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Emergency Care Final

QuestionAnswer
What is an oropharyngeal airway? Used on unconscious patients, supports the base of the tongue, also used as a bite block for oral ETT patients, facilitates suctioning
What is a nasopharyngeal airway? AKA nasal trumpet, inserted through one of the nares and sits in the pharynx above the trachea, can be used to facilitate suctioning
What is an oral endotracheal airway? Tube is passed through the oropharynx into the trachea
What is a nasal endotracheal airway? Passed through the nares into the nasopharynx and into the trachea
What is a tracheostomy tube? A tube placed into an artificial opening (stoma) in the trachea
How does a MacIntosh blade work? Fits into the vallecula and lifts indirectly
How does a Miller blade work? Fits under the epiglottis and lifts directly
What is the difference between a Miller and a MacIntosh blade? Miller blade is straight / MacIntosh blade is curved
What is the appropriate cuff pressure? 20-25 mmHg / 25-30 cmH2O
What are the hazards and complications associated with endotracheal intubation? Poorly tolerated in conscious patients, difficult to stabilize; prone to self-extubation, vagal stimulation, tube obstruction (biting), oral hygiene difficult, inability to talk or eat, risk of right mainstem/esophageal intubation, oral/tracheal injury
What are the hazards and complications associated with nasotracheal intubation? Bleeding, ulceration, necrosis of nares from pressure, obstruction, cuff rupture, vagal stimulation, more difficult, problems with suctioning and kinking, difficult bronchoscopy
What is the FIRST thing that should be done when finding a person "down"? Determine if the patient is conscious ("ARE YOU OKAY?" Sternal rub)
What are the hazards and complications associated with OPA's? Gagging, vomiting, aspiration, laryngospasm, incorrect placement, can displace tongue
What are the indications for OPA's? Restore airway patency and maintain adequate ventilation in unconscious patients, supports base of the tongue, bite block for oral ETT, facilitate oral suctioning
What are the complications and hazards associated with NPA's? Trauma to mucosa, epistaxis, increased Raw
What are the indications for NPA's? Provide airway (better tolerated in conscious patients), guide for suctioning or bronchoscope, used for patients seizing with tightly clinched jaw
When is an OPA a better choice than an NPA? Unconscious patients
When is an NPA a better choice than an OPA? Conscious patients
When is it appropriate to suction a patient? Only when necessary
What signs and symptoms will you see/hear, that will help you determine if a patient needs to be suctioned? Visible secretions, rhonchi, crackles
Where is the best place to check for a pulse during CPR? Carotid on adults and children / Brachial on infants
What is a Passy Muir Valve? Speaking valve used on trach patients
How does a Passy Muir Valve work? One way valve open on inspiration and closes on expiration; cuff must be deflated and inner cannula removed
What is the suctioning procedure? Set vacuum pressure, place PT in semi fowlers or sniff position, pre-oxygenate, use sterile technique to prep equipment, test vacuum, disconnect vent/O2, suction PT, re-oxygenate, clear catheter, assess patient, repeat if needed
How do you recognize right mainstem intubation? Right sided chest rise (Assymetrical) or diminished breath sounds on the left side
How do you correct right mainstem intubation? Pull tube back and reassess chest rise and breath sounds
What equipment is needed for oral intubation? Laryngoscope, metal stylet, ETT tubes, 10 ml syringe, yankauer and suction source, bag/mask unit, CO2 detector, sedation meds, stethoscope, tape/tube holder, tongue depressor/OPA/bite block, sterile suction catheter, manometer
What is the procedure for intubation? Prepare equipment, check proper function, place patient in “sniff” position, ventilate and oxygenate patient, use laryngoscope to visual cords, insert ETT & metal stylet, inflate cuff, remove metal stylet, ventilate patient to confirm placement, tape tube
What equipment is need for nasal intubation? ETT tubes, 10 ml syringe, lubricant, yankauer and suction source, magill forceps, bag/mask unit, CO2 detector, sedation meds, stethoscope, tape/tube holder, tongue depressor/OPA/bite block, sterile suction catheter, manometer
What is the procedure for nasal intubation? Prep equipment, check for proper function, place patient in “sniff” position, ventilate/oxygenate patient, lubricate tube, insert tube through nare, visualize tube in PT throat, use magill forceps to guide tube, inflate cuff, confirm placement, tape tube
What is the procedure for CPR on a victim with suspected neck injury? Jaw thrust
What signs would a patient with an airway obstruction present? Universal choking sign, distended veins in forehead, turning red/blue
When should trach patients have a spare "tube" next to their bed? During trach care
What is the procedure for obtaining a sputum sample? Suction the patient and use a Luken’s trap to collect sample; Hypertonic saline can also be used to obtain a sputum sample without suctioning
What is a Yankauer suction tube? What is it used to clear? From where? A hard, plastic suctioning tube, used to clear secretions/vomit from the mouth and oral cavity
When suctioning via ETT, how would you calculate what size suction catheter to use in comparison to the ETT? ETT size x 3 / 2
What is an obturator? What is it used for and why? Intubation tube that can be placed in the esophagus or trachea; used in emergency situations because it can be inserted blindly
What are the indications for oral intubation? Secure patent airway for MV/CPAP, facilitate suctioning, prevent aspiration, maintain airway, relieve airway obstruction, instill medications
What are the indications for nasal intubation? Same as oral intubation; used for intubation when oral intubation is not possible
What are the indications for suctioning? Obstructed airway, accumulated secretions, depressed cough, inability to swallow, specimen collection
What is the "optimal" type of cuff? High volume, low pressure
What is the purpose of the beveled tip on an ETT? Prevent occlusion
What is the purpose of the Murphy's eye on an ETT? Prevent occlusion
What is the purpose of the cuff on an ETT? Prevent aspiration and maintains seal for MV
What is the purpose of the pilot tube on an ETT?` Carries air to and from the cuff
What is the purpose of the pilot balloon with one way valve on an ETT? Monitors cuff pressure
What is the purpose of the radio-opaque line on an ETT? Used to view ETT on CXR
What is the purpose of the 15 mm OD adapter on an ETT? Used to attach devices
What is a Shiley Trach commonly used for? Mechanical Ventilation
What is a Portex Trach commonly used for? Long term use (lifetime)
What is a Jackson Trach commonly used for? Cuffless metal trach; long term or permanent
What is a Biovana Trach? Foam cuff, needs to be aspirated every 12 hours
What is a Kistner Trach Button? Used to hold stoma open
What is the procedure for cleaning a trach tube? Removed soiled gauze, put on sterile gloves, remove inner cannula, soak in 50/50 sterile water hydrogen peroxide mixture, clean around trach, dry area, clean inside of inner cannula, rinse inner cannula and dry, replace inner cannula, apply new gauze
What is MLT? Minimal Leak Technique; used to set trach pressure, deflate cuff till small air leak occurs to determine adequate inflation
What is MOV? Minimal Occluding Volume; used to set trach pressure, inflate cuff till the minimal occluding volume is reached
What are the hazards and complications associated with suctioning? Trauma to mucosa, contamination, hypoxemia, bradycardia, bleeding
What can be done to prevent hazards and complications with suctioning? Limit suctioning to 15 seconds, only suction when necessary
What is the appropriate suction pressure for an infant? -60 to -80 mmHg (-100 max)
What is the appropriate suction pressure for a child? -80 to -100 mmHg (-120 max)
What is the appropriate suction pressure for an adult? -100 to -120 mmHg (-150 max)
What is the technique for open an airway? Head tilt, chin lift / Jaw thrust
What things can cause a laryngoscope to malfunction? Batteries, bulb
What are the hazards and complications associated with high cuff pressure? Mucosal ischemia, inflammation, hemorrhage, ulceration, tracheomalacia, stenosis, necrosis
Where should the top of the ETT be after intubation? 2-5 cm before the carina / 21-25 cm at the lips / 26-29 cm at the nares
How is the "Carlen's" tube different? What is it used for? Two tubes, allows for separate ventilation of each lung or MV of one lung
What are the indications for artificial airways? Protect airway, relieve obstruction, facilitate suctioning, protect from aspiration, provide a closed system for MV/CPAP
What are the problems associated with prolonged intubation attempts? Inadequate oxygenation
What is the procedure for extubation? (Before, During, After) Explain procedure, place in high fowler, suction airway/mouth (above/below cuff), cut/remove tape, deflate cuff, PT take a deep breath, remove tube(peak inspiration), cough to clear secretions, O2/humidity, observe ,monitor, chart, NEVER leave till okay
What can alter the delivered FIO2 of a manual resuscitator? Inadequate RR, poor seal on mask
Why is cuff volume so important? Ensure proper seal for MV / limit tracheal trauma
What type of endotracheal tube would be used for unilateral lung disease? Carlen's tube
What is the procedure for a bronchoscopy? Prep patient, NPO 8 hours prior, pre medicate patient, place patient in supine or semi fowlers position, insert bronchoscope, obtain desired samples/administer meds/lavage, remove scope, monitor patient, NPO till gag reflux returns
What meds are used for bronchoscopy? Sedatives (Benzodiazepines), pain medications, numbing agents, mucomyst, topical vasoconstrictors
What is a precordial thump? When should it NEVER be used? Using a closed fist to hit the left side of the chest of a cardiac arrest victim in an attempt to restore a normal rhythm; NEVER perform on children
What is an LMA? An inflatable mask that is positioned directly over the opening of the trachea
When is an LMA most often used? Most often used in situations where an oral ETT is difficult to insert
Created by: ashconrad417