Airways Flashcards
Checking position of endotracheal tube
Symmetrical chest movements Listen over epigastrium for gurgling Listen over each Kung for air entry Use CO2 monitor CXR: just above carina
Endotracheal tube:
Complications
Early: Oropharyngeal trauma Laryngeal trauma C-spine injury Oesophageal intubation Bronchial intubation (Right bronchus)
Late:
Sore throat
Tracheal stenosis
Difficult wean
Definitive airways
Orotracheal or nasotracheal
Surgical: tracheostomy, cricothyroidotomy
Types of laryngoscope
McKintosh = curved
Miller = straight
Removable blade, come in different sizes
Laryngoscope Complications (3)
Oropharyngeal trauma
Laryngeal trauma
C-spine injury
Temporary tracheostomy tube:
Indications (3)
Definitive surgical airway
Acutely for maxillofacial injuries
Electively for ITU patients with prolonged ventilation
Advantages temporary tracheostomy over ET tube
Easier to wean patients
No need for sedation
Decreased discomfort
Deceased risk glottis trauma
Easier to maintain oral and bronchial hygiene
Decreases dead space, reducing work of breathing
What is a definitive airway?
Airway which is protected from aspiration
When to use a laryngeal mask airway?
Short day case surgery where patient doesn’t need intubation
Emergency situation if cannot insert ET tube
Complications of an LMA
Dislodgement
Leak
Pressured necrosis in airway
Aspiration (it is a non definitive airway)
When to use a Guedel (aka Oropharyngeal)?
Patient has impaired level of consciousness and need to maintain their airway
Guedel:
Complications
Oropharyngeal trauma
Gagging–> vomiting
Nasopharyngeal airway:
Contraindications
Facial injuries
Evidence of basal skull fracture
Ventilation:
Indications
Respiratory failure refractory to less invasive treatment
At risk airway
Elective post-op ventilation
Physiological control eg hyperventilation in ICP
Benefits of CPAP
Recruitment of collapsed lung units
Decreased shunt, increasing PaO2
Increased lung volume improving compliance resulting in lesser work of breathing
