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Artificial airway1&2
RTH 131
| Question | Answer |
|---|---|
| What are the 4 reflexes | 1.Pharyngeal 2. Laryngeal 3. Tracheal 4. Carinal |
| where do reflexes enerverate | the cranial nerves |
| CNS depression causes what to happen to the reflexes | they deteriorate from pharyngeal down |
| CNS recovery, what happens to the reflexes | the return from carinal up |
| what does the pharyngeal reflex do | cause gag/ swallowing |
| what does the laryngeal reflex do | closes glottis |
| the carinal and tracheal reflexes do the same thing, what is that? | cough response |
| what are the 6 ways the airway can become obstructed | 1. tongue @ back of pharynx from unconsciousness/ CNS abnormality 2. blood 3. foreign object like vomitus/ false teeth 4.edema- extibation swelling/ glottic swelling 5. secretions 6. laryngospasm |
| signs a pt has partial obstruction | 1. stridor 2. can't cough 3. increased RR 4. fair airway exchange 5. exagerated chest/abdominal movement |
| signs a pt has complete obstruction | 1. can't talk 2. cyanosis 3. worse air movement 4. sternal retractions 5. panic 6. unconciousness 7. Resp. arrest |
| why use an artificial airway | 1. establish dependable airway 2. maintain dependable airway 3. give mechanical ventilation |
| what affects the WOB in artifical airways | the inner diameter |
| what are the types of airways | 1. Oropharyngeal 2. Nasopharyngeal 3. endotracheal 4. laryngeal mask 5. tracheostomy tubes 6. Combitube 7. esophogeal obturator |
| what are the 2 main placements of artificial airways | 1. pharyngeal -oropharyngeal/nasopharyngeal 2. tracheal- endotracheal/ tracheostomy |
| can an oropharygeal airway be used in a semiconcious patien | no ONLY unconscious pt |
| what does the ooropharyngeal airway do | keep tongue/soft palate from back of pharynx wall |
| is the oropharyngeal a perminint airway | no, never tape, has to be taken out fast if pt vomit to keep from aspiration |
| what is the most common uses for the oropharyngeal airway | 1. bite block for siezure 2. bite block for ET biting 3. guide for pharyngeal suctioning in unconcious pt |
| which oropharyngeal airway has a innner channel | guedel |
| which oropharyngeal airway has side channels | berman |
| how do you measure an oropharyngeal airway | from the point of jaw to the tip of the chin or past corner of moouth |
| steps for oropharyngeal placement | 1.measure 2.clear mouth 3.extend neck 4.put curve toward roof of mouth, twist once past uvula into place |
| oropharyngeal hazards | 1.gagging/ fighting = remove! 2. push tongue back in throat 3. too big= press epiglottis 4. too small= aspirated |
| another name for nasophayrngeal airway | nasal trumpet |
| what are the uses for a nasopharyngeal airway | 1. keep tongue/soft palate from pharyngeal wall 2. passage for suctioning 3. passage for bronchoscope |
| can the nasopharyngeal airway only be used in unconcious pt | no can be tolerated by semiconscious/ conscious pt |
| what can a nasopharygeal airway be made of | 1.soft rubber 2. silicone 3. PVC - polyvinal chloride |
| in a nasopharygeal airway the phlange end is at what end | the nare end |
| in a nasopharyngeal airway the bevel is at what end | the pharyngeal end |
| the nasopharyngeal airway comes in one length | false! it comes in various lengths and diameters |
| what are the steps to place a nasopharyngeal airway | 1. measure 2.choose largest outer diameter to fit in innerdiameter of the external nare 3.lubricate 4. bevel facing midline 5. gently advance |
| how do you measure a nasopharyngeal airway | from the tip of earlobe to the center of nose |
| hazards of the nasopharyngeal airway | 1. sinusitis 2. otitis media 3. secretion occlusion 4.tissue death- long placement 5. bleeding 6. slipping into nasopaharynx |
| contraindictions of nasopharyngeal airway | 1. nasal traum -POLYPS 2. deformities- deviation 3. coagulation dissorder |
| what is the purpose of ET tubes | 1. artificial ventilation 2. long term airway 3. smoother suctioning 4. risk aspiration 5. relieve upper airway obstruction -epiglottitis/ glottic edema/ laryngospasm 6. prevent airway obstruction-paraylasis/ drugs/ unconciousness/ neromuscular dises |
| what are the types of ET tubes | 1.oral 2. nasal |
| when do you use an oral ET tube | 1st choice in an emergency |
| when do you use a nasal ET tube | elective and requires a breathing pt for blind approach |
| every ET tube has this adapter | 15mm adapter |
| what is the 15 mm adapter on ET tubes used for | 1. ventilator ciriuts 2. resuscitation bags |
| what are ET tubes made of | 1. PVC- polyvinal chloride 2. silicone |
| what end of the ET tube is beveled | the distal end |
| why is the distal end of an ET tube beveled | to help pass the vocal cords |
| in an ET tube, what is the Murphy's Eye for | to still provide wfloe to trachea if the beveled distal end becomes occluded |
| how is the cuff inflated and deflated | by the pilot baloon |
| how do you see ET tubes on an x-ray | a radiopaque line on the ET tube |
| when should you x-ray a pt to make sure the ET tube is in the correct position | everytime you place an ET tube |
| what is the correct position of an ET tube | 2cm or 1 inch above the carina |
| in cm an ET tube is marked from what end | from the distal end up |
| on an ET tube package the are what markings | 1. cm of inner diameter 2. cm of outter diameter 3. IT- implantation tested 4. Z79- approved by commitee for anasthesia |
| what is the size known by | the inner diameter |
| what does IT mean on a ET tube | implantation test- means ET tube has been tested to be nontoxic to living tissue |
| the pilot baloon is attatched to the cuff via what | an inflation tube and spring closure valve |
| oral ET tube size for a male | 8-8.5 |
| oral ET tube size for a femal | 7-7.5 |
| steps for oral intibation | 1. proper size 2. check cuff/ deflate 3. insert stylet 4. choose larygoscope 5. oxygenate 6. insert laryngoscope blade into right side of mouth 7. blade move tongue to left 8. advance blade to find cords 9. put ET tube in cords (5cm)=trachea |
| types of laryngoscopes | 1. miller- straight 2. mcintosh- curved |
| parts of laryngoscope | 1. blade 2. handle |
| what is the equipment you will need for an oral intibation | 1. ppe's-glove/gown/mask/eyewear 2. laryngoscope 3. several ET tubes 4. tape 5. syringe 6. stylet 7. suction 8. resusitator 9. O2 10. stethescope 11. sedative/paralytic |
| always do what before oral intibation | oxygenate with 100% O2 for 1 min |
| where does the Mcintosh go | between epiglottis and base of tongue |
| where does the miller go | under epiglottis and manually lift |
| if placement takes longer then 30 seconds what's the next step | take out and oxygenate patient again before trying again |
| how do you confirm an ET tube placement | 1. ascultate bilateral breath sounds 2. make sure no air at apigastrum 3. look at depth in cm on tube 4. if available use CO2 detector 5. x-ray to verify |
| what do you do if there is not bilateral breath sounds | 1. deflate cuff 2. pull tube back till bilateral heard 3. reinflate cuff 4. secure |
| what is the typical depth from teeth to tube | 21-25cm |
| which rib will the ET tube end at | 4th |
| which thoracic vertebrae will the ET tube end at | 4th thoracic |
| hazards of ET intibation | 1. contaminate tracheobronchial tree 2. cough reduced 3. vocal cord damage 4. edema- laryngeal/trachea 5. mucosal damage 6. occluded tube=no ventilation 7. loose speech 8. tooth trauma 9. bleeding 10. hypotension 11. laceration-pharynx/esophogus |
| complications of ET tubes | 1. poorly tolerate if conscious 2. hard to stabalize- head moves 3. gagging 4. oral secretions stimulated 5. pt biting- occlusion |
| what is the difference of bevels in oral and nasal ET tubes | the bevel will be longer and sharper in nasal ET tubes |
| when is a nasal ET tube used | non emergency situations |
| when are magill forceps used | during nasal ET intibation |
| what is sprayed in nasal passage before ET tube | 1. vasoconstrictor to reduce bleeding 2. Lidocaine -anesthesic |
| what are the 2 methods for inserting a nasal ET | 1. blind- breathing pt 2. direct visual- with laryngoscope/ magill forceps |
| what are the advantages of nasal ET | 1. easier stabalization 2. more tolerated-less gagging/secretion/head movement 3. easier suction 4. less likely for pt to extibate self |
| nasotracheal tube complications are | 1. nasal tissue death 2. otitis media 3. sinus obstruction 4. septal deviation 5. nose bleed |
| nasaltracheal tube common depth is different from the ET tube depth, what is it | 26-29 cm |
| what are nasaotracheal tube placement steps | 1. anesthetize nose 2. lube tube 3. insert during inspiration or use laryngoscope and magill forceps to guide in 4. secure same as ET tube |
| what are the 3 alternative airways | 1. LMA -Laryngeal mask airway 2. Combitube 3. EOA- Esophogeal obturator airway |
| when do you use a LMA | for short term only when nasal/oral not possible, common in anesthesia |
| what are the advantages of the LMA | 1. not a lot of manipulation/ head positioning 2. available from neonate to adult |
| disadvantages for the LMA | 1. expensive 2. hard to get correct size 3. doesn't prevent aspiration |
| why does the LMA have to be checked constantly | for aspiration/ vomit |
| what should be done ever time an artificial airway is placed in a pt | check for bilateral breath sounds before securing |
| can a ET tube be placed through the LMA | yes is can to secure a secure airway |
| 2 main limitations to the LMA | 1. cannot be used on even a semiconscous pt=gag 2. ventilation over 20 cm H2O= gastric destinsion |
| what is a combitube | a double lumen device- can ventilate just one lung or both |
| can a combitube be inserted blindly | yes, when intibation failed or with difficult airways |
| what is the advantage that the combitube has over other ET tubes if inserted into the esophogus | the combitube has 2 cuffs and 2 airway passages. if the distal one ends up in the esophagus then the cuff will keep vomit out of airway and the resuscitator can be moved to the other airway and then ventilate the patient through those holes. |
| combitube is used in what situation | blind intibation |
| what is very important to monitor when testing combitube placement | 1. gastric sounds 2. bilateral breath sounds |
| who should the combitube not be used on | 1. pediatric 2. very short adults |
| what are the advantages to the combitube | 1. can do a blind intibation 2. can be rapidly inserted 3. pharyngeal cuff is well anchored to hard palate |
| what are the disadvantages to the combitube | 1. placement of an ET tube is difficult with a combitube in place already 2. can't be used on pt with gag reflex |
| what is a double lumen ET tube | 1. 2 different lumina- different lengths 2. one goes in either left or right bronchi 3. shorter one ends above carina 4. can ventilate each lung separtly 5. 2 cuffs |
| what are the differences in the double lumen ET tube | 1. one has high volume low pressure cuff 2. one is a high pressure low volume cuff |
| what is unique about the 2 cuffs on the double lumen ET tube | they have a radiopaque line on the cuffs as well as ET tube |
| why do the double lumins 2 cuffs have a radiopaque line | to make sure the placesment of each is in the proper place to keep only one lung ventilated at a time |
| when is a double lumen Et tube used | 1. after lung transplant- lung compliance different 2. when pt has a one sided lung problem 3. during lobe ectomy to ventilate one lung and not the other 4. protect good lung when one is have massive hemoptysis |
| what is a EOA | an esophogeal obturator airway |
| when is a EOA used | during emergency situations for unconscious pt and apneic |
| is a EOA a true ariway | no |
| what is the principle behind EOA | 1. stop airt from getting into stomach 2. esophagus is sealed with cuff- gas only in lungs 3. prevent aspiration |
| what is a the approx. length of the EOA | 37 cm |
| differences betweet EOA to an ET tube | 1. closed off distal end 2.supposed to go into esophagus 3. cuff blocks off esophgus 4. holes at pharyngeal level- not vented through one hole |
| EOA placement directions | 1. check cuff 2. deflate 3. lock in mask 4. place head in neutral position 5.grasp jaw/ lift jaw 6. insert on right side till mask is seated 7. seal mask 8. ventilate- bilateral chest movement/ breath sounds only 9. inflate cuff |
| when should a EOA be removed | 1. pt regain consciousness 2. pt breaths spontainous 3. ET tube is available |
| be prepared for what when removing EOA | the pt will vomit get suction/ turn head/ have vomitus bag/ then deflaite cuff |
| before you take out the EOA what needs to be done about the pt airway | make sure they have a nasal tracheal or ET tube before removing EOA |
| what are the EOA hazards | 1. hole in esophagus 2. tracheal intibation- no ventilation 3. vomit upon removal |
| what should be done if an EOA is placed in a trachea | remove! emergency! no ventilation |
| what are some EOa contraindications | 1. semi conscious pt 2. kids under 16 3. coma easily reversed 4. need longer then 2 hrs 5. pt with esophageal trauma |
| how long can an EOA be in a pt | 2 hrs |
| can kids under 16 use an EOA | no, only made for adults |
| what are the parts of the mouth to mask | 1. mouthpiece 2. one way valve 3. O2 outlet 4. 15/22 mm adapter 5. adequate seal |
| what are the types of self inflaiting bags | 1. ohio hope 2 2. ambu (air mask bag unit) 3. air viva 4. stat blue |
| when are flow inflating bags used | in anasthesia |
| who can use the oxygen powered resuscitator | adults only |
| how does a oxygen powered resuscitator work | 1. 50psi O2 source 2. demand valve delivering 100% O2 |
| what are the steps to use bag resuscitator | 1. stand behind pt 2. put mask on pt 3. hold bridge of nose with thumb 4. hold mask with index fingers 5. grab jaws with rest of fingers 6. can also be attatched to ET tube |
| what does a bag resuscitator do | gives pt IPPB at various oressures |
| is the FIO2 the same witha mask resuscitator | no it is variable with the 1. flow rate 2. reservior 3. RR/ refill rate |
| when do you need to bag a pt | 1. CPR 2. Resp arrest 3. deteriorating pt 4. pre/post oxygenating during suctioning artificial airway 5. transporting pt |
| what are some hazards and complications for bagging a pt | 1. failure to establish airway- in esophagus/ bronchi 2. cervical/spinal trauma- chin lift not hyperextended 3. gastric iinsufflation 4. barotrauma 5. vomit/ aspiration |
| how do you correct gastric insufflation | 1. 2 sec to deliver volume= less problem 2. use cricoid pressure = less problem |
| how can you prevent a barotrauma in bagged pt | 1. use correct size bag 2. use pressure relief valve @ 35-40 cm H2O |
| how can you prevent vomiting in bagged pt | 1. turn patient and compress stomach before 2. in tibate after compressing stomach 3. put in nasogastric tube |
Created by:
Kataleshire
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