airway care Flashcards by BG Ram

Epistaxis

nasal bleeding

change every 24 hours

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Allows for establishing patent airway in patients with suspected neck fracture.

jaw thrust/ modified jaw thrust

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treatment for mild airway obstruction

encourage the pt. to continue spontaneous coaughing and breathing efforts

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manual resuscitation bag

reservoir provides

provides 95-100% oxygen (15l/min)

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manual resuscitation bag

where is the PEEP valve attached

expiratory side of patient valve

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manual resuscitation bag

Check inlet valve if …

if bag fills rapidly and collapses easily with minimal pressure

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manual resuscitation bag

if bag becomes difficult to copress and patient compliance is NORMAL

troubleshot

patient valve may be stuck, open or closed

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Flow inflating resuscitation Bag is used for

manual resucitation of neonates

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Flow inflating resuscitation Bag

Peak insp. pressure is controlled by

Flow to bag
Adjustment of flow control valve
How hard the bag is squeezed

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Flow inflating resuscitation Bag requires

compressed gas source to operate

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Flow inflating resuscitation Bag is also called

Flow inflating Anesthesia Bag

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Flow inflating resuscitation Bag should be kept…

half full between breaths

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Flow inflating bag will not inflate in the presence of

leaks
low flow to bag
opened flow control valve
open pop-off valve

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NAVEL
stands for…

Narcan
Atropine
Valium/ Verse
Epi
Lidocaine

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medication

give ___ for narcotic oversoe

Narcan

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medication

Give ___ for bradycardia

Atropine

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medication

Sedative

Valium/ Verse

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medication

Use Epinephrine during

Aystole

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What do you do when administering medication through the ETT

double the normal IV dose
Flush with 10mL of saline
hyperventilate for 30 sec

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Cuff pressure is directly related to

capillary pressures

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Cuff pressure (mmHg)

20 -25 mmHg

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Cuff pressure (cmH2O)

25-35 cm h2o

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Most serious complication of intubation

Laryngospasm

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Succinylcholine is a

neuromuscula blocking agent

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is indicated if the larynx is in an anterior location or pt is at risk of aspiration

Sellick maneuver (Cricoid pressure)

Blade that fits into valecular

Macintosh

Blade that directly raises epiglottis

Macintosh

blade that fits directly UNDER the epiglottis

Miller

Blade size for adult Blade size for pediatric Blade size for term infant blade size for pre-term infant

size 3 size 2 size1 size 0

ET Tube size for Adult Males

8.0-8.5 mm

ET Tube size for Adult Females

7.0-7.5mm

ET tube size for Pre-term infants

2.5-3.0 mm

ET tube size for Full-term infant

3.0-3.5

# Tube distance marking oral intubation

21-25 cm mark at pt's lips

# Tube distance markings nasal intubation

26-29cm marked at patient nare

oral ETT inserted >25cm | what do you recommend?

right mainstem bronchus intubation withdrawal of endotracheal tube to proper position 21-25cm at lips

Tubes to prevent VAP

(CASS) continous aspiration of subglottic secretions tube

explain CASS | continous aspiration secretions tubes

Continuous suction is provided via separate tube connected to a cacuum pressure of 20mmHg

Double-lumen ET tube is also called

* Edobronchial tube * Carlen's tube

how do you confirm a Double-lumen ET tube placement

the cuff has a radiopaque line that confirms placement

Double-lumen ET tube has two cuffs..

* one cuff is a low pressure, high volume cuff * The other cuff is smaller and a high pressure, low volume cuff

indications for Double-lumen ET tube

* Unilateral lung diseases ventilation * Independent lung ventilation * Bronchopleural fistula * privide airway protection to the unaffected lung

example of a supraglottic airway

Laryngeal Mask airway (LMA)

Laryngeal Mask airway (LMA) is positioned ...

directly over opening into the trachea (hypopharynx)

Contraindication of Laryngeal Mask airway (LMA)

risk of aspiration

indicated for short term ventilation and when intubation is not possible by the oral or nasal route

Laryngeal Mask airway (LMA)

Small diameter semi-flexible tube | Acts as a sylet

Gum elastic bougie

difference between Airway exchange catheter and Gum Elastic Bougie

AEC allows oxygenation and ventilation GEB does not

Another term for stridor

Laryngeal edema

Severe respiratory distress and /or Marked inspiratory stridor | Management

Reintubate

Mod distress/ stridor | management

* oxygen * cool mist aerosol * racemic epinephrine * heliox therapy

Mild distress/stridor Sore throat

* provide humidity, oxygen and/ or racemic epi as necessary

# Other post-extubation complications caused by chronic inflammation

vocal cord polyps

# Other post-extubation complications torn mucosa, does not require reintubation

Mucosal ulceration

# Other post-extubation complications softening or dilation of tracheal carilage

Tracheomalacia

# Other post-extubation complications gradual obstruction (narrowing) that occurs with healing causing stridor

Tracheostenosis

RT's role in Tracheostomy procedure

1. maintain airway, provide ventilation, 2. stabilize trache tube

Trach cuff sould be inflated whenever:

* pt is eating * pt is on positive pressure ventilation

Trach should be changed if

* Tube is obstructed * Tube too small * Punctured cuff

clean stoma with...

hydrogen peroxide

What can you apply to a stoma

sterile dressing and/or antibiotics

# Trach tube Have opening in outer cannula above the cuff

Fenestrated tubes

Fenestrated tube allows

the pt to breath through upper airway and speak when the tube is plugged | deflate cuff and take out inner cannula

Rigid platic tube about 1 inch in length that can be placed in stoma after trach tube is removed

Tracheal button

tracheal speaking devices | describe

one way valve-that attaches to trach tube

How does Tracheal speaking device work?

Inspiration: valve opens and air enters Expiration: valve closes and air passes around cuff and thorugh vocal cords Cuf must be deflated

Laryngectomy

removal of the larynx no longer any connection between the pt's upper and lower resp tract

Performed to treat upper airway carcinoma

Laryngectomy

made of soft pliable material

Laryngectomy tubes

Do Laryngectomy tubes had an inflatabel cuff?

Vacume regulator pressure: Adult

120-150 mmhg

Vacume regulator pressure: Child

100-120 mmhg

Vacume regulator pressure: Infant

80-100 mmhg

a close system or inline suction catheter | name

Ballard | allosw ventialtion and oxygenation during suction

ideal catheter length

20-22 inches

oral suction device | name

Yankauer / Tonsil suction device

catheter size equation

(ID/ 2) x3

used to collect sputum speciment

Lukens trap / sterile suction trap

how to place a Lukens trap

in the upright position between the suction catheter and the suction tubing

Coudé tip catheter | use

angled to help suction the LEFT main stem bronchus

Suction catheter should be in the airway no longer than

15 sec

Extended Trach tube is recomended for

patients who are obese or use cervical collars

Metal trach tube, comes with inner cannula

Jackson trach tube | not for resuscitation or positive pressure ventilation

technique for inserting a nasopharangeal airway

same direction of its shape , without rotation

technique to insert an oralpharangel airway

insert opposite of its anatomic shape (upside down) to back of throat and then rotate into the correct position (180 or 90 degrees)

requires compressed gas source to operate

flow inflating resuscitation bag

if ETT cuff needs more than 25mmhg pressure recommend ..

changing the tube o a larger one

if unable to pass a suction catheter recommend

removing the tube, ventilate and insert a new tube