Airway Final Flashcards
Under what circumstances will some form of airway control always be required?
Situation where the patient cannot adequately Ventilate themselves.
- unconscious
- airway obstruction from tongue
List for possible causes of respiratory failure
- tongue blocking airway
- airway edema
- airway inflammation disease
- CNS depression
List five possible signs or symptoms of respiratory failure
- inability to cough
- increased RR
- cardiac arrest
- fatigue
- SOB
What is the most common cause of airway obstruction?
Tongue blocking the airway
Name an indication for the use of oral pharyngeal airway or OPA
Unconscious patient
List for possible complications for using an OPA
5 are listed
- Does not protect from vomit
- Too long an OPA can occlude the trachea by hitting the larynx
- too short an airway can push the tongue back
- laryngospasm
- soft palate injury
How does the oropharyngeal airway help maintain the airway?
- By lifting the tongue and putting it out of the way
- air is also fed through the berman channels or Gudel hole
What are the two types of oropharyngeal airways?
As well as their differences
Guedel - center hole
Berman - side channels
How do you measure if oropharyngeal airway has proper fit?
Measure from mouth to jawline
What are the five steps to insert an oropharyngeal airway?
- use head neck chin lift to move tongue forward
- insert OPA in reverse
- feed into mouth till resistance is met
- then rotate it 180 degrees and advance till its sitting above the teeth
List 2 indications for the use of nasopharyngeal airways
Frequent suctioning
Semi conscious patient
List four possible hazards of using Nasopharyngeal airway
Nasal trauma
Gastric inflation
Infection
Laryngospasm
How do you measure proper size for nasopharyngeal airway?
Measure from the nose to the tragus
What is the major function of an esophageal obturator airway?
Tube with cuff plugs that esophagus and prevent aspiration into the airways.
But still has a ventilation holes on the tube
What are three indications for the application of an esophageal obturator airway
Possibility of aspiration
Unconscious patient
Short-term ventilation while making plans for intubation
What are five contraindications for the use of an esophageal obturator airway?
- Patients were less than 5 feet tall
- Conscious or semi conscious patients
- Upper airway trauma
- Known esophageal damage
What are three possible complications that may result from inappropriate use of the esophageal obturator airway?
- intubation of the trachea
- gastric rupture
- not securing a tight mask fit can lead to improper ventilation
How long you can use and esophageal obturator for?
1-2 hours
Describe the difference between the esophageal obturator and the esophageal gastric tube airway
-The esophageal gastric tube airway has a port for you to suction gastric contents
What are the steps to correctly insert and esophageal obturator airway
(10 steps)
- Assure patient ventilation with OPA
- check balloon
- assemble mask
- lube it
- lift chin and position head
- insert mask till you seal the face
- seal mask and ventilate
- look for chest rise
- inflate balloon
- auscultation and evaluate respirations
Where should a properly inserted tip of an esophageal obturator be positioned?
In the esophagus
What is the advantage of a Combitube over and esophageal obturator?
Insertion of the tube in either the trachea or the esophagus will allow you to ventilate the patient
What is the greatest complication in using a Combitube?
Not identifying where you inserted the tube and what adapter you should be ventilating with.
What special skills and abilities are required to perform airway control?
Knowledge of respiratory anatomy
Teamwork
When inserting a Combitube how would you know that you inserted a tube into the esophagus or the trachea?
Ventilating from the blue or the first port causes a chest rise and breath sounds indicates you inserted the tube into the esophagus.
- if not ventilate on the second port and recheck for breath sounds because it looks like you into intubated the trachea
When properly position where is a laryngeal mask airway located?
In the hypopharynx right over the trachea
List three possible complications associated with the placement and use of the laryngeal mask
Biting
Wrong size
It can fold on to itself and occlude airway
What is the maximum amount of airway pressure that you can use with and laryngeal mask airway?
What are the benefits of using an LMA over other forms of airway control
Less irritating to the airway
Easier to install compared to endotracheal tube
What does z-79 indicate on the tube?
That it was made with material that has passed the tissue toxicity test
List four advantages of endotracheal tube application
- Protection of airway from vomit
- Long-term placement
- Deep tracheal suctioning with high low tube
- Can be used for drug administration
What is an anode tube?
An endotracheal tube reinforced with wire for stability
What is a Rae tube?
Pre-shape tube that is out-of-the-way from Mouth so doctors can work on that area during surgery
What is a cole tube?
A tapered tube with no cuff for pediatric patients
What is a lindholm tube?
A specially shaped tube for difficult intubation
What is a carlens tube?
Tube designed to be able to ventilate specific bronchioles
What is a lanz tube?
Self inflating pressure cuff
What is pressure necrosis? And how was it managed
- A cuff pressure that is set so high that it cuts off circulation and causes tissue necrosis
- you can manage it by only using minimum occlusion pressure
What is a stylet?
Rod use for stability during insertion of endotracheal tube
What is a bogie?
Rod used as a guide for your ET tube to go into the trachea
Or tube exchanger
What is a cuff manometer?
Instrument used to measure cuff pressure
What is a subglottic evacuation tube and what is its purpose in airway control?
A tube used for subglottic suctioning of material that builds up above and below the cuff to reduce Vap
What is minimal leak and minimal pressure with regards to ET tube cuff control?
It’s a technique to fill the cuff with as little pressure as possible but maintaining positive pressure ventilation.
-fully inflate the cuff, then slowly deflate it till you hear gurgling, then very slowly inflate till the first moment you don’t hear any gurgling.
What is the ideal of pressure and how is it measured?
Using a cuff manometer,
Ideal pressure is 20-24 mmHg or 25-35 cm H20
5 ways you can tell if you correctly placed the endotracheal tube?
- auscultations
- chest rise
- x-ray
- end tidal Co2 detector
- bulb
List possible complications associated with endotracheal intubation
There are 10 in the answers
-esophageal intubation
-bronchial intubation
Aspiration
Bronchospasm
Trauma to the vocal cords
Cuff failure
Cardiac Dysrhythmia
Hypoxemia
Trauma to the lip, Eyes, teeth
Hypotension
List five indications for necessity to intubate
Respiratory failure CNS depression Poor arterial blood gases Airway protection Positive pressure ventilation
Name the six drugs that can be administered through the ET tube
Alien v Atropine Lidocaine Isuprel Epinephrine Narcan/naloxone Valium
List five conditions that might give potential complications during intubation
Facial trauma Combative patient Equipment failure Vomit Abnormal anatomy
What is a Macintosh laryngoscope? And when would you use one
It is the curved laryngoscope and you would use it if you wanted to lift off the vallecula
What is the Miller laryngoscope and when would you use it?
It is the straight blade laryngoscope and you would use it if you wanted to pull on the epiglottis
What is the maguill forceps
Used during nasal intubation to guide the tube
What’s the major physiological landmark that must be visualized to perform a successful endotracheal intubation
Vocal chords
Larynx
List ways to check for proper placement of an endotracheal tube
Chest rise and fall Auscultate X-ray CO2 indicator capnography Bulb
How does an end tidal CO2 indicator work?
During ET tube intubation, what readings will you get?
Litmus paper will change color when exposed to CO2 levels
If you are in the trachea it will change color to show CO2 because it won’t change if it’s in the esophagus
What is procedural sedation and what drugs are typically used?
It prevents patients from having normal protective reflexes
Valium & versed
What are the anatomical landmarks to indicate proper location to perform the crycoidtherotomy?
In between the thyroid cartridge and cricoid cartilage.
On the Cricothyroid membrane
Under what circumstances would an emergency cricoidtherotomy be performed.
3 reasons
Upper airway damage
Uncontrollable emesis
Laryngospasm
How do you ventilate a cricoid tube?
Jet ventilation
List five advantages of a tracheostomy
Airway maintenance for long periods easily replaced Reduces dead space volume More effective for suctioning Improve swallowing
List 10 possible complications associated with tracheostomy
Pneumothorax Infection Permanent scarring Tracheostenosis Ineffective cough Apnea Tracheal fistula
What is a fenestrated tube and what is a good for
Holes on the tube and it improves airflow
What is the purpose and function of the obturator with the tracheostomy tube
When inserting the tracheostomy tube it is used to occlude the distal opening and has a rounded tip for ease of insertion
How long after new tracheotomy tube has been installed may a therapist change it out?
1-2 weeks (new school)
3-4 days (older literature)
What keeps the inflatable call from deflating on it’s own?
Pilot balloon has a one-way valve that prevents it from deflating
If a pilot were to become damaged what could be done to keep the cuff inflated?
You can use the Kelly clap to pinch off deflation and try to repair or replace the pilot balloon
What are the special features of a lanz tube?
Self inflating cuff that fills to 20-25 cm h2o
Name one positive and one negative attributes of using Kamen-Wilkins tube.
Positive - seals airway with minimum occlusion pressure
Negative - can’t use with high pressure ventilation
Why should the inner cannula be in place during suctioning of a fenestrated tube?
Suction catheter can get stuck at fenestration.
When performing a tracheostomy tube plugging with the fenestrated tube special precautions must be followed name three
Deflate the cuff
Remove inner cannula
Clear secretions
When attaching the tracheostomy tube ties how tight or loose should they be?
Loose enough to slip two fingers through
What is cuff herniation and how could it effect ventilation?
Cuff herniations are malformations for over inflation.
It can cause leakages and damage to airway
At what pressure should the tracheostomy tube cuff be maintained?
20-25 mmHg or 25 - 35 cm h2o
List three possible complications of an overinflated cuff
Pressure necrosis
Cuff herniation
Cuff rupture
What are two types of tracheostomy speaking devices?
Trach talk
Paddy-Muir
Besides allowing speech what other physiological functions may be improved using the speaking device
Improved breath support and breathing muscles
List three primary cautions when applying to speaking device
Deflated cuff
Tube small enough to breathe around
Fenestrated tube
List to stoma maintenance devices
Trach button
Montgomery tracheal t-tube
Name two possible serious complications of using tracheostomy button
Impedes respiration if cuff if not deflated
List 10 possible hazards and or complications of suctioning
Hypoxemia Loss of suctioning Mucosal trauma Bronchospasm Infection Pain & discomfort Aspiration Loss of FRC Nose bleed Increased intracranial pressure
What is and are advantages of an angle catheter
Can suction into the bronchioles
What are the advantages of the sleeved catheter?
Infection control
Always ready for suctioning
At what negative pressure is suctioning usually performed
As a general rule suctioning should be limited to what amount of time?
10-15 seconds or less
Why should a patient receive pre-suction ventilation and oxygenation?
To prevent atelectasis and hypoxia due to loss of dead space
What is a vagal response and what are its indicators?
Hypotension and bradycardia
What is the Neo puff used for resuscitation?
Decreases risk for giving ventilation to neonates like to high a tidal volume or pressure
What is a vortran?
Hands-free continuous ventilation that’s attached to a mask
What’s the last step to every intubation?
Auscultation
What is something that you measure right after intubating the patient with regards to tube placement?
The marking on the tooth line to see how far the two goes into the trachea
As well as the position (left, right, middle) on the mouth
What angle of the best is best at preventing VAP?
30 degrees
If the patient has an ET tube and needs to go in to the hyperbaric chamber, what precaution should you take with regards to the cuff?
Filling the cuff with water because the pressure will pop the cuff if it’s filled with air
