T2: Airway and O2 Mgmt (2) Flashcards
6 complications of artificial airway:
1) tube OBSTRUCTION
2) tube DISPLACEMENT
3) SINUSITIS, nasal injury
4) tracheoesophageal FISTULA
5) mucosal LESIONS
6) laryngeal or tracheal STENOSIS
How can we look for signs of laryngeal stenosis after extubating a pt?
listen for hoarseness or stridor;
stridor is serious - call MD
What 2 additional complications do we see with trachs?
- tracheoinnominate artery fistual
- subcutaneous emphysema
Why is a tracheoinnominate artery fistual so dangerous?
the pt could bleed out…there’s nowhere to apply pressure
What 6 steps are taken to extubate?
1) Hyperoxygenate pt
2) Suction ET and oral cavity
3) Deflate ET cuff
4) Remove tube at peak inspiration
5) Instruct pt to cough
6) Monitor every 5 min for respiratory distress
What is a surgical incision into trachea for purpose of establishing an airway?
tracheotomy
What is a stoma (opening) that results from tracheotomy and is more comfortable for the pt?
tracheostomy
Remember: stoma sounds like tracheoSTOMY
5 priority pt problems with artificial airway:
(Remember: M-COIN)
- damaged oral MUCOSA
- inadequate COMMUNICATION
- reduced OXYGENATION
- potential for INFECTION
- inadequate NUTRITION
Other possible complications of an artificial airway:
- pneumothorax
- subcutaneous emphysema
- bleeding
- infection!!!
5 ways to prevent tissue damage with trach:
1) Use minimal leak and occlusive techniques
2) Check cuff pressure often
3) Prevent tube friction and movement
4) Prevent/treat malnutrition, hemodynamic instability, hypoxia
Why do we need to warm, humidify, and filter trach air?
tracheostomy tube bypasses nose and mouth which normally does those things
Why do we need to ensure adequate hydration with trachs?
To keep secretions thin
Common causes of hypoxia in the trach:
- ineffective oxygenation when suctioning
- catheter too large
- suctioning too long
- excessive suction pressure
- suctioning too frequently
T/F: Tracheostomy tube and nutrition: most pts get nutrition through a G-tube or NG tube
True
How long do we elevate the HOB after eating with a trach? Why?
at least 30 min
Prevent aspiration during swallowing
Bronchial and Oral Hygiene: Reposition pt every ___ to ___ hrs
1 to 2 hrs
Bronchial and Oral Hygiene: Ways to break up mucus and promote drainage
- coughing and deep breathing
- chest percussion and vibration
- postural drainage
How do we wean someone from a tracheostomy tube?
- change to uncuffed tube
- gradually decrease the tube size
- trach button has potential for dislodging
When is the cuff deflated?
when pt can manage secretions and does not need assisted ventilation
What are the 2 types of ventilators?
- negative-pressure
- positive-pressure
What are the 3 versions of POSITIVE-pressure vents?
- pressure-cycled
- time-cycled
- volume-cycled
There are 3 main MODES of ventilation:
- AC (Assist-Control Ventilation)
- SIMV (Synchronized Intermittant Mandatory Ventilation)
- BiPAP (Bi-level Positive Airway Pressure)
What are the ventilator CONTROL and SETTINGS?
- Vt (Tidal Volume)
- Rate (breaths per min)
- FiO2 (fraction of inspired O2)
- PIP
- CPAP
- PEEP
- Flow rate
What are 4 indications for mechanical ventilation?
- acute impending ventilatory failure
- refractory hypoxemia
- secretion/airway control
- apnea/respiratory arrest
