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Airway Intubation
Ch33
| Question | Answer | |
|---|---|---|
| Which of the following conditions require emergency tracheal intubation? | * Upper airway or laryngeal edema * Loss of protective reflexes * Cardiopulmonary arrest * Traumatic upper airway obstruction | |
| Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management? | * Hypotension * Bradycardia * Cardiac Arrhythmias * Laryngospasm | |
| All of the following indicate an inability to adequately protect the airway EXCEPT: | 1 Wheezing **** 2 Coma 3 Lack of gag reflex 4 Inability to cough | Wheezing |
| Which of the following types of artificial airways are inserted through the larynx? | 1 pharyngeal airways 2 tracheostomy tubes 3 Nasotracheal Tubes** 4 Orotracheal Tubes** | |
| Advantages of Oral intubation include all of the following except: | 1 reduced risk of kinking 2 Less retching and Gagging 3 easier suctioning 4 less traumatic insertion | Less retching and Gagging |
| Advantages of nasal intubation include all of the following except: | 1 Reduce risk of kinking 2 less retching and gagging 3 less accidental extubation 4 greater long term comfort | reduce risk of kinking |
| Compared with trans pharyngeal intubation, the advantages of Tracheostomy include all of the following except: | 1 greater patient comfort 2 reduce risk of bronchial intubation 3 no upper airway complications 4 decreased frequency of aspirations | decreased frequency of aspirations |
| what is the standard size for endotracheal or tracheostomy tube adapters? | 15mm external diameter | |
| What is the purpose of the additional side port (murphy eye) on most modern endotracheal tubes? | To ensure gas flow if the main port is blocked | |
| What is the purpose of a cuff on an artificial tracheal airway? | To seal off and protect the lower airways | |
| What is the purpose of the pilot balloon on and endotracheal or tracheostomy tube? | To monitor cuff status and pressure | |
| Which of the following feature incorporated into most modern endotracheal tube assist in verifying proper tube placement? | 1 Length markings on the curved body on the tube 2 imbedded radiopaque indicator near the tube tip 3 additional side port near the tube tip (murphy eye) | 1 Length markings on the curved body on the tube 2 Imbedded radiopaque indicator near the tube tip |
| The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which the following perposes? | 1 aid in routine cleaning and tracheostomy care 2 prevent the tube from slipping into the trachea 3 Provide a patent airway should it become obstructed | |
| What is the purpose of a tracheostomy tube obturator? | To minimize trauma to the tracheal mucosal during insertion | |
| In the absence of neck or facial injuries what is the procedure of choice to establish a patent tracheal airway in an emergency? | Orotracheal intubation | |
| While checking a crash cart for intubation equipment you find the following: suction equipment ect.. what is missing? | 1 Obturator 2 Syringe 3 Resuscitator bag or mask 4 Tube stylet | 2 syringe 3 Resuscitator Bag or mask 4 Tube stylet |
| Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following: | 1 Laryngoscope light source 2 endotracheal tube cuff 3 suction equipment 4 cardiac defibrilator | 1 laryngoscope light source 2 endotracheal tube cuff 3 suction equipment |
| Before beginning an intubation procedure the practitioner should confirm the operation of | 1 suction equipment 2 oxygen 3 airway equipment 4 monitors 5 esophageal detectors 6 Check position of the patient | |
| While checking a Miller and Macintosh blade on an intubation tray during and emergency intubation you find the miller blade lights but the Macintosh blade does not work. what should you do now? | Check and replace the bulb on the Macintosh blade | |
| What size endotracheal tube would you select to intubate a 3yr old child? | 4.5 to 5.0mm | |
| What size endotracheal tube would you use to intubate an adult female? | 8mm | |
| What size ET tube would you use to intubate a 1500g newborn infant? | 3.0mm | |
| To make oral intubation easier how should the patients head and neck positioned? | Neck flexed with head supported over towels and tilt back | |
| What is the purpose of the endotracheal tube stylet? | It adds rigidity and shape | |
| What should be the amount of time devoted to any intubation attempt | 30sec | |
| Which is the following statements are false about methods used to displace the epiglottis during oral intubation? | 1 regardless the blade used, the laryngoscope is lifted up & forward 2 the curved Macintosh blade lifts the epiglottis indirectly 3 The straight Miller blade lifts the epiglottis directly 4 levering the laryngoscope against the teeth can aid placement | Levering the laryngoscope against the teeth can aid placement |
| During oral intubation of an adult the endotracheal tube should be advanced into the trachea about how far? | Until is has passed the cords! | |
| Immediately after insertion of and oral ET tube on and adult what should you do? | 1 Stabilize with right hand 2 Use left hand to remove the laryngoscope and the stylet 3 Inflate the cuff 4 Provide ventilation and O2 | |
| Ideally the distal tip of a properly positioned ET tube should be positioned how far above carina? | 3-6cm | |
| What can properly confirm proper ET tube placement? | Fiber-optic laryngoscope | |
| What is the average distance from the tip of a properly positioned oral endotracheal tube? | 21-23cm and 19-21 of a female | |
| When using bulb type esophageal detention device during an intubation attempt, how do you know it works? | The bulb fails to re expand upon release | |
| After an intubation attempt and expired capnogram indicates a CO2 levels near 0 what does this finding probably indicate? | Placement of the ET tube is in the esophagus | |
| When using a capnometry or colorimetry to differentiate esophageal from tracheal placement of and ET tube which of the following result false Neg? | Cardiac Arrest | |
| After intubation of a cardiac arrest victim you observe a slow but steady rise in the expired CO2 levels as measured by a bedside capnometer, what can this explain? | Return of spontaneous circulation | |
| What are some serious complications of oral intubation? | 1 Cardiac arrest 2 acute hypoxemia 3 bradycardia | |
| Mazillofacial injury.. Which airway would you recommend? | Nasal route | |
| To provide local anesthesia and vasoconstriction during nasal intubation what would you recommend? | Mixture of .25 phenylephrine and 3 lidocaine | |
| When preforming a blind Nasotracheal intubation, successful tube passage through the larynx is indicated by? | A harsh cough followed by vocal silence | |
| What is the primary indication for tracheostomy? | When a patient has long-term need for an artificial airway | |
| What factors should be considered when deciding to change from an endotracheal tube to a tracheostomy? | 1 Projected time the patient will need an artificial airway 2 Pt's tolerance of endotracheal tube 3 Pt's overall condition 4 Pt's ability to tolerate surgical procedure 5 Relative risk of continued endotracheal intubation vs. tracheostomy | |
| In a properly performed traditional surgical tracheotomy, entrance to the trachea is made through an incision in what area? | Through or between the 2nd & 3rd tracheal rings | |
| What is false about percutaneous dilatation tracheostomy? | Does not require anterior neck distention | |
| Which of the following techniques maybe used to diagnose injury associated with artificial airways? | 1 laryngoscopy or bronchoscopy 2 Physical examination 3 Air tomography 4 Pulmonary function testing | |
| What is the most common sign associated with the transient glottis edema or vocal cord inflammation that follows extubating? | 1 Orthopnea 2 wheezing 3 hoarsness 4 difficulty in swallowing | Hoarseness |
| Soon after endotracheal tube extubation, an adult patient exhibits a high pitched inspiratory noise heard without a stethoscope. Which of the following actions would you recommend? | 1 Careful observation of the patient for 6hrs 2 STAT racemic epinephrine aerosol treatment 3 immediate reintubation via the nasal route 4 STAT heated aerosol treatment with saline | STAT racemic epinephrine aerosol treatment |
| After removal of ET tube hoarseness and stridor don't resolve with racemic EPI what is the problem? | 1 Glottis edema or cord inflammation 2 Tracheoesophageal fistula 3 Tracheomalacia 4 Vocal Cord paralysis | Vocal cord paralysis |
| Which of the following injuries are NOT seen with tracheostomy tubes? | 1 Tracheomalacia 2 Tracheal Stenosis 3 Glottic edema 4 Vocal cord granulomas | Glottic edema Vocal cord granulomas |
| Tracheal Stenosis occurs in as many as 1 in 10 pt's after prolonged tracheostomy At what sites does this stenosis usually occur? | 1 Cuff size 2 Tip of the tube 3 Stoma site | |
| Flow volume loop demonstrates a fixed obstructive pattern. what is most likely the cause of the problem? | 1 cord paralysis 2 laryngeal web 3 tracheal stenosis 4 tracheomalacia | tracheal stenosis |
| There is evidence of both recurrent aspiration and abdominal distention but minimal air leakage around the tube cuff. what is the problem? | 1 Trachoesophageal fistula 2 Tracheoinnominate fistula 3 Underinflated tube cuff 4 Paralysis of the vocal cords | Trachoesophageal Fistula |
| T-tube Briggs adapter should be switched to what to help limit tube movement in a pt? | Switch from a T-tube to a tracheostomy collar | |
| Which of the following techniques or procedures should be used to help minimize infection of a tracheostomy stoma? | 1 regular aseptic cleaning 2 adherence to sterile techniques 3 regular change of tracheostomy dressings | |
| When checking for proper tube placement of an ET tube or tracheostomy tube on a chest radiograph how far above the carina should it be placed? | 3 to 6 cm | |
| To ensure adequate humidification for a pt with an artificial airway temperatures should be around what? | 1 30 to 32C 2 37 to 40C 3 40 to 42C 4 32 to 35C | 32 to 35C |
| Tracheal airways increase the incidence of pulmonary infections for all of the following reasons except: | 1 Contaminated equipment or solutions 2 Increased aspirations of pharyngeal material 3 Ineffective clearance through cough 4 Lower levels of humidification | Lowe levels of humidification |
| Which of the following is likely to increase the likelihood of damage to the tracheal mucosa? | 1 Using a low residual volume low compliance cuff 2 Using the minimal leak technique for inflation 3 monitoring intra cuff pressures every 1 to 2hrs 4 maintain cuff pressures below 20 gto 25mmHg | Using minimal leak technique for inflation |
| What is the maximum recommended range for tracheal tube cuff pressures? | 20 to 25mmHg | |
| Repeated connecting and disconnecting of a cuff pressure manometer to the pilot tube of a cuffed tracheal airway will do which of the following? | 1 decrease cuff pressure 2 not affect cuff pressure 3 rupture the cuff 4 increase cuff pressure | Decrease cuff pressure |
| Tube obstruction can be caused by: | 1 kinking of tube or biting on tube 2 Herniation of the cuff over the tube tip 3 Obstruction tube orifice against the tracheal wall 4 Mucus plugging | |
| There is a higher potential for aspiration in pt's with a trach tube in: | Spontaneously breathing pt's Pt's with tracheostomy tubes than with ET tubes | |
| Signs of partial tube obstruction include: | Decreased breath sounds Decreased air flow through the tube | |
| What are the steps for extubation? | Suciton orolarynopharynx oxygenate patient suction ET tube Deflate Cuff confirm cuff deflation/REMOVE TUBE | |
| TO successfully remove the tube avoiding complications the vocal cords should: | Maximally Abducted | |
| Alternative cuff designs include: | Lanz tube Kamen-Wilkinson foam cuff | |
| Lanz tube | incorporates an external pressure regulating valve and control reservoir designed to limit the cuff pressure to 16 to 18mmHg | |
| Weaning form Tracheostomy tube can be accomplished by using: | Fenestrated tubes Progressively smaller tubes Tracheostomy buttons | |
| Indications for fiber-optic bronchoscopy include: | To inspect the airway To remove objects from airway To collet samples from the airway To place devices in the airway (aid intubation) | |
| A common problem associated with fenestrated tracheostomy tubes is: | Malposition of the fenestration | |
| Tracheal buttons | Aid in relieving airway obstruction and removal of secreations | |
| LMA | doesn't protect against aspiration one use on unconscious pt's if vent is greater than 20cm H2O gastric distention may occur | |
| Pre-bronchoscopy orders should include: | NPO for @ least 8hrs prior Pt's who have vascular access (IV) Pt's should be premedicated | |
| What are possible complications that can occur during a bronchoscopy? | Hypoxemia Hypotension Cargiver/pt info | NOT Hypercapnia |
| Patient support and monitoring during a bronchoscopy includes: | Pulse Oximetry Oxygen cannulas ECG leads Capnometer | NOT Capnometer |
| O2 should be maintained up to 4hrs after and remain in a sitting position and refrain from eating unstill sensations return | Post extubation | |
| What are the goals of airway preparation for bronchoscopy? | Prevent bleeding Decrease cough and gagging Decrease Pain | |
| What medications are used to premedicate pt's for fiber-optic bronchoscopy? | Benzodiazepines(Valium versed) Atropine Narcan | |
| Criteria needs to be met in assessing the readiness of pt's for extubation: | Max neg insp pressure >30cmH2O Dead space to Tidal Vol ratio <0.7 | |
| After extubation assessment of good air movement can be checked by? | Auscultation Color Vital signs Inspiratory force | NOT inspiratory Force |
| The best tracheal airway route for a pt w/suspected C-1 fracture would be? | Nasal intubation (cannot use SNIFF postion | |
| What general condition requires airway management? | * Airway compromise * Respiratory failure * Need to protect the airway |
Created by:
ebrehmer