Airway Management Flashcards
What are the 2 types of artificial airways and when is each used?
1) Endotracheal Tube (ETT) - Used if artificial airway will be required for 10 days or less.
2) Tracheostomy - Used if patient will be incubated for 21 days or more.
Why is the patient with an altered LOC at risk for upper airway obstruction?
1) Loss of protective reflexes such as cough and swallowing
2) Loss of pharyngeal muscle tone (causes the tongue to fall back and block the airway).
For patients with artificial airways, which 3 pieces of equipment are required to be at the bedside?
1) Bag-valve mask or Ambubag
2) Suction catheters
3) Suction source
What are the implications of low cuff pressure and high cuff pressures on an incubated patient?
1) Low Cuff Pressures - Increases the risk of aspiration pneumonia
2) High Cuff Pressures - Increases the risk of tracheal bleeding, ischemia, and pressure necrosis.
What are the 3 types of tracheostomy tubes and when is each used?
1) Cuffed Tube - Used for patients on mechanical ventilation because the balloon prevents air from escaping through the upper airway.
2) Cuffed Fenestrated Tube - Allows the patient to talk by allowing air to flow up to the larynx through a hole in the shaft of the tube.
3) Cuffless Tube - Often used for permanent tracheostomy patients who are not ventilator dependent.
What are the 7 Early Complications that may occur during the course of Tracheostomy Tube management?
1) Bleeding
2) Pneumothorax
3) Air embolism
4) Aspiration
5) SQ or mediastinal emphysema
6) Laryngeal nerve damage
7) Posterior tracheal wall penetration
What are the 7 Longterm Complications that may occur during the course of Tracheostomy Tube management?
1) Airway obstruction from an accumulation of secretions or protrusion of cuff over the opening of the tube.
2) Infection
3) Rupture of the innominate artery
4) Dysphagia
5) Tracheoesophageal fistula
6) Tracheal dilation
7) Tracheal ischemia and necrosis
(T/F) Deep suctioning may lead to episodes of bradycardia.
True - However, deep suctioning may be necessary in patients with large amounts of secretions in the lower airways, since minimally invasive suctioning removes secretions from central airways only.
(T/F) Installation of normal saline prior to endotracheal suctioning increases the risk of infections and is therefore not recommended.
True
How often should the cuff pressure on an ETT be monitored and at what pressure should it be inflated to?
1) Q8h
2) 20 to 25 mmHg or 25 to 30 cmH2O
Briefly describe what a CPAP is?
Continuous Positive Airway Pressure (CPAP) mask that delivers air under pressure between 4 and 20 cm of H2O to keep the airway and alveoli open during both inspiration and expiration.
How is CPAP used in the home Vs. in the hospital?
1) Home - PTs with sleep apnea
2) Hospital - PTs with hypercapnia, exacerbation of asthma, COPD, and CHF.
Briefly describe what a BiPAP is?
Bi-Level Positive Airway Pressure (BiPAP) devices evolved from CPAP and have the ability to provide two levels of pressure, ranging from 4 to 30 cm H2O. The inspiratory pressure is set with lower expiratory pressure to allow for easier exhalation.
What are the 3 different BiPAP settings?
1) Spontaneous - The patient triggers all breaths delivered.
2) Timed - The machine is set to deliver a set number of breaths per minute.
3) Spontaneous + timed - The patient triggers breaths with a set number of back-up breaths from the machine to ensure adequate ventilation.
What are the 3 main complications of an Oropharengeal Airway?
1) Obstruction of airway
2) Oral trauma (teeth)
3) Can lead to laryngospasms
