Airway management Flashcards
What is an ABG?
Arterial blood gas; invasive
What is a noninvasive method of obtaining CO2 status?
End-tidal CO2
Normal Range of End-tidal CO2
35-45
A most important way to tell if a patient is going into respiratory distress?
If they change from baseline, KNOW YOUR TRENDS!!!
What is colorimetric?
an inexpensive alternative to capnometry
What does colorimetric paper turn if the CO2 is not detected or is low?
Purple
Remember PURPLE=PROBLEM
what does the colorimetric paper turn if the CO2 is adequate?
Yellow
REMEMBER YELLOW=YES
and it should be from 35-45 to turn yellow.
What is capnometric?
the numeric reading of CO2 level
What is Capnographic?
Includes numeric and waveforms to visualize and detect CO2 levels
What is a filterline?
A nasal cannula with a bulb at the end to detect CO2 levels can deliver up to 5 liters of oxygen
What should you do before calling the doctor if the patient’s sats are off on a filterline?
Check the tubing for occlusion or blockage
When do we use ETCO2?
in patients with sleep apnea
in patients on PCA pumps
Patients receiving procedural sedation
will you get an ETC02 reading on a patient that is coding?
NOOOOOO
the patient is temporarily (or permanently) dead, therefore they have no perfusion, which means no oxygen is perfusing throughout the body.
causes of low ETC02?
- Pulmonary embolism
- DKA
- Respiratory conditions ( COPD….etc)
Why would a pulmonary embolism cause low ETC02?
this means there is a blocked pulmonary artery which causes less C02 rich blood to return to the lungs, therefore less c02 is exhaled.
why would DKA cause low ETC02?
DKA presents with rapid and shallow breathing, difficulty breathing, and low ETC02 as the body tries to compensate. Respiratory compensation for this acidotic condition results in Kussmaul respirations and this causes the acidosis to become more severe.
signs and symptoms of a PE?
SOB, Chest pain, SOA, anxiety, sense of doom
What intervention can be used in between needing a ventilator
BiPap can be used in the meantime!
Why does respiratory failure occur with a high ETC02?
increased effort to breathe doesn’t eliminate the excess C02, causing C02 to accumulate in the lungs and more of it is excreted with each breath, causing the ETC02 level to rise.
What can increased work of breathing and C02 retention lead to?
respiratory arrest and assisted ventilation
What is the best way to prevent respiratory arrest?
Continue to monitor!!!
The earlier you catch this, the better off the patient will be!!!!!
Causes of elevated EtC02?
Metabolism: Pain, Hyperthermia, Shivering
Respiratory: Insufficiency, Depression, COPD, Analgesia and sedation
Circulatory: Increased Cardiac output
Medications: Bicarbonate administration
Causes of decreased EtC02?
Metabolic: Hypothermia, Metabolic acidosis
Respiratory: Alveolar hyperventilation, bronchospasm, and mucus plugs
Circulatory: Hypotension, sudden hypovolemia, cardiac arrest, and pulmonary emboli
True or False? EtC02 is a noninvasive method, which continuously monitors inhaled C02 concentration?
FALSE
It is a non invasive method; but it measures exhaled C02, not inhaled.
What is the most common ET tube size?
7.5 and 8.0
What are the 2 places ET tubes can be placed?
Nose and Mouth
Why would the nose be used instead of the mouth?
if there is trauma to the mouth
Indications for endotracheal intubation?
Maintains airway patency Manage the airway Deliver high percentage of oxygen Bypass an obstruction protect airway from aspiration alternative route for meds
What meds can be used through the endotracheal route?
N-Narcan (opioid displacement)
A:Atropine (Increase HR with symptomatic bradycardia)
V: Vasopressin (Increase HR and BP, vasoconstrict)
E: Epinephrine (Increase HR and BP and vasoconstrict)
L: Lidocaine (rate control and heart support)
When do you sedate the patient for an ET insertion?
If the patient is awake, and not unconscious
What is the best way to prepare for intubation?
KNOW THE SIGNS OF RESPIRATORY DISTRESS AND ACT BEFORE IT GETS TO THIS POINT
What is a RSI?
rapid sequence intubation; when they push the paralytic and intubate at the same time
When can a RSI not be done?
with a patient that is comatose or in cardiac arrest
Why is a RSI performed?
Decreases risks of aspiration, combativeness, and injury to the patient
What is the Train Of Four?
delivers electrical impulse to the radial or temporal artery, this is done to check for effectiveness of the paralytics.
what is the goal for a Train of Four?
2 of 4 is the goal; The artery will flicker twice if effective.
When do we use the temporal artery instead of the radial for the Train of Four?
If the Radial doesn’t work.
What does a high train of four indicate?
That the paralytic is not strong enough
What does a low train of four indicate?
that the paralytic is too strong
What is the most common sedative used?
Midazolam (versed)
Why are paralytics used for intubation?
to prevent the patient from being combative, bucking the vent, pulling the ETT and increases the ease of ventilation
Examples of paralytics?
Succinylcholine, Vecuronium, Mivacurium, Rocuronium, Pancuronium, Curare
How long do you ventilate before ET placement?
100% 02 for 3-5 minutes
what is the longest an intubation attempt should last?
30 seconds MAXIMUM
How to confirm ET placement?
XRAY
Why is C02 not detected during cardiac arrest?
There is no perfusion
How can you tell if the tube has gone in the right main stem?
Not bilateral lung sounds
can you get a false positive on a Colorimetric detector?
Yes, if there is the presence of gastric acid, and acidic drugs, such as trach administered epinephrine, it can give a false positive.
why is incorrect tube placement considered an emergency?
The patient is not ventilating
Nursing management related to incorrect placement
Stay with pt and maintain airway ( BVM 100% 02), Support ventilation, prepare for reintubation, monitor VS, EKG, and pulse ox
What do we chart as the nurse?
cm of placement at a landmark (ex. 38cm at lip) and size of tube (ex. 8.0 French)
Complications of intubation?
Injury to the lips, teeth and oropharynx, vocal cords; vomiting and aspiration, trigger of the vagus nerve causing bradycardia, esophageal intubation, right main stem intubation
Where should the ET be placed?
3-5cm above the carina
NSG management related to ET cuff
maintain proper cuff inflation
Stabilize and seals ET within trachea
prevent escape of vent gases
cuff can cause tracheal damage from pressure on mucosa
how to prevent tracheal trauma from ET cuff?
measure and record ET cuff pressure
IF IN DOUBT CALL RT!!!!!!!!!!
When do you suction?
when secretions are visible, mouth is full, or decrease in 02!
Why do we not suction unless absolutely necessary?
can alter the ABG, cause the pt extra stress
Indications for suctioning?
Visible secretions, sudden onset of respiratory distress, potential aspirations of secretions, increase in peak airway pressures alarming, auscultation of extra breath sounds over trachea and bronchi (fluid buildup in lungs), increased RR, and coughing, drop in Pa02 or SP02.
complications r/t suctioning
hypoxia, bronchospasm (coughing), increased ICP, dysrhythmias, PVCs, Hyper or hypotension, mucosal damage, bleeding, infection
technique for suctioning?
hyperoxygenate before and after each suctioning pass insert catheter the length of the tube limit each pass to 10 seconds or less assess trends in SP02 limit pressures to 120mmHG or less avoid vigorous catheter insertion
Indications for suctioning?
visible secretions, decrease in 02, bucking the ventilator
How to prevent Ventilator Associated Events (VAE)?
- Q2H oral care
- DVT prophylaxis (heparin, lovenox (SQ or drip))
- Gut feedings
- Elevating HOB (30 degrees)
- handwashing and gloving
- prevention of pressure ulcers.
ET med dosage?
2-2.5 times higher through the ETT, mixed with NS, followed by 1-2 ventilations/
preferred route for NAVEL medications?
IV and IO
Liters used on Nasal Cannula?
1-6 liters/min delivering 25-45% 02
Liters used on Simple Face Mask?
6- 10 Liters/min delivering 35-60% 02
Liters used on nonrebreather mask?
10-15 L/min delivering up to 100% 02
liters used on venturi mask?
4-8 l/min delivering 24-60% oxygen
