Cardioversion Flashcards
Cardioversion
-A therapeutic procedure that involves administering a low voltage current to the heart in an attempt to convert a cardiac dysrhythmia to normal sinus rhythm
-Indications for non life threatening arrhythmias
-Unstable martial fibrillation
-Unstable atrial flutter
-Stable ventricular tachycardia
Cardioversion
Procedure
-The electric current is synchronized with the Pts own rhythm
-Male sure synchronizing switch is ON before cardioverting
-Begin with 50-100 joules (watt-seconds) for most non lethal dysrhythmias such as atrial fibrillation and martial flutter, and ventricular tachycardia with a pulse
-Electric shock is delivered in the R wave of ECG
-Oxygen, resuscitation equipment and emergency drugs should be present in the event of a cardiopulmonary arrest
-If ventricular fibrillation occurs
-Check Pts pulse
-Turn off synchronizing sitch
-Immediately defibrillate
-Midazolam (versed) is a strong, short acting sedative given prior to the cardioversion.
Defibrillation
-Defb is similar to cardioversion except that it is used when life threatening cardiac dysrhythmias are prest
-Indication for defib include
-Pulseless ventricular tachycardia
-Ventricular fibrillation
-Normal 360 joules of electrical energy is sufficient for defib
-Synchronizing switch is turned OFF
Tracheostomy
-Indication to bypass partial or complete upper airway obstruction, to facilitate prolonged mechanical ventilation, or ro provide access for frequent secretion clearance
-Absolute contraindications
-Due to bleeding, elective tracheotomy should not be performed until severe coagulopathies are corrected
-Critically ill PTs should be stabilized as much as possible beforehand
Tracheostomy
-Indications and Advantages
-Preferred for long term intubation
-When upper airway obstruction prevents intubation
-If not an emergency, should be done carefully under sterile conditions with the PT intubated. ET tube is removed only a trach tube us ready to be inserted
-Easier to stabilize, suction, and tolerate. Some have removable inner cannula that can be cleaned by brushing or rinsing with hydrogen peroxide
-PT is able to eat and even speak with the talking trach tube
-There are fewer hazards and minimal airway resistance
Tracheostomy
-Complications
-Immediate: (24 hours)
-Bleeding major hazards
-Pneumothorax
-Air embolism
-Subcutaneous emphysema
-Late: (24-48 hours)
-Infection
-Hemorrhage
-Obstruction
-T-E fistula
Tracheostomy
-The cuff should be kept deflated unless:
-The pt is eating
-Pt is on PPV
-The tracheostomy tube should not be changed more often than once a week unless
-Obstruction , unable to pass a suction cath, then pull tube out and ventilate
-Tube too small, very high cuff pressure (>20mmHG) needed to seal the tube. Then Change the larger tube
-Punctured cuff, unable to seal the trach. Replace the tube if a seal is required
-Care of trach after removal
-Do ot suture stoma closed
-Apply sterile dressing and or antibiotic to site
-Clean periodically with hydrogen peroxide
-Have Pt cough to clear secretions
Type of Tracheostomy Tubes
-A tracheostomy (trach) tube is a curved tube that is inserted into a tracheostomy stoma (the hole made in the neck and windpipe (Trachea)) There are different purposes. These are manufactured by different companies. However, a specific type of tracheostomy tube will be the same no matter which company manufactures them.
-A commonly used tracheostomy tube consists of three parts,
-A commonly used tracheostomy tube consists of three parts, Outer cannula with a flange (neck Plate), inner cannula, and an obturator. The outer cannula is the outer tube that holds the tracheostomy open. Attach cloth ties or velcro strap around the neck. The inner cannula fits inside the outer cannula. It has a lock to keep it from being coughed out, and it is removed for cleaning. The obturator is used to insert a tracheostomy tube. It fits inside the tube to provide a smooth surface that guides the tracheostomy tube when it is being inserted
-There are different types of tracheostomy tubes available and the pt should be given the tube that best suits his/ her needs.
-There are different types of tracheostomy tubes available and the pt should be given the tube that best suits his/ her needs. The frequency of these tube changes will depend on the type of tube and may possibly alter during the winter or summer months. Practitioners should refer to specialist practitioners and or the manufacturers for advice.
Cuffed Tube with Disposable inner Cannula
-Indication
Used to obtain a closed circuit for ventilation
Recommendations
Cuff should be inflated when using with ventilators
Cuff should be inflate just enough to allow minimal air leak
Cuff should be deflated if PT uses a speaking valve
Cuff pressure should be checked twice a day
Inner cannula is disposable
Cuffed Tube with Reusable Inner Cannula
-Indications
Used to Obtain a closed circuit for ventilation
Used for PT with tracheal problems
Used fo Pt who are ready for decannulation
Cuffed Tube with Reusable Inner Cannula
-Recommendations
Cuff should be inflated when using with ventilator
Cuff should be inflated just rough to allow minimal air leak
Cuff should be deflated if pT uses a speaking valve
Cuff pressure should be checked twice a day
-Save the decannulation plug if the PT is close to getting decannulated
-PT may be able to eat and may be able to speak without speaking valve
-Inner Cannula is not disposable. You can reuse it after cleaning it thoroughly
Cuffless tube with Disposable Inner Cannul;a
-Indication
Used for PTs with tracheal problems
Used for Pts who are ready for decannulation
-Recommendation
Save the decannulation plug if the Pt is close top getting decannulated
PT may be able to eat and may be able to talk without a speaking valve
Inner cannula is disposable
Fenestrated Cuffed Tracheostomy Tube
-Indication
Used for PTs who are on the ventilator but are not able to tolerate a speaking valve to speak
-Recommendation
There is a high risk for granuloma formation at the side of the fenestration
There is a higher risk for aspirating secretions
It may be difficult to ventilate the PT adequately
Fenestrated Cuffless Tracheostomy Tube
-Indication
-Used for PTs who have difficulty using a speaking valve -Recommendations -There is a high risk for granuloma (medical term for a ball like collection of immune cells trying to destroy a foreign substance formation at the site of the fenestration (hole)
Metal Tracheostomy Tube
-Indication
Metal tube with inner cannula and obturator. Also referred to as Jackson trachs.
Used in long term situations
When Pt are required or determined to be put on trach for long periods or for the rest of their lives, it then is determined that the jackson trach is more cost efficient
They are used over and over without having to replace
-Recommendations
Pt cannot get MRI
One needs to notify the security personnel at the airport prior to metal detection screening
Silicone Foam Cuff Trach TUbe
-Silicone foam cuff trach tubes have an angled tube shaft that is designed to reduce pressure at the stoma site and tip trauma to the anterior wall of the trach. The angled design conforms to the anatomy and allows the tube to remain centered in the trachea to reduce pressure along the tracheal wall
-The foam cuff passively expands to provide a trachea seal to prevent leaks and protect agonist aspiration -Silicone foam cuff trach tubes prevent tracheal dilation by automatica;;by adjusting to changes in the shape of the pts tach. The silicone foam cuff provides the lowest possible sealing pressure to prevent aspiration while protecting the tracheal wall -Foam cuff tubes are best suited to long term ventilator pts, where cuff pressure on the tracheal wall is a concern. And also for home care PTs where it may not always be convenient to monitor cuff pressure
Tracheostomy Button
-This device consists of a hollow outer cannula and solid inner cannula. It fits from the skin just inside the anterior wall of the trach. With the solid inner cannula in place, the Pt breathes through the upper airway. When the inner cannula is removed, the pt can breathe through the button, and suction catheter can be passed through the button to aid airway clearance. Since a tracheostomy button does not extend into the trachea and does not have a cuff, its use is limited when there is a risk of aspiration or during positive pressure ventilation
-Used in sleep apnea PTs who require ventilation at night
Laryngectomy Tubes
-Indication
Surgical removal of the PTs larynx
Performed to treat upper airway carcinoma (cancer)
No longer any connection between the PTs upper and lower respiratory tract
PT will breathe through a laryngectomy tube initially
Pt can not be orally or nasally intubated
Laryngectomy tube will be removed after 3-6 weeks, then PT will have a permanent stoma
-Laryngectomy Tubes
Laryngectomy tubes are designed to maintain PTs airway after a laryngectomy has been performed
Laryngectomy tubes are made of soft pliable material
Most are available in various sizes and are generally shorter in length than a standard tracheostomy tubes
May have inner cannula
Laryngectomy tubes do NOt have an inflatable cuff
Replace with cuffed endotracheal tube if positive pressure ventilation is required
