airway management Flashcards
(34 cards)
what three areas do respirtatory therapist need to be proficient in
*maintaining airway clearance
*inserting artificial airway
*assisting physicians during specialized airway procedures
what are the key components of an ETT and what is the purpose (there are seven components)
1.promiximal end of tube contains a 15 mm adapter
2.length marking indicate the distance from distal end
3.Murphys eye-side port on distal end and ensure gas flow if main port becomes obstructed
4.cuff-inflation of the cuff seals off lower airway
-prevent aspirations or to provide postitive pressure ventilation
5.pilot balloon-used to monitor cuff status & pressure
6.valve on pilot balloon-connection for a syringe that allows inflation & deflation of the cuff
7.radiopaque indicator-embedded on distal end of tube & allows for identification of tube position on chest x ray. confirm exact location of ETT in trachea. ensures it is correctlymplaced
what are the average sized ETT used for women?men?
women-7.0-7.5
men-8.0-8.5
which equipment needs to be assembled and checked prior to intubation
equpiement needed:
Sniffing position-aligns airway for better visual
Towels-help with stiffing
Stethoscope- check breath sounds and placement
Resuscitation bag-used before intubation to preform ventilation/ and after to ventilation of lungs after intubation.
Suction- keeps airway clear by removing secretions/blood
10 mm syringe- inflate ett cuff
ETT holder-secures ETT after placement
C02 indicator-insures ETT is in lungs not Espophagus
-gold “good”, purple “bad”
ETT and stylet- secures/guides
Lubricant- applied to ETT to ease insertion
suction equipment is assembled & pt is hyperoxygenated
how do you insert the laryngoscope
*hold in left hand
* insert in the right side of mouth&move toward the center (displace the tongue)
*tip of blade is advanced until epiglottis is visualized. (important for gaining access to vocal cords & subsequently the trachea)
*advance laryngoscope until reach base of tongue. if vocal cords surrounding structures are not visible inserted to far &may be in esophagus
what are the two types of laryngoscope blades
Mcintosh blade
miller blade
how do they allow visualization of the epiglottis
macintosh blade(curved)-indirectly lifts the epiglottis by advancing into the varacella
miller blade-it directly lifts the epiglottis
how do you insert the ETT
*tube is inserted from the right side of mouth
*tube is advanced w/out obsurring the glottic opening
*placement is confirmed when cuff is advanced past vocal cords
*as soon as tube in place stabilize tube w/right hand (do not let go of the ETT for any reason)
*withdraw laryngoscope stlyet w/left hand
*after removing stylet cuff should be inflated (20-30cmH2O) & ventilation is immediately provided
what pressure is the ETT cuff inflated to?
20-30cm H20
how do we measure the cuff pressure
cuff manometer
measures cuff on ETT&TT ensures cufff pressure is 20-30
what can happen if cuff pressures are too high
tracheal damage or insufficient ventilation
*High cuff pressure→elevated tracheal wall pressure→causes restricted blood flow to tracheal mucosa→mucosal ischemia→tissue inflammation→mucosal necrosis (tissue starts to die)–>mucosal ulceration.
where should the ETT be positioned above the carina
3-5 cm above
how to assess placement of ETT at bedside
*auscultation of chest &abdomen
-should hear bilateral sounds. no sounds in stomach
*observation of chest movement (both sides of chest rise equally)
-bilateral
*capnometry
*colorimetry- gold=good Purple=pull back
*only direct larynoscopy&bronchoscopy can absolutely confirm tube placement
when would we perform nasotracheal intubation
when oral route is not available
*maxillofacial injuries or under going oral surgery challenging to place endotracheal tube via mouth
what are the two techniques for nasotracheal intubation
Blind-listen for airflow through the tube
-proper placement indicated by cough. -sound w/disappear if placed in espophagus
Direct visualization- uses direct or video laryngoscope
-once tube is visualized in orpharynx mafilcorceps are used to advance ETT directly into trachea. ensuring accurate placement into the airway
when do we change from an endotracheal tube to a tracheostomy tube
*continued need for an artifical airway
*intubated 7-14 days, tracheostomy is considered
-elimination of vocal cord injury
-increased pt comfort
-less need for deep sedation
-shorter weaning time
-easier secretion removal
-decreased WOB
what are the key components of TT and what is the purpose? (7 components)
*outer cannula structure where cuff &flange are attached
*flange-prevent tube from slipping into the trachea&away to secure the tube to neck
*cuff/pilot balloon-same an ETT
cuff-prevent aspiration or to provide positive pressure ventilation
pilot: monitor cuff status & pressure (2-30)
*obturator-has rounded tip used for tube insertion
-placed w/in the outter cannula w/the tip extended past the outer tube minimize mucosal trauma during insertion
*radiopaque confirm placement on chest xray confirms tt in correctly positioned in trachea provide critical checkpoint insertion to ensure pt safety
*inner cannula-removeable cannula placed w/in the outer cannual & locks into olace w/a 15mm adapter
-can be disposable,non disposable
-allows tube to be removed & cleaned/disposed if it were to become occluded by thick secretions or blood clots
what is a laryngectomy
surgical procedure where the larynx or voice-box is removed due to laryngeal cancer. stoma is created into trachea, pt will breath through stoma.pt w/no longer breath through nose or mouth
traceosphageal puncture TEP
small opening b/w trache& esophagus prosthesis is inserted into opening allow Pt to speak during exhalation directing air from the trachea vibrationg tissue & producing speech
what do you use to disinfect a non-disposable inner cannula during tracheostomy care
hydrogen peroxide mixed with sterile water put into basin, brush to remove dried secretions
what are we assessing around the stoma during tracheostomy care
bleeding or abnormalities
redness, pus, swelling, foul smell
what do you do with your findings
chart findings
what should always be in the patients room or near by for patient with a tracheostomy
routine care equipment
emergency essentials
suction,inner cannula replacements, bag valve mask, lubricant, cleaning trach care supplies
why would a tracheostomy tube need to be charged/replaced
Long term mechanical ventilation , current tube develops a problem
Mucus plugging or damage to the cuff.
different tube size
