Airway management Flashcards
What is the procedure for extubation?
- Eplain procedure
- assess pt
- suction orally and tracheal
- assess upper airway- cuff leak
- suction tracheal
- preoxygenate
- unsecure tube
- big breath in
- deflate cuff and cough
- pull all oral tubes
- suction mouth- cough
- apply O2 and access patient
Equipment for intubation
- Correct size ETT
- lubricant
- suction
- syrine and yaneaur
- syringe
- laryngoscope
- stylet
- CO2 detector
- BMV device
- oxygen
- sedative and paralytic agents
- PEEP valve
- oral and nasal airwyas
- Tape to secure tube
What are some procedural hazards of intubation?
- Traume
- upper lip
- dental
- eye
- mucus membranes and oropharynx
- Hypoxia
- acute hypoxic encephalopathy- sudden low O2 in the brain
- failure of O2 at the source
- Improper procedure
- inability to intubate
- vomiting, regurgitation, and aspiration
- rupture of esophagus
What are some complications immediately post-extubation?
- Hypoxemia
- Laryngeal spasm- emergency must re-intubate
- airway obstruction
- vomiting, aspiration, regurgitation
- sore throat
- vocal cord injury
- post-intubation stridor
- difficult extubation
- avulsion of vocal cords-shreded them
- nerve injury
What are some Post procedure complications of intubation?
- Hypoxemia
- esophageal intubation
- endobronchial intubation- right main stem
- bronchospasm- albuterol
- difficulty with ventilation
- laryngeal intubation- not far enough
- accidental extubation
- rupture of trachea or bronchi
- tension pneumo
- Hypertension, tachycardia, arrthymias
- Elevated ICP
- hypotensive
Indications for endotracheal intubation
- Apena
- CPR
- loss of airway protective reflexes
- need for airway management
- airway obstruction
- upper airway hemorrhage/edema
- airway secretion clearance
What is the sequence for RSI?
- Preparation (tool and equipment)
- pre-oxygenate
- Pre-treatment
- Paralysis with induction
- Positioning- head tilt, chin thrust
- placement with proof- CO2 detection
- Post-intubation management
- sedation management
- vent settinfs
What are contraindications for nasopharyngeal placement?
- Incorrect sizing
- Epistaxis- continuous nose bleeds
- damage to anatomy
- carnal vault intubation- facial trauma victims
What is a cuff leak?
Why do we do it?
- removing air from the cuff
- done to access for upper airway edema
Indications for placement of a tracheostomy tube?
- Long term need– over 2 weeks
- mechanical ventilation dependence
- cancer of the upper airway
- OSA
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At what generation do we lose cartilage?
At what generation do we lose bronchiolar epithelium?
11
18
What are the complications of nasotracheal intubation?
- Epistaxis
- submucosal dissection- go through mucus membranes
- trauma
- pressure necrosis of the nose
- Eustachian tube obstruction
- maxillary sinusitis- sinus infection of the maxilla
What are indications for oropharyngeal airway placement?
- Alternative to nasopharyngeal airway to maintain patency, prevent upper airway obstruction
- Unconscious patient with no gag reflex
- Bite block
- Optimize bag-mask-valve ventilation
Where should the Tip of the ETT be in the lungs?
- 3-5 or 3-6 cm above the carina
What are indications for the nasopharyngeal airway?
- Alt. to oral airway
- frequent suctioning
- semi-awake, awake with present gag reflex
Tracheostomy hazards
- Infection
- Subcutaneous emphysema
- bleeding
- esophageal erosion
- mucus plugging
What is the ideal cuff pressure?
- 20-30cm H2O to prevent channeling and decrease risk of VAP
What are the medications require for RSI?
- Neuromuscular blocking agents:
- succinycholine
- rocurinium
- Induction agents
- etomidate
What are some hazards of intubation?
- placement damage: esophageal intubation
- During intubation:
- cutting lips
- mucosal damage
- Long term use
- Extubation:
- Stridor
- laryngospasm
How do we confirm the placement of an ETT?
- Gold standard” positive return of end tidal CO2
- Bilateral breath sounds
- Condensate in ETT
- chest rise
- CXR
What are the complications of long term intubation?
- Ulceration of the mouth, pharynx,larynx and trachea
- Gramulomas
- synechiae and web formation
- tracheal stenosis
What is the acronym for how to apply cricoid pressure?
- BURP
- Backward
- Upward
- Right ward
- Pressure
What is the purpose of type 1 and 2 alveolar cell? The pores of Kohn? Alveolar macrophage”
type 2- produces surfactant
type 1- gas exchange
pore of Kohn allow communication and a secondary way to fill adjacent alveoli
Macrophages clear infectious, toxic or allergic particles that got into the respiratory tract
When do we intubate?
pH below 7.25
NIV: 7.35-7.25
other reasons to intubate are apnea or inability to protect the airway
Contraindications to endotracheal tubes
- airway/vocal cord damage
- DNI order
Indications for intubation
- ventilatory support
- airway protection
- secure the airway
- secretion management
- anestheia
Oropharyngeal contraindications and hazards
- incorrect sizing
- worsening obstruction
- broken teeth
- damage to anatomy
- vomiting and aspiration
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What are considerations that should be made before extubation?
- Spontaneous awakeing trail (SAT)
- turn down sedation
- Spontaneous breathing trial
- change vent settings to assist
- Resolution of reason for intubation
What is MOV? What is MLV?
minimal occlusion volume
minimal leak volume
2 ways to access that there is enough volume in the ETT
