5.1 - RESPIRATORY AND IATROGENIC CAUSES OF DYSPHAGIA Flashcards
What does “iatrogenic” mean?
Due to treatment/medical intervention
What are the two types of artificial airways?
Endotracheal Tube (through the mouth/nose)
Tracheostomy Tube (hole created in the trachea)
What are the two types of trach tubes?
Cuffed
Uncuffed
What is a cuffed trach tube?
What does it do? (2)
It has an inflatable cuff on the end
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Does not allow air or other substances to pass the tube
Forces air through the tube
What are the inner and outer tubes of a trach called
Outer Cannula
Inner Cannula (2nd cannula)
What is the progression of trach use to removal?
(1) Cuffed trach
(2) Cuffless trach (allows for natural mouth breathing)
(3) Removal
What is a Passy-Muir Valve?
Can it be used with a cuffed trach?
Why or why not?
A one-way value that allows for natural exhalation and speech
Yes, but only if the cuff has been deflated.
Your patient will suffocate because they won’t be able to exhale.
What are the four factors that increase the risk of aspiration?
Poor sub-glottic pressure.
Poor/disrupted laryngeal elevation
Reduced upper airway sensitivity
General muscle weakness.
How might surgery cause dysphagia? (3)
What type of surgery carries a high risk for dysphagia?
Damage to nerve endings (peripheral nerves, LMN)
Damage to brainstem during skull base surgeries.
Edema (temporary)
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Surgery for cancers
What is a Thyroidectomy?
Removal of the thyroid gland
What are the dysphagia risks for Thyroidectomies?
2
Impairment of the Vagus nerve endings
This could cause VF paralysis
What is a Carotid Endarterectomy?
Removal of plaques from arteries
What are the dysphagia risks for Carotid Endarterectomies?
Vagus nerve impairment
Pharyngeal constrictor action, VF actions impaired
What are the dysphagia risks for Cervical Spine Procedures? (2)
What is one example?
Impairment of CN IX (glossopharyngeal) and X (vagus)
Could also impair brainstem connections to peripheral nerves
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Anterior Cervical Fusion
What is an Anterior Cervical Fusion?
Decompression of Spinal cord/nerve roots
What are the dysphagia risks for Skull Base Surgeries?
Brain stem impairment
What do we call the removal of thyroid gland?
Thyroidectomy
What do we call the surgical removal of plaques from arteries?
Carotid Endarterectomy
What do we call the Decompression of Spinal Cord/Nerve Roots?
Anterior Cervical Fusion
What kinds of medications might cause dysphagia?
6
Antipsychotics
Anti-convulsants
Depressants
Respiratory medications
Cardiac medications
Cholesterol controllers
What kinds of side effects may be seen with Anti-Psychotics + Depressants?
(2)
Tardive dyskinesia (isolated dysarthria of oral cavity.)
Xerostomia
What kinds of side effects may be seen with Respiratory + Cardiac Medications
(2)
LES impairment
Subsequently GERD
What kinds of side effects may be seen with Cholesterol Controllers?
Generalized myopathies
Among healthy adults, ___% of swallowing occurs during the exhalation stage.
80%
Patients with Chronic Obstructive Pulmonary Disease are more likely to swallow at times during the ______ cycle when they have low ___________.
Breathing
Sub-glottic air pressure
Patients with Chronic Obstructive Pulmonary Disease often swallow ____________ or inhale _________________. This means __________ could be drawn into the airway
During inhalation
Immediately after a swallow
Residue in the pharynx
How might we be able to gauge DECREASED sub-glottic pressure in a patient?
Decreased loudness
How might we be able to gauge INCREASED sub-glottic pressure in a patient?
(2)
Pain + discomfort
Pulse changes
What causes a patient with a trach to have reduced upper airway sensitivity?
Lack of use
