Exam 2 Breathing Systems II [6/24/24] Flashcards
What is a Mapleson Circuit used for?
- delivery of oxygen and anesthetic agents
- removal of carbon dioxide
S52
How many types of Mapleson Circuits are there?
- Six Types (A → F)
S52
What are the components of the Mapleson Circuit?
- Reservoir bag (operator end)
- not all have this
- Corrugated tubing
- not all have this
- APL valve (variable positioning)
- Fresh gas inlet (variable positioning)
- Patient connection/Facemask (Patient end)
S53
What components are absent in all Mapleson Circuit Systems?
- CO2 absorber
- Unidirectional Valves
- Separate Inspiratory and Expiratory Limbs
S54
What is another name for the Mapleson Circuit Systems?
- Carbon Dioxide Washout Circuits
- Flow-controlled Breathing Systems
S54
How does the Mapleson Circuit System prevent rebreathing without a CO2 absorber?
- FGF must be significantly greater than minute ventilation to “washout” the CO2.
S54- lecture
What is another name for Mapleson A?
- Magill’s System
S55
- Where does fresh gas flow enter in the Mapleson A circuit?
- Where is the APL valve located in the Mapleson A circuit?
- FGF enters near the reservoir bag (the operator end)
- APL valve located on patient end
S55
- Of all the systems, what is Mapleson A best at?
- What is Mapleson A the worst at?
- Best efficiency of all systems for spontaneous ventilation
- Worst efficiency of systems for controlled ventilation
S55
How to prevent rebreathing with Mapleson A?
FGF must be ≥ minute volume to prevent rebreathing during spontaneous ventilation
S55
In a Mapleson A circuit, rebreathing during controlled ventilation occurs unless minute ventilation is what?
- unless minute ventialtion is very high
- more than 20 L/min
S55
normal VE=4-6L, so if 20L/min pt is breathing really fast or Vt is significantly increased. PLEASE CONFIRM
Mapleson A Circuit:
What is vented out from the APL valve in spontaneous ventilation during expiration?
- Dead space gas (orange)
- Alveolar gas (red)
FGF has to be very high to help vent this off.
S56
Mapleson A Circuit:
What is vented out from the APL valve in controlled ventilation during expiration?
- APL valve does not open on expiration.
S56 + lecture
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)
S56
Where are the APL Valve and Fresh gas inlet located in the Mapleson B Circuit?
Where is the reservoir bag?
- APL and FG inlet located near the patient
- reservoir bag at the end of the system
S57
Why is the Mapleson B Circuit considered inefficient and obsolete?
- Significant fresh gas is vented through APL during exhalation
- Blue (FGF)
- Red (alveolar gas)
S57-58
FGF is right next to the APL, as soon as the pt breaths out & as soon as the FGF comes in, it flows through the APL valve, making this more inefficient.
FGF should be ____ times the minute volume during spontaneous and controlled ventilation to prevent rebreathing in the Mapleson B circuit.
- FGF should be 2x minute volume
S57
Where are the APL Valve and Fresh gas inlet located in the Mapleson C Circuit?
- APL and FGF located near the patient
S59
Mapleson C is identical to Mapleson B except for what specific difference?
- Omission of the corrugated tubing
S59
Looks like an ambu bag
How much FGF is needed for the Mapleson C circuit to prevent rebreathing?
- FGF needs to be 2x minute volume to maintain efficiency
S59
When are Mapleson’s C circuits usually used?
- Emergency resuscitation
S59
What happens with FGF with Mapleson C?
- FGF goes in, not losing as much when its vented to APL valve compared to mapleson B
- its based on the expiratory pause [is it better or worse]
S60 Lecture
Mapleson D has a 3 way T piece that includes?
- pt connection
- fresh gas inlet
- corrugated tuping
S61
Where are the reservoir, APL Valve, and Fresh gas inlet located in the Mapleson D Circuit?
- Reservoir at the end
- APL valve is located near the reservoir bag
- FGF inlet is located near the patient
S61
what can be added to mapleson D?
PEEP valves may be added
S61
Which system is the most efficent system for controlled ventilation?
mapleson D
S61
in Mapleson D FGF is ____x minute ventialtion
FGF 2-2.5x minute ventilation
S61
what is bain modification in mapleson D?
FGF coaxial inside tubing
S61
Which circuits are known to have “T-modifications” or are known as the “T-group”?
- Mapleson D
- Mapleson E
- Mapleson F
S61, 63, 65
What circuit is a modification of Mapleson D?
What is modified?
- Bain Circuit
- Fresh gas flows through a narrow inner tube (coaxial) nested within the outer corrugated tube.
- The central fresh gas tubing enters the corrugated hose near the reservoir bag, but the fresh gas actually empties into the circuit at the patient’s end. Exhaled gases pass down the corrugated hose, around the central tubing, and are vented through the pop-off valve near the reservoir bag.
- Exhaled gases passing down the outer corrugated hose add warmth to the inspired fresh gases by countercurrent heat exchange.
S61- lecture
What is the drawback of the bain circuit?
- disconnection or kinks are not know it bc its inside the corrugated tubing
S61 Lecture
What is happening with mapleson D circuit with spontaneous breathing?
- APL valve is open.
Inspiration:
- FGF come in + alveolar gas [pt gets a both]
Expiration:
- Some alveolar gas gets vented out via pop off valve.
- Dead space gas might or might not get vented out depending on FGF.
- might stay in the reservoir bag & delivered to the pt when squeezed
S62- lecture
what is happening in mapleson D circuit with assisted breathing?
- Partially closed APL
- If we are increasing the pressure in the system [d/t partially closed APL] when we squeeze on inspiration, the DS gas and alveolar gas can get vented out via the pop off valve
- Depends on how much FGF goes to the reservoir bag.
- Since FGF is towards the the pt end, a lot will go towards the pt.
S62
What is another name for Mapleson E?
- Arye’s T-piece
S63
What is missing in the Mapleson E circuit?
- No reservoir bag
- No APL valve
S63
Where does FGF enter the Mapleson E circuit?
- Near the patient
S63-lecture
What forms the reservoir if there is no Reservoir Bag on the Mapleson E circuit?
- Corrugated Tubing atached to the T-piece forms reservoir
S63
What patient population is the Mapleson E circuit designated for? Why?
- Spontaneous breathing pediatric patients to deliver O2
- Age: Less than 5 years
- Weight: Less than 20 kg
- Has decreased resistance in the system bc of no APL valve which is why its preferred in pediatrics.
S63
How would you increase the pressure of the Mapleson E circuit without an APL valve?
- Occluding the end of the corrugated tubing
S63- lecture
What is happening with mapleson E during spontaneous breathing?
- limb is open to the atmosphere.
- great for spontaneous breathing.
S64 lecture
what is happening with mapleson E during controlled breathing?
- can only do controlled by pinching of the end of the tubing.
- will need to pinch, which allows FGF to inflate the lungs, then release the pinch to allow to expire the gases then repeat.
- Closely watch pressures and for chest rise and fall to prevent increases in pressure.
- no way to give extra help without timing it appropriately. Bc we cant read it and say how much pressure is being given.
S64-lecture
What is the other name for the Mapleson F circuit?
- The Jackson Rees Modification (of Mapleson E)
S65
What is missing in the Mapleson F circuit?
What is less likely to develope with this circuit?
- No APL Valve
- Excessive pressure less likely to develope.
S65
- Where is the FGF inlet on the Mapleson F circuit?
- Where is the Reservoir Bag on the Mapleson F Circuit?
- Is there anything special about the Reservoir Bag on the Mapleson F Circuit.
- FGF inlet near patient
- Reservoir Bag on the operator side
- Reservoir Bag is open (with a hole)
S65- lecture
How can pressure be generated in the Mapleson F Circuit?
- The reservoir bag hole may be occluded by the operator’s hand to control bag distension and pressure or fitted with a pop-off or PEEP valve for more precise control.
S65- lecture
What does the reservoir bag on the Mapleson F circuit allow?
- Allow for easy tactile and visual monitoring of the patient’s respiratory effort.
- Can be used to give breaths
- Can pinch the hole to increase pressure on the breath.
S65- lecture
What is the FGF rate for the Mapleson F circuit?
- 2-2.5 x minute ventilation
S65
What is happening in mapleson F circuit?
- DS gas goes to the reservoir bag and then goes to the atmosphere via the hole
-Pt is getting mostly alveolar gas and FGF.
S66 Lecture
⭐️Improved rebreathing efficiency is due to what factor?
- Location of the pop-off valve relative to FGF
FGF located near patients will experience less rebreathing.
S67
⭐️Which Mapleson Circuits will experience significant amounts of fresh gas vented through pop-off at end-expiration?
- Mapleson B
- Mapleson C
S67
⭐️Which systems have FGF that drive exhaled alveolar gas away from pt
- Mapleson D
- Mapleson E
- Mapleson F
S67
⭐️Rank the groupings of the Mapleson Circuit in efficiency for spontaneous ventilation from GREATEST to LEAST
- Mapleson A
- Maplesons D,F,E
- Maplesons C,B
All Dogs Can Bite
S67