Airway Management & Mechanical Ventilation

Question 1

PEEP

Answer 1

Positive End Expiratory pressure
-one level of pressure at the end of each breath

Question 2

CPAP

Answer 2

Continuous positive airway pressure
- non-invasive
- pt actively doing the work of breathing

Question 3

EPAP

Answer 3

Expiratory positive airway pressure
-non-invasive
-patient actively doing the work of breathing

Question 4

PS

Answer 4

Pressure support - to overcome the dead space

Question 5

IPAP

Answer 5

Inspiration positive airway pressure
-overcomes the WOB with a BiPAP/ETT

Question 6

Airway pressure or PIP

Answer 6

Peak inspiratory pressure
-the level of pressure in the thoracic cavity at the peak of pressure

Question 7

V (t)

Answer 7

Tidal volume
Measured in exhalation in mls

Question 8

Oral airway

Answer 8

**ONLY FOR UNCONSCIOUS PTS
-sits on gag reflex

Insert sideways and rotate inside mouth
Can cause laryngospasm, gagging, vomiting, oral trauma

Question 9

Nasal airways

Answer 9

NOT IN ICU
May used for NT suctioning
Must change q8-12h
Can cause severe nasal trauma

Question 10

Indications for placement of an endotracheal tube (ETT)

Answer 10

-airway maintenance and protection
-secretion control
-Oxygenation and/or ventilation

**increased aspiration risk; epiglottis is open and ET tube collects biofilm which can slide down into the trachea

Question 11

What is rapid sequence intubation? What supplies are needed?

Answer 11

Placement of ETT by qualified provider, done under 5 min

Supplies:
-suction with tonsil and catheter
-MRB and mask with O2
- laryngoscope with blades
- variety of ET sizes
-stylet to make the tube stiff
-lidocaine jelly
-IV + ensure working status
-sedation or NMB
- pulse ox
-CO2 detector

Question 12

Now that the tube is in place, what are immediate actions of the nurse?

Answer 12

-IMMEDIATELY check for bilateral breath sounds and chest movement (breath sounds in uppers and lowers)
-verify with CO2 detector: should be getting CO2 return
-CXR: end of tube should be 3-4cm above the carina
—carina= cough center
-note the # on ETT at the lips, teeth, nose

Question 13

What is the nurse’s role during ETT intubation procedure?

Answer 13

Know complications, monitor the patient, and prevent the complication (if possible), Be prepared to intervene
-VS, call out VS, O2 sats to determine when to ventilate when needed

Question 14

What are complications of ET intubation?

Answer 14

-Nasal/oral ulceration
-tube displacement
-tube obstruction (foreign body, biting, secretions, cuff herniation)
-microaspiration
-laryngeal or tracheal injury
-tracheoesophageal fistula d/t pressure necrosis

Question 15

Normal cuff pressure

Answer 15

20-25 mmHG or 25-30 cm H2O
-proper cuff pressure helps to reduce VAP
—prevents bacteria and other ‘stuff’ from sliding down the trachea

Question 16

What are indications for suctioning the ET tube?

Answer 16

NEVER routine- only when indicated
-secretions
-coughing
-Resp. Distress
-crackles over trachea
-adventitious breath sounds
-increase peak airway pressures
-decreasing SaO2 or paO2