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Artificial airway1&2

RTH 131

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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