Breathing Systems Part II (Ericksen) Exam 2 Flashcards
Which of the following are components of a Mapleson circuit? (Select 5)
A) Reservoir Bag
B) Corrugated Tubing
C) Oxygen Concentrator
D) Patient Connection
E) Inspiratory Valve
F) CO2 Absorber
G) Heat Exchanger
H) Fresh Gas Inlet
I) Expiratory Valve
J) APL Valve
A)Reservoir Bag
B)Corrugated Tubing
D) Patient Connection
H) Fresh Gas Inlet
J) APL Valve
Not all Maplesons have all these components
Rabbits Can Play Fun Activities
Mapleson circuits do not include a __________.
A. Reservoir Bag
B. CO2 Absorber
C. Corrugated Tubing
D. Patient Connection
B. CO2 Absorber
Unlike more complex anesthesia circuits, Mapleson circuits lack __________ , which then negates the use of separate pathways for inspiratory and expiratory limbs.
A. Fresh Gas Inlets
B. Patient Connections
C. Reservoir Bags
D. Unidirectional Valves
D. Unidirectional Valves,
Mapleson circuits are also known as __________ or __________.
A. Closed Circuits, Fresh Gas Flow Systems
B. High Flow Circuits, Flow-Controlled Breathing Systems
C. Carbon Dioxide Washout Circuits, Flow-Controlled Breathing Systems
D. Dual Limb Circuits, Low Flow Circle Systems
C. Carbon Dioxide Washout Circuits, Flow-Controlled Breathing Systems
In the Magill’s System or Mapleson A circuit, the fresh gas flow (FGF) enters near the __________, which is opposite of the patient.
A. Adjustable Pressure-Limiting (APL) Valve
B. Reservoir Bag
C. Patient Connection
D. Corrugated Tubing
B. Reservoir Bag
The APL valve in a Mapleson A circuit is positioned near the __________.
A. Fresh Gas Inlet
B. Reservoir Bag
C. Patient Connection
D. Overflow valve
C. Patient Connection
Mapleson A circuits are the MOST efficient for __________ ventilation and worst for __________ ventilation.
A. Controlled, Spontaneous
B. Spontaneous, Controlled
C. Manual, Automatic
D. Spontaneous, Manual
B. Spontaneous, Controlled
To prevent rebreathing in a Mapleson A circuit, the fresh gas flow must be ________ than or equal to the ____________ volume during spontaneous ventilation.
A. Greater/ Tidal
B. Greater/ Minute
C. Less/ Inspiratory
D. Less/ Minute
B. Greater/ Minute
Which of the following statements are true about the Mapleson A circuit? (Select 2)
A. Requires less than 20L/min of minute ventilation to prevent rebreathing
B. Rebreathing during controlled ventilation occurs unless minute ventilation is very low
C. Rebreathing during controlled ventilation occurs unless FGF is very high
D. Requires more than 20L/min of FGF to prevent rebreathing
C. Rebreathing during controlled ventilation occurs unless FGF is very high
D. Requires more than 20L/min of FGF to prevent rebreathing - this is considered wasteful during controlled ventilation
What gasses are represented by the blue, orange and red color?
Blue - Fresh Gas Flow
Orange - Dead Space Gas
Red - Alveolar Gas
To prevent rebreathing, Fresh Gas Flow must be __________ than or equal to minute volume to prevent rebreathing during spontaneous breathing.
A) Greater
B) Less
C) Easier
D) Harder
A) Greater
*When the patient is expiring, a lot of gas goes out of the pop-off valve, but the FGF has to be very high >20L/min in order to help ventilate off that gas. *
When the patient is inspiring, they get a little bit of the dead space and alveolar gas with some FGF
During controlled ventilation with a Mapleson A system, rebreathing occurs unless FGF is more than __________L/min
A) 10
B) 20
C) 30
D) 40
B) 20L/min
* A lot of this FGF is wasted through the APL valve during inspiration, so patient only gets a little bit of FGF with dead space and alveolar gas*
In the Mapleson B circuit, the APL valve and fresh gas flow (FGF) are positioned near the __________.
A. Reservoir Bag
B. Patient
C. End of the system
D. Opposite the patient
B. Patient
The reservoir bag in the Mapleson B system is located at the __________ of the system.
A. Beginning
B. Middle
C. End
D. Last Third
C. End
Mapelson B
Much of the fresh gas flow (FGF) is vented through the APL valve during __________, making the system inefficient.
A. Inhalation
B. Exhalation
C. Both Inhalation and Exhalation
D. The Expiratory Pause
B. Exhalation
For the Mapleson B system to be efficient, the fresh gas flow (FGF) should be ________ times the minute volume during spontaneous and controlled ventilation to prevent rebreathing.
A. 1x
B. 2x
C. 3x
D. 4x
B. 2x
What is the Mapelson B considered, due to it being unrealistic and not used anymore.
A) Current
B) Modern
C) Obsolete
D) Updated
C) Obsolete
In the Mapleson B, since the FGF is near the APL valve, gas will take the path of least resistance and a lot of FGF and ____________ gas will be vented out.
A) Dead Space
B) Fresh
C) Alveolar
D) Mixture
C) Alveolar
*Patient will get some FGF but not a lot *
The Mapleson C circuit is identical to the Mapleson B circuit except that it omits the __________, making it similar to an AMBU bag.
A. APL Valve
B. Reservoir Bag
C. Corrugated Tubing
D. Fresh Gas Inlet
C. Corrugated Tubing
Not losing as much FGF and Alveolar Gas to atmosphere through the APL valve
The Mapleson C circuit is almost as efficient as the Mapleson A circuit during __________ ventilation.
A. Controlled
B. Spontaneous
C. Manual
D. Assisted
B. Spontaneous
In the Mapleson C system, the fresh gas flow (FGF) should be __________ times the minute volume.
A. 1x
B. 1.5x
C. 2x
D. 3x
C. 2x
The Mapleson C system is commonly used for __________.
A. Routine Surgery
B. Emergency Resuscitation
C. Long-term Ventilation
D. Chronic Respiratory Failure
B. Emergency Resuscitation
EMERGEN - C
Looks like an AMBU bag
The Mapleson C system’s efficiency during spontaneous ventilation is based on __________.
A. Fresh gas flow rate
B. Expiratory pause length
C. Position of the APL valve
D. Reservoir bag size
B. Expiratory pause length
As long as it is a minimal expiratory pause
The Mapleson D circuit consists of a 3-way T-piece, which includes the patient connection, fresh gas inlet, and __________.
A. Reservoir Bag
B. Corrugated Tubing
C. APL Valve
D. CO2 Absorber
B. Corrugated Tubing
In the Mapleson D system, the fresh gas flow (FGF) should be __________ times the minute ventilation.
A. 1x
B. 2x
C. 2 - 2.5x
D. 2.5 - 3x
C. 2 - 2.5x
The Mapleson D system is considered the most efficient system for __________ ventilation.
A. Spontaneous
B. Manual
C. Controlled
D. Assisted
C. Controlled
In the Bain modification of the Mapleson D circuit, the fresh gas flow is __________, inside the corrugated tubing.
A. Parallel
B. Coaxial
C. External
D. Intermittent
B. Coaxial
*With the fresh gas inlet its like an inspiratory limb with flow going towards the patient. *
Worry about disconnections, pay attention to kinks of inner hose
In the Mapleson D system, __________ valves may be added to provide extra pressure and support during ventilation.
A. PEEP
B. APL
C. Inspiratory
D. Demand
A. PEEP
During spontaneous ventilation with the Mapleson D system, the APL valve is __________.
A. Closed
B. Partially Closed
C. Open
D. Sealed
C. Open
In the Mapleson D system, since the fresh gas flow (FGF) is closer to the patient, it is more likely to __________.
A. Get vented out
B. Go to the reservoir bag
C. Go to the patient
D. Mix with dead space gas
C. Go to the patient
In the Mapleson D system during spontaneous ventilation, the patient receives a mix of __________ and __________ gas.
A. Dead Space, Fresh Gas Flow (FGF)
B. Alveolar, Dead Space
C. Fresh Gas Flow (FGF), Alveolar
D. CO2, O2
C. Fresh Gas Flow (FGF), Alveolar
Some of the alveolar is vented out through the APL valve, Dome of the dead space may get vented out or caught in reservoir bag
With manually controlled ventilation in the Mapleson D system, the APL valve is __________ to increase pressure in the system.
A. Fully open
B. Partially closed
C. Fully closed
D. Slightly open
B. Partially closed
When squeezing the reservoir bag during inspiration in manually controlled ventilation with the Mapleson D system, some of the __________ gas and some of the __________ gas get vented out of the Pop-off valve.
A. Dead Space, Alveolar
B. Fresh Gas Flow (FGF), Alveolar
C. Dead Space, Fresh Gas Flow (FGF)
D. Alveolar, O2
A. Dead Space, Alveolar
In the Mapleson E (Ayre’s T-piece) system, the __________ attached to the T-piece forms the reservoir.
A. APL Valve
B. Reservoir Bag
C. Corrugated Tubing
D. Fresh Gas Inlet
C. Corrugated Tubing
End of system from the corrugated tubing is open to atmosphere
The Mapleson E system does not include a __________ or __________, which decreases resistance in the system to the atmosphere.
A. Corrugated Tubing, Fresh Gas Inlet
B. Reservoir Bag, APL Valve
C. Patient Connection, Fresh Gas Flow
D. CO2 Absorber, Fresh Gas Inlet
B. Reservoir Bag, APL Valve
This decreases resistance in the system
The Mapleson E system is preferred in __________ due to its decreased resistance.
A. Adults
B. Teenagers
C. Geriatrics
D. Pediatrics
D. Pediatrics
p-EEEEE-diatrics
The Mapleson E system is used in __________ patients to deliver oxygen.
A. Controlled Ventilation
B. Manually Ventilated
C. Spontaneously Breathing
D. Mechanically Ventilated
C. Spontaneously Breathing
Can pinch the end of the corrugated tubing to do controlled ventilation. Pinch to increase pressure and assist in breathing and open the end for expiration. Hard to gauge pressure, monitor chest rise and fall to not put too much pressure .
Why would we use the Mapleson E instead of simple mask, NRB or nasal cannula?
A) Delivers higher O2 flow rates
B) Delivers higher pressures
C) Delivers lower pressures
D) Removes more Deadspace gas
A) Delivers higher O2 flow rates
Cannot assist to take a DEEP breath
The (Jackson Rees) Mapleson F system is a modification of the __________ system.
A. Mapleson A
B. Mapleson B
C. Mapleson D
D. Mapleson E
D. Mapleson E
In the Mapleson F system, a __________ is added when compared to the Mepleson E system.
A. PEEP Valve
B. Reservoir Bag
C. CO2 Absorber
D. One-way Valve
B. Reservoir Bag (with a hole at the end)
Can see volume increasing and decreasing and helps moniotr RR
The recommended fresh gas flow (FGF) for the Mapleson F system is __________ times the minute ventilation.
A. 1 - 1.5x
B. 1.5 - 2x
C. 2 - 2.5x
D. 2.5 - 3x
C. 2 - 2.5x
The Mapleson F system is less likely to develop excessive pressure because it does not have a(n) __________.
A. Fresh Gas Inlet
B. Reservoir Bag
C. APL Valve
D. PEEP Valve
C. APL Valve
To increase pressure or assist in breathing, pinch off end at reservoir bag.
Where would you see the Mapleson F used mostly?
A) OR
B) ICU
C) ER
D) All the above
See this for patient transport also ICU to OR or vice versa
The Mapleson F system is functionally similar to the __________ system.
A. Mapleson A
B. Mapleson B
C. Mapleson D
D. Mapleson E
C. Mapleson D
Dead space gas is going out of the reservoir bag to the atmosphere through the hole at the end
Mapleson D does not have a hole in its reservoir bag like F…
In the Mapleson F system, the patient primarily receives a mix of __________ and __________.
A. Dead Space gas, Fresh Gas Flow (FGF)
B. Alveolar gas, Dead Space gas
C. Fresh Gas Flow (FGF), Alveolar gas
D. CO2, O2
C. Fresh Gas Flow (FGF), Alveolar gas
For spontaneous ventilation, which Mapleson system has the best efficiency?
A. Mapleson A
B. Mapleson B
C. Mapleson C
D. Mapleson D
A. Mapleson A
For controlled ventilation, which Mapleson system is considered the worst in terms of efficiency?
A. Mapleson D
B. Mapleson E
C. Mapleson F
D. Mapleson A
D. Mapleson A
Improved rebreathing efficiency in Mapleson circuits is due to the location of the __________ relative to FGF.
A. Reservoir Bag
B. Pop-off Valve
C. Patient Connection
D. Corrugated Tubing
B. Pop-off Valve
In BC systems, significant amounts of fresh gas are vented through the pop-off valve at __________.
A. Start of Inspiration
B. End of expiration
C. Middle of inspiration
D. During the entire respiratory cycle
B. End of expiration
In DEF systems, the fresh gas flow (FGF) drives exhaled alveolar gas __________ the patient.
A. Towards
B. Away from
C. Bypass
D. Under
B. Away from
Which order for spontaneous ventilation is from best to worst?
A) DFE BC A
B) A DFE CB
C) A CB DFE
D) DEF BC A
B) A(best) DFE CB(worst)
All Ducks Fly East Carrying Balloons
Which order for controlled ventilation is from best to worst?
A) A DFE CB
B) A DEF CB
C) DFE CB A
D) DFE BC A
D) DFE(best) BC A(worst)
Dinosaurs Fly Every Blue Cloud Around
One of the advantages of Mapleson circuits is that they are __________. Select 3
A. Expensive
B. Simple
C. Heavy
D. Lightweight
E. Difficult to assemble
F. Inexpensive
B. Simple
D. Lightweight
F. Inexpensive
An advantage of Maplesons is changes in the fresh gas flow (FGF) composition result in __________ changes in the circuit.
A. Slow
B. Minimal
C. Rapid
D. Unnoticeable
C. Rapid
An advantage of Mapleson circuits is that they have __________ resistance to gas flow.
A. High
B. Moderate
C. Low
D. Variable
C. Low
One advantage of Mapleson circuits is that they produce no toxic products due to the lack of __________.
A. Potassium hydroxide
B. Volatile gasses
C. CO2 Absorbent
D. Corrugated Tubing
C. CO2 Absorbent
Mapleson circuits do not degrade with __________.
A. Temperature changes
B. High pressure
C. Volatile Anesthetics
D. Long-term use
C. Volatile Anesthetics
One disadvantage of Mapleson circuits is that they require __________ fresh gas flow (FGF).
A. Low
B. Moderate
C. High
D. Variable
C. High
remember to have a FULL O2 tank when transporting patient to and from OR
The conservation of heat and humidity in Mapleson circuits is __________.
A. More efficient
B. Less efficient
C. Extremely efficient
D. Unchanged
B. Less efficient
Scavenging is challenging in Mapleson circuits except in Mapelson D because the APL valve is located __________ from the patient.
A. Close
B. Directly
C. Away
D. Next to
C. Away
The Mapleson circuit that only has the APL valve is closer to the reservoir bag?
A. Mapleson A
B. Mapleson B
C. Mapleson C
D. Mapleson D
D. Mapleson D
Mapleson circuits are not suitable for patients with malignant hyperthermia (MH) because it may not be possible to increase FGF to remove excess __________.
A. O2
B. N2
C. CO2
D. H2O
C. CO2
The Circle System allows for __________ flow.
A. Bidirectional
B. Unidirectional
C. Variable
D. Oscillatory
B. Unidirectional
What is A?
Expiratory Valve
What is B?
Pressure transducer port
What is C?
Pressure Gauge
What is D?
Bag-ventilator selector switch
What is E?
APL valve
What is F?
Scavenger outlet
What is G?
Peep Valve
What is H?
Reservoir Bag
What is I?
Co2 absorber
What is J?
Fresh gas inflow
What is K?
Galvanic oxygen sensor
What is L?
Inspiratory Valve
What is M?
Gas sample port
What is N?
Expiratory low sensor
In a circle system, when the ventilator is off, you are ____________ it during spontaneous breathing.
A) Going through
B) Bypassing
C) Going under
D) Going around it
B) Bypassing… sailing on by
True or False
During spontanous ventilation in a circle system, flows and gasses from the reservoir bag pass through the CO2 absorber during inspiration.
True
Spontaneous inspiration on circle system
True or False
Fresh gas flow passes through the CO2 absorber during spontaneous exhalation into the reservoir bag, APL valve or scavenger outlet
True
If pressure gets too high in reservoir bag, flows get vented out the APL valve and scavenging system
The extent of rebreathing and conservation of exhaled gases in the Circle System depends on __________.
A. Fresh Gas Flow (FGF)
B. CO2 Absorber
C. Placement of APL Valve
D. Reservoir Bag
A. Fresh Gas Flow (FGF)
Higher fresh gas flow (FGF) results in __________ rebreathing and __________ waste gas.
A. Less, greater
B. More, less
C. Less, less
D. More, greater
A. Less, greater
One of the rules to prevent rebreathing in a circle system, unidirectional valves must be located between the patient and the __________ on both the inspiratory and expiratory limbs.
A. Fresh Gas Inlet
B. Reservoir Bag
C. APL Valve
D. CO2 Absorber
B. Reservoir Bag
One of the rules to prevent rebreathing in a circle system is that the fresh gas inflow cannot enter the circuit between the expiratory valve and the __________.
A. CO2 Absorber
B. Inspiratory Valve
C. APL Valve
D. Patient
D. Patient
One of the rules to prevent rebreathing in a circle system is that the APL valve cannot be located between the patient and the __________ valve.
A. Expiratory
B. Inspiratory
C. Unidirectional
D. Fresh Gas
B. Inspiratory
Which of the following best describes a semi-closed circle system?
A. No rebreathing occurs; all expired gas is vented.
B. Full rebreathing occurs; no expired gas is vented.
C. Partial rebreathing occurs; some waste flow is vented.
D. All expired gas is rebreathed without CO₂ removal.
C. Partial rebreathing occurs; some waste flow is vented.
True or False
A Circle Systems that are Semi-closed is considered contemporary systems
True
In a semi-closed circle system, what happens to the waste gas flow?
A. It is entirely rebreathed.
B. It is vented through APL valve
C. It is vented through the oxygen supply.
D. It is completely eliminated.
B. It is vented through APL or the waste gas valve of the ventilator.
What is an example of the use of a semi-closed circle system?
A. High-flow anesthesia
B. Open anesthesia
C. Low-flow anesthesia
D. Closed anesthesia
C. Low-flow anesthesia
In low-flow anesthesia, the fresh gas flow (FGF) is:
A. Greater than minute ventilation
B. Equal to minute ventilation
C. Less than minute ventilation
D. Not related to minute ventilation
C. Less than minute ventilation
What percentage of expired gas is rebreathed after CO₂ removal in a semi-closed circle system?
A. 10%
B. 25%
C. 50%
D. 75%
C. 50%
*with lower flows, to make up the minute volume, it has to be rebreathed to make up the volume that is lost
*
Which of the following best describes a semi-open circle system?
A. Complete rebreathing of gases
B. Non-rebreathing system
C. Complete breathing with minimal waste gas venting
D. Non-rebreathing system with no venting
B. Non-rebreathing system
In a semi-open circle system, what characterizes the fresh gas flow (FGF)?
A. FGF is equal to minute ventilation
B. FGF is less than minute ventilation
C. FGF is higher with minimal rebreathing
D. FGF is negligible with complete rebreathing
C. FGF is higher with minimal rebreathing
Higher FGF with minimal rebreathing and more venting of waste gas
Which of the following is an example of the use of a semi-open circle system? Select 3
A. Low-flow anesthesia
B. Post-operative ventilators
C. High-flow anesthesia
D. Open drop anesthesia
E. ICU ventilators
F. Scuba gear
B. Post-operative
E. ICU ventilators
F. Scuba gear… :)
In a closed circle system, the rate of oxygen inflow:
A. Is higher than metabolic demand
B. Is less than metabolic demand
C. Exactly matches metabolic demand
D. Is independent of metabolic demand
C. Exactly matches metabolic demand
What happens to waste gas in a closed circle system?
A. It is partially vented
B. It is fully vented
C. It is not vented at all
D. It is only vented during emergencies
C. It is not vented at all
In a closed circle system, how are volatile anesthetics (VAs) added to the circuit?
A. They are not added
B. In gaseous form
C. In liquid form
D. Through a separate oxygen supply
C. In liquid form in precise amounts or through the vaporizer
Which type of anesthesia is an example of a closed circle system?
A. High-flow anesthesia
B. Low- and minimal-flow anesthesia
C. Low flow anesthesia
D. Low- and high flow anesthesia
B. Low- and minimal-flow anesthesia
Which of the following statements are true about the closed circle system? (Select 2)
A. Rebreathing is complete.
B. It is practical and commonly used.
C. Waste gas is vented completely
D. It is rarely done due to impracticality.
E. Oxygen inflow is less than metabolic demand.
A. Rebreathing is complete.
D. It is rarely done due to impracticality.
Which of the following is an advantage of low-flow anesthesia?
A. Increased use of volatile anesthetics (VAs)
B. Difficulty in rapidly adjusting anesthetic depth
C. Improved temperature and humidity control
D. Increased environmental pollution 💀
C. Improved temperature and humidity control
What is a disadvantage of low-flow anesthesia?
A. Decreased use of VAs
B. Easy to rapidly adjust anesthetic depth
C. Accumulation of unwanted exhaled gases
D. Reduced environmental pollution 🌼
C. Accumulation of unwanted exhaled gases
One of the benefits of low-flow anesthesia includes:
A. Higher operating costs
B. Decreased use of volatile anesthetics
C. Increased waste gas ventilation
D. Complicated setup and operation
B. Decreased use of volatile anesthetics
Which of the following is an advantage of low-flow anesthesia?
A. Difficulty in rapidly adjusting anesthetic depth
B. Accumulation of unwanted exhaled gases
C. VA degradation by-products
D. Reduced environmental pollution
D. Reduced environmental pollution
Which of the following are disadvantages of low-flow anesthesia? (Select 3)
A. Difficulty in rapidly adjusting anesthetic depth
B. Improved temperature and humidity control
C. Possibility of accumulating unwanted exhaled gases
D. VA degradation by-products
E. Reduced environmental pollution
A. Difficulty in rapidly adjusting anesthetic depth
C. Possibility of accumulating unwanted exhaled gases ( CO, acetone, methane)
D. VA degradation by-products ( CO, Compound A)
Which of the following are advantages of the circle system? (Select 2)
A. Low fresh gas flow (FGF) used
B. Complex design
C. Elimination of CO₂
D. CO or compound A production
A. Low fresh gas flow (FGF) can be used
C. Elimination of CO₂
Which of the following are considered disadvantages of the circle system? (Select 2)
A. Prevention of OR pollution
B. Complex design
C. Conservation of moisture/heat/gases
D. Compromise of tidal volume (Vt) during controlled ventilation
E. Unstable inspired gas concentration
B. Complex design
D. May compromise tidal volume (Vt) during controlled ventilation
*Lost tidal volume in corrugated tubing *
Which features contribute to the circle system’s effectiveness? (Select 3)
A. Relatively stable inspired gas concentration
B. Conservation of moisture/heat/gases
C. Prevention of OR pollution
D. Misconnections/disconnections
A. Relatively stable inspired gas concentration,
B. Conservation of moisture/heat/gases,
C. Prevention of OR pollution 🌸
What we give the patient is what is returned back. Maybe not 100%, but if there is a big discrepancy then investigate it
What are some potential disadvantages with the use of the circle system? (Select 2)
A. Elimination of CO₂
B. Misconnections/disconnections
C. Relatively stable inspired gas concentration
D. CO or compound A
B. Misconnections/disconnections, (ASA Closed Claims Project)
D. CO or compound A
Which components of the self-inflating manual resuscitator (AMBU) is used to increase oxygen pressure when needed? select 2
A. Self-expanding Bag
B. T-shaped non-rebreathing Valve
C. Oxygen reservoir
D. Pop-off valve
D. Pop-off valve
AKA APL valve
A. Self-expanding Bag
Which of the following are components of a self-inflating manual resuscitator? (Select 3)
A. Self-expanding Bag
B. CO2 absorbent canister
C. Bag Inlet Valve
D. Oxygen concentrator
E. T-shaped non-rebreathing Valve
A. Self-expanding Bag,
C. Bag Inlet Valve
E. T-shaped non-rebreathing Valve,
*also includes pop off valve, excess oxygen venting valve, and oxygen reservoir
Which of the following are components of a self-inflating manual resuscitator? (2)
A. Pop-off valve
B. L-shaped rebreathing valve
C. Excess Oxygen waste valve
D. Excess CO2 venting valve
A. Pop-off valve
C. Excess oxygen venting valve
Which of the following is a primary use of a self-inflating manual resuscitator?
A. Continuous mechanical ventilation
B. Hand ventilation
C. Long-term oxygen therapy
D. Aerosol drug delivery
B. Hand ventilation in the absence of an oxygen or air source
Self-inflating manual resuscitators are commonly used during:
A. Routine patient monitoring
B. Patient transport
C. Routine surgical procedures
D. Diagnostic imaging
B. Patient transport
In emergency situations, a self-inflating manual resuscitator is essential for:
A. Measuring blood pressure
B. Delivering CPR
C. Administering intravenous fluids
D. Monitoring heart rate
B. Delivering CPR
ALWAYS have and AMBU bag in set up and attached to anesthesia machine!
What can occur if the head is not positioned appropriately and oxygen is going down the esophagus when using a self-inflating manual resuscitator? Select 2
A. Hypoxia
B. Barotrauma
C. Hypercapnia
D. Hypocapnia
E. Gastric insufflation
F. Laryngospasm
B. Barotrauma
E. Gastric insufflation
What is a significant concern related to the variation when using a self-inflating manual resuscitator?
A. Variations in RR, oxygen concentration and PEEP
B. Variations in tidal volume, oxygen concentration and PEEP
C. Variations in tidal volume, PIP, and PEEP
D. Variations in patient temperature
C. Variations in tidal volume, PIP, and PEEP
What issue can nonrebreathing valves cause in a self-inflating manual resuscitator?
A. Generation of resistance
B. Increase in oxygen levels
C. Decrease in oxygen levels
D. Increase in carbon dioxide levels
A. Generation of resistance
What is the primary purpose of using bacterial filters?
A. To enhance the smell of anesthetic gases
B. To prevent contamination or infection
C. To filter out solid particles from anesthesia gases
D. To cool the air before inhalation
B. To prevent contamination or infection by airborne diseases
Which of the airborne diseases is mentioned in the slide that bacterial filters help prevent? (Select 2)
A. COVID
B. Malaria
C. M. Tuberculosis
D. Influenza
A. Covid
C. M. Tuberculosis
PUI stands for _________, which indicates a person may be positive with an airborne disease.
Person under Investigation
Where are bacterial filters placed in the anesthesia machine setup?
A. On the inspiratory limb
B. On the patient’s mask
C. On the oxygen tank
D. On the expiratory limb
D. On the expiratory limb
What is a characteristic of a small-pore compact matrix in bacterial filters?
A. Low airflow resistance
B. High airflow resistance
C. No airflow resistance
D. Variable airflow resistance
B. High airflow resistance
How is a small-pore compact matrix designed to pick up more pathogens?
A. It is less dense
B. It is pleated to create a smaller surface area
C. It is pleated to create a larger surface area
D. It is coated with antimicrobial agents
C. It is pleated to create a larger surface area
What is a feature of a less dense, larger pore size arrangement in bacterial filters? (Select 2)
A. Increased airflow resistance
B. Smaller surface area
C. Less airflow resistance
D. Higher pathogen capture
B. Smaller surface area
C. Less airflow resistance
SMALLER surface area - picking up less pathogen
Permanent electrical polarity increases ________ forces that hold organisms within the matrix.
A. Gravitational
B. Magnetic
C. Van der Waals
D. Electromagnetic
C. Van der Waals
Which of the following is a disadvantage of hydrophobic bacterial filters?
A. Decreased resistance
B. Increased efficiency
C. Increased resistance
D. Allows pathogen passage
C. Increased resistance
and Decreased Efficiency
Where is the combination filter + HME placed?
A. At the patient’s mask
B. At the oxygen tank
C. At the Y-piece
D. On the expiratory limb
C. At the Y-piece
Inspiratory and Expiratory barrier
Which of the following can cause obstruction in bacterial filters? Select 4
A. Dry air
B. Sputum
C. Edema fluid
D.Nebulized aerosols
E. Low humidity
F. Excessive oxygen flow
G. Malpositioning
B. Sputum
C. Edema fluid
D.Nebulized aerosols
G. Malpositioning
*If the filter gets wet, secretions, vomit, blood it gets even harder to get oxygen through. *
Leakage in bacterial filters can occur due to issues with ________.
A. A crack in the patient mask
B. Damaged housing of a gas line filter
C. Loose connections
D. Overuse of the filter
B. Damaged housing of a gas line filter
What is the recommended type of filter for COVID+ or PUI patients?
A. Carbon filter
B. Heat and moisture exchange filter
C. Pleated mechanical filter
D. Paper filter
B. Heat and moisture exchange filter HMEF
Electrostatic filter is acceptable
**
When is the inspiratory limb filter recommended?
A. For all patients
B. When contaminated by a previous patient
C. After cleaning the maching
D. For pediatric patients
B. Only when the machine may have been contaminated by a previous patient
What type of filter is preferred for the expiratory limb filter?
A. Electrostatic filter
B. Carbon filter
C. Pleated mechanical filter
D. Paper filter
C. Pleated mechanical filter
True or False
An airway filter at the end of the Y-piece is required for Covid+ and PUI patients but optional for others
True
What does humidity refer to in the context of humidification equipment?
A. Temperature of a gas
B. Amount of water vapor in a gas
C. Volume of gas
D. Pressure of gas
B. Amount of water vapor in a gas
How is absolute humidity defined?
A. Percent saturation of water vapor at a particular temperature
B. Pressure exerted by water vapor in a gas mixture
C. Mass of water vapor present in gas in mg H₂O/L of gas
D. Volume of water vapor in a gas mixture in mg H₂O/L
C. Mass of water vapor present in gas in mg H₂O/L of gas
What is relative humidity?
A. Percent saturation; amount of water vapor at a particular temperature
B. Mass of water vapor present in gas in mg H₂O/L of gas
C. Pressure exerted by water vapor in a gas mixture
D. Percent saturation; Amount of gas vapor in a water
A. Percent saturation; amount of water vapor at a particular temperature
What does water vapor pressure refer to?
A. Amount of water vapor in a gas
B. Mass of water vapor present in gas in mg H₂O/L of gas
C. Percent saturation of water vapor at a particular temperature
D. Pressure exerted by water vapor in a gas mixture
D. Pressure exerted by water vapor in a gas mixture
Where does maximal contact of inspired gas with large mucosal surface area occur?
A. In the trachea
B. In the nasal cavity
C. In the bronchi
D. In the alveoli
B. In the nasal cavity
By which point has heating and humidification of inspired gas occurred?
A. Mid-trachea
B. Carina
C. Bronchi
D. Alveoli
A. Mid-trachea
What is the temperature and absolute humidity of gas at the mid-trachea?
A. 37°C with an absolute humidity of 40-48 mg/L
B. 34°C with an absolute humidity of 34 to 38 mg/L
C. 30°C with an absolute humidity of 34 to 38 mg/L
D. 34°C with an absolute humidity of 40-48 mg/L
B. 34°C with an absolute humidity of 34 to 38 mg/L
95%-100% relative humidity
As gas travels distally, it is headed to body temperature. What absolute humidity corresponds to 100% relative humidity at body temperature?
A. 30 mg/L
B. 38 mg/L
C. 44 mg/L
D. 50 mg/L
C. 44 mg/L
This is right at the carina. At 37C
As gas travels distally, it is heated to body temperature: Select 3
A. Isothermic saturation boundary
B. Right at the carina
C. Is affected by the patient’s breathing rate
D. Occurs at the bronchioles
E. Results in a decrease in absolute humidity
F. Occurs in the nasal cavity
G. Can vary with external humidity and heating devices
A. Isothermic saturation boundary
B. Right at the carina
G. Can vary with external humidity and heating devices
What happens to inspired gas in cold ambient temperatures?
A. It has high absolute humidity
B. It has little capacity to hold water vapor
C. It requires little heat energy to warm
D. It does not affect the upper airway
B. It has little capacity to hold water vapor
In cold ambient temperatures, how does the upper airway respond?
A. It transfers small amounts of heat and moisture
B. It transfers moderate amounts of heat and moisture
C. It does not transfer any heat or moisture
D. It transfers large amounts of heat and moisture
D. It transfers large amounts of heat and moisture
What is true about warm ambient temperatures?
A. Little heat energy is expended to warm inspired gases
B. The inspired gas has low absolute humidity
C. The upper airway transfers large amounts of heat and moisture
D. Lots of heat energy is expended to warm inspired gases
A. Little heat energy is expended to warm inspired gases
Cool inspired gas may trigger bronchospasm, and this effect is especially noted in patients with ________ and ______. (Select 2)
A. Patients with COPD
B. Patients with diabestes
C. Patients with asthma
E. Patients with fibrosis
F. Patients with heart disease
A. Patients with COPD
C. Patients with asthma
Still poorly understood how it happens
What is a consequence of underhumidification on the respiratory tract?
A. Increased secretion clearance
B. Secretions thin
C. Secretions thicken
D. Enhanced ciliary function
C. Secretions thicken
Decreases ciliary function
What happens to surfactant activity during underhumidification?
A. Surfactant activity is enhanced
B. Surfactant production remains unchanged
C. Surfactant production increases
D. Surfactant activity is impaired
D. Surfactant activity is impaired
This makes opening and closing of the alveoli difficult
Underhumidification can cause: Select 3
A. Mucosal susceptible to injury
B. Thinned secretions
C. Body heat loss
D. Enhanced surfactant activity
E. Tracheal tube obstruction
A. Mucosal susceptible to injury - friable
C. Body heat loss - use bear huggers and blankets
E. Tracheal tube obstruction - increases resistance and WOB from thickened secretions
Why is it especially important to conserve humidity and heat in neonates and infants?
A. They have a lower metabolic rate
B. Their respiratory systems are fully developed
C. They are more susceptible to dehydration and heat loss
D. They produce more surfactant
C. They are more susceptible to dehydration and heat loss
What is a consequence of overhumidification in the airway?
A. Increased mucosal viscosity
B. Reduced mucosal viscosity
C. Enhanced mucociliary transport
D. Decreased airway resistance
B. Reduced mucosal viscosity and risk of water intoxication and inefficient mucociliary transport
What risks are associated with overhumidification in the airway?
A. Reduced airway resistance and improved ventilation, risk of pulmonary infection and V/Q mismatch
B. Reduced risk of pulmonary infection and V/Q mismatch, surfactant concentrated, atelectasis
C. Improved mucosal function and hydration, improved atelectasis
D. Increased airway resistance, risk of pulmonary infection, surfactant dilution, atelectasis, and V/Q mismatch
D. Airway resistance, risk of pulmonary infection, surfactant dilution, atelectasis, and V/Q mismatch
How can overhumidification obstruct sensors?
A. By increasing sensor sensitivity
B. By improving sensor accuracy
C. By leading to inaccurate readings
D. By enhancing sensor function
C. ETCO2 sampling line can get condensation, leading to inaccurate readings
What is the aim of humidification devices in the lower respiratory tract?
A. To decrease humidity levels
B. To reproduce more normal physiologic conditions
C. To reproduce more resistance in the airways
D. To add dead space in the airways
B. To reproduce more normal physiologic conditions
Do not burn the patient. Shouldn’t add resistance or dead space and infection
How does a Heat and Moisture Exchanger (HME) function?
A. Actively heats and humidifies the air
B. Reduces airway humidity
C. Increases airway resistance
D. Passively humidifies the air
D. Passively humidifies the air
How do heated humidifiers function?
A. Actively heat and humidify the air
B. Passively humidify the air
C. Decrease airway temperature
D. Increase airway resistance
A. Actively heat and humidify the air
What does the Heat and Moisture Exchanger (HME) do with exhaled heat and water?
A. Discards it
B. Conserves it
C. Increases it
D. Decreases it
B. Conserves some of it and returns it to the patient
What additional function does the HMEF provide?
A. Enhances airflow
B. Reduces airway resistance
C. Bacterial/viral filtration
D. Increases dead space
C. Bacterial/viral filtration *and prevention of inhalation of small particles HME-Filter *
The HME is designed to be ________ with the exchange medium enclosed in plastic housing.
A. Reusable
B. Fragile
C. Disposable
D. Permanent
C. Disposable
The HME is placed close to the patient, between the ________ and the proximal end of ETT or ________.
A. end of the ventilator/LMA
B. Inspiratory tube/ oxygen source
C. Y-piece/LMA
D. Oxygen source/LMA
E. Y-piece/HME filter
C. Y-piece/LMA
HME Can cause more dead space
What is a potential effect of using an HME on ETCO₂ readings?
A. Low ETCO₂ readings
B. High ETCO₂ readings
C. No effect on ETCO₂ readings
D. Variable ETCO₂ readings
A. Low ETCO₂ readings
How does an HME affect resistance and dead space in the circuit?
A. Decreases resistance and dead space
B. Increases resistance and dead space
C. No effect on resistance and dead space
D. Only affects resistance, not dead space
B. Increases resistance and dead space
What factor may reduce the efficiency of an HME?
A. Small tidal volume (Vt)
B. High humidity levels
C. Large tidal volume (Vt)
D. Low resistance
C. Large tidal volume (Vt)
Hydrophobic models
*Larger models may reduce filtering *
What type of barrier does a hygroscopic HME use?
A. Plastic membrane with moisture -retaining chemicals
B. Metal mesh coated with moisture -retaining chemicals
C. Paper with moisture-retaining chemicals
D. Fabric barrier with moisture -retaining chemicals
C. Paper or other fiber barrier coated with moisture-retaining chemicals
May have some electrostatic properties
What is a characteristic of hygroscopic HMEs? Select 2
A. They do not absorb water
B. They release moisture in exhalation
C. They release water in inspiration
D. They have large pores
E. They absorb water in exhalation
C. They release water in inspiration
E. They absorb water in exhalation
A potential drawback of hygroscopic HMEs is that they are prone to becoming ________, leading to increased inspiratory/expiratory resistance.
A. Hydrophilic
B. Unsaturated
C. Saturated
D. Unabsorbant
C. Saturated
Reduced heat and moisture retention - may need to change it out more
What is an advantage of hydrophobic HMEs with pleated membranes and small pores?
A. They retain moisture better than hygroscopic HMEs
B. They are more efficient filters of pathogens
C. They are not prone to saturation
D. They do not increase resistance
B. They are more efficient filters of pathogens
Where should a heated humidifier be placed?
A. In the expiratory limb
B. Downstream of the unidirectional valve in the inspiratory limb
C. Upstream of the unidirectional valve in the inspiratory limb
D. In the patient’s nostrils
B. Downstream of the unidirectional valve in the inspiratory limb
Which type of patients are humidifiers used for? Select 2
A. Patients with hypertension
B. Neonates
C. Elderly
D. Patients with hypothermia
E. Patients with diabetes
F. Patients with fractures
G. Patients with hyperthermia
B. Neonates
D. Patients with hypothermia
How does a bubble or cascade humidifier work?
A. By passing gas over a heated water reservoir
B. By heating water outside the vaporizer and then pumping it
C. By injecting water vapor and heat directly in the inspiratory limb
D. By absorbing water vapor in a bubble
D. By absorbing water vapor in a bubble
Active process
How does a counter-flow humidifier function?
A. By passing gas over a heated water reservoir
B. By injecting water vapor and heat directly in the inspiratory limb
C. By heating water outside the vaporizer
D. By absorbing water vapor in a bubble
C. By heating water outside the vaporizer and then pumping it to the top of the vaporizer
What is the role of inline humidifier?
A. They absorb water vapor in a bubble
B. They heat water outside the vaporizer and pump it to the top before the Y-piece
C. They inject water vapor and heat directly in the inspiratory limb before the Y-piece
D. They pass gas over a heated water reservoir
C. They are plastic capsules and inject water vapor and heat directly in the inspiratory limb before the Y-piece
Why should water traps be changed frequently in humidifiers?
A. To increase the humidity of the gas
B. To decrease the risk of contamination
C. To maintain the temperature of the gas
D. To decrease the delivered volume
B. To decrease the risk of contamination and infection
Condensation in a humidifier can decrease ________.
A. Delivered Vt
B. Oxygen concentration
C. Temperature of the gas
D. Risk of infection
A. Delivered Vt
True or False
Humidifiers may be heated or unheated
True
What is one of the main advantages of humidifiers?
A. They are more cost-effective than HME
B. They can deliver saturated gas at body temperature or higher
C. They are smaller and more portable than HME
D. They do not require electrical devices
B. They can deliver saturated gas at body temperature or higher
What is a potential disadvantage of using humidifiers?
A. They cannot deliver gas at body temperature
B. They are less effective than HME
C. They are bulky and may have contamination issues
D. They are simpler to clean and maintain than HME
C. They are bulky and may have contamination issues
Water aspiration risk!!
What is a risk associated with the use of humidifiers that involve heating devices?
A. Water aspiration
B. Electrical malfunction and/or thermal injury
C. Lower efficiency compared to HME
D. Reduced gas saturation
B. Electrical malfunction and/or thermal injury
True or False
HME is higher cost than Humidifier
False
