E2 - Breathing Systems II Flashcards
What is a Mapleson Circuit used for?
A. used for the delivery of oxygen and anesthetic agents
B. used for the delivery of anesthetic agents only
C. used for the delivery of oxygen and anesthetic agents and the removal of CO2
D. used for the removal of CO2 only
C. used for the delivery of oxygen and anesthetic agents and the removal of carbon dioxide
What are the 5 components of a Mapleson Circuit?
PRCAF
- Patient connection/Facemask
- Reservoir bag
- Corrugated tubing
- APL valve
- Fresh gas inlet
What 3 components are absent in all Mapleson Circuit Systems?
CUS
- CO2 absorber
- Unidirectional Valves
- Limbs (separate inspiratory and expiratory limbs)
What are 2 other names for the Mapleson Circuit Systems?
A. CO2 washout circuits
B. Flow-controlled breathing systems
C. CO2 controlled system
D. Corrugated Circuits
A. Carbon Dioxide Washout Circuits
B. Flow-controlled Breathing Systems
How does the Mapleson Circuit System prevent rebreathing without a CO2 absorber?
A. The pop off valve allows it to escape
B. FGF must be lower than minute ventilation
C. The CO2 goes into the reservoir bag
D. FGF must be significantly greater than minute ventilation.
D. FGF must be significantly greater than minute ventilation to “washout” the CO2.
What is another name for Mapleson A?
A. Adjustable system
B. Magill’s system
C. Bain system
D. Main system
B. Magill’s System
For MAPLESON A circuit
Where does fresh gas flow enter? Where is the APL valve located?
A. both on patient’s end
B. operator end; patient end
C. both on operator’s end
D. patient end; operator end
B. FGF enters from the operator end, near the reservoir bag; APL valve located on patient end
What is Mapleson A best at compared to the other systems?
What is Mapleson A the worst at?
- Best efficiency of all systems for spontaneous ventilation
- Worst @ controlled ventilation (b/c FGF needs to be 20 L/min or higher!)
For MAPLESON A Circuit:
What is vented out from the APL valve in spontaneous ventilation during expiration?
2 gases
- Dead space gas (yellow)
- Alveolar gas (red)
For MAPLESON A Circuit:
What is vented out from the APL valve in controlled ventilation during expiration?
A. dead space gas
B. both dead space and alveolar gas
C. alveolar gas
D. APL valve does not open
D. APL valve does not open
For MAPLESON A Circuit:
What is vented out from the APL valve in controlled ventilation during inspiration?
- Mostly fresh gas (blue)
- Some alveolar gas (red)
- Increase the risk of rebreathing alveolar gas (red)
that’s why this is the worst one for controlled ventilation!
For MAPLESON B Circuit:
Where are the APL Valve and Fresh gas inlet located?
A. near the patient
B. near the operator
C. near the reservoir bag
D. on seperate ends
A. APL and FG inlet are both located near the patient!
For MAPLESON B Circuit:
Why is the Mapleson B Circuit considered inefficient and obsolete?
- Much of fresh gas is vented through APL during exhalation
- Blue (FGF)
- Red (alveolar gas)
For MAPLESON B Circuit:
FGF should be ____ times the minute volume during spontaneous and controlled ventilation to prevent rebreathing in Mapleson B.
A. 3x
B. 2x
C. 20x
D. 10x
B. FGF should be 2x minute ventilation
for mapleson B circuit
For MAPLESON C Circuit:
Where are the APL Valve and Fresh gas inlet located?
A. near the patient
B. near the operator
C. near the reservoir bag
D. on seperate ends
A. APL and FGF both located near the patient
identical to mapleson B in this sense
Mapleson C is identical to Mapleson B except for what specific difference?
A. No reservoir bag
B. No APL valve
C. No corrugated tubing
D. No CO2 absorber
C. NO corrugated tubing
How much FGF is needed for the Mapleson C circuit to prevent rebreathing?
- FGF needs to be 2x minute volume to maintain efficiency
similar to mapleson B also
What are Mapleson C circuits used for?
- Emergency resuscitation
Emergen-C
Where are the APL Valve and Fresh gas inlet located in the Mapleson D Circuit?
A. both near reservoir bag at the end
B. APL near reservoir bag at the end + FGF inlet near the patient
C. APL near patient + FGF inlet near reservoir bag
D. both near patient
B. APL valve is located near the reservoir bag at the end of circuit + FGF inlet is near the patient
Which circuits are known to have “T-modifications” or are known as the “T-group”?
- Mapleson D
- Mapleson E
- Mapleson F
T-piece = DEF
Which circuit is the MOST efficient for controlled ventilation?
- Mapleson D
What kind of valve can be added to Mapleson D circuits?
A. another APL valve
B. expiratory valve
C. PEEP valve
D. inspiratory valve
C. PEEP Valve
FGF rate should be ___ times minute ventilation in Mapleson D circuits.
- 2 to 2.5 times
What is a Bain modification of Mapleson D?
FGF coaxial (narrow inner tube) inside corrugated tube.
What is another name for Mapleson E?
A. Arye’s T-piece
B. Bain T-Piece
C. Emergency T-Piece
D. APL T-Piece
A. Arye’s T-piece
What is missing in the Mapleson E circuit that the other circuits have? Select 2.
A. Reservoir bag
B. CO2 absorber
C. APL valve
D. HME
E. humidifier
no reservoir bag (A) + No APL valve (C) in mapleson E circuits!
used in spontaneously breathing pts to deliver O2; mainly pediatrics!!
For MAPLESON E Circuit:
Where does FGF enter?
Near the patient
What forms the reservoir in the Mapleson E circuit if there is no Reservoir Bag?
Corrugated Tubing
What patient population is the Mapleson E circuit designated for? select 2
A. controlled ventilation
B. only adults
C. spontaneous breathing
D. pediatric patients
E. this one is obselete; won’t use it
C. Spontaneous breathing
D. pediatric patients
since there’s much lower resistance w this circuit
Age: Less than 5 years / Weight: Less than 20 kg
What is the other name for the Mapleson F circuit?
A. Ayre’s T piece
B. Circle system
C. Jackson Rees Circuit
D. Bain Circuit
C. Jackson Rees Circuit
What is the Jackson Rees modification of Mapleson E?
A. added APL
B. added reservoir bag
C. added FGF coaxial tubing
D. added co2 absorber
B. open Reservoir bag is added!
still no APL tho similar to mapleson E
For MAPLESON F circuit:
Where is the FGF inlet?
Where is the Reservoir Bag?
What is special about the Reservoir Bag on this circuit?
- FGF inlet - near patient
- Reservoir Bag - on the operator side
- Reservoir Bag is open
How can pressure be generated in the Mapleson F Circuit since it doesn’t have an APL valve?
- The reservoir bag hole may be occluded by the operator’s hand to control bag distension and pressure
- OR fitted with a pop-off/PEEP valve for more precise control.
For MAPLESON F Circuit:
What is the FGF rate?
- 2-2.5 x minute ventilation
similar to Mapleson D circuit’s FGF rate
Improved rebreathing efficiency is due to what factor?
A. Amount of FGF
B. Minute ventilation
C. Location of the pop-off valve relative to FGF
D. Whether or not there is a CO2 absorber
C. Location of the pop-off valve relative to FGF
FGF located near patients will experience less rebreathing.
Which Mapleson Circuits will experience significant amounts of fresh gas vented through pop-off at end-expiration? Select 2.
A. mapleson A
B. mapleson B
C. mapleson C
D. mapleson D
E. mapleson E
F. mapleson F
B. Mapleson B
C. Mapleson C
see the FGF leaving thru APL near pt
Which systems have FGF that drives exhaled alveolar gas away from pt? hint t piece ones
A. Bain’s circuit
B. Maplesons DEF
C. Mapleson AB
D. Ayre’s
B. Mapleson DEF
Rank the groupings of the Mapleson Circuit in efficiency for spontaneous ventilation.
- Mapleson A > Maplesons DFE > Maplesons CB