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