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airway management RCP 330 > rcp 330 week 1 > Flashcards

rcp 330 week 1 Flashcards

1
Q

bronchospasm

A

abnormal contraction of the smooth muscle of the bronchi, resulting in acute narrowing and obstruction.

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2
Q

bronchospasm stimulated by

A

catheter in the lower airway
patients with hyperactive airway disease

*stop suctioning and administer aerosolized bronchodilator

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3
Q

preventing hypoxemia when suctioning

A

preoxygenate the patient
not disconnecting the ventilator
closed suction technique
steady FiO2/ PEEP - lung decruitment

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4
Q

Maxillary trauma

A

NPA (nasopharyngeal)

  • direct visualization
  • blind passage
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5
Q

size of artificial airway adapter

A

15mm

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6
Q

purpose of pilot balloon

A

used to measure cuff status and pressure when the tube is in place

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7
Q

Complications associated with suctioning

A 
hypoxemia 
cardiac dysrhythmias 
hypotension / hypertension
atelectasis
mucosal trauma
ICP
bacterial colonization of lower airway
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8
Q

hypoxemia

A

not pre oxygenating enough, use closed suction technique and maintain FiO2 levels and PEEP

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9
Q

cardiac dysrhythmias

A

vagal nerve stimulation, agitation, hypoxemia, stop suctioning, keep a pulse ox on during admistering and apply O2/ ventilation

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10
Q

hypotension / hypertension

A

cardiac dysrhythmia, hypoxemia, anxiety, stress, pain, coughing, stop suctioning, apply O2 / ventilation, explain procedure, be calm, pre oxygenate

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11
Q

atelectasis

A

too much negative pressure and not appropriate catheter size, use closed-system technique and do not disconnect patient, pre oxygenate

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12
Q

mucosal trauma

A

too much negative suction pressure, shallow suction method and use NPA

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13
Q

ICP

A

cough, discomfort, previous injury, administer lidocaine 15 min before suctioning to minimize ICP to prevent

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14
Q

bacterial colonization of lower airway

A

using normal saline, open-system technique, and disconnecting vent. ETT patients, sterile technique should be used with a closed-system. Only use normal saline when necessary

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15
Q

steps for intubation

A 
assemble and check equipment 
position patient
pre oxygenate / ventilate
insert laryngoscope 
visualize glottis
displace glottis
insert tube
assess tube position
stabilize tube and confirm placement
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16
Q

position patient

A

align mouth, pharynx, and larynx

moderate cervical flexion
extension of atlantooccipital joint
placement of pillows under shoulders
flexes neck and tilts head backward
sniffing position
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17
Q

features on ETT that indicate placement

A

tube markings in cm

radiopaque

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18
Q

assess tube position

A 
auscultation of chest and abdomen
observation of chest movement
tube length 
light wand
capnometry 
colorimetry
flexible laryngoscopy / bronchoscopy 
videolaryngoscopy 
ultrasound
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19
Q

miller blade

A

straight blade and directly displaces epiglottis

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20
Q

mcintosh

A

curved blade and indirectly displaces epiglottis

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21
Q

ETT depth

A

men 21-23

women 19-21

22
Q

indications for tracheostomy tube

A

overcoming upper airway obstruction or trauma
people with poor protective reflexes
prolong period of intubation

23
Q

cuff pressures

A

normal 20-30cmH2O

high = cuts off mucosal blood flow

  • tissue damage
  • tracheal wall injury

low = aspiration of oral secretions

24
Q

how often are patients suctioned

A

only when indicated

25
Q

suctioning adults pressures

A

-120 to -150

26
Q

suction time vs total time

A

suction time = 10 seconds

total time = 15 seconds

27
Q

when a patient does not tolerate suctioning

A

discontinue treatment

28
Q

equipment needed for intubation

A 
oxygen flowmeter and tubing
suction apparatus
flexible sterile suction catheters 
sterile gloves for endotracheal suctioning 
yankauer tip suction
manual resuscitation bag and mask
colorimetric carbon dioxide detector 
oropharyngeal airways
laryngoscope (two) with assorted blades
endotracheal tubes (three appropriate sizes)
tongue depressor
stylet
stethoscope
tape or endotracheal tube holder
10-mL or 12-mL syringe 
water-soluble lubricating gel
magil forceps
local anesthetic 
towels
barrier precautions
29
Q

equipment needed for nasotracheal suctioning

A

vacuum source
calibrated, adjustable regulator
collection bottle and connecting tube
disposable, sterile gloves
sterile suction catheter
standard precautions, goggle, masks
oxygen source with calibrated flow meter or ventilator
pulse oximeter
manual resuscitation bag equipment with O2 enrichment device for emergency use
stethoscope
**sterile water-soluble lubricating jelly

30
Q

nosopharyngeal airway

A

patients who require nasotracheal suctioning
- minimizes damage to mucosa
facial surgery
helps maintain patency of upper airway

31
Q

artificial airway inserted into larynx

A

endotracheal tube

32
Q

murphys eye

A

side port

ensures gas flow if the main port should become obstructed

33
Q

purpose of artificial airway cuff

A

prevent tracheal mucosal injury
minimize aspiration
seal to prevent air leaks during ventilation

34
Q

advantages of tracheostomy with inner cannula versus without

A

can be cleaned or replaced if obstructed or occluded instead of changing a whole trache

prevents emergency changing of whole device

recommended for patients going home with a TT or in situations in which humidity delivered to the airway is less than optimal

35
Q

tracheostomy inserted

A

traditional - over second or third ring

percutaneous - circoid and first ring or between first and second ring

36
Q

symptom of vocal cord inflammation and glottic edema

A

stridor
retractions
inability to feel airflow in upper airway

37
Q

complications with intubation / rare and serious

A 
laryngeal lesions
glottis edema
vocal cord inflammation
laryngeal / vocal cord ulcerations
vocal cord paralysis
vocal cord stenosis
38
Q

steps to wean a patient off a tracheostomy tube

A
  • fenestrated tubes
  • progressively smaller tubes
  • tracheostomy buttons
  • patient should have sufficient muscle strength to generate cough ( peak expiratory pressure > 40 cmH2O)
  • ideally there should be no active pulmonary infection, and the volume and thickness of secretions should be acceptable
  • patency of upper airway assessed via bronchoscopy
  • adequate swallow must be present to decrease risk of aspiration
39
Q

device commonly used to suction secretions or fluids from the oropharynx

A

rigid tonsillar

yankauer suction tip

40
Q

special catheter used to facilitate entry into the left mainstem bronchus

A

curved-tip catheter

41
Q

emergency tracheal airway

A

orotracheal (oral passage)

42
Q

why is suction equipment needed for intubation

A

vomitus or secretions may obscure the pharynx or glottis

43
Q

disadvantage os using colorimetric / capnography

A

patients who recently consumed carbonated fluids

cardiac arrest patients that get a false-negative due to poor pulmonary blood flow

44
Q

final step to confirm ETT placement

A

bronchoscope

45
Q

advantages of LMA

A 
ease and speed
someone who is inexperienced 
you dont need equipment
greater amount of ventilation
emergency use
46
Q

disadvantage of LMA

A

doesnt protect against aspiration

cannot be used in conscious or semicomatose patients bc of the stimulation of gag reflex

47
Q

8 basic steps of trach care

A 
assemble and check equipment 
explain procedure
suction patient
clean inner cannula
clean and examine stoma site
change tie and holder
replace clean inner cannula
reassess patient
48
Q

3 airway emergency

A

tube obstruction
cuff leaks
unplanned extubation

49
Q

tubing becomming obstructed

A

kinking of tube or patient biting tube
herniation of the cuff over the tube tip
obstruction of the tube orifice against the tracheal wall
mucous plugging

50
Q

patients that might need to remain intubated even after the ventilator is removed

A

surgically treated throat and laryngeal cancer

patients with respiratory failure

51
Q

when a patient does not tolerate endotracheal suctioning

A

patient becomes bradycardic from vasovagal reflex, STOP and provide 100% FiO2

52
Q

when a patient does not tolerate nasotracheal suctioning

A

patient may gag or regurgitate … avoid suctioning after meals

if gagging or regurgitating occurs, reposition patient and suction oropharynx

airway management RCP 330 (1 decks)

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