Interventions-Manual Ventilation Flashcards

Question

Signs of Loss of Airway Patency

Answer 1

Tachypnea and dyspnea Noisy snoring respirations Paradoxical breathing Tracheal tug or retractions Nasal flaring-Usually seen in babies Expiratory Grunting-Is a compensation for collapse and usually seen in babies Cardiac dysrhythmias-Pressure in chest and low oxygen levels will affect the heart Stridor Absence of breath sounds or visible chest movement Cyanosis-Can be misleading due to polycythemia or hypothermia, will be check at the inside of the lips

Answer 2

Hot Potato Voice- Horse Voice Difficultly in Swallowing Secretions Drooling is a very serious sign Dyspnea STRIDOR-Means a complete obstruction is imminent Cough

Answer 3

High pitched **inspiratory** sound **Indicated that airway has already lost at least 50% of its usual caliber** **Complete obstruction may be imminent** The volume and pitch are related to the velocity of air flow-Air flow is dependent on patient’s level of consciousness and inspiratory muscle strength Often audible but may be detected early via auscultation over the trachea-Can normally be heard without a stethoscope If it is epiglottitis don’t place the stethoscope near the throat just keep them calm

Answer 4

Patients with obvious oral trauma Awake or semi-conscious patients May cause vomiting or gagging IMPORTANT-If a patent is awake enough to spit or tongue the device out then they are too awake for the device to be used

Answer 5

Proper sizing Place the airway next to the face with the flange at the mouth and the tip of the airway should reach the angle of the jaw (tragus of the ear)

Answer 6

May cause trauma to the lips, mouth, or teeth-Rare May cause pressure necrosis Difficult to perform mouth care May cause gagging and vomiting-May push the tongue back

Answer 7

* Semi-awake patients who require some airway maintenance and do not tolerate the OPA * Ay be used when insertion of OPA is difficult or contraindicated * Maybe used to facilitate deep suctioning * Pierre-Robin Syndrome (in neonates) * Micrognathia-Tiny Chin * Mandibular hypoplasia

Answer 8

Obvious nasal trauma Deformities of the nose Basal fractures of the nose (Racoon eyes and battle sign)-This may indicate skull fractur but use history to help determine Coagulation disorder-NPA can cause nosebleeds

Answer 9

If too long can enter into the esophagus causing gastric distension and hypoventilation May cause vomiting and laryngospasm (big issue with infection) in semi-conscious patient Injury of nasal mucous with bleeding Sinusitis Bypassing natural defenses Otitis Media (ear infection) Intubation of meninges (basal skull fracture) Occlusion of airway by secretions Tissue necrosis

Answer 10

Hand squeezing a bag provides the mechanical force necessary to generate a positive pressure Requires an oxygen source to deliver FiO2 greater than 0.21 In the baby and child versions they will have pop off valves

Answer 11

* Universal connector (15/22 mm) * This allows them all to be connected to trachs * Requires an O2 sources for FiO2 \>0.21 * Oxygen flow meter * 50 psi source * Wall outlet * Cylinder * Originally designed for use during CPR

Answer 12

Does not require a compressed gas source for operation Re-usable or disposable

Answer 13

* Self –inflating bag * (volume depends on patient population) * Air inlet/Oxygen Reservoir attachment site * Oxygen Inlet * Patient Outlet * Valve assembly * One way, non-rebreathing * Oxygen reservoir (required for high FiO2) * Pressure release (pop-off) valve (optional) * Pressure Gauge / Guage attachment site (optional)

Answer 14

* Spring-Loaded * Diaphragm * Duckbill (most common) * Leaf-type * Fishmouth

Answer 15

* Used when unable to bag * Commonalities * Universal connector (15/22 mm) * This allows them all to be connected to trachs * Requires an O2 sources for FiO2 \>0.21 * Oxygen flow meter * 50 psi source * Wall outlet * Cylinder

Answer 16

* Non-Rebreathing Valve (Self-Inflating) * Prevents rebreathing of exhaled gases * High Pressure Pop-Off Valves (self-Inflating) * Prevents delivery of overly high pressure to patient (infant and children only) * Maximum circuit pressure control (T-Piece Resuscitator) * Will take away the variability of the pressure delivered in a breath * Standard 15/22 mm connectors * Allows for easy connection and disconnection

Answer 17

* Resuscitators capable of delivering FiO2 \> or = 0.95 * Must be able to operate at-Extreme temperatures and Relative humidity 40-96% * Deliver Vt \> or equal to 600 ml into test lung for adult baggers * With compliance of 0.2L/cmH2O * With resistance of 20 cmH2O/L/sec * Non-rebreathing valve withstand oxygen flow rate up to 30lpm * If valve malfunctions due to foreign obstruction (e.g. vomitus), must be restored within 20 seconds * Must have standard 15/22 mm connectors * Adult resuscitators not have pressure limiting system * Resuscitators for infants and children have pressure relief valve that limits PIP to: * 40 +/- 10 cmH2O for children * 30 +/- 5 cmH2O for infants * When incorporating pressure limiting system, override capability must exist and must be apparent to operator * Resuscitator able to operate after being dropped from height of 1 meter on to concrete floor * Easily disassembled for sterilization and disinfection purposes * Should not be possible to accidentally interchange parts * making unit malfunction * not function at all

Answer 18

Connect bag to mask and O2 Should not use entire volume of bag Assess for mask seal Should feel some resistance in the bag. Does the chest rise? Can you hear a leak?

Answer 19

Remove mask and reseat to face Is airway patent Head tilt chin lift? OPA Suction oropharynx Two hand mask seal Reinserting patient's false teeth

Answer 20

Goal is for visible chest rise Chest rise and fall with ventilation Breath sounds with ventilation Improving SpO2 Capnograph waveform-end tidal CO2 (confirmation of intubation and can tell us about effectiveness of CPR by seeing if you are pumping enough blood through the body)

Answer 21

* 12 breaths per minute * Every 5 seconds * Target 500-600 mls for an adult * Ti 1.0s * Decrease insufflation of stomach with gentle ventilation * Esophageal sphincter opening pressures ~25cmH2O

Answer 22

M.O.A.N.S. * **M- Mask Seal** * Bushy beards, trauma * **O- Obesity/Obstruction** * ↑ weight of chest, ↓ diaphragmatic excursion * ↑ Resistance 2° to swelling, adipose tissue * **A- Age** * Older than age 55 (not a hard,fast rule) * **N- No Teeth** * Face tends to cave in * **S- Stiff, Snoring Hx** * Lungs resistant to ventilation (asthma, COPD)

Answer 23

* Delivery of excessive high airway pressure (most common) * Common in intubated patients * Defective nonrebreathing valve * Can cause an inspiratory leak and tidal volume escaping through the exhalation port and not delivered to the patient * Faulty pressure-relief valves * Can cause gas delivery at excessively high pressures and increases the risk of barotrauma

Answer 24

A tracheostomy is a surgically created hole at the front of the neck into the trachea. The procedure of creating this hole and placing a tube within it (through which the patient breathes) is called a tracheotomy.

Answer 25

Indications of a tracheotomy include: - Upper airway obstruction or trauma - Continuing need for artificial airway after a prolonged period of oro/nasotracheal intubation - To facilitate removal of secretions from tracheobronchial tree when patient is unable to raise secretions - Inability to wean from artificial airway even after being weaned off of mechanical ventilation - Long term care patients with neuromuscular disease - Obstructive sleep apnea

Answer 26

Cricothyroidotomy is a surgical incision to the trachea which passes through the cricothyroid membrane and results in the insertion of an endotracheal tube or a tracheostomy tube. Under this method, a single horizontal incision is done through the skin to the trachea. Percutaneous dilatory tracheostomy (PDT) is the more common method of tracheotomy due to its effectiveness, simplicity, and low incidence of complications. This method is performed mostly in the ICU if the patient is in the unit and intubated for more than 7 days. PDT is performed mostly with the Ciaglia method: a guide wire is placed between the first and second or second and third tracheal rings and plastic dialators is pushed through the soft tissue until the appropriate size is met. This method is usually aided with the use of a bronchoscopy.

Answer 27

DOPE: Displacement: Reposition (if possible) or remove tube and bag until reintubation is possible. Obstruction: (Most Common!) Many different causes, but move patient’s head/neck to reposition, deflate cuff, suction catheter through tube, or flush tube with saline or mucus shaving device Pressure: The pressure of the cuff on the ETT can cause issues if under-inflated or over-inflated. If under-inflated, air and secretions can leak around the cuff and cause ventilation issues. Over-inflation can cause the trachea to become inflamed and cause further ventilatory issues. Equipment: Anything that causes a stoppage in the flow of oxygen to the patient. Check the tubing or vent to see if any kinks have developed, and have back-ups. You can also remove tube and bag patient until they can be reintubated.

Answer 28

The mucosal cavity of the mouth will provide humidification and warming of inspired air Much less efficient than nose

Answer 29

A passage way from the epiglottis of the esophagus to cricoid cartilage (C6)

Answer 30

15:22 mm (ID:OD)

Answer 31

Lower tidal volumes to be delivered

Answer 32

Allows for higher oxygen concentrations to be delivered

Answer 33

Chest expansion

Answer 34

Limit ventilating pressures to less than 25 cmH2O

Interventions-Manual Ventilation Flashcards

(62 cards)