
C) plastic
Pliable and expandable
Expiratory and Inspiratory tubes do no contribute to dead space due to __________ gas flow.
A) bidirectional
B) turbulent
C) unidirectional
D) steady
C) unidirectional
As long as unidirectional valves are opening and closing properly and there is flow, the exp/insp tubing does not contribute to dead space
Breathing tubing has __________ resistance and is somewhat distensible.
A) High
B) Moderate
C) Long
D) Low
D) low
Distensible or stretches out
Two breathing tubes may be connected; longer tubes do not increase __________.
A) Dead space
B) Volume
C) Resistance
D) Direction
A) Dead space
*Dead space is only from the Y-piece to the patient. *
Before use, pressure check circuits should be done to __________ cm H₂O.
A) 15
B) 20
C) 30
D) 45
C) 30 cmH20
Which part of this tubing system would you have a mix of inspiration/expiration of gasses?
A. Bidirectional Gas Flow
Which part(s) of the tubing system Is considered dead space?
A. Bidirectional gas flow
C. Y-piece
The picture above also shows dead space in the elbow, connector from elbow to ETT and the ETT tube. Anything DISTAL to the Y-piece is deadspace
If the Inspiratory valve is open what part of the system should be closed?
D. Expiratory Limb
Whenever the Expiratory Limb is open, the inspiratory limb is closed.
If flow is trying to go forward and the inspiratory valve is stuck, that part of the breathing system contributes to ________________.
A) Fresh Gas Flow
B) Expiratory Reserve
C) Deadspace
E) Bidirectional Gas flow
C) Deadspace
The primary purpose of unidirectional valves in a breathing system is to __________.
A) control the temperature of the gas
B) direct respiratory gas flow
C) measure the pressure of the gas
D) increase the volume of the gas
B) direct respiratory gas flow in the correct direction
Unidirectinal valves typically use disks with knife edges, rubber flaps, or __________ to control gas flow.
A) sleeves
B) turn dials
C) push buttons
D) relief valve
A) sleeves
rubber flaps and sleeves or are old school, mostly metal disks
For optimal performance, unidirectional valves must open widely with __________.
A) high resistance
B) little pressure
C) a lot of pressure
D) rapid movement
B) little pressure
To prevent backflow, unidirectional valves must __________.
A) open slowly and partially
B) close completely and rapidly
C) stay partially open at all times
D) close slowly with high resistance
B) close completely and rapidly
with NO backflow to prevent Apparatus dead space
__________ resistance and __________ competence in unidirectional valves ensure that they move easily and don’t take a lot of pressure to lift the disk.
A. High, low
B. high, high
C. Low, low
D. Low, high
D. Low, high
Which of the following statements are true about the unidirectional inspiratory valve? (Select 2)
A) Opens on inspiration
B) Closes on inspiration
C) Prevents backflow of exhaled gas
D) Prevents backflow of inhaled gas
A) Opens on inspiration
C) Prevents backflow of exhaled gas
Which of the following statements are true about the expiratory valve? (Select 3)
A) Opens on inspiration
B) Closes on inspiration
C) Prevents rebreathing
D) Opens on exhalation
B) Closes on inspiration
C) Prevents rebreathing
D) Opens on exhalation
Apparatus dead space can occur in which of the following locations? (Select 2)
A) Distal limb of the Y-connector
B) Tube/mask
C) CO₂ absorber canister
D) Fresh gas inflow site
A) Distal limb of the Y-connector
B) Tube/mask
Where are unidirectional valves typically located in a breathing circuit?
A) Near CO₂ absorber canister casing
B) Fresh gas inflow site
C) Anywhere near the inspiratory limb
D) Anywhere near the expiratory limb
E) Pop off valves
F) All of the above
F) all of the above
True or False
The arrow pointing away from the patient towards the ventilator is for inspiratory unidirectional valve?
False - Inspiratory arrow is pointed going towards the patient for the unidirectional valve
*Expiratory arrow for the unidirectional valve is pointing away from the patient towards the vent *
Which features are necessary for the proper function of unidirectional valves? (3)
A. Transparent CO2 canister
B. Hydrophobic nature
C. Ability to open and close appropriately
D. Arrows or directional words
E. Connection to an external monitor
B. Hydrophobic nature
C. Ability to open and close appropriately
D. Arrows or directional words
Unidirectional valves must meet certain criteria. Which of the following are true? (3)
A. Must have a clear dome.
B. Placed between the patient reservoir bag.
C. Must be manually operated.
D. Must be hydrophobic.
E. Must be connected to a humidifier.
A. They must have a clear dome.
B. They must be placed between the patient and the reservoir bag.
D. They must be hydrophobic.
Breathing/Reservoir Bags are made out of non-slippery: (select 3)
A) Plastic
B) PVC
C) Rubber
D) Socks
E) Latex
A) Plastic
C) Rubber
E) Latex - phasing out of OR d/t allergies
What shape are Breathing/Reservoir Bags designed to be for one-hand ventilation?
A. Spherical
B. Cubical
C. Ellipsoidal
D. Cylindrical
C. Ellipsoidal
What is the traditional volume for adult Breathing/Reservoir Bags?
A. 1L
B. 2L
C. 3L
D. 6L
C. 3L
0.5L for peds and max of 6L
What size female connector must Breathing/Reservoir Bags have on the neck?
A. 20 mm
B. 22 mm
C. 25 mm
D. 28 mm
B. 22mm female connector on the neck
What is the minimum pressure required for Breathing/Reservoir Bags?
A. 20 cm H₂O
B. 25 cm H₂O
C. 30 cm H₂O
D. 35 cm H₂O
C. 30cm H20
What is the maximum pressure range for Breathing/Reservoir Bags?
A. 30 - 40 cm H₂O
B. 35 - 55 cm H₂O
C. 40 - 60 cm H₂O
D. 45 - 65 cm H₂O
C. 40 - 60 cm H₂O
How does the distending pressure of plastic Breathing/Reservoir Bags compare to rubber bags?
A. 0.5 times
B. Equal
C. 1.5 times
D. 2 times
D. 2 times
What is true about reservoir bags and why we have them?
A) To give more pressure to help patients breath during light sedation
B) The bag offers pressure even if the patient is spontaneously breathing and the APL valve is open
C) So we can control the amount of pressure going into the patient with the APL valve closed a little bit
D) All of the Above
D) All of the above
*Ericksen - slide 30
Pt’s are breathing spontaneously we can add more pressure to help the patient breath. Close the APL valve a little bit and increase the pressure in our system. If we are doing assisted breathing, we can control the amount of pressure going into them.
If we open the APL valve, they are breathing on their own with a good tidal volume, the bag offers some pressure. Always some degree of pressure.*
Time stamp of 102:30, slide 30
Which of the following is a function of a reservoir bag? (Select 2)
A. Reservoir for CO₂
B. Reservoir for anesthetic gases
C. Reservoir for O₂
D. Accurate measurement of tidal volume
B. Reservoir for anesthetic gases
C. Reservoir for O₂
*When we have air flow, the bag fills up and gets tight, the flow never stops filling up *
How can a reservoir bag assist with ventilation?
A. By providing breathing stimulation
B. By decreasing spontaneous ventilation
C. By administering anesthetics
D. By means of manual ventilation
D. By means of manual ventilation
Squeeze the bag
What type of ventilation can a reservoir bag assist with?
A. Spontaneous ventilation
B. Forced expiration
C. Active breathing
D. Decreasing respiration cycles
A. Spontaneous ventilation
How does a reservoir bag help monitor ventilation?
A. By providing afferent feedback
B. By visual/tactile monitoring of ventilation
C. By recording data of ventilation
D. By estimating the respiration rate
B. By visual/tactile monitoring of ventilation
You can see the bag opening and closing, you can see pt. taking deep/shallow breaths. If the bag is quivering the patient is breathing rapid and shallow. Open APL valve and allows them to take deeper tidal volumes. Estimation of volume of ventilation
How does a reservoir bag protect the patient during ventilation?
A. Filtering out impurities
B. Relieving negative pressure
C. Relief from excessive positive pressure
D. Cooling the exhaled air
C. Protecting from excessive positive pressure
*Some of the pressure will go into the bag and not stay in the patients lungs and relieve that pressure. *
The gas inflow site has a _____.
A. fresh gas outlet
B. fresh gas inlet
C. CO₂ outlet
D. CO₂ inlet
B. fresh gas inlet
The _________________ recieves gases and vapors from the machine and delivers the mixture via the fresh gas inlet to the circuit
A. oxygen tank
B. common gas inlet
C. common gas outlet
D. anesthetic reservoir
C. common gas outlet
Gases are delivered from the common gas outlet to the circuit
In circle systems, the gas inflow site is located near the inspiratory unidirectional valve or _____.
A. expiratory unidirectional valve
B. CO₂ outlet
C. CO₂ absorbent canister housing
D. fresh gas inlet
C. CO₂ absorbent canister housing in circle systems
The preferred location for the gas inflow site is between the CO₂ absorbent and _____.
A. expiratory valve
B. inspiratory valve
C. common gas outlet
D. fresh gas inlet
B. inspiratory valve
The APL valve is also known as a the _____ valve.
A. check
B. pop-off
C. flow
D. release
B. pop-off
Old people call it this
The APL valve permits gas to _____ the circuit.
A. enter
B. circulate within
C. leave
D. filter
C. leave
The dome valve of the APL is loaded by a _____ and screw cap.
A. lever
B. spring
C. piston
D. diaphragm
B. spring
The APL valve is ________-adjustable.
A. patient
B. time
C. user
D. temperature
C. User -we are twisting it
The APL valve controls pressure in the _____ system.
A. oxygen supply
B. breathing
C. vacuum
D. anesthesia
B. breathing
When the screw cap of the APL valve is tightened, _____ gas pressure is required to open it.
A. less
B. some
C. more
D. no
C. more
If its tightened clockwise we are closing it, reduces gas leaving and more pressure to open it. Increases pressure in the breathing system
The APL valve releases gases to the _____ system.
A. heating
B. cooling
C. scavenging
D. filtering
C. scavenging
In which direction should the APL valve be turned to increase pressure?
A. Counterclockwise
B. Clockwise
C. Perpindicular
D. Parallel
B. Clockwise - closing
To decrease pressure, which motion should be applied to the APL valve?
A. Clockwise
B. Upward
C. Counterclockwise
D. Downward
C. Counterclockwise - opening
How many clockwise turns does it take to move the APL valve from fully open to fully closed?
A. 0.5 to 1 turn
B. 1 to 2 turns
C. 2 to 3 turns
D. 3 to 4 turns
B. 1 to 2 turns
What must be present to indicate the direction to close the APL valve?
A. An arrow
B. An circle
C. A square
D. A sound
B. An arrow
During spontaneous respiration, the Check Valve disc is _____ during inspiration.
A. Open
B. Closed
C. Partially open
D. Bypassed
B. Closed
During mechanical ventilation, the APL valve is _____.
A. Open
B. Closed
C. Partially open
D. Bypassed
D. Bypassed
vent is doing the work
During assisted/manual ventilation, the APL valve is _____ during expiration.
A. Open
B. Closed
C. Partially open
D. Bypassed
C. Partially open
Excess is diverted
Matching
Matching
What feature of the absorber canister allows for visual inspection?
A. Opaque sides
B. Transparent sides
C. Colored sides
D. Reflective sides
B. Transparent sides
How many absorber canisters can be used in a series (stacked)?
A. Only one
B. Two or three
C. One or two
D. Four or five
C. one or two
What must be done to the absorber canister before use?
A. Shake it
B. Warm it
C. Remove the wrap
D. Top it off
C. Remove the wrap!!!!
Remove it. Remove it. Remove it
…did you remove it
What is the function of the side/center tube in the absorber canister?
A. To filter the gas
B. To humidify the gas
C. To heat the gas
D. To return the gas to the patient
D. To return the gas to the patient
True or False
Absorber Cansiter Housing - Incorporates valves that open when the canister is removed to prevent gas loss
FALSE
Incorporates valves that close when the canister is removed to prevent gas loss
You can change this in the middle of a case
When were canisters with absorbent invented?
A) 1924
B) 1942
C) 1934
D) 1925
A) 1924
What is the initial reaction that occurs with carbon dioxide and water in the absorbent?
A. Formation of a solid
B. Formation of an aqueous solution
C. Formation of a gas
D. No reaction occurs
B. Formation of an aqueous solution
What type of reaction is involved when carbon dioxide combines with hydroxides in the absorbent?
A. Endothermic reaction
B. Exothermic reaction
C. Neutral reaction
D. No reaction
B. Exothermic reaction
Which compounds does carbon dioxide combine with to form a carbonate in the absorbent?
A. Sodium, potassium, lithium, or calcium
B. Magnesium, aluminum, or iron
C. Sodium chloride, potassium chloride, lithium chloride, calcium chloride
D. Water, oxygen, and nitrogen
A. Sodium, potassium, lithium, or calcium
all hydroxides
What happens to the absorbent when it is exhausted?
A. It remains unchanged
B. It turns into carbonates
C. It dissolves completely
D. It releases oxygen
B. It turns into carbonates
Any hydroxides, they interact with CO2 that is passing through to form a exothermic reaction and that is what leads to exhausting absorbent.
*When absorbent is exhausted it turns into carbonates, it changes the color from white to purple. *
Why do newer absorbents have less than 2% sodium or potassium hydroxide, or none at all?
A. To reduce the cost of production
B. To prevent toxic reactions to humans
C. To increase the absorbent’s effectiveness
D. To enhance the color-changing property
B. To prevent toxic reactions to humans when using sevoflurane and desflurane
Which of the following are components of soda lime absorbents? (Select 5)
A. Calcium hydroxide
B. Sodium hydroxide
C. Potassium hydroxide
D. Lithium hydroxide
E. Water
F. Large amounts of silica and clay
G. Small amounts of silica and clay
A. Calcium hydroxide
B. Sodium hydroxide
C. Potassium hydroxide
E. Water
G. Small amounts of silica and clay
Silica and clay keep it from hardening and drying out.
Absorbent becomes exhaused when all the hydroxides become carbonates
Soda lime can absorb ____% of its weight in CO₂.
A. 15%
B. 19%
C. 25%
D. 30%
B. 19%
100 g of soda lime can absorb approximately ____ L of CO₂.
A. 20 L
B. 25 L
C. 26 L
D. 30 L
C. 26 L CO2
this is a lot it can scrub
What is the approximate percentage of calcium hydroxide in soda lime?
A. 60%
B. 70%
C. 80%
D. 90%
C. 80%
What is the approximate percentage of sodium hydroxide and potassium hydroxide in soda lime?
A. 3%
B. 5%
C. 7%
D. 10%
B. 5%
Leads to Compound A
CO
Destruction of inhaled gases
What is the approximate percentage of water in soda lime?
A. 10%
B. 12%
C. 15%
D. 20%
C. 15%
Which of the following are components of calcium hydroxide lime absorbents? (Select 5)
A. Calcium hydroxide (70%)
B. Calcium chloride (0.7%)
C. Calcium sulfate (0.7%)
D. Sodium hydroxide (0.7%)
E. Water (14.5%)
F. Polyvinylpyrrolidone (0.7%)
G. Potassium hydroxide (14.5%)
A. Calcium hydroxide (70%)
B. Calcium chloride (0.7%)
C. Calcium sulfate (0.7%)
E. Water (14.5%)
F. Polyvinylpyrrolidone (0.7%)..say that 3 times fast
Calcium hydroxide lime is the same thing as _______.
A. Soda lime
B. Amsorb
C. Baralyme
D. Litholyme
B. Amsorb
What are the three things are not a concern with Calcium hydroxide lime?
A) Compound A
B) CO production
C) Endothermic reactions
D) Formation of water
E) Destruction of inhaled gases
A. Compound A
B. CO
E. Destruction of inhaled gases
Which of the following statements are true about lithium hydroxide (LiOH) as an absorbent? (Select 3)
A. Reacts with CO₂ to form carbonate
B. Has less CO₂ absorption capacity
C. Used in submarines
D. Used in spacecrafts
A. Reacts with CO₂ to form carbonate
C. Used in submarines
D. Used in spacecrafts
What is one of the benefits of using lithium hydroxide as an absorbent?
A. Less CO₂ absorption capacity
B. More CO₂ absorption capacity
C. Reacts with CO₂ to form water
D. Interacts with volatile gasses
B. More CO₂ absorption capacity
What is one reason lithium hydroxide is preferred for CO₂ absorption despite its high cost?
A. It interacts with volatile gases
B. It is inexpensive
C. It does not interact with volatile gases
D. It is easy to produce
C. It does not interact with volatile gases
Due to NOT having KOH and NaOH
What is a safety concern when handling lithium hydroxide?
A. It is non-reactive
B. It causes burns
C. It causes bleeding gums
D. It causes fingernails to fall off
B. It causes burns to skin, eyes, and lungs
Litholyme uses a ________ catalyst and does not react with inhaled anesthetic agents.
A. Sodium chloride
B. Lithium chloride
C. Potassium chloride
D. Calcium chloride
B. Lithium chloride
NO KOH and NaOH
Litholyme contains no activators or strong bases, which means it does not form ________ and ________.
A. Compound A; oxygen
B. Carbon dioxide; oxygen
C. Compound A; CO
D. Lithium; carbonate
Compound A; CO
Litholyme has no regeneration, meaning pH indicators do not become ________.
A. Red
B. Purple
C. Colorless
D. Green
C. Colorless
Its going to change to purple and not change back to colorless
Litholyme has lower ________ reactivity, which reduces the risk of fire and economic/environmental impact.
A. Endothermic
B. Exothermic
C. Neutral
D. Photochemical
B. Exothermic
Spira-Lith uses anhydrous ______ powder within a nongranular partially hydrated polymer sheet.
A. NaOH
B. KOH
C. LiOH
D. CaOH
C. LiOH Lithium Hydroxide
What are some advantages of Spira-Lith? (Select 3)
A. Larger surface area
B. Longer duration of use
C. Contains color indicator
D. Cost-effective
E. Turns from white to violet
F. Requires monitoring inspired CO₂
A. Larger surface area for reaction
B. Longer duration of use
D. Cost-effective
Disadvantage–>Requires monitoring inspired CO₂ (no color indicator) NO color change
Which of the following are features of Spira-Lith? Select 4
A. Anhydrous LiOH powder
B. Nongranular
C. Small surface area for reaction
D. Contains activators or strong bases
E. Reduced temperature production
F. Partially hydrated polymer sheet
A. Anhydrous LiOH powder
B. Nongranular
E. Reduced temperature production
F. Partially hydrated polymer sheet
What is the most common dye used as an absorbent indicator?
A. Ethyl orange
B. Cresyl yellow
C. Ethyl violet
D. Methyl red
C. Ethyl violet
Other colors are Ethyl orange to yellow
and Red to Cresyl yellow.
What happens to the pH during carbonate formation in absorbents?
A. pH becomes more alkaline
B. pH becomes less alkaline
C. pH remains neutral
D. pH becomes acidic
B. pH becomes less alkaline
white to blue/ethyl violet
What color change does an exhausted absorbent undergo when the pH is <10.3?
A. Blue to green
B. Yellow to orange
C. White to purple
D. There is no color change
C. White to purple <10.3
pH >10.3 is colorless
What can cause the bleaching of the absorbent indicator?
A. Sunlight
B. Fluorescent lights
C. UV light
D. Incandescent lights
B. Bright Fluorescent lights for a long time.
Not a problem in the operating room
Which of the following are factors that reflect the reliability of absorbent indicators? Select 3.
A. Regeneration
B. Color fading
C. Temperature changes
D. Pressure changes
E. Capnometry
A. Regeneration
B. Color fading
E. Capnometry
If you are unsure the absorbent canister is exhausted, dried out or dessicated, change it out. Another way to know is if you see increase in ETCo2.
What is the typical mesh (granular) size range used in the canister?
A. 1 – 3
B. 2 – 6
C. 4 – 8
D. 6 – 10
C. 4 – 8 mesh size
Granular size - grapenuts
What is the primary goal of selecting the appropriate mesh size in the canister?
A. Minimize absorption and maximize resistance
B. Maximize absorption and minimize resistance
C. Minimize both absorption and resistance
D. Maximize both absorption and resistance
B. Maximize absorption and minimize resistance
What is the texture of the surface described in the mesh?
A. Smooth and regular
B. Rough and irregular
C. Sticky and uneven
D. Soft and pliable
B. Rough and irregular, like grape nuts
What proportion of the canister volume is gas?
A. One-third
B. One-fourth
C. One-fifth
D. Half
D. Half
What effect does excess liquid water within the canister have?
A. Increases surface area and efficiency of CO₂ absorption
B. Decreases surface area and efficiency of CO₂ absorption
C. Has no effect on surface area and efficiency of CO₂ absorption
D. Enhances resistance but does not affect absorption
B. Decreases surface area and efficiency of CO₂ absorption
What does channeling refer to in the context of the canister?
A. Large passageways allowing gas to flow through high-resistance areas
B. Small passageways allowing gas to flow through low-resistance areas
C. Large passageways allowing gas to flow through low-resistance areas
D. Small passageways allowing gas to flow through high-resistance areas
B. Small passageways allowing gas to flow through low-resistance areas
Decreases functional absorptive capacity
Which picture is an example of Channeling?
E. Channeling. Path of least resistance
Which of the following can help minimize channeling in the canister?
A. Circular baffles
B. Horizontal flow placement
C. Temporary mounting
D. Loose packing
A. Circular baffles
Round circular tube that goes through or on the side of the canister
Which of the following strategies help minimize channeling in the canister? (Select 4)
A. Oblong baffles
B. Placement for vertical flow
C. Permanent mounting
D. Prepackaged cylinders
E. Avoiding overly tight packing
F. Temporary mounting
E. Avoiding overly loose packing
B. Placement for vertical flow
C. Permanent mounting - can move it
D. Prepackaged cylinders - remove the plastic
E. Avoiding overly tight packing - compacting
What leads to the formation of Compound A?
A. Decomposition of nitrous oxide
B. Decomposition of sevoflurane
C. Decomposition of isoflurane
D. Decomposition of halothane
B. Decomposition of sevoflurane
Compound A is possibly ______ in humans.
A. Hepatotoxic
B. Cardiotoxic
C. Neurotoxic
D. Nephrotoxic
D. Nephrotoxic -in rats mostly
Which of the following factors contribute to the formation of Compound A? Select 4
A. Endothermic reactions
B. High FGF
C. Increased absorbent temperature
D. Higher inspired sevoflurane
E. Dehydrated absorbent
F. Use of KOH and KCL
G. Low FGF
C. Increased absorbent temperature - carbonate formation
D. Higher inspired sevoflurane concentrations
E. Dehydrated absorbent
G. Low FGF
Happens with KOH and NaOH
What type of absorbent condition leads to carbon monoxide production?
A. Wet absorbent
B. Dry absorbent
C. Acidic absorbent
D. Neutral absorbent
B. Dry absorbent
Carboxyhemoglobin levels greater than _______ can cause a “dip in pulse ox.”
A. 15%
B. 25%
C. 35%
D. 45%
C. >35%
Which monitoring devices do not pick up carbon monoxide production effectively? (Select 2)
A. Co-oximetry
B. Pulse oximetry
C. Capnography
D. Blood gas analyzers
E. IR gas monitors
B. Pulse oximetry
E. IR gas monitors
Co-oximetry picks up this, but only if you have a fancy OR
When are the highest levels of carbon monoxide typically observed?
A. End of the day
B. Middle of the week
C. Monday, 1st case
D. During routine maintenance
C. “Monday, 1st case”
*Leaving the flows up, drying out absorbent, not sure if the absorbent is exhausted. *
Which anesthetic gas is associated with the highest levels of carbon monoxide production?
A. Sevoflurane
B. Halothane
C. Isoflurane
D. Desflurane
D. Desflurane
*Desflurane ≥ enflurane > isoflurane > halothane > sevoflurane
*
Which factors contribute to the production of carbon monoxide in the anesthetic circuit? Select 3
A. Decreased concentration of gasses
B. Increased temperatures
C. Low FGF rates
D. Strong base absorbents
E. High FGF rates
F. Hydrated absorbent
B. Increased temperatures
C. Low FGF rates
D. Strong base absorbents
Also Increased concentrations of anesthetic gasses
What type of reactions can lead to fires and explosions in absorbents?
A. Endothermic reactions
B. Exothermic reactions
C. Neutral reactions
D. Photochemical reactions
B. Exothermic reactions
Which types of absorbents interact with sevoflurane to produce heat?
A. Acidic absorbents
B. Neutral absorbents
C. Desiccated strong base absorbents
D. Hydrated weak base absorbents
C. Desiccated strong base absorbents
What are examples of desiccated strong base absorbents?
A. Baralyme and anhydrous LiOH
B. Sodium hydroxide and calcium hydroxide
C. Potassium hydroxide and magnesium hydroxide
D. Silica gel and activated charcoal
A. Baralyme and anhydrous LiOH
At what temperature can absorbents exceed, leading to fire in some breathing circuits?
A. 100 degrees Celsius (212 degrees Fahrenheit)
B. 150 degrees Celsius (302 degrees Fahrenheit)
C. 200 degrees Celsius (392 degrees Fahrenheit)
D. 250 degrees Celsius (392 degrees Fahrenheit)
C. 200 degrees Celsius (392 degrees Fahrenheit)
What flammable degradation products can buildup at high temperatures within the absorber?
A. Formaldehyde, methanol, and formic acid
B. Carbon dioxide, Tapatio, and methane
C. Ammonia, Absorbic Acid, and hydrogen
D. Formaldehyde, Carbon dioxide, and formic acid
A. Formaldehyde, methanol, and formic acid
Which factors contribute to the risk of fires and combustion in absorbent heat production? Select 5
A. Exothermic reactions
B. Desiccated strong base absorbents
C. Hydrated absorbents
D. Buildup of high temperatures
E. Flammable degradation products
F. Avoiding the use of sevoflurane
G. Oxygen or Nitrous rich gasses
A. Exothermic reactions
B. Desiccated strong base absorbents
D. Buildup of high temperatures
E. Flammable degradation products
G) Oxygen or Nitrous
What should be done to gas flows after each case according to APSF recommendations?
A. Increased
B. Left unchanged
C. Turned off
D. Reduced to half
C. Turned off
Vaporizers turned off when not in use to prevent dessication
How should compact canisters be managed according to APSF recommendations?
A. Change less frequently
B. Change more frequently
C. Change at the same frequency as regular canisters
D. Do not use compact canisters
B. Change more frequently
Also change when color change has happened
What is the APSF recommendation for changing absorbent in a two-canister system?
A. Change the top canister only
B. Change both canisters
C. Change the bottom canister only
D. Change one canister at a time
B. Change both canisters
