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From Flashcardlet > 323-Midterm > Flashcards

323-Midterm Flashcards

Study Guide for Airway Management Midterm

1
Q

Immediate Complications of Tracheostomy

24 hours

A
  1. Pneumothorax
  2. Bleeding
  3. Air embolism–tearing of pleural vein
  4. Subcutaneous emphysema
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2
Q

Late Complications of Tracheostomy

1-2 days

A
  1. Hemorrhage
  2. Infection
  3. Airway obstruction
  4. Tracheoesophageal fistula
  5. Interference with swallowing
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3
Q

Minimal Leak Technique (MLT)

A

Performed by placing stethoscope beside larynx, listen for airflow as cuff is inflated. Inflate cuff until no airflow is heard, and then withdraw air slowly until a slight leak is heard

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4
Q

Minimal Occluding Volume (MOV)

A

Performed by placing stethoscope beside larynx, listen for airflow as cuff is inflated. Slowly inflate just to the point where no leak is heard

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5
Q

Steps for weaning patient from tracheostomy tube

A
  1. Inner cannula is removed
  2. Cuff is deflated so patient can breathe around cuff and through fenestration and talk
  3. Remaining outer cannula is plugged at the 15mm adapter
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6
Q

Pediatric tube name

A

Cole tube (tapered)

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7
Q

Name of tube that can ventilate one lung

A

Double Lumen Endobronchial Tube

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8
Q

How to minimize airflow resistance when choosing an ET tube

A

Largest diameter tube that fits through patient’s glottis without harm during intubation should be used. Larger the internal diameter of the tube, the less the airway resistance it causes.

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9
Q

EOA Removal Complications

A
  1. Causes vomiting and regurgitation that imposes the risk for aspiration
  2. Should only be removed after trachea has been intubated and endotracheal tube cuff is inflated
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10
Q

Determine French Size

A

Outer Diameter (OD) X 3

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11
Q

Equipment needed to perform MLT and MOV

A
  1. Stethoscope
  2. Syringe
  3. Cuff Manometer
    * *Cuff pressures should be kept below 20 mm Hg (27 cm H2O)–if possible
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12
Q

Type of ET and Tracheostomy cuff needed and Why?

A
  1. Large volume
  2. Low pressure
  3. High compliance

**Larger size that allows pressure to be transferred to trachea over a wider area. Lower pressure prevents tracheal damage.

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13
Q

Advantage of fenestrated tracheostomy tube

A

Allows ventilation through larynx

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14
Q

Appropriate size airways for adults

A
  1. Average female (7.0-7.5-8.0)
  2. Normal adult male (8.0-8.5)
  3. Large adults (9.0-10.0)
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15
Q

Airways that are inserted blindly

A

EOA
EGTA
Combitube
All others, besides ET tube

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16
Q

Airways which are left in during intubation with ET tube

A

EOA
EGTA
Combitube
LMA

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17
Q

Nasopharyngeal airway uses and descirption

A
  1. Reduce discomfort associated with nasotracheal suctioning
  2. Reduce trauma when passing a fiberoptic bronchoscope (in non-intubated patients)
  3. Provide patent airway when acess to oral cavity is limited

**Flexible rubber tubing, with or without flange

18
Q

How to determine proper size for oropharyngeal airway

A

Hold against patient’s face with flange against lips. End of airway should reach angle of jaw. Flange should be placed just outside the patient’s lips when inserted.

19
Q

Causes of air leakage around ET tube

A
  • Cuff defect
  • Tube too small
  • Cuff not adequately inflated
  • Leak in pilot cuff
  • Positive pressure exceeds 45-50 cm H2O
  • Tracheal stenosis
  • Tracheal malacia
20
Q

How long is the Trachea?

A

10-12 cm long

21
Q

If tracheostomy tube rests close to an artery, what happens and what should be done?

A

It will pulsate with the patient’s heartbeat.

The physician should be notified immediately and it should be re-positioned or readjusted to get it off artery

22
Q

How is ET and Trach tube sized?

A
  1. French
  2. Jackson
  3. Internal diameter
  4. External diameter
23
Q

What size tube should be used for a 3yo child?

A

4.5-5.0

24
Q

How to determine proper size for nasopharyngeal airway?

A

Place tube next to patient’s cheek with tip of nose. Flange should extend to front of ear (earlobe). Diameter should fit patient’s airway without excessive tightness.

25
Q

How to determine if the tube is positioned correctly and where it should be located.

A
  1. Bilateral breath sounds
  2. Bilateral chest movements
  3. Listen for air over stomach
  4. Stat X-ray
  5. Markings on tube
  6. Condensation
  7. Colorimeter
  8. Capnometer
26
Q

Which airways provide the best airway protection?

A

ET Tubes

27
Q

Which airways provide the least airway protection?

A
  • Nasopharyngeal
  • Oropharyngeal
  • LMA
28
Q

Tubes that can be used in conscious patients.

A
  • ET Tubes

- Nasopharyngeal

29
Q

“F-29” marking indicates

A

ASTM Indicates materials of the ET tube have been tested and are safe for patient use.

30
Q

Endotracheal tube cuff should have what type of properties?

A

Low pressure, high residual voume

31
Q

Appropriate cuff pressures

A

20-25 mm Hg/27-34 cm H2O

32
Q

Pressure >5 mm Hg affects what flow and how?

A

Lymphatic flow and glottic edema

33
Q

Pressure >20 mm Hg affects what flow and how?

A

Venous flow and congestion

34
Q

Pressure >30 mm Hg affects what flow and how?

A

Arterial flow and necrosis

35
Q

Function of Outer cannula

A

Maintains patency of a tracheostomy stoma and serves as attachment site for cuff. Firmly attached to neck plate (flange)

36
Q

Function of Inner cannula

A

Aids in maintaining airway patency. Can be removed for cleaning.

37
Q

Function of Obturator

A

Has smooth tapered end which facilitates insertion. Used to guide outer cannula through stoma.

38
Q

Function of Fenestrations (openings)

A

Allow ventilation through larynx. Used in weaning a patient from traditional tracheostomy tube

39
Q

Indications for Intubation

A
  1. Relief of upper airway obstruction–caused by laryngospasm, epiglottitis, or glottic edema
  2. Protection of airway
  3. Facilitate tracheal suctioning
  4. Assist manual or mechanical ventilation
40
Q

Distance from teeth to carina.

A

Adults: 23-27 cm

Infant/child: ~12 cm

41
Q

ET and Trachea cuff functions

A
  1. Prevent aspiration

2. Provide positive pressure to lungs

42
Q

Which airway would be best tolerated in a patient with periods of consciousness?

A

Nasopharyngeal airway

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