airway management
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| write the 4 needs for artificial airways | Relief of airway obstruction, facilitation for suctioning, protection of airway, prolonged artificial ventilation
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| what is the most common cause of upper airway obstruction? | soft tissue obstruction
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| what sounds are made with upper airway obstruction? | Stridor or snoring
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| write 6 other causes of upper airway obstruction | bleeding, edema, foreign body, lesions, tumor, vomitus
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| How do you provide temporary relief from upper airhead? | Head tilt or jaw thrust
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| reflexes pharyngeal- | gag and swallowing
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| Laryngeal reflexes | closure of epiglottis
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| tracheal-reflexes | cough
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| carinal- | cough
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| action for which the pharyngeal is responsible | gag and swallowing
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| action for which the laryngeal reflex is responsible | closure of epiglottis
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| what type of patient would a oropharyngeal airway be indicated | unconscious patient only-Don't use if gag reflex is present
may be used with bag-mask patients
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| what type of patient would a nasopharyngeal airway be indicated | semi-conscious who gag with an oropharyngeal airway
conscious patients
unconscious patients with clenched jaws or traumatic damage to the mouth or mandible
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| steps on determining an airway cuff's minimal occlusive volume or MLV | using a stethoscope (on the neck where the cuff is located) and a positive pressure breath (self inflating bag or manual breath from a mechanical ventilator), determine if there is a leak during inspiration at peak airway pressure.
If no leak is heard, s
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| advantages of using a nasotracheal tube over an orotracheal tube | easier to stabilize
easier to suction
equipment is more stable when attached
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| consideration that must be taken account when one places an artificial airway that will allow direct access to the lower airway | circumvents the normal mechanisms to keep the lower airway sterile
effectiveness of cough lost because of loss of functioning vocal cords
can't communicate
upper airway humididfication is lost-need to use a humidifier
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| complications related to the placement of an endotracheal tube | vocal cord damage:
A. superficial damage-Granuloma damage
B. Trauma during intubation
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| Tracheal stenosis and tracheomalacia | too much pressure in cuff or too large of a tube
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| complication related to E T tube placement | Obstruction due to secretions
tracheoesophageal fistula
leak due to broken cuff
tracheal necrosis
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| complication related to E T tube placement | displacement into main stem bronchi
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| problem associated /overinflated cuff 18 torr or greater causes | venous flow obstruction (congestion)
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| physical characteristics and markings found on orotracheal, nasotracheal, and tracheostomy tubes and their specific meanings and/or function | made from PVC or silicone
standard 15mm endotracheal tube adapter inserted into machine end
pilot line (inflating tube for cuff)
Pilot balloon -palpate to see how much air in cuff by feel
body-top of cuff to bottom of endotracheal tube adaptor
cuff
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| why is a water soluble lubricant used for inserting a nasal airway | ease of insertion and prevent toxic reax from petroleum products
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| what complications might arise from the use of a nasopharyngeal airway | sinusitis, epistaxis, gagging, air way obstruction
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| complications from improperly sized oropharyngeal airway | gagging vomiting airway obstruction, septoperforation
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| what type of airway should be used on a semi consciousness patient in the recovery room | nasopharygeal
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| what type of airway should be used to an elderly-nonintubated patient who requires frequent suctioning | nasal trumpet
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| what type of airway should be used to a patient in cardiac arrest in the ER receiving BLS | oropharyngeal and endotracheal tube
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| proper sequence for replacing the ETC | 1. suction pharynx
expose vocal chords with laryngoscope
intubate w/endotrach tube
insure proper placement and inflate cuff
deflate ET cuff and remove ETC
Be prepared for vomiting if pt vomits
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| what equip would employ when setting up a pt to receive 40% O2 w/a laryngeal airway in place | O2 flow meter, nebulizer set at 40% corrugated tubing from nebulizer to water trap, from water trap corrugated tubing to a briggs T which hooks to the15mm adapter of the LMA
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| pt regaining consciousness and the laryngeal airway the patient has been removed. what should you do with the device | put in biohazard bag and send to central supply for sterilization. or dispose of single patient use laryngeal airway.
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| what type of artificial tracheal would you use: Cardiac arrest | oropharyngeal for bagging and endotracheal tube if pt came in wi combitube use that for bagging
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| C-1 fracture what kind of artifical tracheal would you use | nasopharygeal for bagging followed by nasal intubation If not poss try cricothryroidotomy
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| you are changing a trache tube in pt w/no spont. resp. who is mech vent. you can't get tube in? | take a pair of kellys and dilate the stoma and slip the tube in, or change the size of the tube, ventilate patient
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| 16yr old quadriplegic with C7 fracture | the cuff needs to be deflated and changed to a non cuffed type endotracheal tube
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| what type of artificial tracheal would you use?Cardiac Arrest | Oro. for gagging and ET tube if pt came in w/combitube use that for bagging
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| 3 yr old with epoiglottitis | ET tube in surgery for controlled environ, or if unable to pass ET, then trach, tube or emergency cricothyroidotomy or percutaneous tracheotomy
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| pt with paralyzed vocal cords | cuffed or uncuffed unfiniestrated trach tube
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| fractured jaw | Nasopharygeal, if risk of aspiration use trach tube w/cuff
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| alert stroke pt who cannot cough | nasal trumpet, if chronic use ET tube if very long term use trach tube or trach button
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| safety precautions that one should be taken during oral hygeiene of the intubated pt. | 2 caregivers present, 1 for mouth care and 1 support of tube to prevent accidental extubation. Need manual resuscitator w/mask as we;; as intubation equipment
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| mrs. king, open heart surgery and is 20 hours post op describe how would assess her readiness | mental status
current vent settings
vitals
ECG
Pulse Ox
Vital capacity
spont tidal volume H MIP Hemodynamic stability
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| mr. is intubated... | tube is too small-need larger size increase fiO2 and increase volume on vent
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| pt with paralyzed vocal chords | cuffed or uncuffed unfinestrated trach tube
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| pt w/dysphagia and chronic aspiration | cuffed unfinestrated trach. tube
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| fractured jaw | nasopharygeal, if rish of aspiration use trach tube w/cuff
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| mr kee is intubated ...... | tube is too small need a larger size. Increase FIO2 and increase volume on vent
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| biggest problem associated w/ overinflated cuff 30 torr or greater? | stops arterial capillary blood flow (ischemia)
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| problem associated with overinflated cuff of 5 torr or greater cuases | lymphatic flow obstruction (edema)
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| what is the formula to convert ID to ODmm to French | MM X 3.14
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| formula to determine catheter size in French | {(IDmm X 3)/2}+2
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