Artificial Airways Flashcards
Why are artificial airways used?
WILL BE ON EXAM
to maintain patency of airway so air can flow in to and out of the lungs
What are the 4 types of airways?
- oropharyngeal
- nasopharyngeal
- endotracheal
- tracheostomy
In what circumstances would an artificial airway be needed?
if the pt is unconscious, head injury, overdose, general anesthesia, etc.
Which airway would be used when the pt is unconscious and their tongue is blocking the airway?
oropharyngeal
When would you NOT use an oropharyngeal airway?
in a conscious or semi-conscious person as it could stimulate the gag reflex resulting in vomiting and a potentially obstructed airway
How do you insert an oropharyngeal airway?
insert with the distal end curved upward along the top of the tongue then rotate 180 degrees once the airway reaches the soft palate at the back of the throat then slip airway past uvula into oral pharynx
Should you tape an oropharyngeal airway in place?
NO– you want them to spit it out as they wake up
How do you measure an oropharyngeal airway?
measure from the corner of the mouth to the angle of the jaw
When would you use a nasopharyngeal airway?
when the pt is conscious because it has a lower likelihood of inducing gag reflex as it is inserted into the nose
How do you determine the size of a nasopharyngeal airway?
measure from the tip of nose to earlobe and slightly smaller than the nares– the diameter of the trumpet should be approx. the same as pts little finger
NOTE: if the trumpet is too tight it can prevent drainage of sinuses and lead to infection
When is a nasopharyngeal airway contraindicated?
in pts with severe head or facial injuries or ave evidence of basilar skull fracture due to the possibility of direct intrusion upon brain tissue– raccoon eyes and/or cerebrospinal fluid leaking from ears or nose
What is the process of inserting an endotracheal tube called?
tracheal intubation– usually just called intubation
What are the indications for using an endotracheal tube?
upper airway obstruction (burns, tumour, bleeding), apnea (MI), high risk of aspiration, respiratory distress, and ineffective clearance of secretions
Are pts able to speak when intubated?
NO– the ETT passes through the epiglottis and glottis so they can’t speak or call for help when they need it!
What is the term for removing an endotracheal tube?
extubation
When is a tracheostomy appropriate?
when a pt needs long term airway support or to bypass upper airway
What is a tracheostomy?
surgical opening in the trachea just below the larynx
What are the advantages of a tracheostomy compared to an endotracheal tube?
-pt comfort
-pt able to talk (with adaptive device of add on speaking valve)
-improved management of secretions
-potential to wean from the ventilator
-trach tube is more secure, giving more mobility
What are the parts of a tracheostomy tube?
flange, outer and inner cannula, pilot balloon, cuff, obturator, and plug
What is the difference between a cuffed and uncuffed trach?
cuffed– inflated cuff produces an airtight seal between tube and the trachea, air pressure needs to be checked q8h
uncuffed– used when pt can protet their airway from aspiration and when pt does not need mechanical ventilation (and used for kids because they have small enough tracheas)
What should the air pressure in a tracheostomy tube’s cuff be?
20-25 gmH2O
What are the complications of a tracheostomy?
-bleeding
-subcutaneous emphysema
-pneumothorax
-pneumonia
-tube obstruction
-tube dislodgement
-cuff malfunction
-skin breakdown
-tracheal stenosis
-tracheaomalacia
-fistula formation
What is subcutaneous emphysema?
gas or air under the skin– feels like rice krispies when palpated– air escaped from incision to the subcutaneous tissue
Define pneumothorax
injury to the pleura during trach insertion that can lead to air accumulating in the pleural space
Define tracheal stenosis
narrowing of the trachea (scarring)
Define tracheaomalacia
flaccidity of the tracheal support cartilage which leads to tracheal collapse especially when increased airflow is demanded
Define fistula formation
tracheal-esophageal fistula (a tube-like passage between trachea and esophagus)– which means that everything the pt eats or drinks will end up in the trachea
What is special about the first trach change?
-no sooner than 7 days post-surgery
-first trach dressing change is done by the physician
How often should the trach tube be changed?
after the first trach tube change, the tube should be changed approximately once a month
What are the indications for suctioning a trach?
-respiratory distress
-change in mental status (anxious)
-noisy or visible respirations
-suspected aspiration or secretions
-poor or absent cough reflex or sustained cough
-client request
Complications caused by suctioning?
-irritating to mucous membranes
-increases secretions if done too frequently
-causes O2 saturation to drop
-can lead to infection if not performed aseptically
What should the suctioning be set at for an infant? Child? Adult?
infant– 40-60mmHg, max 5 sec
child– 60-80mmHg, max 5 sec
adult– 80-120mmHg, max 10 sec
How long should you wait between suctioning passes?
at least 1 min for recovery
Define pleural space
the space between the inner and outer lining o the lung– normally very thin and lined with only a small amount of fluid
about 25mL of pleural fluid per lung normally
What is the purpose of a chest tube?
-to remove (drain) air and/or fluid from the pleural space
-to restore normal intrapleural pressure and allow full expansion of the lungs
-commonly inserted to resolve: pneumothorax
(air), hemothorax (blood), pleural effusion (other liquid, ex. pus), to drain blood from the mediastinum after open heart surgery
Describe a pneumothorax
-presence of air in the pleural space
-disrupts the negative pressure causing the lung (or portion) to collapse
-signs and symptoms include: dyspnea, pain, decreased breath sounds on affected side
What are the 3 types of pneumothorax?
- closed (spontaneous)– no external wound, the lung just spontaneously collapses with no apparent cause
- open (sucking chest wound)– penetrating chest wound, cover with dressing secured on 3 sides to allow air to escape and prevent tension pneumothorax
- tension–EMERGENCY– accumulation of air in the pleural space causing increased intrapleural pressure
What are the signs and symptoms of a tension pneumothorax?
-severe respiratory distress
-chest pain
-absence of breath sounds on affected side
-tracheal shift to unaffected side
-muffled heart sounds
-engorged neck veins
-hypotension and signs of shock
-tachycardia
-low oxygen saturation
-cyanosis
-loss of consciousness
-cardiac arrest
How is a tension pneumothorax treated?
with needle decompression in 2nd ICS MCL
Describe a hemothorax
-accumulation of blood in the pleural space
-causes: blunt or penetrating chest trauma, chest surgery, lung malignancy, anticoagulant therapy, PE
-a combination of open pneumothorax and hemothorax is called a hemopneumothorax
Signs and symptoms: dyspnea, diminished breath sounds on affected side, pain and shock
What is the treatment for hemothorax?
a larger sized chest tube inserted around the 5th ICS MAL
Describe a pleural effusion
-accumulation of fluid other than blood in the pleural space disrupts the negative pressure causing lung or a portion of the lung to collapse
Signs and symptoms: dyspnea and pain
What are the 3 types of pleural effusions?
- hydrothorax– serous fluid
- empyema– pus
- chylothorax– chyle (lymph from digestive tract)
When is a mediastinal chest tube used?
to prevent cardiac tamponade (blood collecting in the pericardial sac compressing the myocardium and preventing the heart from pumping effectively)– inserted in the mediastinum after open heart surgery
NOTE: NOT in the pleural space!
What should be at the bedside for safety when the pt has a chest tube?
-2 clamping forceps
-bottle of NS or SW
-extra drainage unit
-extra dressing supplies
