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Ch 33 Egans, Persing 49-59

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Question
Answer
Conditions requiring management of AW are impending or actual   AW compromise Respiratory failure Need to protect AW  
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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  
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Contraindications for Emergency AW managment   Pt is a DNR  
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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  
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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  
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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  
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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  
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Signs of lower AW obstruction   All listed for upper AW obstruction Wheezing  
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Completely obstructed AW signs   Respiratory efforts w/no breath sounds or suggestion of air movement  
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Signs of apnea   No respiratory efforts seen May be associated with Cardiac arrest  
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Signs of Respiratory arrest   Elevated RR High or low ventilatory volumes Signs of Sypathetics nervous system hyperactivity  
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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  
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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  
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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  
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Generally a woman is intubated with what size?   No. 7 or 7.5  
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Generally a man is intubated with what size?   No. 8 or 8.5  
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ET tube size and distance from incisors for infant<1kg   Size 2.5 mm, Length 6.5-8 cm  
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ET tube size and distance from incisors for infant 1-2 kg   Size 3.0 mm, Length 7-8 cm  
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ET tube size and distance from incisors for infant 2-3 kg   Size 3.5 mm, Length 8-9 cm  
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ET tube size and distance from incisors for infant 4 kg   Size 3.5-4.0 mm, Length 9-10 cm  
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ET tube size and distance from incisors for 6 months   Size 3.5-4.0 mm, Length 10-11 cm  
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ET tube size and distance from incisors for 18 months   Size 3.5-4.5 mm, Length 11-13 cm  
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ET tube size and distance from incisors for 3 yrs   Size 4.5-5.0 mm, Length 12-14 cm  
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ET tube size and distance from incisors for 5 yrs   Size 4.5-5.0 mm, Length 13-15 cm  
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ET tube size and distance from incisors for 6 yrs   Size 5.5-6.0 mm, Length 14-16 cm  
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ET tube size and distance from incisors for 8 yrs   Size 6.0-6.5 mm, Length 15-17 cm  
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ET tube size and distance from incisors for 12 yrs   Size 6.0-7.0 mm, Length 17-19 cm  
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ET tube size and distance from incisors for 16 yrs or small woman   Size 6.5-7.0 mm, Length 18-20 cm  
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ET tube size and distance from incisors for women (AVG)   Size 7.5-8.0 mm, Length 19-21 cm  
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ET tube size and distance from incisors   Size 8.0-9.0 mm, Length 21-23 cm  
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What blade is commonly used to intubate adults?   No. 3 curved macintosh or Straight Miller laryngscope blade  
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Generally, where should the Orotracheal tube be initially inserted in men?   21-23 cm mark at the teeth  
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Generally, where should the Orotracheal tube be initially inserted in women?   19-21 cm mark at the teeth  
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Absolute contraindication for percutaneous dilation tracheostomy   Need for emergency surgical AW  
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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  
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