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Principles I Final > Delivery > Flashcards

Delivery Flashcards

1
Q

What is the delivery component of the SPDD model?

A

How we control and monitor the interaction of gases with the patient

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2
Q

What determines if the circuit is semi-open or semi-closed in a circle circuit?

A

Dependent on the amount of fresh gas flow put into the system

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3
Q

What type of circuit is created if the fresh gas flows are greater than minute ventilation?

A

Semi-open, No rebreathing

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4
Q

How do you calculate minute ventilation?

A

Take the breaths per minute and multiply it by the tidal volume

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5
Q

What is an example of a closed circuit?

A

Circle with pop off valve closed

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6
Q

What type of circuit is created if the fresh gas flows are less than minute ventilation?

A

Semi-closed, partial rebreathing

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7
Q

What does APL stand for?

A

Adjustable pressure limiting valve (pop off valve)

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8
Q

After exhalation, what two places can the gas go?

A

CO2 absorberAnesthesia reservoir bag

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9
Q

What are the seven components of a circle system?

A
  1. Fresh gas inflow source
  2. Unidirectional valves
  3. Two corrugated tubes
  4. Y-piece connector
  5. Overflow valve
  6. Gas reservoir bag
  7. CO2 absorber
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10
Q

What size is the corrugated tubing used in the circle system?

A

22 mm diameter in adults

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11
Q

What are the two types of unidirectional valves in the circle system?

A

Inspiration

Expiration

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12
Q

How does a floating valve work?

A

Opens with pressure and closes with pressure, it moves in the direction its being pushed by gas

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13
Q

What type of valves are the inspiratory and expiratory valves in the circle system?

A

Floating valves

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14
Q

What should be avoided between the patient and the inspiratory limb?

A

Avoid overflow valve

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15
Q

What should be avoided between the expiratory limb and the patient?

A

Avoid fresh gas inflow

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16
Q

How much rebreathing occurs in a closed circle system?

A

Complete rebreathing

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17
Q

What are some advantage of utilizing a circle system?

A 
Constant inspired concentrations
Conserve respiratory heat and humidity
Useful for all ages
Useful for closed system or low flow
Low resistance
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18
Q

What are some disadvantage of utilizing a circle system?

A

Relatively complex
Opportunities for misconnections/disconnections
Malfunction of unidirectional valves
Less convenient and portable than NRB circuit

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19
Q

Where is headspace located in the circle system?

A

Dead space is located between y-piece and the patient

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20
Q

When does no rebreathing occur in the circle system?

A

1-1.5 x minute ventilation no rebreathing occurs

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21
Q

What times during anesthetic practice would we want no rebreathing to occur?

A

PreoxygenationInduction (wash-in)

Emergence (washout)

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22
Q

When would be a good time to administer low flows to a patient?

A

Maintenance, it conserves heat, humidity and volatile agent

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23
Q

What are the tasks of the CO2 absorption system?

A

Makes rebreathing possible
Conserves gases and volatile agents
Decreases OR pollution
Avoids hazards of CO2 rebreathing

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24
Q

What is the composition of Soda Lime?

A

CaOH 94%
NaOH 5%
KOH

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25
Q

What is the soda lime chemical reaction?

A

CO2 + H2O H2CO3H2CO3 + NaOH Na2CO3 + H2O + Energy

Na2CO3 + CaOH CaCO3 + NaOH

26
Q

What is the absorptive capacity of soda lime?

A

26L of CO2 per 100g of absorbent

27
Q

What tells us the Soda lime and baralyme absorbents have been exhausted?

A

pH become less alkaline less than 10.3 ethyl violets indicator changes from colorless to blue

28
Q

What does the term mesh refer to?

A

The number of openings per linear inch, 4 mesh and 8 mesh

29
Q

Why is there a mixture of 4 mesh and 8 mesh in the CO2 absorber?

A

Compromise between resistance to airflow and surface area for absorptive capacity

30
Q

What anesthetic is incompatible with soda lime?

A

Trichloroethylene

31
Q

What are the two products if trichloroethylene and soda lime are combined?

A

Dichloroacetylene (cranial neurotoxin)
Phosgene (pulmonary irritant)
This is mostly seen in developing countries

32
Q

What can be produced if Sevoflurance is run with FGF < 2?

A

Compound A, potential renal injury

33
Q

What anesthetic has the greatest potential to produce carbon monoxide?

A

Desflurane

34
Q

What two things does a circle system have that a non-rebreathing system lacks?

A

Unidirectional valves

Carbon dioxide absorption

35
Q

What is a benefit to utilizing a non-rebreathing system?

A

Without CO2 absorbers and unidirectional valves the resistance (work of breathing) is low

36
Q

What are advantages of using a non-rebreathing system (semi-open)?

A

PortabilityLow resistance = low work of breathing
Absence of rebreathing
Inexpensive, few moving parts
Allow rapid changes in anesthetic

37
Q

What are disadvantages of using a non-rebreathing system (semi-open)?

A

Lack of conservation of moisture or heat

Requires high FGF, not economical (lots of agent used)

38
Q

How doe non-rebreathing systems work?

A

Exhales gas enters expiratory limb
APL opens
Inspiration draws in gas from expiratory limb (only has fresh gas if flow is high enough)

39
Q

Professor who described five different seem-open systems?

A

Mapleson

40
Q

What is the basic composition of the Mapleson systems?

A

Various arrangements of fresh gas inflow, tubing, reservoir bag and expiratory valve

41
Q

What are the characteristics of the Mapleson A system?

A

No rebreathing if FGF > alveolar ventilation,
Overflow valve opens during expiration when maximum pressure is reached
Insufficient with controlled ventilation

42
Q

What are the characteristics of the Mapleson B system?

A

Fresh gas inlet and overflow valve closer together to prevent rebreathingRequires FGF > 2-2.5 times the minute ventilation

43
Q

What are the characteristics of the Mapleson C system?

A

Shorter expiratory limb than Mapleson B

Requires FGF 2-2.5 times minute ventilation

44
Q

What are the characteristics of the Mapleson D system?

A

Fresh gas inlet and overflow valve opposite Mapleson A

Requires FGF 2-3 times minute ventilation

45
Q

What are the characteristics of the Mapleson E system?

A

Valveless and bagless (basically T piece)
Expiratory limb must be greater than patient’s tidal volume FGF 3 times greater than minute ventilation to prevent hypercarbia

46
Q

On the Mapleson E system, why must the expiratory limb be greater than the patient’s tidal volume?

A

To prevent entrainment of room air

47
Q

What are the characteristics of the Mapleson F system?

A

Requires FGF 2-3 times minute ventilation

Minimal dead space/ low resistance

48
Q

The Mapeson __ is a Jackson-Rees modification of the Mapleson ___

A

Mapleson FMapleson D

49
Q

What does the term Coaxial refer to?

A

“A tube within a tube”

50
Q

What is the adaptor called that connects the Coaxial Mapleson D to the anesthesia machine?

A

Bain

51
Q

What are major benefits to the Bain Mapleson D circuit?

A

Designed to conserve some heat and humidity

52
Q

What patient population is the Bain Mapleson D typically seen in?

A

Pediatrics

53
Q

What are some advantages of the Bain Circuit?

A

FGF warmed by exhaled gases
Improved humidification
Ease of scavenging waste gases
Lightweight

54
Q

What are some disadvantages to the Bain Circuit?

A

Kinking of inner tube
Rebreathing if inner tube disconnected
Increased resistance
FGF 200-300mL/Kg prevent hypercarbia

55
Q

What is the name of the test to use on a Bain Circuit if kinking or disconnect is suspected?

A

Pethick test (inner gas hose integrity kinked or disconnected)

56
Q

How do you perform the Pethick test?

A

Occlude end of circuit
Close APL valveFill circuit with O2 flush valve
Release occlusion at elbow and flush
Venturi bag flattens bag if inner tube is patent

57
Q

What type of ventilators do not require a driving gas?

A

Piston Ventilators

58
Q

What are some hazards of ventilators?

A

Disconnection
Occlusion/obstruction of breathing circuit
Misconnection
Failure of emergency O2 supplyInfection

59
Q

What type of ventilator setting limits the tidal volume by the amount of pressure within the circuit?

A

Pressure Control Ventilation

60
Q

What is the pressure limit on pressure control ventilation?

A

Pressure limit 20cm H2O

61
Q

What ventilator mode delivers a set volume at a set rate?

A

Controlled Mandatory Volume

62
Q

What can the CRNA control on the ventilator?

A

Inspiratory flow control
I:E ratio control
Rate Control
Tidal Volume Control

Principles I Final (17 decks)

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