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Airway management

Exam 1 RRT

Purpose of stylet a thin wire inserted into a catheter to maintain rigidity or into a hollow needle to maintain patency
Hazards of intubation Tracheal damage, vocal cord damage, right mainstem intubation, cuff rupture, aspiration, hypoxemia, tachycardia, arrhythmia, nosocomial infection, esophageal intubation, hemorrhage, broken teeth, laryngospasm, vagaries stimulation
Complications of intubation Kinked airway, ruptured cuff, pilot line cut, pts bites throug tube, excessive mucus build up or plugs, continuous coughing.
Complications of suctioning Trauma to mucosa (most common), contamination, hypoxemia (most severe), bradycardia, bleeding,
Procedure to avoid complications Lubricate catheter and use gentle technique (trauma), use sterile technique (contamination), avoid Vagal stimulation (bradycardia), avoid suctioning vigorous ( bleeding)
Contraindications of nasotracheal suctioning Occluded nasal passages, nasal bleeding, epiglottitis or croup
Why is it important to use proper catheter size for suctioning Too large= possible Atelectasis , too short=not enough suctioning will happen
To determine catheter size ETT size X 3/2= max size of catheter
Direct Laryngoscope Is placed in mouth along the right side of the tongue
Indirect Laryngoscpe Uses mirror to examine
Indifications for artificial airways Relieve airway obs, facilitate removal of secretions, protect lower airway from aspiration, ptovide mechanical ventilation, instill medication
Meds that can be used down the ETT Vasopressin said, Atropine, Narcan, Epinephrine
What drug reverses Benzos Flumazenil
Types of OPA Berman - "I" beam= 2 parallel channels, Guedes= Most common- hole in the middle
Advantage of Oral vs nasal easier insertion, less airway resistance; can use a larger tube; decrease WOB, no sinus problems, easier suction, easier to pass bronchoscope, decreased risk of kinking
Nasal vs oral adv More comfortable, less risk of mainstem intubation, better stabilization of tube, better oral hygiene, pt can communicate and swallow liquid with unruffled tube, no biting or occlusion
Disadvantages oral vs nasal Poorly tolerated in conscious pts, difficult o stabilize; pt pushes with tongue, more prone to self-extubation, vagal stimulation, tube obs (biting), Oral hygiene difficult, cant talk or eat, mainstem or esophageal intubation, risk of injury in mouth
Nasal vs oral disadvantages Bleeding, ulceration, necrosis of nares from pressure, obs of sinus drainage, cuff rupture with intubation, possible vagal stimulation but less than oral, more difficult to perform, greater problems with suctioing and kinking, more difficult bronchoscope
Cuff inflation and technique Minimal leak technique: cuff volume maintains a seal except at max inspiratory pressure, place stethoscope over laryngeal area, slowly nflate, cuff until leak stops, once sealed, remove small amount of air , until small expiratory leak is heard
Pressure of air removal of cuff 0.25-0.5 ml
Weaning Parameter NIF= >-20 mmhg, VC= >10 ml/kg, Vt= >5 ml/kg, f= 8-30 bpm, MV= <10 lpm, RSBI >100 (RSBI= f/Vt)
Lbs to kg 1lb=2.2kg
Stoma Artificial opening, hole
Tracheotomy Surgical procedure to create stoma
Tracheostomy The opening through the neck into the trachea. Stoma in neck
Immediate complication of a tracheotomy Bleeding (major), pneumothorax, air embolism, sub-q emphysema
Late complications of a tracheotomy Infection, hemorrhage, obstruction, T-E fistula
Parts of ETT Body, beveled tip, murphy's eye, cuff, pilot tube, pilot balloon with one way valve, radio-opaque line, placement marking, ETT size, 15 mm OD adapter
Purpose of Beveled tip and urphy's eye on ETT Prevents occlusion
Purpose of Cuff Prevent aspiration
Purpose of Pilot tube Thin tubing that carries air to/from cuff
Purpose of pilat balloon one way valve Monitors uff pressure
Purpose of radio-opaque Used to assess tube position on CXR
Purpose of placement markings Cm indicates the depth of tube
Purpose of ETT size Determines Internal diameter which is in mm
Purpose of 15 mm OD adapter Use to attach devices ( bag/mask, ventilator)
Suction Pressures Infant= -60- -80 mmHg (-100 max) Children= -80- -100 mmHg (-120 max) Adult= -100- -120 mmHg ( -150 max)
Max time to suction 15 secs
ETT size for Male/Female 8.0-9.0 ID (M) 7.0-8.0 (F)
Avrg distance from tip of ETT to lip 21-25 cm
Trach button Plastic tube placed in stoma to maintain open after trach tub is removed. Advantages: pt can eat, talk, and cough normally
Fenestrated trach tube Trach with holes which lets pt to speak and for weaning. Main hazard: granulations through holes
Jackson Trach Cuffless,metal trach. For long term, less secretions, no adaptor for ventilation/bagging, more comfortable
Passey-muir valve Speaking valve that can be attached to a trach tube or trach button, one way valve opens when pt inspires to slow air in, valve closes at exhalation, which allows air to pass through vocal cords for speech, cuff must be deflated.
Hazards of Passey-Muir valve If pt is ventilator dependent, will result in some loss of delivered Vt
Laryngoscopes blades Miller- straight, fits under epiglottis and lifts directly MacIntosh-curved, fits into vallecula and lifts indirectly
Created by: Edi8612