Exam 1: Intubation and Mechanical Ventilation (MV)

Question 1

What are some indications for intubation and mechanical ventilation?

Answer 1

• Hypoxemia/unable to oxygenate with other oxygen delivery
• Respiratory Acidosis
• Surgery or procedures (peri or post)
• Inability to protect airway (obtunded or in coma)
• Tachypnea
• Neuromuscular Disease

Question 2

In order to mechanically ventilate, you need a/an ___________________?

Answer 2

An artificial airway

Question 3

What are 3 functions of an artificial airway?

Answer 3

• Provide a patent airway
• Provided a means to supply oxygen/ ventilate
• Provide a way to clear secretions

Question 4

When is an endotracheal tube used?

Answer 4

When anticipated artificial airway is needed for no longer than 10-14 days

Question 5

Where are endotracheal tubes inserted?

Answer 5

Inserted into the mouth or nose

Question 6

With and ET tube, once inserted, the tip should lie ____ cm above _________.

Answer 6

2, the carina

Question 7

Who can insert an ET tube?

Answer 7

• Anesthesiologist, Critical Care Provider, Hospitalist (and more)
• Respiratory Therapist
• Certified Nurse Anesthetist
• Matt
• Carrie

Question 8

Where is the cuff located?

Answer 8

On the distal end of the ET tube

Question 9

What is the purpose of the cuff?

Answer 9

Creates a seal

Question 10

On an ET tube, the pilot balloon is at the__________ end of the tube.

Answer 10

proximal

Question 11

You are at Mission. Someone yells, “LET’S INTUBATE THIS PATIENT.”

What do you do?!

Answer 11

• Provide oxygen
• Lift head of bed
  **Keep talking to your patient **
• Call for help/ Coordinate care
• Gather supplies
• Assess, assess, assess

Question 12

Your provider has given you medications to deliver to your patient. What should you do as you give them?

Answer 12

Announce it as you give them!

Question 13

What are some general types of meds you give when it is intubation time?

Answer 13

Sedation
Analgesic
Paralytic

Question 14

Limit time of intubation attempts to ____________. Then, _________________.)

Answer 14

30 seconds, bag-valve-mask

Question 15

How often should you check BP with intubation?

Answer 15

A minimum of every five minutes

Question 16

What about tele and SpO2?

Answer 16

Continuous telemetry and SpO2

Question 17

How do you confirm ET tube placement?

Answer 17

X-ray

Question 18

Other ways to confirm placement of an ET tube?

Answer 18

• Waveform capnography
• Auscultation
• Bronchoscope
• Esophageal detector

Question 19

The provider has shouted, “THE TUBE IS IN!”

What do we do now, frends?

Answer 19

Listen…
• Over lungs
• Over stomach
Look…
• Breathing
Order an x-ray
Monitor

Question 20

How do we secure the ET tube?

Answer 20

• Assess and document where the tube is ”26 cm at the lips”
• Tape
• Bite block?
• Place tube holding device (often called by brand name)
• Reassess and document tube placement
• Assess and maintain airway

Question 21

What will it sound like if there is a cuff leak?

Answer 21

Gurgle-y sound
Assess for potential dislodgement

Question 22

Does everyone get sedated with ET tubes?

Answer 22

• Not everyone needs sedation!
• NOT having sedation can help with delirium and getting off vent quicker to wake up more

Question 23

Does everyone need restraints when intubated?

Answer 23

• Not everyone needs restraints!
• Good to do temporarily until you know if they are more aware

Question 24

Acronym for the most common reasons things are going wrong with MV:

Answer 24

DOPE!

Dislodgement (of tube)
Obstruction (often sputum)
Pneumothorax (listen → MV can cause)
Equipment failure

Question 25

Where are some common misplacements -- places the ET tube travels that ain't right?

Answer 25

* Esophagus * Right mainstem (more common – bigger, straighter shot) * Left mainstem * Too high

Question 26

Your patient is intubated and is becoming agitated, moving around the bed a lot. You notice that he becomes tachypneic and tachycardic and his SpO2 falls from 94% to 87%. Upon your assessment, he has diminished breath sounds on the left. You check the ET tube placement and note that the ET tube is no longer 24 cm, as you documented this morning. It is now 27 cm at the lips. Your first action is to * Notify the provider * Notify respiratory therapy * Order a PRN x-ray * Move the tube back to where it was on your morning assessment

Answer 26

Notify the provider → need an order. Before and after x-ray is gold standard

Question 27

How long should someone be on MV?

Answer 27

ONLY UNTIL THE UNDERLYING PROCESS IS FIXED

Question 28

What are the 2 main things MV helps with?

Answer 28

* Improved gas exchange * Reduced work required for effective breathing

Question 29

What should you try before you move patient to MV?

Answer 29

* Try bipap first After that, if not doing well, move onto MV

Question 30

What are some ventilator types?

Answer 30

* Positive Pressure * Push air into lungs at a set pressure (all else varies) * Time-Cycled * Push air into the lungs at a set time * Volume Cycled * Push air into the lungs at a set volume (limit pressure) * Microprocessor * Positive Pressure

Question 31

What is FiO2?

Answer 31

The fraction of inspired oxygen. Range: 21-100%. This is the concentration of oxygen in the gas mixture. The gas mixture at room air has a fraction of inspired oxygen of 21%, meaning that the concentration of oxygen at room air is 21%.