Manual Ventilation Flashcards

Question

Peripheral Causes

Answer 1

* Peripheral causes come from outside of the body * Infection * Abscess * Neoplastic (carcinomas) * Physical and Chemical Agents * Thermal * Caustic Injuries- Can cause swelling * Inhaled toxins * Allergic/Idiopathic * Traumatic

Answer 2

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 that is 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

Answer 3

**Viral and bacterial infection** laryngotracheobronchitis (e.g. croup) Parapharyngeal and retropharyngeal abscess Lingual tonsillitis Hematomas or abscess of the tongue or floor of the mouth Epiglottitis (also known as supraglottitis) Similar to croup but the patient will have low energy and is very serious and in this case we do not manipulate the airway

Answer 4

Laryngeal carcinomas Hypopharyngeal and lingual (tongue) carcinomas

Answer 5

Foreign bodies Chocking something shoved up a nose Thermal injuries-Can cause swelling Caustic Injuries- Can cause swelling Inhaled toxins

Answer 6

Angiotensin converting enzymes inhibitors induced angioedema

Answer 7

Blunt and penetrating neck and upper airway trauma

Answer 8

When the CNS is depressed and comes from within the body The causes of CNS depression varies Most common cause of upper airway obstruction is the tongue Includes-Decrease in cardiac output, TBI, Anesthesia, drug overdose, hypoxemia/hypercarbia, hypothermia/hyperthermia, metbolic derrangements

Answer 9

COPD, Asthma, ARDS, Pneumonia, moderate PEs

Answer 10

Hypo/hyperglycemia hypo/hypernatremia hypokalemia (lead to heart malfunction) metabolic acidosis hepatic encephalopathy

Answer 11

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 12

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 13

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 14

Head-tilt/ Chin-Lift Jaw Thrust Maneuver Occasionally opening the airway is all that is require to re-establish the airway

Answer 15

Used when no c-spine injury is evident Performed with patient on his back and unconscious Place palm across patient forehead, and firmly tilt head backwards. Fingers of other hand placed under ye bony part of lower jaw to bring chin forward and teeth almost to occlusion Supports jaw and helps tilt head back Mouth should not be completely closed, and rather should be slightly open This maneuver elevates the tongue off the posterior pharyngeal wall, hopefully relieving obstruction If fingers press too deeply into the soft tissue under chin, may obstruct airway by oving the tongue If dentures are not too loose the head tilt chin lift with make the mouth to mouth seal easier. If denture can not be kept in placed though they must be removed Babies have a large occiput and when putting them in this position make sure to not do the full chin lift but rather put them in the sniffing position

Answer 16

The jaw thrust is the safest initial approach to opening the airway with suspected neck injury as it is accomplished without extending the neck. The head is supported without tilting it backwards or tuning it side to side Used to accomplish the forward displacement of mandible Grasp the angle of the patient lower jaw and lifting with both hands, one on each side, displace mandible forward while titling the head backwards This will elevate the tongue and hopefully relieve the obstruction If the lips are closed, retract the lower lip with thumb

Answer 17

Use a PHARYNGEAL AIRWAYS

Answer 18

Devices used to elevate the tongue off the posterior pharyngeal wall and away from the hard and soft palates, thereby establishing a patent airway through which spontaneous ventilation can be achieved Breath stacking will occur when you do not fully allow them to exhale

Answer 19

Rigid, curved devices with an air passage, placed through the mouth with the end resting distal to the tongue above the glottis opening

Answer 20

* Used in patients with decreased submandibular tone * Obtunded 2 degrees to any of the central cause of airway obstruction * Anesthesia * Deep sedation * Used when manually ventilating a patient * Used as aid for deep suctioning * Used as a bite block * Some model used to facilitate intubation

Answer 21

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 22

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 23

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 24

AKA nasal trumpet Soft or semi-rigid hollow tube placed through the nares, the tip lying distal to the tongue above the glottic opening May be sized in mm I.D. or French sizes

Answer 25

* 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 26

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 27

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 28

Used when pt. is not breathing on their own ## Footnote Manual Resuscitator Bag-Valve-Mask (BVM) Bag-Mask Ventilator (BMV) “Bagger” “Portable handheld devices that provide a means of delivering positive pressure to a patient’s airway” “Deliver room air (R/A), oxygen air-oxygen mixtures via a mask or through an adapter that attaché directly to a patients ET” You will know you are giving enough air if there is chest rise

Answer 29

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 30

* 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 31

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

Answer 32

* 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 33

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

Answer 34

* 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 35

* 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 36

* Operation manual should specify * BVM device underwent safety and standard testing * Criteria was met

Answer 37

* 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 38

Hand Positioning-Single Hand Lift chin up to the mask

Answer 39

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 40

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 41

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 42

* 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 43

Manual ventilation skill with proper equipment is a fundamental premise of advanced airway management Anybody (almost) can be oxygenated and ventilated with a bag and a mask The art of bagging should be mastered before the art of intubation

Answer 44

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 45

* 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 46

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 47

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 48

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 49

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 50

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

Answer 51

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

Answer 52

Most of air moved through the respiratory tract during respiratory breathing enters through the nares and nasal cavity Mouth breathing will be used during things like exercise to reduce resistance at higher ventilation rates

Answer 53

The corniculate and cuneiform cartilage function to support the soft tissue on either side of the vocal cords

Answer 54

* Cricoid Cartilage- only laryngeal structure that forms a complete ring of cartilage around the airway and the narrowest region of the upper airway in infants * The cricothyroid ligament is occasionally used as the location for placement of a emergency placement for an artificial airway

Manual Ventilation Flashcards

(78 cards)