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NPS Kettering Workbook > Airway Management > Flashcards

Airway Management Flashcards

1
Q

Indications for OPA

A

Unconscious pt
Support base of tongue
Bite block
Facilitate oral sx
Facilitate bag/mask ventilation

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2
Q

Indications for NPA

A

Conscious pt
Support base of tongue
Facilitate/decrease trauma in NT sx
Pierre robin syndrome
Following ENT surgery

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3
Q

How should the NPS respond if a child with an OPA begins to gag?

A

Remove, airway, suction, give oxygen

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4
Q

How should the specialist prevent mucosal trauma while inserting NPA?

A

Water-soluble lube

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5
Q

How to determine correct size in OPA

A

Angle of jaw to corner of mouth

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6
Q

How to determine correct size of NPA

A

Earlobe to tip of nostril

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7
Q

Describe technique of inserting OPA

A

Insert upside down to back of throat then rotate to correct position

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8
Q

Why are uncuffed tubes typically used in infants and children under 8 y/o?

A

Narrowest part of aw is the cricoid cartilage in infants, tube secures itself

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9
Q

5 indications for intubation

A

Maintain patent aw
Access for sx
Provide mechanical ventilation
Protect airway
Administer meds

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10
Q

How to pre-oxygenate neonates prior to intubation

A

Adjust FiO2 to maintain target SPO2

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11
Q

How to pre-oxygenate peds prior to intubation

A

100% for 5 minutes

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12
Q

Recommend medications for intubation

A

Sedatives: -lam, -pam
Neuromuscular blockade: succs, vec

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13
Q

Patient placement during intubation

A

Supine in sniffing position

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14
Q

Avoid _______ in positioning the head of neonates and infants during intubation

A

Hyper-extension

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15
Q

Miller blade is preferred in what population?

A

Neonates

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16
Q

What is indicated if the vocal cords are not easily visualized?

A

Cricoid pressure (sellick meneuver)

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17
Q

Uncuffed tube placement procedure

A

Vocal cord guide at level of vocal cords, halfway between vocal cords and carina (Middle third of trachea)

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18
Q

Cuffed tube placement procedure

A

Below vocal cords, 1-2cm above carina (middle third of trachea)

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19
Q

Used to guide nasal intubation

A

Magill forceps

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20
Q

How to confirm tube placement

A

Look, listen, capnograph/CO2 detector
Best: CXR

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21
Q

How often should cuff pressure be measured

A

Every 8 hrs

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22
Q

Methods for measuring cuff pressure

A

3-way stopcock, pressure manometer, cufflator

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23
Q

Cuff pressure should not exceed

A

20 cmH20

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24
Q

If the cuff pressure exceeds 20cmH20, the NPS should consider

A

A bigger tube

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25
Q

Describe MLT

A

Slight leak during peak inspiration

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26
Q

When should the ETT be replaced?

A

Unable to pass sx catheter
Cuff pressure >20
In uncuffed: ventilating pressure exceeds 20cmH20 without an air leak
Unable to add air to cuff

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27
Q

Items required for intubation

A

Blade
Correct size tube and one smaller
Laryngoscope
Bag

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28
Q

What should the NPS do if the laryngoscope light doesn’t work?

A

Tighten bulb
Switch blade
Check batteries

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29
Q

3 laryngoscope visualization devices

A

Flexible fiberoptic laryngoscope
Lighted stylets
Video laryngoscope

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30
Q

Tube size/laryngoscope size:
<1000g <28wk GA

A

2.5/miller 00

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31
Q

Tube size/laryngoscope size:
1000-2000g 28-34wk GA

A

3.0/miller 0

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32
Q

Tube size/laryngoscope size:
2000-3000g 34-38wk GA

A

3.5/miller 0

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33
Q

Tube size/laryngoscope size:
>3000g >38wk GA

A

3.5-4.0/miller 1

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34
Q

Insert ETT to (cm):
23-24wks 500-600g

A

5.5

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35
Q

Insert ETT to (cm):
25-26wks 700-800g

A

6.0

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36
Q

Insert ETT to (cm):
27-29wks 900-1000g

A

6.5

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37
Q

Insert ETT to (cm):
30-32wks 1100-1400g

A

7.0

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38
Q

Insert ETT to (cm):
33-34wks 1500-1800g

A

7.5

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39
Q

Insert ETT to (cm):
35-37wks 1900-2400g

A

8.0

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40
Q

Insert ETT to (cm):
38-40wks 2500-3100g

A

8.5

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41
Q

Insert ETT to (cm):
41-43wks 3200-4200g

A

9.0

42
Q

What types of tubes are typically used in children<= 8y/o

A

Uncuffed

43
Q

What types of cuffs should pediatric pts have?

A

Low pressure, high volume floppy cuffs

44
Q

Cuff pressure should not exceed

A

20cmH20

45
Q

Laryngoscope blade, ETT size, and sx catheter size:
6mos

A

Miller 1, 3.5, 8Fr

46
Q

Laryngoscope blade, ETT size, and sx catheter size:
1yr

A

Miller 1, 4.0, 8Fr

47
Q

Laryngoscope blade, ETT size, and sx catheter size:
2yr

A

Miller 2, 4.5, 10Fr

48
Q

Laryngoscope blade, ETT size, and sx catheter size:
4yr

A

Miller 2, 5.0, 10Fr

49
Q

Laryngoscope blade, ETT size, and sx catheter size:
6yr

A

Miller 2, 5.5, 10Fr

50
Q

Laryngoscope blade, ETT size, and sx catheter size:
8yr

A

Miller 2/mac 2, 6.0, 10Fr

51
Q

Laryngoscope blade, ETT size, and sx catheter size:
10 yr

A

Miller 3/mac 3, 6.5, 12 Fr

52
Q

Laryngoscope blade, ETT size, and sx catheter size:
12 yr

A

Miller 3/mac 3, 7.0, 12 Fr

53
Q

Laryngoscope blade, ETT size, and sx catheter size:
>12yr

A

Miller/mac 3, 7.0-8.5, 12 Fr

54
Q

Formula to calculate tube size

A

(Age + 16) / 4

55
Q

Formula to calculate tube length/insertion depth

A

Tube size x 3

56
Q

If ETT is too small:

A

Increased airway resistance
Poor seal for ventilation, large leak

57
Q

If ETT is too large:

A

Decreased perfusion to airway wall
Necrosis/stenosis
No air leak heard at high ventilating pressures (>30cmH20)
Vocal cord damage

58
Q

3 objectives for tube maintenance

A

Adequate humidity
Suction to maintain patent aw
Use MLT

59
Q

Sudden deterioration of intubated child could be from

A

Displacement
Obstruction
Pneumothorax
Equipment failure

60
Q

Indications for LMA

A

Short term ventilation
Difficult aw
Aw management prior to hospitalization

61
Q

Where in the pharynx should the LMA be placed

A

Above epiglottis

62
Q

How should the NPS place the ETT when an LMA is present?

A

Through LMA lumen

63
Q

What conditions indicate that the patient is ready for extubation

A

Stable ventilation and oxygenation
Hemodynamically stable
Adequate SBT
Minimal vent settings
Able to protect airway
Positive leak

64
Q

At what point in the respiratory cycle should the ETT be removed

A

On inspiration

65
Q

What to do if severe respiratory distress and/or marked inspiratory strider occurs post-extubation?

A

Reintubate

66
Q

What to do if moderate distress/stridor occurs post-extubation

A

Give oxygen
Cool mist aerosol/racemic
Steroids/heliox

67
Q

What to do if mild distress/stridor occurs post-extubation

A

Provide humidity/oxygen as necessary

68
Q

Strategies to prevent VAP

A

Handwashing
Oral care
HOB 30-45 degrees
Minimize intubation time (daily SBT/NIV)
Gentle suctioning
Vent circuit care (in-line sx, drain, etc)
MDI
Hi-lo

69
Q

3 indications for tracheotomy

A

Long-term intubation
Upper airway obstruction prevents intubation
Ongoing need for pulmonary hygiene

70
Q

5 advantages of tracheostomy

A

Easier to stabilize, suction, tolerate
Pt can eat
Pt can talk
Provides for long-term ventilation
Fewer hazards/less airway resistance than ETT

71
Q

Immediate complications of trach

A

Bleeding
Pneumo
Air embolism
SubQ
Inadvertent decan

72
Q

Later complications of trach

A

Infection
Hemorrhage
Obstruction
TE Fistula
Accidental decan

73
Q

Advantage of fenestrated trach

A

Weaning, speaking

74
Q

When should a tracheal button be recommended?

A

Maintain stoma

75
Q

When should a trach tube be changed out?

A

1 week post op
Every 1-2 weeks

76
Q

When the trach tube cuff should be inflated

A

During eating
On PPV
Low Vte alarm

77
Q

Factors increasing risk of unplanned extubation/decan

A

Improperly secured
Misplaced ETT
Lack of adequate sedation
Lack of restraints
Procedures

78
Q

Equipment readily available for re-insertion of tube

A

Manual bag/mask
Oxygen
Sx
Laryngoscope
Replacement tube (same size and one smaller)

79
Q

Conditions that may increase the difficulty of endotracheal intubation

A

Craniofacial syndromes
Orofacial trauma
Airway infections (epiglottitis)
LT stenosis/obstruction

80
Q

3 methods to managing difficult airway

A

LMA
Flexible fiberoptic intubation
Laryngoscope visualization devicesh

81
Q

How many attempts allowed for intubation?

A

3

82
Q

ETT insertion procedures requiring physician

A

Retrograde intubation
Cricothyrotomy
Emergency trach

83
Q

3 purposes of suctioning

A

Maintain patent aw
Stimulate cough
Specimen collection

84
Q

Four indications for suctioning

A

Accumulated secretions
Obstructed airway
Depressed cough
Inability to swallow

85
Q

Mos common hazard of suctioning

A

Trauma to mucosa

86
Q

Most severe hazard of suctioning

A

Bradycardia

87
Q

When is the catheter advanced during NT suctioning?

A

During inspiration

88
Q

When suctioning mouth and nose, which comes first?

A

Mouth

89
Q

What FiO2 should be used when suctioning neonates? Peds?

A

Increase by 10-20%
100% for 1-2 minutes

90
Q

Vacuum pressure range for neo and peds

A

60-80mmHg
80-100mmHg

91
Q

Vacuum pressure should be measure with tubing ____

A

Occluded

92
Q

What happens to the vacuums pressure when the suction collection bottle is full?

A

Shuts off

93
Q

Formula to determine catheter size

A

(ID of tube/2) x 3

94
Q

How many openings should there be on standard suction catheter?

A

2

95
Q

Purpose of the coude catheter

A

Angled to help suction left mainstem

96
Q

Indications for closed/in-line catheters

A

High oxygen/PEEP
Infection
Frequent suctioning
Reduce VAP
Hemodynamic instability

97
Q

Time limit for sx catheter in aw

A

10 sec

98
Q

Time limit for sx applied

A

5 sec

99
Q

Purpose of bulb suction device

A

Safest way to clear oropharynx

100
Q

Purpose of oral suction device

A

Suction mouth and throat

101
Q

Vacuum pressure for meconium aspirtator

A

80-100

NPS Kettering Workbook (8 decks)

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