Art of war I & I Flashcards
1
Q
airway
definitive
4 points
A
- cuffed beneath the glottis
- attached to oxygen (except tracheostomy)
- secured in place
- airway is therefore protected from aspiration
2
Q
Nasopharyngeal airway
What is it
Use: 2
Complications: 2
Indications: 2
Contraindications: 2
A
Non- definitive airway adjunct - keep the airway patent and prevents tongue obstructing the airway
-
Use:
- sized against pt’s little finger diameter
- secured with safety pin
-
complications:
- bleeding - trauma to nasal mucosa
- Intracranial placement
-
Indications:
- airway adjunct in pt with gag reflex
- can still trigger gag reflex
-
Contrainidcations:
- BoS # or facial injuries
- severe coagulopathy
3
Q
Oropharyngel (or Guedel) airway
What is it
Use: 1
Complications: ?
Indications: 3
Contraindications: 1
A
- What is it:
- non-definitive airway adjunct - keeps airway patent and prevents tongue obstructing the airway
- Use:
- sized from angle of mandible to level of the incisors
- Complications: ??
- Indications:
- Pt breathing in an obstructed manner - some degree of partial upper airway obstruction
- only used if pt has reduced GCS as it can initiate a gag reflex
- if pt conscious -> nasopharyngeal airway (usually inserted in right nostril)
- Contraindications:
- pt has injuries to face or a condition that prevents the mouth from opening
4
Q
iGel vs LMA
A
-
iGel
- Newer version with small tube that shows if pt has vomited (early LMAs did not)
- Has another port to allow NG tube passage for suction
- Does not inflate, but gel moulds to pt anatomy with heat
- Single use only
- LMA
- Can be autoclaved for reuse
- Pilot balloon and inflatable seal
5
Q
Laryngeal mask airway
Use: 3
Indications: 1
Disadvantages: 2
Complications: 4
A
- Use:
- Inflatable cuff to seal over larynx
- Listen for an air leak if tube not positioned correctly
- Muscle paralysis is not required
- Indications:
- Day cases where intubation not required
- Disadvantages:
- Not definitive - above the glottis so does not prevent reflux
- Not suitable for high pressure ventilation or PEEP
- Complications:
- Dislodgement
- Leak
- Pressure necrosis in airway
- Aspiration
6
Q
Mc Kintosh laryngoscope
Indications: 1
‘blades’: 2
use: 1
cautions: 2
complications: 3
A
- Indication:
- ET intubation
- Blades:
- McKintosh = curved;
- Miller = straight - paeds
- Use:
- Held in left hand, tongue swept to the side, ET placed with R hand
- Caution:
- Pts with RA or ank spond -> atlantoaxial instability
- Loose teeth
- Complications:
- Mouth / teeth trauma
- Cervical spine damage
- Failure
7
Q
Endotracheal tube
Use: 3
How to check positioning: 5
Types and indications: 3 types
Murphy’s eye
Complications: 4
A
- Use:
- Cords between two black lines
- Bougie may be used for difficult airways
- Position confirmed and secured with tape
- Checking its in the right place:
- Inspect for symmetrical expansion
- Listen over epigastrium for gurgling
- Listen over each lung for air entry
- Check end tidal CO2 - waveform capnography
- Check SpO2
- Types & indications:
- Singe lumen cuffed ET tube
- Indications:
- Surgery with a risk of aspiration
- Inadequate pre-op fasting (emergency)
- Delayed gastric emptying (pregnancy or obstruction)
- Hiatus hernia with reflux
- All abdominal, thoracic, pelvic and neurosurgery
- Whenever access to the airway is limited - Oral surgery, head and neck, ENT
- Surgery in prone position
- Double-lumen cuffed ET tube: Allows separate ventilation of the two lungs.
- Indications:
- Lobectomy, pneumonectomy, bronchopulmonary lavage
- Indications:
- Uncuffed ET tube
- Indications:
- children as the trachea is not as strong.
- Indications:
- Murphy’s eye:
- second hole at the end of the tube in case main hole becomes blocked
- Complications:
- Failure to intubutate, intubation of oesophagus or one bronchus only
- Oropharyngeal / laryngeal trauma
- C-spine injury - atlanto-axial instability
- Long term use -> stenosis, difficulty weaning, sore throat
8
Q
Cricothyroidotomy: 3
When? How long? larynx?
A
- Emergency where ET intubation has failed
- Allows approximately 30 minutes of ventilation.
- Cricothyroidotomy will only work with at least a partially patent larynx.
9
Q
Tracheostomy tube (definitive surgical airway)
Position: 1
Inserts: 2
Indications: 3
Advantages: 6
disadvantages: 1
Complications; immediate/early/late
A
- Position:
- 2 rings beneath cricoid cartilage
- Inserts:
- Non-fenestrated - no risk of aspiration, but cannot talk
- Fenestrated - risk of aspiration, but allows pt to talk by diverting air through vocal cords
- Indications:
- Long term ventilation (ITU)
- Easier to wean off ventilator - vocal cords are not passed
- Reduces dead space so ventilation is more efficient
- Allows more effective suctioning
- Upper airway obstruction; max-fax injuries
- Post laryngeal surgery
- Long term ventilation (ITU)
- Advantages over ET tube:
- Easier to wean pts
- No need for sedation
- Decreased discomfort
- Easier to maintain oral and bronchial hygiene
- Decreased risk of glottis trauma
- Decreased dead space -> reduced work of breathing
- Disadvantages:
- Dries secretions, humidified air usually required
- Complications:
- Immediate - haemorrhage, surgical trauma to oesophagus, r. laryngeal n., pneumothorax
- Early - tracheal erosion, tube displacement, obstruction, surgical emphysema, aspiration pn.,
- Late - trracheomalacia (softening of the tracheal cartilage causing collapse on expiration), trachea-oesophageal fistula, tracheal stenosis
10
Q
Oxugen delivery systems: 2 examples
_Variable performance_ (vs fixed) Deliver a proportion of the patient’s ventilatory requirements - depends on:
- Oxygen flow rate, respiratory pattern (RR, peak insp/exp flow rate & pause)
- The amount of air entrained
A
Examples:
Nasal Canulae:
- Can deliver 24-30% O2 at flow rates from 1-4 l /min
- Dry & uncomfortable
- Use for short period only
Face mask (Hudson):
- Max O2 conc. achieved is 60%
- Not to be used for COPD patients
11
Q
Fixed performance oxygen delivery systems: 2 exmples
Can deliver all of the patients ventilatory requirements
Inspired O2 concentration determined by the oxygen flow rate & _not the respiratory pattern_
A
Venturimask
Non rebreather
12
Q
Venturi masks
descrition + colours
A
is a fixed performance oxygen delivery system that:
Can deliver all of the patients ventilatory requirements
Inspired O2 concentration determined by the oxygen flow rate & not the respiratory pattern
O2 masks (Hudson) with colour coded venturi heads Have different air-entrainment apertures for different O2 concentration delivery Colours (written on side)
- Blue - 24%Boys -
- Want - White - 28%
- Only - Orange - 31%
- Young - Yellow - 35%
- Randy - Red - 40%
- Girls - Green - 60%
13
Q
Non-rebreather
description: 3
indications: 1
Use: 2
A
- Describe:
- it is a fixed performance oxygen delivery system that:
- Can deliver all of the patients ventilatory requirements
- Inspired O2 concentration determined by the oxygen flow rate & not the respiratory pattern
- High flow oxygen at 90%
- it is a fixed performance oxygen delivery system that:
- Indications:
- resus
- Use:
- first inflate the bad by pressing on button tabs
- then place on pt
14
Q
Non-invasive ventilations
2 types
A
CPAP
- Recruits collapsed lung units
- Decreased shunt therefore increases PaO2
- Increased lung volume - improves compliance - decreases work of breathing
- Little effect on PaCO2
BiPAP
- Biphasic positive airway pressure
- Used in severe T2RF
15
Q
Invasive ventilation
?airway tyoe
Infications: 4
Complications: 5
A
- Airway:
- ET or tracheostomy
- Indications:
- Respiratory failure refractory to less invasive tx
- At risk airway
- Elective post-op ventilation
- Physiological control (eg hyperventilation in raised ICP)
- Complications:
- Cardiovascular compromise
- Pneumothorax
- Fluid retention
- Ventilator acquired pneumonia
- Complications of artificial airway
