Airway - Tracheostomy for ALS

Question 1

This is an “…opening in the neck that communicates with the trachea.”

Answer 1

Tracheostomy

Question 2

T/F: Endotracheal intubation is for the patient in acute respiratory failure.

Answer 2

True

Question 3

T/F: For the pt unable to wean off a ventilator or with underlying conditions that may cause need for continuous advanced airway, tracheostomies are an ideal solution.

Answer 3

True

Question 4

List the “advantages” to a tracheostomy.

Answer 4

• easily replaced after a tract forms.
• Speech is possible with the use of a Passy-Muir one-way valve.
• Suctioning is simple,

Question 5

The trachea is appx. ___ in length and ____ in diameter.

Answer 5

4”; 1/2”

Question 6

Label the following:

Answer 6

A: Epiglottis
B: Vocal cords
C: Thyroid cartilage
D: Cricothyroid membrane
E: Cricoid cartilage
F: Esophagus
G: Trachea
H: Tracheostomy tube

Question 7

How does a tracheostomy differ from a cricothyrotomy?

Answer 7

• Tracheostomy occurs below the thyroid cartilage and enters the trachea directly.
• The cricothyrotomy passes through the cricothyroid membrane first, before entering the trachea.

Question 8

The hole created surgically in a tracheotomy is known as a ________.

Answer 8

Stoma

Question 9

This is the hole created in the trachea using serial dilators, and it matures after several days to a week.

Answer 9

Tract

Question 10

T/F: The tracheostomy is the name for the device placed into the trachea after a surgical incision.

Answer 10

False. The “tracheostomy” is the actual surgical incision. The “tracheostomy tube” is what is placed into the stoma.

Question 11

Label the following:

Answer 11

A: Obturator - the firm rod used for introducing device. Must be removed, as it blocks airflow
B: Outer cannula: Rigid tube inserted into

Question 12

Flaccidity of the tracheal cartilage; “Floppy” trachea; Can be the result of high cuff pressures in tracheostomy tube cuffs.

Answer 12

Tracheomalacia

Question 13

Narrowing of the trachea; can be the result of high cuff pressures in trach tube cuffs.

Answer 13

Tracheal stenosis

Question 14

An abnormal passageway connecting one or more places between the esophagus and the trachea; can be the result of high cuff pressures in trach tube cuffs.

Answer 14

Tracheoesophageal fistula

Question 15

Areas of inflammation; raised, red bumps; can be the result of high cuff pressures in trach tube cuffs.

Answer 15

Granuloma

Question 16

Infection and inflammation of the trachea; can be the result of high cuff pressures in trach tube cuffs.

Answer 16

Tracheitis

Question 17

Each “French” unit in a tracheostomy or endotracheal tube is equal to _____ mm.

Answer 17

0.33

Question 18

Resistance to airflow increases by a factor of 4 with _____.

Answer 18

decrease in tube diameter.

Question 19

What are the key advantages of tracheostomy tube over ETT in long-term ventilation?

Answer 19

• Reduced resistance to airflow/work of breathing
• Ability to clear secretions with suction
• Reduction of injury to vocal cords
• Comfort

Question 20

What’s the max pressure of the cuff in tracheostomy tubtes?

Answer 20

20-25 mmHg

Question 21

What important upper airway f(x) is bypassed by tracheostomy tubes?

Answer 21

Warming, filtering, and humidification of inhaled air.

Question 22

Which type of lubricant is required for tracheostomy tubes?

Answer 22

Water-based

Question 23

If you are unable to re-insert a tracheostomy tube, what is your next course of action?

Answer 23

Occlude the stoma, ventilate with BVM, and transport rapidly.

Question 24

Max suction pressure for clearing a trach

Answer 24

120 mmHg