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Flashcards in Airway management and ventilation Deck (25)
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1

Endotracheal ventilation

- where is the tube placed

- uses

Endotracheal ventilation 

Tube is placed into trachea via mouth (orotracheal) or via nose (nasotracheal)

Aim: to maintain patent airway 

Use:

- perioperative management of anaesthetised patient

- emergency medicine: acute respiratory failure, poor oxygenation and ventilation, the risk of respiratory compromise  

2

What else should be used (as a guide) in endotracheal intubation?

Laryngoscope - to visualise pharynx 

3

What is indicative of the correct placement of the endotracheal tube? (2)

- bi-lateral breath sounds on auscultation

- exhaled CO2 measurement

4

Possible complications of endotracheal tube insertion (4)

- dental damage 

- tracheal stenosis 

- oesophageal misplacement of the tube 

- infections

5

What is the preferred mode for long-term intubation?

Tracheostomy 

6

What does tracheostomy involve?

Creation of reversible or permanent stoma below a cricoid cartilage 

7

When do we use the procedure of cricothyrotomy

Cricothyrotomy is usually used as a last resort - in emergency situations such as acute obstruction of the airway by blood, oedema or foreign body 

 

*also used if intubation/ventilation with the supraglottic device has failed

8

Where the incision is made in cricothyrotomy? 

In cricothyroid membrane

9

What is done once the access to the airway (intubation) has been gained? What's the next step? Why?

Mechanical ventilation

Aim: to assist and replace spontaneous breathing

10

What are the complications of mechanical ventilation? 

- barotrauma (e.g. pneumothorax) 

- ventilator-induced lung injury -> clinically looks like Adult Respiratory Distress Syndrome

 

11

What GCS would be indicative for endotracheal ventilation? 

GCS of =/< 8

 

*as in that case protective reflexes such as cough and gag will be reduced -> so can insert endotracheal tube

12

What do we need to do before extubation and why?

  • We need to suction airways 
  • Aim: to minimise the risk of aspiration (fluids, foreign materials)

13

Criteria for extubation (what would be indicative to extubate a patient?) - 3 criteria

  • sufficient spontaneous breathing 
  • presence of protective reflexes (coughing, swallowing)
  • adequate level of consciousness (eye-opening, obeying requests) 

14

Where the incision is made in tracheostomy?

Tracheostomy 

Horizontal incision between cricoid cartilage and sternal notch -> insertion of suture and fixation of tracheostomy tube

15

What must be done and why post- tracheostomy insertion? 

Post tracheostomy 

Chest X-ray -> to exclude pneumothorax and tube displacement 

16

Definition of mechanical ventilation

Mechanical ventilation - use of respirator to assist or completely replace spontaneous breathing 

17

What agents do we use to suspend spontaneous breathing (for purpose)? (3) 

Aims

- opioids

- muscle relaxants 

- hypnotic agents

 

Aim: to permit intubation, suppress respiratory centres, reduce muscular resistance for mechanical ventilation

18

What is capnometry/capnography? 

Allows assessment of CO2 concentration in exhaled air -> to determine if ventilation is adequate 

19

What's weaning?

The process of easing a patient off mechanical ventilatory support

20

Side effects of mechanical ventilation?

If PEEP (positive end-expiratory pressure) is set too high: inflation of the lung with decreased compliance

  • Barotrauma → rupture of alveoli → pulmonary emphysema, pneumomediastinum, pneumoperitoneum, pneumothorax, and/or tension pneumothorax. 
  • ↓ Cardiac output (as venous return is obstructed by increase in intra-thoracic pressure)
  • ↓ Liver perfusion

21

Mechanism of action of a ventilator

Mechanism of action

  • PEEP (positive end-expiratory pressure)↑ alveolar pressure and alveolar volume → collapsed or unstable alveoli reopen → improves ventilation/perfusion relation

 

  • Provides an adequate arterial PaO2 at a low and safe concentration of oxygen (< 60%) → reduces the risk of oxygen toxicity

22

Bronchospasm 

- what is this/what happens? 

- what does it lead to?

Bronchospasm 

Bronchoconstriction during anaesthesia -> leads to severe hypoxia and hypotension if left untreated 

23

Risk factors for bronchospasm (3)

- smoking 

- reactive airway disease (asthma, COPD)

- viral upper respiratory tract infection

24

Clinical features of bronchospasm

Clinical features of bronchospasm

  • Acute onset of dyspnea
  • Wheezing 
  • Prolonged expiration
  • ↑ Peak airway pressures and ↓ tidal volumes

25

Treatment of bronchospasm 

 

- basic management 

- pharmacological (1st and 2nd line)

A. Basic measures

  • Discontinuation manipulating measures/surgery
  • Manual ventilation with a FiO2 of 100%
  • Deepen anesthesia
  • Exclude differential diagnosis (e.g. pneumothorax, laryngospasm)

 

B. Pharmacotherapy in severe bronchospasm

- First-line: salbutamol

- Secondline: adrenalineipratropiumhydrocortisone