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Sp: Sim Lab 1 > 22. Nasal Intubation > Flashcards

22. Nasal Intubation Flashcards

1
Q

where does the pituitary gland sit

A

in the sphenoid bone

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2
Q

what causes increased bleeding in the nasal cavity

A

adenoid pad
(very vascular)

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3
Q

nasal intubation indications

A

oral not available
- jaw wired shut
- severe oral cavity swelling
impedance
- dental surgery
- OMFS surgery
better tolerated in extended care

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4
Q

why are nasal intubations better tolerated for extended care pts?

A

decreases sedation requirements

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5
Q

nasal intubation absolute contraindications

A

epiglottitis
midface instability
hx of basal skull fracture/surgery
bleeding disorders
choanal atresial

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6
Q

basal skul fractures/surgeries

A

pituitary tumors
meningiomas
chordomas
trigeminal neuralgia surgery

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7
Q

bleeding disorders

A

thalassemia
anti-coagulants

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8
Q

choanal atresia

A

failure for nare to open

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9
Q

nasal intubation relative contraindications

A

obstruction of nasal airway
-lg polyps
- foreign bodies
recent nasal surgery
frequent epistaxis

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10
Q

epistaxis

A

nose bleeds

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11
Q

prolonged nasal intubation: issues

A

nasal damage
local abscesses
otitis media (cant drain ears)
sinusitis

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12
Q

nasal intubation complications

A

epistaxis
fractured turbinate
avulsed nasal polyps
septal abscess
avulsed adenoids
bacteremia

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13
Q

nasal intubation equipment

A

magic forceps
nasal RAW endotracheal tube
red robinson catheter
warming (towels/saline)
laryngoscope

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14
Q

why do you need to warm nasal tubes

A

tubes are stiff
need to make more pliable

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15
Q

nasal dilators

A

28Fr
30Fr
32Fr
34F

work up sequentially

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16
Q

increase diameter of Nasal Rae

A

increase length of nasal Rae

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17
Q

nasal rae sizing limiting factor

A

overall diameter
preformed bend (RAE)

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18
Q

which nasal rae tubes can be inserted deeper?

A

larger diameters

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19
Q

what should you do prior to rolling pt back for nasal intubation?

A

vasoconstrict both nares

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20
Q

nasal vasoconstrictors

A

1% phenylephrine
afrin/oxymetazoline
4% cocaine pledget
epinephrine pledget

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21
Q

which nasal vasoconstrictor provides analgesia?

A

4% cocaine pledget

22
Q

most common nasal vasoconstrictors

A

pehnylephrine
afrin

23
Q

nasal rae insertion

A

along floor of nasal passage
perpehndicular to face
bevel directed laterally

24
Q

which way is bevel during nasal rae insertion

A

bevel directed laterally

25
Q

why do we need to cover the murphy eye during nasal intubation?

A

murphy eye causes scraping, bleeding, trauma

26
Q

how do you direct the nasal Rae into glottic opening?

A

use the magil forceps

27
Q

what do you need to be cautious off when using magil forceps?

A

do not grab onto the tube cuff
it could tear

28
Q

securing nasal rae

A

pad connector
dont fishhook nare
tape circumferential

29
Q

fishhooking the nare can cause

A

cut off blood flow
blanching tissue
tissue necrosis

30
Q

head flexion with nasal rae

A

pushes NETT deeper into trachea

risk mainstem or carina stimulation

31
Q

head extension with nasal rae

A

withdraws NETT out of trachea

risk tube popping out of airway

32
Q

retrograde intubation

A

place needle through cricothyroid membrane
thread seldingwire through neck and out of mouth
place arndt catheter over seldingwire
remove selding wire
ETT over catheter
remove catheter

33
Q

retrograde intubation requires

A

time
proper MV
definitive pre-ox

34
Q

jet ventilation indications

A

removal of foreign bodies
evaluation of airway dynamics
removal of lesions

35
Q

jet ventilation limitations

A

airway pollution (open airway)
no end-tidal measuring
possible loss of airway
limits ability to multitask

36
Q

jet ventilation anesthetics

A

TIVA only

37
Q

when is jet ventilation used?

A

typically with rigid bronchoscope

38
Q

types of jet ventilation

A

supraglottic
subglottic

39
Q

supraglottic jet ventilation

A

air introduced above glottic opening
rigid bronchoscope accessory port

40
Q

subglottic jet ventilation

A

typically emergency only
small catheter intriduced through glottic or through cricothyroid membrane

41
Q

jet ventilator hooks up to what air supply?

A

wall supply
DISS
50 psi

42
Q

what should you ask surgical team about prior to starting jet ventilation?

A

ask to see the O2 jet adapter

43
Q

do you use an ETT or LMA prior to jet ventilation

A

LMA (typically Igel) w/100% FiO2

44
Q

jet ventilation handle squeeze frequency/duration

A

8 times/min
duration <1 second

45
Q

jet ventilation pressure

A

15 psi (ideal)
25-50 psi may be needed

depends on level of compliance

46
Q

how do you verify adequate pressure during jet ventilation

A

watch for chest rise

47
Q

ventilation includes

A

O2 IN
CO2 OUT

48
Q

do you paralyze during jet ventilation

A

yes

49
Q

what are common symptoms post-jet ventilation?

A

coughing
irritation

treat w/narcotics and humidified air

50
Q
A

Sp: Sim Lab 1 (23 decks)

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