Airway Care Flashcards
Which pharyngeal airway is indicated for conscious patients, facilitates deep tracheal suctioning, and is used to decrease trauma during nasotracheal suctioning?
Nasopharyngeal
Which pharyngeal airway is indicated for unconscious patients, can be used as a bite block, and can facilitate oral suctioning?
Oropharyngeal
What is the most common complication of a nasopharyngeal airway?
Trauma to mucosa
What is epistaxis?
Nasal bleeding
What are five purposes for endotracheal intubation?
- Provide a patent airway
- Access for suctioning
- Means for mechanical ventilation 4. Protect the airway
- Direct instillation of medication
What are the medications that can be directly instilled through an ET tube?
Hint: ALIEN V
Atropine (bradycardia) Lidocaine (PVCs) Isuprel (bradycardia) Epinephrine (asystole) Narcan (drug overdose) Valium/Versed (sedative)
How should an RT respond to an ET Tube by-passing the normal filtration, humidification and warming mechanisms?
Provide adequate humidity
How should an RT respond to an ET Tube disrupting the mucus transport system?
Suction PRN
What is the most serious complication of intubation?
Laryngospasm
What are some complications of intubation?
Infection, right mainstem bronchus intubation, VAPs
When it comes to assessment if tube position, what is involved with inspection?
Looking for bilateral chest movement during inspiration
When it comes to assessing correct tube position, what is involved in auscultation?
Breath sounds should be heard in both sides of the chest
Why are Chest X-Rays good for assessment of correct tube position?
The radiopaque line on the endotracheal tube can be easily visualized to assess placement
What is the correct sequence for assessment of tube placement?
Inspection of chest movement
Auscultation for breath sounds
Capnography or CO2 detectors
Chest X-Ray
With Tube Maintenance, what helps maintain patency?
Suctioning
What is the best way to prevent obstruction when it comes to tube maintenance?
Humidification (100% Humidity @ 37 Celsius)
How should an RT troubleshoot a laryngoscope if the light does not work?
- Tighten Bulb
- Check handle attachment
- Change blades
- Check batteries
What equipment is only used for nasal intubation?
Magill Forceps
What equipment is used only for oral intubation?
Stylet
Where should the ET Tube be at the patient’s lips/teeth?
Approximately between 21-25 cm mark
Which special tube can be indicated for independent lung ventilation, unilateral lung diseases, and surgery?
Double-lumen endotracheal tube or Carlen’s Tube
How can an RT replace a Laryngeal Mask Airway (LMA) with an endotracheal tube?
A standard endotracheal tube can be inserted directly through the LMA into the trachea if necessary
What level of vacuum pressure is applied to the Hi-Lo Evac/ CASS tubes?
20 mm Hg
In extubation, what helps prevent vocal cord damage?
Removing the tube at peak inspiration
What is the management response for a patient that shows Mild distress/stridor and a sore throat?
Provide humidity, oxygen and/or racemic epinephrine as necessary
What is the management response for a patient that shows moderate distress/stridor?
Oxygen, cool mist aerosol and racemic epinephrine to reduce swelling
Why might an RT reintubate a patient after extubation?
Observed severe respiratory distress and/or marked inspiratory stridor
What causes vocal chord polyps?
Chronic inflammation
What causes mucosal ulceration?
Torn mucosa
Does mucosal ulceration require reintubation?
No
What is the name for a softening or dilation of tracheal cartilage?
Tracheomalacia
What is the name for a gradual obstruction (or narrowing) of the trachea that occurs with healing?
Tracheostenosis
Which post-extubation complication causes stridor?
Tracheostenosis
When is tracheostomy preferred over endotracheal tube intubation?
Long-term ventilation
What circumstances should the tracheostomy tube cuff be inflated?
Eating and positive pressure ventilation
If the suction catheter is unable to pass, what should the RT do?
Remove the tube, ventilate, and replace with a new tube
What kind of tracheostomy tube is recommended for weaning and temporary ventilation?
Fenestrated
What is the purpose of the tracheal button?
Used to maintain the stoma
In what circumstances is an extended tracheostomy tube indicated?
Obese patients or those that use cervical collars
What is the procedure that disrupts the connection between the upper and lower respiratory tract?
A laryngectomy
What is the purpose of bronchial hygiene therapy?
To improve mobilization of secretions, prevent accumulation of secretions, improve ventilation
What are the hazards and contraindications of bronchial hygiene therapy?
Unstable cardiovascular system, unstable pulmonary system, unstable post-operative status, untreated tuberculosis
What is the result of stimulation of the Alpha Receptors?
Vasoconstriction of arterial smooth muscle
Which type of medications elicit the alpha response?
Blood pressure medications
What is the result of stimulation of the Beta 1 response?
An increase of the rate and strength of contractility of the cardiac muscle.
What kind of medications elicit the Beta 1 adrenergic response?
Cardiac drugs
What is the result of the stimulation of the Beta 2 Adrenergic response?
Bronchodilation and a weak vasodilation effect
Which kind of drugs elicit the Beta 2 Adrenergic response?
Respiratory medications
What is the formula to calculate how man mg are in a medication solution?
(Drug % x 10) dosage = number of mg of drug
Example of Dilution calculation:
How many mg are in 20 ml of a 0.5% solution of Albuterol?
100 mg of Albuterol
The RT is to administer 2.5 mg of Albuterol. The medication is available in a 0.5% solution. How many ml of Albuterol should be administered?
0.5 ml of Albuterol
What kind of Beta 2 Adrenergic medications are theophylline (aminophylline) and caffeine examples of?
Methylxanthine drugs
Flovent (Fluticasone), Qvar (Beclomethasone), Pulmicort (Budeniside), Aerobid (Flunisolide), Azmacort (Triamcinolone) and Prednisone are examples of what kind of drug?
Corticosteroids
What are two examples of corticosteroids that do not end in the suffix -one?
Budesonide (Pulmicort) and Flunisolide (Aerobid)
What antibiotic is used to treat oral candidiasis (thrush)?
Antifungal Agent Nystatin
What is the best way to control secretions?
Good hydration
What is the primary action of acetycysteine?
Dissolves disulfide bonds
Which mucolytic drug is recommended for Cystic Fibrosis?
Pulmozyme
What are two examples of cardiac glucosides?
Digitalis and digitoxin
Which conditions are cardiac glycosides used to treat?
Treatment of CHF, atrial tachycardia and fibrillation
What are two drugs used to treat atrial arrhythmias?
Quinidine and propranolol
Which two anti-arrhythmic agents are used to treat ventricular arrhythmias?
Lidocaine and amiodarone
Which two drugs are used to treat bradycardia?
Atropine and epinephrine
What purpose are vasodilator drugs used for?
Decrease blood pressure
What vasodilator drug is used for hypertension?
Sodium nitroprusside (Nipride)
What vasodilator drug is used to treat hypotension?
Dopamine
What is the effect of Sodium Nitroprusside (Nipride)?
Decreases blood pressure
What is the effect of Dopamine?
It’s used to increase blood pressure
Which diuretic can be used for pulmonary edema, liver and kidney disease, and CHF?
Furosemide (Lasix)
What are the indications for the use of sedatives?
Manage fear and anxiety, increase comfort while receiving mechanical ventilation, and induce sleep
What are two examples of anesthetics used for critically ill patients?
Propofol (Diprivan) and Ketamine (Ketalar)
What are two examples of narcotic analgesics?
Morphine and fentanyl
What is the difference between anesthetics and analgesics?
Anesthetics reduce a patients ability to perceive sensations whereas analgesics reduce sensation to pain
