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Resp 2.6 II

Airway management pp

QuestionAnswer
Tracheotomy an incision into. The procedure establishing access to the trachea
Tracheostomy forming a new opening. The opening created by the tracheotomy procedure
stoma hole in trachea without tube in place
tracheostenosis narrowing of the lumen of the trachea
tracheal granumola caused by abrasion of tube tip or at the stoma site
TE fistula hole between the trachea and the esophagus
Tracheomalacia softening of the tracheal cartilage
Why would you choose a trach Pt needed artificial airway more than 7-10 days, pt tolerance for ET tube, pt ability to tolerate surgery, relative risks of continuing ET tube
When is the incision collar incision 2 cm from the suprasternal notch; incision through the 2nd and 3rd tracheal rings
On x ray where is trach tip 4-6 cm above carina
Complications of trach bleeding, pneumothorax, air embolism, subcutaneous emphysema....Late complications: infection, hemorrhage, tracheal stenosis
How to minimize infection use sterile technique during suction, wash hands etc,, and regular change of dressing
Advantages of trach tubes long term, more comfortable, less movement in trachea, allows speaking and eating, more efficient suctioning, resistance to airflow is less because it is wider, shorter and less curved
What is the shiley weaning tool; has fenestration (hold in outer cannula only), this forces the pt to ventilate through fenestration and around tube
How to use fenestrator or shiley when inner cannula is removed you deflate cuff and cap outer cannula
Problems with shiley possible formation of granular tissue at fenestration site (tissue plugs up the hole)
What does the Spiral wire embedded tube do help prevents bending and kinking
What is the Jackson metal tube for long term use, no cuff
Fenestrated tube hole located at curve of outer cannula, the purpose is to allow pt to try breathing without the use of tube (remove inner cannula)
Foam cuff (Bivona) cuff inflates when exposed to room air, not when air is added to pilot tube
Lanz tube has pressure relief valve in pilot, releases pressure when it exceeds limit.... It automatically maintains intracuff pressure at 30 cmH20 to help reduce the risk of tracheal damage during long term intubations
Pitt speaking tube allows pt to speak while on ventilator with cuff inflated
What does the Pitt look like 2 thin tubes attached to trach tube, one for cuff and one to be occluded forcing air up over vocal cords... The end of line occluded to create speech is attached to gas source (flowmeter) (cuff stays inflated)
Passy- Muir speaking valve one way valve attaches to the 15 mm adaptor, allows for speech and secretion management
how does passy muir work Its a one way valve that allows air only during inspiration Blue-colored used with vents....White spontanously breathing, shorter tube
Trach button aid in weaning from trach tube. It keeps stoma open. It extends from skin to just insdide the tracheal wall.
What does trach button look like short, soft hollow tube which firts in stoma in place of trach tube
Olympic tracheostomy button hard plastic device that keeps stoma open, does not bend and does not have cuff, does not maintain closed circuit therefore mechanical ventilation is not possible. (one way valve for speech)
If pt is on vent and needs trach care (cleaning) remove inner cannula and re insert clean tube as fast as possible! Hit alarm silence on vent
When will you do a tracheostomy change out When you need a new one, when pt's condition is unstable, edema around site that may make change difficult
Methods for weaning from tracheostomy tube Tracheostomy buttons, fenestrated tubes, progressively smaller trach tubes
What is the laryngeal mask airway hollow tube with a spoon shaped mask. The mask has a cuff attached to the end of it which inflates to permit the area around the tracheal glottis and epiglottis to be sealed. It sits on the esophageal sphincter
what is the biggest problem with the LMA regurgitation during insertion
What are the indications for LMA when intubation is difficult or mask is difficult when using bag, pt who fears vocal cord damage, resp arrest, elective surgery or bronchoscopy
Hazards of LMA pt with full stomach (aspiration risk), it may leak if ventilating pressure is greater than 20 cmH20
Esophageal tracheal combitude 2 tubes in 1 that will operate as a functional airway device regardless of whether the tube is inserted into the esophagus or trachea
Indications for ETC unconscious, apneic adults, Cspine injury, lack of equipment
Advantages of ETC minimal training, airway regardless of location,
Disadvantages of ETC if inserted to far, the pharyngeal balloon can obstruct the glottis
What is the most common causes of airway obstruction tube obstruction
What are the causes of airway obstruction kinking of tube, herniation of cuff over tube tip, jamming of tube orifice against tracheal wall, mucous plugging
How do you know there is an obstruction peak airway pressure on ventilator increase, decreased breath sounds, decreased airflow through tube
How do you know if there is COMPLETE obstruction resp distress, no breath sounds, no gas trough tube
If kinked/jammed tube what do you do move head slightly
If potential herniation what do you do deflate cuff
If obstruction is in tube remove inner cannula
When will you need to remove entire airway and replace it? if all the methods are not working
On x ray where should trach tube be 4-6 cm above the carina
Created by: TnJFarrington12