Advanced Respiratory Flashcards
What 7 things put people at risk for losing their airway?
- decreased CNS- Surgery, anesthetic, alcohol, drugs-benzos
- Trauma- Skidoo-hyperextended neck, etc.
- Infections
- Latronergic-d/t medical procedure
- Foreign Bodies- kids and intellectually impaired
- tumors- anywhere in the body
- Angioedema- allergy, anapylaxis
What do you see with a complete airway obstruction?
See-saw chest movements. Attempted respirations but no air entry
What do you see with a partial airway obstruction?
- Stridor:airway swelling, compression by hematoma
- Secretions: saliva, blood
- Snoring; tongue relaxation
- Smash: risk of teeth/blood in the airway
What 2 kinds of patients, would you anticipate a future airway obstruction?
Inhalation injury/burn: since, carbonaceous sputum
Swelling neck: compression from expanding hematoma or neck mass
What in an Endotracheal tube used for?
When someone is unable to protect/maintain their own airway: trauma, cardiac arrest, ventilatory compromise/failure,
Short term solution
placement can be determined by equal air entry on both sides of the tube
What is End-tidal Co2?
Measures Co2 as it leaves the endo tube
It can tell placement
Normal: 35-45 mmHg
ETCO2 is 55mmHg, is the patient hyperventilating or hypoventilating?
HYPOventilation
ETCO2 is 28mmHg, is the patient hyperventilating or hypoventilating?
HYPERventilating
What is a tracheostomy used for?
NOT an emergency
Long term ventilation, airway obstruction, airway protection, management of secretions.
Used for those who are totally unstable, coma, trauma, head injury
Also used for quadriplegic or paraplegic
What can go wrong with a trach?
Tube obstruction d/t Dry mucous membranes
Tube Dislodgment
Hemorrhage-when bleeding is uncontrolled, can be early or late
What are the best practice guidelines for suctioning a trach?
Suction only when necessary/agency policy
Use appropriate size of suction catheter
Use the lowest, most effective suction pressure (80-120)
Insert the catheter no further than the carina
Suction no longer than 15 seconds,
Suction continuously, not intermittently
AVOID saline lavage
Provide hyperoxygenation before and after the suction procedure
What do you want to know about a new patient’s trach?
Date of insertion: tube type, size, cuff status (inflated or deflated)
Secretions: type, amount, color, odor,
frequency of suctioning, patient response to suctioning
Last time:
1. Inner cannula was changed
2. Entire trach was changed
3. Tube was suctioned
What NEEDS to be at the bedside for a patient with a trach?
- Trach insertion tray, until established (2 weeks after initial change)
- Bag valve mask, working oxygen and suction
- suction catheter and yankeur suction device
- trach tube obturbator (in a plastic bag taped to the head of the bed)
- Spare tracheostomy tubes, of the same SIZE and TYPE, and one tube of one size smaller and type
- 10ml for inflating/deflating cuff (if trach is cuffed)
- PPE, clean and sterile gloves
- Humidification supplies (trach mask, corrugated tubing, humidity bottles, sterile water).
Adventitious sounds: Fine crackles
-Sound, mechanism,
Sound: short crackling/popping
Mechanism: previously dilated airways pop open
Never normal
eg. CHF, COPD
Adventitious sounds: course crackles
-Sound, mechanism,
Sound: Bubbling, gurgling, velcro
Mechanism: Air collides with secretions
eg. pulmonary edema, pneumonia, pulmonary fibrosis
Adventitious sounds: High pitched wheeze
-Sound, mechanism,
Sound: polyphonic, musical, squeaking
Mechanism: Air squeezed through airways compressed from swelling, secretions, tumors. Diameter of the airway is diminished.
eg. diffuse airway obstruction, asthma, emphysema
Adventitious sounds: Low pitched wheeze
-Sound, mechanism,
Sound: Monophonic, musical snoring
Mechanism: Air squeezed through airways compressed from swelling, secretions, tumors. Diameter of the airway is diminished.
eg. single bronchus obstruction, bronchitis
Adventitious sounds: Stridor
-Sound, mechanism,
Sound: Often inspiratory
Mechanism: partially obstructed airway. Swelling or obstruction
eg. croup, foreign body, epiglottis
Adventitious sounds: Pleural Friction Rub
-Sound, mechanism,
Sound: inspiratory and expiratory
Mechanism: Caused by inflamed pleural linings rubbing together
eg. pleurisy, pneumonia
How can you tell if you are hearing a pleural rub of pericardial rub?
Ask the patient to hold their breath, if it continues it is probably pericardial
Disorder: Pneumonia. What would percussion and auscultation sound like?
Percussion: dull over consolidation
Auscultation: Bronchial breath sounds over consolidation, crackles
Disorder: Atelectasis. What would percussion and auscultation sound like?
Collapsed alveoli pop open
Percussion: Dull over affected area
Auscultation: faint or no breath sounds