| Question | Answer |
| Conditions requiring management of AW are impending or actual | AW compromise
Respiratory failure
Need to protect AW |
| Indications for emergency AW managment | AW EMG b/f et intubation, obstruction of AW, Apnea, coma
penetrating neck trauma
Cardipul arrest/unstable dysrythmias
severe bronchospasm
pulmonary edema
narcotics
foreign body obstruction
choanal antresia in neonates
apsiration or risk of |
| Contraindications for Emergency AW managment | Pt is a DNR |
| Hazards & Complications of Emergency AW managment | Failure to establish a patent AW, intuabte trachea or recognize esophogeal intubation
Upper AW trauma, laryngeal & esophageal damage
Aspiration
C-spine trauma
Unrecognized Bronchial intubation
Eye injury
Vocal cord paralaysis
ET Tube Issues |
| Which pt's need AW emergency management? | Pt inability to protect AW adequately (w*w/o respiratory distress)
Partial or complete obstructed AW
Apnea, maybe associated with cardiac arrest
Hypoxemia, hypercarbia, or acidemia
Respiratory distress |
| PT is unable to protect AW adequately if | Coma
Lack of gag reflex
inability to cough
May or may not be associated with respiratory distress |
| Sings of partially obstructed AW | Ineffective pt effort to ventilate
Paradoxial respiration
stridor
Use of accessory muscles
PT pointing to neck
choking motions
Cyanosis and distress |
| Signs of lower AW obstruction | All listed for upper AW obstruction
Wheezing |
| Completely obstructed AW signs | Respiratory efforts w/no breath sounds or suggestion of air movement |
| Signs of apnea | No respiratory efforts seen
May be associated with Cardiac arrest |
| Signs of Respiratory arrest | Elevated RR
High or low ventilatory volumes
Signs of Sypathetics nervous system hyperactivity |
| Monitor Clinical signs during emergency management of AW | Lvl of consciousness
Presence of
& character of breath sounds
Vent ease
Symty & amt of chest movmt
Skin color & character (Temp & diaphoresis)
Upp AW snds (crowing, snoring, stridor)
Exce secretions
debris in AW
Epigastric snds
retractions
na |
| Monitor Physiological variables during emergency management of AW | Vent frqy, VT, and AW pressure
presence of CO2 in exhaled gas
HR & Rhythm
P/Ox
ABG values
CXS |
| ET position accuracy check: | Bilateral BS
Symmetric chest movement
Absence or ventil sounds of epigastrium
Condensate in tube, correlates with exhalation
Visualization of tube through vocal cords
Esophagel detector devices
Capnometry
endoscopic visualization |
| Generally a woman is intubated with what size? | No. 7 or 7.5 |
| Generally a man is intubated with what size? | No. 8 or 8.5 |
| ET tube size and distance from incisors for infant<1kg | Size 2.5 mm, Length 6.5-8 cm |
| ET tube size and distance from incisors for infant 1-2 kg | Size 3.0 mm, Length 7-8 cm |
| ET tube size and distance from incisors for infant 2-3 kg | Size 3.5 mm, Length 8-9 cm |
| ET tube size and distance from incisors for infant 4 kg | Size 3.5-4.0 mm, Length 9-10 cm |
| ET tube size and distance from incisors for 6 months | Size 3.5-4.0 mm, Length 10-11 cm |
| ET tube size and distance from incisors for 18 months | Size 3.5-4.5 mm, Length 11-13 cm |
| ET tube size and distance from incisors for 3 yrs | Size 4.5-5.0 mm, Length 12-14 cm |
| ET tube size and distance from incisors for 5 yrs | Size 4.5-5.0 mm, Length 13-15 cm |
| ET tube size and distance from incisors for 6 yrs | Size 5.5-6.0 mm, Length 14-16 cm |
| ET tube size and distance from incisors for 8 yrs | Size 6.0-6.5 mm, Length 15-17 cm |
| ET tube size and distance from incisors for 12 yrs | Size 6.0-7.0 mm, Length 17-19 cm |
| ET tube size and distance from incisors for 16 yrs or small woman | Size 6.5-7.0 mm, Length 18-20 cm |
| ET tube size and distance from incisors for women (AVG) | Size 7.5-8.0 mm, Length 19-21 cm |
| ET tube size and distance from incisors | Size 8.0-9.0 mm, Length 21-23 cm |
| What blade is commonly used to intubate adults? | No. 3 curved macintosh
or
Straight Miller laryngscope blade |
| Generally, where should the Orotracheal tube be initially inserted in men? | 21-23 cm mark at the teeth |
| Generally, where should the Orotracheal tube be initially inserted in women? | 19-21 cm mark at the teeth |
| Absolute contraindication for percutaneous dilation tracheostomy | Need for emergency surgical AW |
| Relative contraindication for percutaneous dilation tracheostomy | Children <12 yrs
poor landmarks secondary to body habitus, abnormal anatomy, or occluding thyroid mass
PEEP> 15 cm h20
Coagulopathy
Pulsating blood vessel of trach site
Limited C-spine flex
Hx diff intubation
infection, burn, malignancy at trach si |