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Principles I* > E2- Breathing System I > Flashcards

E2- Breathing System I Flashcards

1
Q

functions/definitions of breathing system

A
  • Receives gas mixture from the machine
  • Delivers gas to the patient
  • Removes CO2
  • Provides heating and humidification of the gas mixture
  • Allows spontaneous, assisted, or controlled respiration
  • Provides gas sampling ,, measures airway pressure ,, + monitors the volume
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2
Q

Resistance

  • When gas passes through tube – pressure at _______ LOWER than _____
  • What part has highest pressure?
  • A drop is pressure is a measure of _______.
  • P2 = pressure at ____ + P1 = pressure at ____
A
  • outlet lower than inlet
  • beginning of tube
  • resistance
  • beginning + end
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3
Q

Resistance varies with ________? What can also change resistance?

A
  • volume of gas passign through per unit time
  • flow types (laminar / turbulent)
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4
Q
  • Laminar flow is ____ and ______.
  • Particles move _____ to tube walls.
  • Where is the flow fastest?
  • What Law relates to laminar?
A
  • smooth + orderly
  • parallel
  • center
  • Poiseuilles law
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5
Q

What is A, B, C, D, E, F

A
  • A = laminar
  • B = generalized turbulent
  • C = localized turbulent d/t sharp turn or narrowing
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6
Q
  • Turbulent flow lines are not parallel + composed of what?
  • Where is turbulent flow fastest?
A
  • Eddies = particles moving in opposite direction of general flow
  • SAME across diameter of tube
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7
Q

Generalized vs. Localized Turbulent flow

A
  • Generalized
    o When flow of gas through tube exceeds critical flow rate
  • Localized
    o Gas flow rate below critical flow rate … but encounters constrictions, curves, or valves
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8
Q
  • To minimize resistance … gas-conducting pathways should have ??
A
  1. minimal length
  2. maximal internal diameter
  3. without sharp curves or sudden changes in diameter
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9
Q

What is the significance of resistance?

A
  • imposes strain with ventilatory modes when pt must do work
  • change parallels change in WOB
  • watch flow volume loops!
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10
Q

What causes more resistance than breathing system?

A

ETT

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11
Q
  • What is compliance?
  • Measures _____ (mL/cmH2O)
  • What does compliance help determine?
A
  • Ratio of change in volume to change in pressure - V/P
  • distensibility
  • Vt
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12
Q

What are the 2 most distensible components?

A

Reservoir bag + breathing tubing

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13
Q

What is rebreathing?
What 3 things is it influenced by?

A
  • To inhale previously **inspired gases ** – CO2 may or may not be removed
  1. Fresh gas flow
  2. Dead space
  3. Breathing system design
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14
Q
  • Amt of rebreathing varies _____ with total FGF.
  • What FGF is there NO rebreathing?
  • At what FGF is there rebreathing ?
  • What is the function of exhaled gases in rebreathing?
A
  • inversely
  • FGF/min = or > Vm – NO rebreathing
  • FGF < Vm – YES rebreathing
  • make up required volume
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15
Q

Types of dead space

  • Apparatus? What is it + what decreases it
  • Physiologic
  • Anatomical
  • Alveolar
A
  • Apparatus – vol in breathing system by gases rebreathed without change in composition
    Decreased by having inspiratory + expiratory limb separation CLOSE to patient as possible
    Anything distal to Y piece (elbow, ett)
  • anatomic + alveolar
  • conducting airways - adds H2O vapor
  • vol alveoli ventilated but not perfused
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16
Q
  • What does rebreathing reduce?
  • Rebreathing causes 3 altered inspired gas tensions
A
  • heat + moisture loss from pt
    • reduce inspired oxygen tension
    • Inhaled anesthetics (induction = increase ,, emergence = decrease)
    • CO2 (increase)
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17
Q

What makes up FGF?

A

Air, nitrous, oxygen
NOT anesthetic gases bc they’re a pressure

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18
Q

6 desirable characteristics of a breathing circuit?

A
  • Low resistance to gas flow
  • Minimal rebreathing
  • Removal of CO2 at rate of production
  • Rapid changes in delivered gas when required
  • Warmed humidification of inspired gas
  • Safe disposal of waste gases
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19
Q

Name and Describe the four classifications of breathing circuits.

A
  • Open - No reservoir bag and no rebreathing (nasal cannula)
  • Semi-Open - Reservoir bag but no rebreathing d/t FGF > minute ventilation.
  • Semi-Closed - Reservoir bag w/ partial rebreathing
  • Closed- Reservoir bag and complete rebreathing, FGF equivalent to patient uptake
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20
Q

In closed circuit, amt of rebreathing depends on ____?

A

FGF

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21
Q

When would you want a closed breathing circuit?

A
  • Conserve patient’s temperature
  • Trying to be economical and not waste any gas
  • Trying to perform low flow anesthesia
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22
Q

Name the components of the breathing system.

A
  • Facemask, LMA, ETT
  • Y-piece with mask/ tube connectors
  • Breathing tube (corrugated tubing)
  • Respiratory Valves (unidirectional)
  • Fresh gas inflow site
  • APL (Pop-off) Valve leading to scavenger
  • CO2 absorption canister
  • Reservoir Bag
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23
Q
  • The facemask needs to fit between the _____________ and in the groove between the ___________ and _______.
  • Facemask is clear + what allows it to seal the face?
A
  • interpupillary line
  • mental process
  • alveolar ridge
    pneumatic cushion
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24
Q

The facemask will connect to the Y-piece/connector, how big is the female connection?

A
  • 22 mm
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25
Q

A fitting that joins together 2 or more components.

A
  • Connectors/ Adapters
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26
Q

What are 3 advantages of connectors and adaptors?

A

* Extends distance b/w patient and breathing system
* Change angle of the connection
* Allow more flexibility/ less kinking (The accordion will give you the most flexibility)

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27
Q

What are 3 disadvantages of connectors and adaptors?

A
  • Increased resistance
  • Increased dead space
  • Additional locations for disconnections
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28
Q

How long is the breathing tubing?
What is the internal volume of the breathing tubing?

A
  • 1 meter in length
  • 400-500 mL for each meter in length
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29
Q

Describe the flow in the corrugated breathing tubing.

A
  • ALWAYS Turbulent Flow
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30
Q

True/False: Breathing tubes connected together to increase tube length will increase dead space.

A
  • False
  • Longer tubes do not create deadspace
  • Dead space is only from Y-piece to patient d/t unidirectional valves
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31
Q

Pressure check the circuit before use. What value should this be?

A
  • 30 cm H2O
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32
Q

With a normal tidal volume. How much air is in the anatomical deadspace?

A
  • 150 mL

That is why we deliver at least 300 mL of tidal volume in simulation for adequate ventilation.

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33
Q

What directs respiratory gas flow in the correct direction?

A
  • Unidirectional valves

These unidirectional valves must open widely with very little pressure.
**Low resistance, high competence. **
Open/Close rapidly with no backflow.

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34
Q

The inspiratory valve opens on ___________.
The inspiratory valve close on _________.
What does the inspiratory valve prevent?

A
  • The inspiratory valve opens on inspiration.
  • The inspiratory valve close on exhalation.
  • Prevents backflow of exhaled gas
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35
Q

The expiratory valve opens on ___________.
The expiratory valve close on _________.
What does the expiratory valve prevent?

A
  • The expiratory valve opens on exhalation.
  • The expiratory valve close on inspiration.
  • Prevents rebreathing
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36
Q

Proper valve placement and functioning prevents any part of the circle system from contributing to _________.

A
  • Apparatus Dead Space

If valve no worky = appartus dead space = TEST Q!

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37
Q

What composes the apparatus dead space?

A
  • Distal limb of Y-connector
  • Tube/mask/LMA
38
Q

The unidirectional valves are located near what 3 parts of breathing system?

A
  • CO2 absorber canister
  • Fresh gas inflow site
  • APL Valve
39
Q

What are 5 requirements of unidirectional valves?

A
  • Arrows/ Directional words
  • Hydrophobic - needs to repel water/moisture
  • Must open and close appropriately
  • Clear dome - need to visualize if valves are working
  • Must be placed between patient and reservoir bag
40
Q

How much volume is in a traditional reservoir bag? Range?

A
  • 3 L

Can range from 0.5 to 6 L

41
Q

All reservoir bags must have _____ mm female connector on the neck.

A
  • 22 mm
42
Q

reservoir bags must adhere to pressure standards
* minimum pressure of approximately ______ cm H2O
* maximum pressure of approximately ____ cm H2O
* plastic bags have ____ the distending pressure of rubber bags

A
  • 30 cm H2O (minimum)
  • *40 - 60 cm H2O (maximum)
  • 2x

Although most bags adhere to these standards, some latex-free bags have exceeded the upper pressure limit.

43
Q

Which unidirectional valve is more likely to be stuck? Inspiratory or Expiratory?

A
  • The expiratory valve is more vulnerable because it is subject to greater moisture exposure.

Miller pg. 605

44
Q

What are 5 functions of the reservoir/breathing bag?

A

(1) Reservoir for anesthetic gases/oxygen

(2) A means of delivering manual ventilation
(3) assisting spontaneous breathing

(3) Serving as a visual / tactile monitor a patient’s spontaneous breathing efforts
*estimates volume of ventilation

(4) Partially protecting pt from excessive positive pressure in the breathing system.

45
Q

What is another name for the Gas Inflow site?

A
  • Fresh gas inlet
46
Q

Where is the preferred location of the fresh gas inflow site?

A
  • Between CO2 absorbent + inspiratory valve
47
Q

When does the fresh gas scrub out the CO2 absorber?

A
  • During expiration

During expiration, the inspiratory valve will be closed. When this occurs, fresh gas will travel to the CO2 absorber.

48
Q

What is the downside of having the fresh gas inflow valve so close to the CO2 absorbent?

A
  • Fresh gas can dry out the absorbent
49
Q

What is the Adjustable Pressure-Limiting Valve (APL) / Pop-off Valve?

A
    • “Pop-off valve”
    • Permits **gas to leave circuit **
  • Closed = gas doesn’t leave .. stays in circuit = higher pressure to open
  • Open = gas leave … to scavengerDome valve loaded by a spring + screw cap
  • User-adjustable
  • Controls pressure in breathing system
  • Releases gases to scavenging system
50
Q

Clockwise motion of the APL valve will ______ pressure.

A
  • Increase

clockwise on clock increases #s

51
Q

Counterclockwise motion of the APL valve will ______ pressure.

A
  • decrease
52
Q

How many turns does it take for the APL valve to go from fully open to closing fully?

A
  • 1-2 clockwise turn
53
Q

Explain APL Use (chart)
Spotaneous?
Assisted/manual?

A
54
Q

APL setting during mechanical ventilation?

A

BYPASSED

55
Q

Can the absorbent be replaced in the middle of a surgical case?

A
  • Yes, the housing compartment incorporate valves that closes when removed to prevent gas loss
56
Q

Absorbent Chemical Reaction

A
  • Absorbent is a chemical reaction
  • Carbon dioxide + water = initial reaction
  • Exothermic reaction that combines CO2 with Ca hydroxide to form calcium carbonate
  • Hydroxides – interact with CO2 to form exothermic reaction – exhausting absorbent
  • absorbent turns to carbonates when exhausted – color change
57
Q

5 types of absorbents + brand name?

A
  1. Soda Lime = SODASORB
  2. Calcium Hydroxide Lime = AMSORB
  3. Lithium Hydroxide
  4. Litholyme
  5. Spira-Lith
58
Q

Name the 4 components of soda lime.

A
  • Calcium hydroxide (80%)
  • Sodium hydroxide/ Potassium hydroxide (5%)
  • Water (15%)
  • Small amount of silica/clay - keep from hardening/drying out
59
Q

Because CO2 does not react quickly with calcium hydroxide, what are the catalysts required to speed up the reaction?

A
  • Sodium hydroxide
  • Potassium hydroxide
60
Q

How do you know when the soda lime has been fully exhausted?

A
  • It turns from white to purple
    * All hydroxides have become carbonates
61
Q

Soda lime can absorb _____% of its weight in CO2.

100 grams of soda lime can absorb _______ L of CO2.

A
  • 19%
  • 26 L
62
Q

Name the components of Calcium Hydroxide Lime (Amsorb Plus).

A
  • Calcium hydroxide (70%)
  • Calcium chloride (0.7%)
  • Calcium sulfate (0.7%)
  • Polyvinylpyrrolidone (0.7%)
  • Water (14.5%)
63
Q

What is the drawback of Soda Lime? Cause?

A
  • Compound A formation (found in rats) = SEVO
  • Carbon Monoxide formation = DES
  • Destruction of inhaled gases
    Caused by Na/K strong bases

Calcium hydroxide lime decreases Compound A formation, CO formation, and destruction of inhaled gases.

64
Q

Name This Absorbent:
- Reacts with CO2 to from carbonate
- More CO2 absorption capacity
- Used in submarines and spacecraft
- Not usually used in anesthesia

A
  • Lithium Hydroxide
65
Q

Name This Absorbent:
- Has a** Lithium chloride **catalyst and does not react with inhaled gases
- No activators/strong bases
- Does not form Compound A and carbon monoxide
- Has color change (white to purple) but no regeneration
- ↓ Fire Risk

A
  • Litholyme
66
Q

**Name this Absorbent:
- Anhydrous LiOH powder, hydrated polymer sheets
- No activators/strong bases
- ↓ Temperature production
- Cheap
- No color indicator, no color change

A
  • Spira-Lith
    S = sheets
67
Q

Which of the following absorbent does not have any Calcium Hydroxide in it?

  • Soda Lime
  • Litholyme
  • Spiralith
A
  • Spiralith has 0% CaOH2

Soda Lime (Sodasorb) and Litholyme both contain about 75% Calcium Hydroxide

68
Q

Which of the following absorbent is composed of 95% Lithium Hydroxide?

  • Soda Lime
  • Litholyme
  • Spiralith
A
  • Spiralith has 95% LiOH
69
Q

Which of the following absorbent has color indication?

  • Soda Lime
  • Litholyme
  • Spiralith
A
  • Soda Lime
  • Litholyme
70
Q

What is the most common dye for absorbent indicators?

A
  • Ethyl Violet

Ethyl violet causes soda lime to turn from white to purple when exhausted

71
Q

What color will ethyl orange and cresyl yellow turn when exhausted?

A
  • Yellow
72
Q

Carbonate formation will cause pH to become less ________ and cause the contents of the CO2 canister to turn from white to _______.

A
  • less alkaline (lower pH) - more acidic
  • blue violet (purple)
73
Q

At what pH is the soda lime exhausted + experience color change?

A

< 10.3

When im exhausted, im an ass (acidic)

74
Q

When absorbent is exposed to bright fluroscent light for a period, what can happen?

A
  • Bleaching
  • Absorbent indicator does not work as well
75
Q

Absorbents have high reliability indicating CO2 rebreathing, but what is the gold standard? Why?

A
  • Capnometry
  • bc regeneration can occur + color fades
76
Q

CO absorbent granules are measured in what units? What is normal?

A
  • Mesh Size
  • 4-8 mesh size (most optimal for CO2 absorbers)
77
Q

The ability of the workstation’s absorber to remove CO2 is related to three main factors:

A
  • The amount of absorbent surface area exposed to the exhaled gas
  • The intrinsic capacity of the absorbent to remove CO2
  • The amount of non-exhausted absorbent remaining.
78
Q

The size and shape of the absorptive granules are intended to maximize ________ while minimizing ________ .

A
  • Maximize Absorption
  • Minimize resistance to airflow
79
Q

Roughly 50% of volume CO2 canister will be composed of _______.

A
  • gas
80
Q

What factors can decrease the efficiency of CO2 absorption?

A

* Excess water in the canister (change canister if you see liquid)
* Decrease surface area

81
Q

Small passageways that allow gas to flow through low-resistance areas, decreasing functional absorptive capacity.

A
  • Channeling
82
Q

What are 5 ways to minimize channeling?

A
    • Circular baffles (flow-directing panels)
    • Placement for vertical flow
    • Permanent mounting
    • Prepackaged cylinders
    • Avoiding **overly tight **packing
83
Q

The decomposition of sevoflurane will form this substance.

A
  • Compound A

2-fluoromethyl-2,2-difluoro-1-(trifluoromethyl) vinyl ether

84
Q

Compound A causes what toxicity in rats?

A
  • Nephrotoxic in rats
  • Possible in humans
85
Q

Compound A formation occurs with 5:

A
  • Low FGF (1-2 L/min)
  • Increased absorbent temperature
  • Higher inspired sevoflurane concentrations (1.5 to 2 MAC)
  • Dehydrated absorbent
  • Absorbent containing NaOH or KOH
86
Q

Carbon monoxide can occur due to what factor?

A
  • Dry absorbent + leaving FGF on
  • ‘Monday, 1st case’- gas left on over the weekend
    • Increased Temperature
    • Increased Concentration of anesthetic gases
  3. * Low FGF rate
  4. *** Strong base **absorbents (KOH or NaOH)
87
Q

Rank the order of anesthetic gases from highest to lowest level of carbon monoxide formation.

A

Desflurane ≥ enflurane > isoflurane > > halothane = sevoflurane

88
Q

How does an exothermic reaction leading to fires and explosions occur with anesthetic gases?

A
  • Desiccated strong base absorbents interact with sevoflurane
  • Examples of strong base absorbents:** Baralyme, anhydrous LiOH**

Buildup of
high temperatures,
flammable degradation products (formaldehyde, methanol, and formic acid),
oxygen or nitrous rich gases w/in the absorber all provide basis for combustion

89
Q

Which anesthetic gas should be avoided with desiccated strong base absorbents?
What temps can absorbers reach?
What else avoided?

A
  • Sevoflurane
  • > 200 C
  • strong bases ,, desiccated
90
Q

Anesthesia Patient Safety Foundation = 6 Recommendations

A
  • ALL gas flows + vaporizers turned off after each case
  • Absorbent changed regularly
  • Change when **color change **indicates exhaustion
  • Change all absorbent
  • Change absorbent when uncertain about the state of hydration
  • If using compact canisters, change more frequently

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