click below
click below
Normal Size Small Size show me how
Test 5 Theories
Ch 33 Egans, Persing 49-59
Question | Answer |
---|---|
Conditions requiring management of AW are impending or actual | AW compromise Respiratory failure Need to protect AW |
Indications for emergency AW managment | AW EMG b/f et intubation, obstruction of AW, Apnea, coma penetrating neck trauma Cardipul arrest/unstable dysrythmias severe bronchospasm pulmonary edema narcotics foreign body obstruction choanal antresia in neonates apsiration or risk of |
Contraindications for Emergency AW managment | Pt is a DNR |
Hazards & Complications of Emergency AW managment | Failure to establish a patent AW, intuabte trachea or recognize esophogeal intubation Upper AW trauma, laryngeal & esophageal damage Aspiration C-spine trauma Unrecognized Bronchial intubation Eye injury Vocal cord paralaysis ET Tube Issues |
Which pt's need AW emergency management? | Pt inability to protect AW adequately (w*w/o respiratory distress) Partial or complete obstructed AW Apnea, maybe associated with cardiac arrest Hypoxemia, hypercarbia, or acidemia Respiratory distress |
PT is unable to protect AW adequately if | Coma Lack of gag reflex inability to cough May or may not be associated with respiratory distress |
Sings of partially obstructed AW | Ineffective pt effort to ventilate Paradoxial respiration stridor Use of accessory muscles PT pointing to neck choking motions Cyanosis and distress |
Signs of lower AW obstruction | All listed for upper AW obstruction Wheezing |
Completely obstructed AW signs | Respiratory efforts w/no breath sounds or suggestion of air movement |
Signs of apnea | No respiratory efforts seen May be associated with Cardiac arrest |
Signs of Respiratory arrest | Elevated RR High or low ventilatory volumes Signs of Sypathetics nervous system hyperactivity |
Monitor Clinical signs during emergency management of AW | Lvl of consciousness Presence of & character of breath sounds Vent ease Symty & amt of chest movmt Skin color & character (Temp & diaphoresis) Upp AW snds (crowing, snoring, stridor) Exce secretions debris in AW Epigastric snds retractions na |
Monitor Physiological variables during emergency management of AW | Vent frqy, VT, and AW pressure presence of CO2 in exhaled gas HR & Rhythm P/Ox ABG values CXS |
ET position accuracy check: | Bilateral BS Symmetric chest movement Absence or ventil sounds of epigastrium Condensate in tube, correlates with exhalation Visualization of tube through vocal cords Esophagel detector devices Capnometry endoscopic visualization |
Generally a woman is intubated with what size? | No. 7 or 7.5 |
Generally a man is intubated with what size? | No. 8 or 8.5 |
ET tube size and distance from incisors for infant<1kg | Size 2.5 mm, Length 6.5-8 cm |
ET tube size and distance from incisors for infant 1-2 kg | Size 3.0 mm, Length 7-8 cm |
ET tube size and distance from incisors for infant 2-3 kg | Size 3.5 mm, Length 8-9 cm |
ET tube size and distance from incisors for infant 4 kg | Size 3.5-4.0 mm, Length 9-10 cm |
ET tube size and distance from incisors for 6 months | Size 3.5-4.0 mm, Length 10-11 cm |
ET tube size and distance from incisors for 18 months | Size 3.5-4.5 mm, Length 11-13 cm |
ET tube size and distance from incisors for 3 yrs | Size 4.5-5.0 mm, Length 12-14 cm |
ET tube size and distance from incisors for 5 yrs | Size 4.5-5.0 mm, Length 13-15 cm |
ET tube size and distance from incisors for 6 yrs | Size 5.5-6.0 mm, Length 14-16 cm |
ET tube size and distance from incisors for 8 yrs | Size 6.0-6.5 mm, Length 15-17 cm |
ET tube size and distance from incisors for 12 yrs | Size 6.0-7.0 mm, Length 17-19 cm |
ET tube size and distance from incisors for 16 yrs or small woman | Size 6.5-7.0 mm, Length 18-20 cm |
ET tube size and distance from incisors for women (AVG) | Size 7.5-8.0 mm, Length 19-21 cm |
ET tube size and distance from incisors | Size 8.0-9.0 mm, Length 21-23 cm |
What blade is commonly used to intubate adults? | No. 3 curved macintosh or Straight Miller laryngscope blade |
Generally, where should the Orotracheal tube be initially inserted in men? | 21-23 cm mark at the teeth |
Generally, where should the Orotracheal tube be initially inserted in women? | 19-21 cm mark at the teeth |
Absolute contraindication for percutaneous dilation tracheostomy | Need for emergency surgical AW |
Relative contraindication for percutaneous dilation tracheostomy | Children <12 yrs poor landmarks secondary to body habitus, abnormal anatomy, or occluding thyroid mass PEEP> 15 cm h20 Coagulopathy Pulsating blood vessel of trach site Limited C-spine flex Hx diff intubation infection, burn, malignancy at trach si |