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Respiratory care > Airway management > Flashcards

Airway management Flashcards

1
Q

What is the procedure for extubation?

A
  1. Eplain procedure
  2. assess pt
  3. suction orally and tracheal
  4. assess upper airway- cuff leak
  5. suction tracheal
  6. preoxygenate
  7. unsecure tube
  8. big breath in
  9. deflate cuff and cough
  10. pull all oral tubes
  11. suction mouth- cough
  12. apply O2 and access patient
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2
Q

Equipment for intubation

A
  • 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
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3
Q

What are some procedural hazards of intubation?

A
  • 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
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4
Q

What are some complications immediately post-extubation?

A
  • 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
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5
Q

What are some Post procedure complications of intubation?

A
  • 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
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6
Q

Indications for endotracheal intubation

A
  • Apena
  • CPR
  • loss of airway protective reflexes
  • need for airway management
  • airway obstruction
  • upper airway hemorrhage/edema
  • airway secretion clearance
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7
Q

What is the sequence for RSI?

A
  1. Preparation (tool and equipment)
  2. pre-oxygenate
  3. Pre-treatment
  4. Paralysis with induction
  5. Positioning- head tilt, chin thrust
  6. placement with proof- CO2 detection
  7. Post-intubation management
    1. sedation management
    2. vent settinfs
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8
Q

What are contraindications for nasopharyngeal placement?

A
  • Incorrect sizing
  • Epistaxis- continuous nose bleeds
  • damage to anatomy
  • carnal vault intubation- facial trauma victims
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9
Q

What is a cuff leak?

Why do we do it?

A
  • removing air from the cuff
  • done to access for upper airway edema
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10
Q

Indications for placement of a tracheostomy tube?

A
  • Long term need– over 2 weeks
    • mechanical ventilation dependence
    • cancer of the upper airway
    • OSA
      *
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11
Q

At what generation do we lose cartilage?

At what generation do we lose bronchiolar epithelium?

A

11

18

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12
Q

What are the complications of nasotracheal intubation?

A
  • Epistaxis
  • submucosal dissection- go through mucus membranes
  • trauma
  • pressure necrosis of the nose
  • Eustachian tube obstruction
  • maxillary sinusitis- sinus infection of the maxilla
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13
Q

What are indications for oropharyngeal airway placement?

A
  • Alternative to nasopharyngeal airway to maintain patency, prevent upper airway obstruction
  • Unconscious patient with no gag reflex
  • Bite block
  • Optimize bag-mask-valve ventilation
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14
Q

Where should the Tip of the ETT be in the lungs?

A
  • 3-5 or 3-6 cm above the carina
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15
Q

What are indications for the nasopharyngeal airway?

A
  • Alt. to oral airway
  • frequent suctioning
  • semi-awake, awake with present gag reflex
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16
Q

Tracheostomy hazards

A
  • Infection
  • Subcutaneous emphysema
  • bleeding
  • esophageal erosion
  • mucus plugging
17
Q

What is the ideal cuff pressure?

A
  • 20-30cm H2O to prevent channeling and decrease risk of VAP
18
Q

What are the medications require for RSI?

A
  • Neuromuscular blocking agents:
    • succinycholine
    • rocurinium
  • Induction agents
    • etomidate
19
Q

What are some hazards of intubation?

A
  • placement damage: esophageal intubation
  • During intubation:
    • cutting lips
    • mucosal damage
  • Long term use
  • Extubation:
    • Stridor
    • laryngospasm
20
Q

How do we confirm the placement of an ETT?

A
  • Gold standard” positive return of end tidal CO2
  • Bilateral breath sounds
  • Condensate in ETT
  • chest rise
  • CXR
21
Q

What are the complications of long term intubation?

A
  • Ulceration of the mouth, pharynx,larynx and trachea
  • Gramulomas
  • synechiae and web formation
  • tracheal stenosis
22
Q

What is the acronym for how to apply cricoid pressure?

A
  • BURP
  • Backward
  • Upward
  • Right ward
  • Pressure
23
Q

What is the purpose of type 1 and 2 alveolar cell? The pores of Kohn? Alveolar macrophage”

A

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

24
Q

When do we intubate?

A

pH below 7.25

NIV: 7.35-7.25

other reasons to intubate are apnea or inability to protect the airway

25
Q

Contraindications to endotracheal tubes

A
  • airway/vocal cord damage
  • DNI order
26
Q

Indications for intubation

A
  • ventilatory support
  • airway protection
  • secure the airway
  • secretion management
  • anestheia
27
Q

Oropharyngeal contraindications and hazards

A
  • incorrect sizing
  • worsening obstruction
  • broken teeth
  • damage to anatomy
  • vomiting and aspiration
    *
28
Q

What are considerations that should be made before extubation?

A
  • Spontaneous awakeing trail (SAT)
    • turn down sedation
  • Spontaneous breathing trial
    • change vent settings to assist
  • Resolution of reason for intubation
29
Q

What is MOV? What is MLV?

A

minimal occlusion volume

minimal leak volume

2 ways to access that there is enough volume in the ETT

Respiratory care (12 decks)

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