IHS Breathing Systems

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sethars
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279678
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IHS Breathing Systems
Updated:
2014-07-26 16:47:06
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Breathing systems
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  1. 1. How do breathing systems negatively effect breathing?
    1. All breathing systems add resistance to flow. Especially bc of unidirectional valves and connectors
  2. 1. What are ways to minimize resistance to flow?
    • 1. use the Largest lumen possible
    • 2. Reduce circuit length
    • 3. curved connectors
    • 4. controlled ventilation
  3. 1. what is the primary purpose of breathing circ?
    1. Deliver anesthetic Gases and O2 to pt and remove CO2
  4. How do you calculate pt tidal volume?
    6-10ml/kg. ~7ml/kg
  5. 1. What is different from ICU ventilators vs Anesthesia machine?
    1. ICU vents. do re-breath gases
  6. What are the four factors that affect rebreathing of gases?
    • - design of circuit
    • - FGF rate
    • - ventilation mode
    • - pt's respiratory pattern
  7. What are the adv and disadvantages of rebreathing
    • 1. Cost reduction
    • 2. tracheal warmth and humidity
    • 3. decreased exposure to OR ppl

    • 1. CO2 accumulation
    • 2. potential for O2 depletion
    • 3. Increase system pressure.
  8. 1. where does mechanical dead space begin?
    1. pt's incisors
  9. 1. Mechanical Dead space gas is the 1st gas inhaled at the beginning of each respiratory cycle.
    2. Define Mechanical dead space
    • 1. T
    • 2. the volume of gas in a breathing system that are rebreathed without any change in composition.
  10. FGF and rebreathed gas are inversely proportional?
    T
  11. Main components of breathing system.
    • ! Deliver gases from machine to alveoli in the same concentration as set and in shortest possible time
    • ! Effectively eliminate CO2
    • ! Minimal apparatus dead-space
    • ! Low resistance
  12. 1. How are breathing systems classified?
    • 1. The presence or absence of reservoir bag
    • 2. degree of rebreathing
    •     - means of neutralizing CO2
    •     - presence of unidirectional valves
  13. 1. When will there be rebreathing?
    1. when the FGF is < pt minute ventilation
  14. 1. Mapleson breathing system
    • - NO unidirectional valves
    • - NO way to absorb CO2 - FGF washes out circ.
    • - No inspiratory and exp limb - Rebreathing can occur when pt inspiratory flow > FGF
    • - Vol of circ is = or > pt TV to minimize FGF
  15. What are the 2 distinct functional mapleson groups?
    • 1. Mapleson A
    • 2. Mapleson D,E,F
  16. 1. Another name for Mapleson A circuit?
    2. T/F - it is the most efficient circuit for spontAAAneous ventilation?
    • 1. Magill circuit
    • 2. T
  17. 1. How do you calculate a normal VE?
    2. In controlled ventilation how much FGF is needed to prevent rebreathing?
    • 1. ~ 80ml/kg/min
    • 2. 3x pt's minute volume
  18. 1. What is the Mapleson D,E, and F group called?
    1. T-piece group
  19. 1. Mapleson D is the most efficient at controlleDDD ventilation
    1. T
  20. 1. Mapleson E features?
    2. AKA?
    • 1. No reservoir
    • 2. NO Pop-off
    • 3. requires 3x pt VE to prevent Rebreathing
    • 4. unable to us vent

    2. Ayre's T-Piece
  21. 1. Mapleson F - AKA?
    2. T/F its a mapleson E with a reservoir bag and expiratory port but no valve
    1. Jackson-Rees or Modified Ayres t-piece
  22. 1. Bain System - is like which mapleson?
    What is the difference?
    2. Great for controlleD vent. to preserve FGF
    but uses 2.5-3x FGF for spontaneous breathing
    • 1. Mapleson D
    • 2. exhaled gas leaves outer tube. FGF enters through small internal tube
  23. What are the advantages of Bain system?
    • 1. Warming of Gas and improved humidification
    • 2. ease of scavange
    • 3. APL
    • 4. disposable and sterile
  24. Disadvantages of Bain
    • 1. increased resistance
    • 2. kinking of inner FGF tube
    • 3. Unrecognized disconnection of FGF = Increased Rebreathing
  25. What is the test that determines if the gas inlet tube is kinked?
    Pethick test
  26. What is the most commonly used breathing circ?
    - what are its advantages?
    • - Circle system
    • - decrease rebreathing CO2 by unidirectional valves and absorber
    • - reduces need for high FGF
    • - Conserves heat and humidity
    • - Reduces OR pollution
    • - constant inspired concentrations
    • - useful for all ages
    • - low resistance
  27. 1. The FGF must be between the absorber and the inspiratory valve
    1. T
  28. What is normal dead space percent of TV?
    intubation?
    mask?
    • 33%
    • 0.46
    • 0.65
  29. 1. T/F Soda lime and baralyme reaction is exothermic?
    2. What are the bypoducts of this reaction?
    • 1. T
    • 2. Carbonates, Water, and Heat
  30. What are the components of CO2 absorber?
    What are the active components?
    How much CO2 can be absorbed?
    • Silica
    • 1. 94% CaOH
    • 2. 5% NaOH
    • 3. 1% KOH
    • 23-26L/100g of absorbent
  31. What happens if absorber bcomes too dry?
    1. degradation of volatile anesthetics
  32. 1. What is the pH sensitive die that changes color when 50-70% of the die is exhausted?
    2. T/F Regeneration of exhausted granules may revert color back to original if rested. But, absorbent is still exhausted
    1. Ethyl violet - changes to violet in presence of carbonic acids
  33. KOH is often not included or minimized in absorbers d/t its negative effects. What are they?
    • - increased temp
    • - Carbon Monoxide formation - Des,Enflurane, Isoflurane
    • - Formaldehyde
    • - Compound A formation - Sevoflurane
  34. Baralyme consist of?
    • Just
    • 1. 80% CaOH
    • 2. 20% BaOH2 (the activator)
    • no longer available dt fire hazard
  35. 1. What is Amsorb and its composition?
    2. Amsorb advantage?
    • 1. CaHO
    • 2. Less degredation of volatile anesthetics
    • sevo -> compound A
    • desflurane -> CO
    • 3. alkaline free
    • 4. Does not deteriorate as easily with dessication
  36. 1. Granule size for Amsorb is?
    • 1. 4-8 mesh 4-8 openings/in2
    • - lg the size < resistance, but < surface area
  37. 1. Optimal CO2 neutralization requires what about the pt TV?
    1. the Pt's full TV accommodated within canister
  38. What should you do to minimize absorber channeling?
    1. shake before use.
  39. What are the toxic reactions with volatile agents and CO2 absorbers
    What increases the chance of toxins?
    • Sevo - Compound A
    • - baralyme
    •  - Temp
    • - low flows
    • - high gas conc.
    • - fresh absorbent
    • Recomended 2-5L/min flows
  40. Des, Enfl, Iso have the risk of creating?
    What increases this risk
    • - CO build up
    • - Carboxyhemaglobin may increase up to 30%
    • - occurs with soda lime but > with baralyme
    • - low flow
    • - High anesthetic concentration ^ production
    • - high temp
    • - dessicated granules - turn off FGF at end of each day.
    • - Flush with 100% 02 for 1min at start of Day
    • - Soda lime dormant for > 24 should be changed and dated
  41. 1
  42. 1. CO2 + water -> carbonic acid (H2CO3)
    • 2. H2CO3 + 2NaOH -> Na2CO3 + 2H2O + Heat
    •  - This is a fast reaction
    • 3. Na2CO3 + Ca(OH)2 -> CaCO3 + 2NaOH + Heat
    •  - This is a slow reaction
    • 4. H2CO3 + Ca(OH)2 -> CaCO3 + 2H2O + Heat
    •  - This is very slow reaction

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