Airway management rcp 250

Question 1

What 3 areas do respiratory therapists need to be proficient in?

Answer 1

Airway clearance techniques, insert and maintain artificial airways, and assist physicians in performing special procedures

Question 2

Suctioning

Answer 2

application of negative pressure to the airways through a collecting tube

Question 3

suctioning can be performed via

Answer 3

the upper airway (oropharynx), the lower airway (trachea and bronchi), bronchoscopy

Question 4

Oropharynx suction device

Answer 4

Rigid tonsillar / Yankauer

Question 5

Nasotracheal suction device

Answer 5

flexible suction catheter

Question 6

endotracheal suction device

Answer 6

in-line, closed system suction catheter / ballard

Question 7

techniques for endotracheal suctioning

Answer 7

Open / Closed

Question 8

Open technique

Answer 8

sterile technique that requires disconnecting patient from ventilator - used more commonly with tracheostomy patient not receiving mechanical ventilation

Question 9

closed technique

Answer 9

uses sterile, closed-system, in-line suction catheter that is attached to ventilator circuit - can be advanced into patients endotracheal airway without ventilator disconnection

Question 10

Indications for endotracheal suctioning

Answer 10

abnormal breath sounds (course crackles- rhonchi)

Question 11

What are normal suction pressures

Answer 11

neonates (80-100 mmHg), Children (100-120 mmHg), Adults (120-150 mmHg)

Question 12

What can happen if suction pressure is too high?

Answer 12

atelectasis due to too much negative pressure

Question 13

suction catheter sizes

Answer 13

usually 22 inches long - diameter of catheter should be less than 50% of the internet diameter of the artificial airway in adults / less than 70% in infants / small children

Question 14

figuring the proper catheter size

Answer 14

multiply the tube diameter by 2, then use the next smallest catheter size

Question 15

what can happen if the catheter is too large?

Answer 15

can cause airway obstruction, atelectasis, or hypoxemia

Question 16

hyperoxygenation

Answer 16

before suctioning deliver oxygen for 30-60 seconds

Question 17

you do not apply suctioning when

Answer 17

inserting the catheter

Question 18

When do you apply suction and for how long

Answer 18

suction while withdrawing the catheter and for 15 seconds

Question 19

Reoxygenation

Answer 19

deliver 100% of oxygen for 30-60 seconds after suctioning

Question 20

Steps for Endotracheal Suctioning

Answer 20

1. Assess patient for indications
2. Assemble and check equipment
3. Assess patient for hyperoxygenation
4. Insert catheter
5. Apply suction and clear catheter
6. Reoxygenate patient
7. Monitor patient and assess outcomes

Question 21

Adverse responses

Answer 21

Hypoxemia
Cardiac Dysrythmias
Hypotension
Hypertension
Atelectasis 
Mucosal Trauma
ICP
Bacterial colonization of lower airway

Question 22

Nasotracheal suction

Answer 22

patients with retained secretions without an artificial airway

Question 23

Nasotracheal suction procedure

Answer 23

use sterile water lubricating jelly, place patients in the sniffing postion,

Question 24

atelectasis

Answer 24

correct suction pressures, and suction for the max of 15 seconds, use the correct catheter size, avoid disconnection from ventilator, use High FiO2/ PEEP

Question 25

sputum samples

Answer 25

to identify organisms infecting the airway to determine sensitivity and identify the appropriate antibiotics. Sterile technique.

Question 26

OPA - oropharyngeal airway

Answer 26

prevent airway obstruction by keeping tongue pulled toward and away from the posterior pharynx

Question 27

measure OPA

Answer 27

corner of the mouth to the angle of the jaw

Question 28

how to insert OPA

Answer 28

invert the OPA to insert then twist it into place (can cause gagging/ vomiting)

Question 29

contraindication of OPA

Answer 29

trauma to the oral cavity or madibular/ maxillary areas of the skull, facial deformities

Question 30

NPA - nasopharyngeal airway

Answer 30

restores patency by separating the tongue from the posterior pharyngeal wall - most often used for frequent nasotracheal suctioning

Question 31

measure NPA

Answer 31

place NPA on the side of patients face with the flange even with patients nose - measure from nares to earlobe

Question 32

how to insert NPA

Answer 32

bevel faces septum and down one nostril with lubricant

Question 33

contraindications for NPA

Answer 33

trauma to nasal region or foreign object present

Question 34

components of ETT

Answer 34

1. length markings (indicates distance in CM from distal end) 2. Murphy Eye (side port for gas flow in case bottom becomes obstructed) 3. CUFF (inflation of cuff seals lower airway, prevents aspiration, provides positive pressure) 4. Pilot Balloon (used to monitor cuff status / pressure) 5. valve on Pilot Balloon (connection for syringe that allows inflation / deflation cuff) 6. Radiopaque Indicator (distal end, identifies tube position on chest xray)

Question 35

Specialized endotracheal tubes

Answer 35

used for special ventilation methods, lung pathological conditions, and surgical procedures

Question 36

double-lumen ETT

Answer 36

used for independent lung ventilation when unilateral lung disease occurs. double components

Question 37

combi-tube

Answer 37

designed to be inserted blindly through the oropharynx and into the trachea or the esophagus (if placed in trachea functions like ETT, if in esophagus ventilation occurs through a seriers of holes into the trachea

Question 38

LMA - laryngeal mask airway

Answer 38

inserted deep inside oropharynx, cuff is inflated once inserted, usually used by paramedics

Question 39

average size of ETT for women

Answer 39

7.0-7.5

Question 40

average size of ETT for men

Answer 40

8.0-8.5

Question 41

equipment needed for ETT

Answer 41

``` suctioning equipment, and appropriate pressures laryngoscope - handle and lighting appropriate size of ETT Inflate and deflate cuff and check for any leaks Lubricant Stylet to insert in tube Towels colorimetric carbon dioxide detector stethoscope Syringe Oxygen/ Tubing ```

Question 42

How to insert laryngoscope

Answer 42

hold in left hand insert into right side of mouth and move toward the center (displacing the tongue) Tip of blade is advanced until epiglottis is visualized

Question 43

laryngoscope blades

Answer 43

1. macintosh- curved - epiglottis is displaced indirectly by advancing tip of the blade into the vallecula 2. Miller - straight - epiglottis is displaced directly by advancing tip of the blade over its posterior surface

Question 44

Inserting ETT

Answer 44

1. tube is inserted from the right side of the mouth 2. advanced without obscuring the glottic opening 3. when cuff is advanced past vocal cords - placement 4. stabalize tube with right hand / withdraw laryngoscope and stylet with left hand/ cuff is inflated and ventilation starts immediately

Question 45

what pressure is the ETT cuff inflated to

Answer 45

20-30 cmH2O

Question 46

Where is the ETT positioned above the carina

Answer 46

3-5CM

Question 47

How to assess placement of the ETT at bedside

Answer 47

``` breath sounds - no gastric sounds chest movement colorometer laryngoscope brocnhoscope xray tube length ```

Question 48

Tube Length

Answer 48

women (19-21cm) | men (21-23cm)

Question 49

Steps of ETT

Answer 49

1. assemble and check equipment 2. position patient 3. preoxygenate and ventilate patient 4. insert laryngoscope 5. visualize glottis 6. displace epiglottis WATCH TEETH 7. insert ETT 8. assess ETT position 9. Stabilize ETT

Question 50

Nasotracheal intubation

Answer 50

when oral route is unavailable due to maxillofacial injuries or undergoing oral surgery

Question 51

Two techniques for nasotracheal intubation

Answer 51

BLIND or DIRECT visualization, Blind - listen to airflow and breath sounds become louder Direct- video laryngoscope