Quiz 1 Flashcards

Question

pH indication for intubation

Answer 1

pH of 7.25 or less means you will need to do on intubation

Answer 2

Ther period from the start of anaesthesia to the establishment of a depth of anaesthesia adequate for operation (unconsious)

Answer 3

Passage of a tube through the nose or the mouth into the trachea for maintenance of the airway auring anaesthesia, or in a patient with an imperilled (at risk) airway

Answer 4

The administration, after preoxygenation of a potent **induction** agent followed immediately by a rapidly acting neuromuscular blocking agent to **induce** unconscious and motor paralysis for tracheal **intubation** To render the patient unconsious and paralyzed and thn to intubate the trachea without the use of BMV

Answer 5

1. Preparation 2. Preoxygenation 3. Pretreatment 4. Paralysis of Induction 5. Positioning-HOB 6. Placement with Proof-CO2, polymetric, ausculatation (listen to stomach first), mist on tube, chest rise 7. Postintubation Management-CXR to see placement

Answer 6

**T-minus 5-10 minutes** Assessed for difficultly of intubation (LEMON), monitoring equitment has been attached (SpO2, ECG, BP), drugs prepared, intubation equitment ready **Will occur at the same time as preoxygenation**

Answer 7

Used to assess how difficult the intubation will be ## Footnote **L-Look Externally** (if it looks difficult it probably will be) **E-Evaluate 3-3-2 Rule** (3 finger in you mouth, 3 for chin length, and 4 hyoid cartilage to ligament).Mandible of Adequate Size ( to allow tongue displacement). **M-Mallampati Score** **O-Obstruction/Obesity** **N-Neck Mobility**

Answer 8

Examine the neck and mouth DCAP BLS TIC-Deformity, Contusion, Abrasion, Puncture, Burn, Lacration, Swelling, Tenderness, Instability, Crepidious Bleeding Tracheal Deviation JVD Massess

Answer 9

Class One-Can view soft palate, uvula, facus, pillars Class Two-Can view soft palate, uvula, and facus visible Class Three-Soft Palate, base of uvula visible Class Four-Hard palate only visible

Answer 10

C-Spine mobility assessed by measureing the distance from lower border fo mandible to thyroid notch at full neck extension Distance should be greater the 4 finger in adults

Answer 11

Oxygen equitment and bagger-assembled and checked Suction Equitment-Assembled, cheked, and turn on Laryngoscope-Assembled and checked Endotracheal Tube-Opended, Distal End lubricated, Stylet inserted and shaped, cuff checked and deflated, syringe attached Tube Securign Device-Opened/Made/PreCut Tube Placement Confirmation Device

Answer 12

Infant \>1000g Tube Size 2.5 and Diameter 9-11 Infant 1000-2000g Tube Size 3.0 and Diameter 9-11 Infant 2000-3000g Tube Size 3.5 and Diameter 10-12 Infant \>3000g Tube Size 4.0 and Diameter 11-12

Answer 13

Generally women should be intubated with a number 7 or 7.5 orotraheal tube A man is generally intubated with an 8-8.5 orotracheal tube Another way to solve (Does not work for infants) is (Age / 4) + 4= Tube Size

Answer 14

The blade will depend upon the pat as straight blades are preferred in neonates Also who is performing the laryngosope will have a preferrence

Answer 15

**T Minus 3-5 min** Eastablish an oxygen reservior within the lungs, blood, and body tissue Allow for several minutes of apnea time before desaturation to 90%-8 min for a healthy 70 kg adult (will be different if patient is obese or have other health conditions) Once sat reach 90% after they will start to drop rapidly as desats from 90-0% will occur in 120 seconds

Answer 16

Usually done with manual resuscitator-3-5 minutes to obtain highest SpO2 100% O2 provides patient with reservere during intubation procedure

Answer 17

**T Minus 3 min** Administration of drugs to mitigate adverse effects associated with intubation or underlying co-morbities Drugs include-Lidocaine (Prevent gagging) and Fentanyl (relax pt. and prevent ICP) Gagging increases ICP

Answer 18

**T-Zero** We are not ready to intubate as pt. is sedated and paralyzed Rapidly acting induction (sedation) agent given by IV push-Midazolam, propofol, etomidate, katamine Neuromuscular blocking agent (paralytic) which are fast acting and a shirt duration-Succinylcholine, rocuronium DO NOT PARALYZE WITHOUT SEDATION

Answer 19

Make any final adjustment to patient position as the patient goes unconsious and flaccid Want them in sniffing position Sellick Manoeuver (Optional)-Push back on cricoid cartilage No Bagging at this time **T Plus 20-30 seconds**

Answer 20

ETT inserted Stylet removed and cuff inflated Tube placement confirmed T Plus 45-60 seconds

Answer 21

Insert blade into the right of the mouth and sweep tongue to the left

Answer 22

Look for the arytenoids and epiglottis and if seen proceed to visulize the glottis if they are not seen the blade is liklely to have gone in too far **Curved (MacIntosh) Blade:** Tip in the vallecula, resting on the hyoepiglottic ligemant. Lift and apply pressure flipping the epiglottis forward **Straight (Miller) Blade:** Advance blade tip over posterior surface of epiglottis

Answer 23

For grade 3 or 4 Mallmpati Score we use this **B-**Backwards **U-**Upwards **R-**Rightwards **P-**Pressure May bring the glottis down into view, improve view by full 1 grade

Answer 24

Visulization CO2 Detecteion Esophageal Detection Device (EDD)

Answer 25

Most Reliable Capnometry Colormetry-Up to 6 breaths, Color change from purple to yellow is good and no color change is bad Be careful to use during cardiac arrest

Answer 26

Deflate bulb attached directly to 15mm connector of ETT If bulb inflate it is good use immediatly after intubation before bagging resumes

Answer 27

21-23 cm ATT is good \<18 ATT or \>25 be very careful tube depth alone give no indication of esophasgus or trachea

Answer 28

Visulization of the tracheal rings through a cameria in the brochscopy Only true gold standard

Answer 29

ETT Secured PPV initiated Chest XRay obtained (Distal tip 2-5 cm above carina) Hypotension is present is treated (may be caused due to the sedation agents used) Long term sdation ordered and given Cuff pressure ajusted T plus one minute

Answer 30

Seals the airway during positive pressure vetilation Prevent or minimize aspiration

Answer 31

Early tracheal tube had low volume and high pressure cuffs which caused major airway damage Now the norm is **high volume and low pressure** in order to reduce the incidence of airway damage. Over inflation of the cuff is equal to using the older low volume high pressure cuff The new high volume low pressure cuff makes contact with a greater surface are and therefore less pressure is required to seal the airway

Answer 32

20-25 mmHg 25-35 cmH2O If **cuff pressure is too high** tracheal mucosal perfusion pressure has been exceeded which may result in **tracheomalacia, tracheal stenosis** If **cuff pressure is too low** is can result in secretions that will leak into the trachea and bronchi which may result in ventilator assisted pneumonia

Answer 33

Minimal Occulding Volume or Pressure Technique (MOV)-Injecting small amount of air until no leak is heard at PIP Minimal Leak Test (MLT)-Inject small amount of air until leak is no longer heard then withdraw a small amount of air is heard at PIP (technique not recommended MOV and MLT are used when it is not possible to measure cuff pressure, as whenever possible a cuff pressure manometer should be used During a positive pressure breath, airways expand on inspiration. Therefore pressure in the trachea is less on inspiration than expiration. This means that the amount of **ischemia that may result depends upon cuff pressure and the rate of PPV**

Answer 34

Open Mouth Insert Laryngoscopy Visualize Glottis Displace Epiglottis Use Magill Forceps to manipulate the tube into the glottic inlet Advance Tube

Answer 35

Apply Sellick's Manouver-Aligns axis advancing tube with trachea and occuldes esophasgus Listen for breath sounds as tube approach the glottis Advance tube though glottic (preferrably on inspiration)

Answer 36

28 cm at nares for men 26 cm at nares for women

Answer 37

Is the patient getting better, is their inital condition resolved/imprved? Is there any impeding conditions that may require ventilatory support? Can patient manage secretions? Can the patient protect their own airway through an adequate cough (requires minimal suctioning)

Answer 38

**CNS Assessment-**Adequate CNS function needed to stable ventilatory drive and cough. LOC, anxiety, depression, and dyspnea can impact weaning success **Airway Evaulation**-Can pt. maintain airway, what is the risk of aspiration (they may be able to protect the airway but not ventilate). What is their LOC, secretions, cough, positive cuff leak test (means no swelling in airway and they are breathing past the cuff) **Oxygenation**-P/F Ratio (PO2 to FiO2 Ratio) needs to be greater than 300 **Respirtory Muscle Strength**-MIP or NIF is -20 cmH2O Stable VS, hemodynamics, nutiriotional status, functioning GI Tract

Answer 39

1) Can the patient breath spontaneously- Are they initiating each breath on their own 2) Suction mouth and upper airway 3) Deflate the cuff 4) Briefy occlude the EET 5) If the patient is unable to breathe around the occulasion, then the laryngeal edema should be expected

Answer 40

After a 30-120 min spontaneous breathing trial pt. that can be extubated should have the following 1. Resolution to their disease 2. Hemodynamic Stability 3. Adequate Oxygenation-Low FiO2 needs and PEEP 4. Adequate Ventilatiory Status-PaCO2, normal pH

Answer 41

Resuscitation Bag, O2 source, and O2 mask Suctioning Saline to help with secretions Syringe (10 mL) for cuff deflation

Answer 42

Watch for signs of O2 failure and Ventilation Failure * Decreased SpO2 * Increased FiO2 * Increased WOB * Decreased LOC An exubation is considered successful is patient is able to remain extubated for 24 hours

Answer 43

**Airway Obstruction-**Due to laryngeal edema causing stridor (smoke, epiglottitis, angioedema) or compression of airway (tumor, abscess, trauma, post op). Only 1% will experience stridor and of that 1% require reintubation **Hoarseness-**Will occur in up to 70% of extubated ICU patients, oral intubation and large tubes will increase risk. If does no resolve for 2 weeks it indicates that there is a serious complication (vocal cord paralysis) **Cough-**About 25% of ICU pt. following prolonged intubation will develop cough **Sore Throat-**15% of short term intubation and 40% of long term intubations have a sore throat **Aspiration-**Sensory deficit and incompetent laryngeal reflexes post extubation will increase risk of aspiration, especially in pt. with an impaired cough **Odynophagia-**Painful swallowing or talking. If severe may indicate glottic infection or ulceration (very rare) **Vocal Cord Paralysis-**Permanent bilateral vocal cord paralysis is very rare but unilateral transient cord paralysis is common

Answer 44

Very rare but if occurs use cool aerosol with supplemental O2 Tx with nebulized 1:1000 epinephrine Tx with Heliox mixtures by NRBM Children are at a greater risk

Answer 45

Procedure of establishing to the trachea via neck

Answer 46

Opening created by a tracheotomy May be permenant or temporary Usually associated with a tracheostomy tube Unable to phonate as insufficent air passing through the vocal cords

Answer 47

An Artifical airway inserted into the trachea via a tracheostomy

Answer 48

Surgical incision into the larynx Usually a permanent stoma is linking the trachea to the surface of the neck Trachea no longer in communication with pharynx Unable to phonate as the vocal cords are no longer there

Answer 49

An opening between two cavivties or canals or between such and the of the body Often used interchangeably with trachesostomy

Answer 50

Upper airway trauma or obstruction Continuing need for artifical airway after a prolonged period of oral/naso intubation To facilitate removal of secretions Inability to wean from artifical airway Long term care patients with neuromuscular diseases Obstructive Sleep Apnea-At night everything is floppy making it harder to breath

Answer 51

Plastic Rigid (Common) Bent 90 15 mm Connecter (common) May be cuffed or uncuffed may be fenestrated or unfenestrated

Answer 52

Used for suctioning Used for ventilation Can be removed for cleaning Inner diameter limits airflow

Answer 53

Provides rigidity that can be used to protect the airway May or may not be fensatrated May or may not be cuffed Outer diameter customizes fit

Answer 54

Makes the passage through tissues less trauamtic during insertion Prevents blood or muscus form entering tube while being inserted Removed when the trach is in place Kept at pt. bedside and may be needed if trach tube gets dislodgeed and has to be reinserted

Answer 55

Optional Comes in various sizes at the distal end of the tube Designed to seal and protect airway and to maintain position of tube All cuffs inflated by syringe via attachment pilot balloon and accessible at all times Can cause ischemia if over pressurized

Answer 56

It is a shared responsibility between the RN, RTs, and pt. Done dily or as needed the trach will need to be change every 3 months

Answer 57

1. Assemble and check equitment 2. Assess the patient 3. Explain the procedure 4. Suction (if needed) 5. Remove and clean inner canula 6. Clean stoma site 7. Change the ties (if needed) 8. Re-insert inner cannula 9. Reassess the pt. 10. Chart procedure

Answer 58

Trach care is only done if needed during first 24 hour post op Inner Canula-Check q1h during first 24 hrs post op and clean q4h or prn during first 24 hours post op Trach care is done **aseptically** for the 72 hours post op

Answer 59

the selction of humidifcation device should be based on pt. needs and assessment of the aireway and includes the volume an thickness of secretions as well as the history of mucus plugging or tube occulasion Devices that can be used-Artifical nose, humidifer, large volume neb, instillation neb

Answer 60

phonation requires airflow through vocal cords at a sufficient force and a tracheostomy will negate that process Device that can be use includes-passey muir valves (most common), talking trachs, artifical larynx, Blom-Singer valve (cheap so everyone can afford it)

Answer 61

Causes of loss of airway patency can be divided into 2 general categories **Central Causes**-Any condition that leads to a depression of the CNS (i.e. \<8) **Peripheral Causes-**Airway obstruction caused by something originating outside the body

Answer 62

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 63

Acute myocardial infarction (MI) Cardiac tamponade-But when cause through a infection it is considered to be a peripheral cause CHF V fib or V tach Hypovolemic Shock Septic Shock Massive Pulmonary Embolism

Answer 64

Decrease in tone of submandibular muscles leads to posterior displacement of tongue against the posterior pharyngeal wall While in a comatose state the position of the chin will worsen the obstruction • C-spine adopts a semi flexed position, narrowing the distance between the tongue and posterior pharyngeal wall • Epiglottis gravitates towards the larynx partially occluding the airway • Negative pressure cause by respiratory efforts in presence of obstruction draws tongue towards the airway

Answer 65

Peripheral causes come from outside of the body Peripheral causes include Infection Infection • 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 Neoplastic • Laryngeal carcinomas • Hypopharyngeal and lingual (tongue) carcinomas Physical and Chemical Agents • Foreign bodies • Chocking something shoved up a nose • Thermal injuries-Can cause swelling • Caustic Injuries- Can cause swelling • Inhaled toxins Allergic/Idiopathic • Angiotensin converting enzymes inhibitors induced angioedema Traumatic • Blunt and penetrating neck and upper airway trauma

Answer 66

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

Answer 67

**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 68

Laryngeal carcinomas Hypopharyngeal and lingual (tongue) carcinomas

Answer 69

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

Answer 70

Angiotensin converting enzymes inhibitors induced angioedema

Answer 71

Blunt and penetrating neck and upper airway trauma

Answer 72

COPD, Asthma, ARDS, Pneumonia, moderate PEs

Answer 73

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

Answer 74

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 75

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 76

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 77

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

Answer 78

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

Answer 79

* 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 80

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 81

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 82

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 83

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 84

* 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 85

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 86

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 87

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 88

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 89

* 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 90

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

Answer 91

* 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 92

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

Answer 93

* 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 94

* 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 95

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

Answer 96

* 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 97

Hand Positioning-Single Hand Lift chin up to the mask

Answer 98

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 99

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 100

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 101

* 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 102

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 103

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 104

* 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 105

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 106

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 107

**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 108

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.

Quiz 1 Flashcards

(132 cards)