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Neonate Class 2019 > Chapter 13 > Flashcards

Chapter 13 Flashcards

Airway Management

1
Q
  1. Intubation Indications
A
  1. Pulmonary Function (disease)
  2. Provide an airway (obstruction)
  3. Protect the airway (aspiration)
  4. Pulmonary hygiene (secretion removal)
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2
Q
  1. What are the Equipment needed for intubation? ETT
A 
Sterile
Nontoxic clear plastic
1 cm markings
Murphy’s eye
15 mm adaptor
2.5 to 10 size range, see page 224
ID = (age ÷ 4) + 4
Adult size at 12-14 years, F 7-8.5, M 8-10
Cuffed vs. uncuffed
Up to practitioner
All sizes (except 2.5) come with cuffs or without
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3
Q
  1. How many Blades and handles are there? Two
A
  1. Straight and curved

2. Straight used the most

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4
Q
  1. LMA
A
  1. Back-up airway for difficult intubations
  2. Short term ventilation
  3. Low pressure ventilation
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5
Q
  1. What are Suction equipments? Two
A
  1. Yankauer (tonsil tip)

2. Catheters etc. Sx 80-100

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6
Q
  1. What are the Procedure Orotracheal intubation?
A
  1. Sniffing position (towel under head or shoulders) do not overextend Preoxygentate
  2. 30 seconds max
  3. CO2 detector
  4. Auscultate
  5. Direct visualization CXR
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7
Q
  1. What are the equipment for Nasotracheal intubation?
A

One size smaller than oral

Magill forceps Blind (don’t do)

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8
Q
  1. Oral vs nasal
A
  1. Comfort not really an issue

2. Nasal more stable Can’t bite tube Sinus issues

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9
Q
  1. Neonatal intubation
A

There is a formula to determine the depth, ie the number at the lip

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10
Q
  1. Difficult
A

Flexible fiberoptic
Emergency trach
Epiglotittis, take to surgery

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11
Q
  1. Airway management (Intubated patient)
A 
1. Monitoring
SpO2, HR, BP, etc
2. Complications
-Laceration of tissue
-Pneumothorax 
-Esophageal intubation 
-Laryngospasm 
-Bronchospasm
-Hypoxia
-Arrhythmias
-After intubation: Kinking
-Biting
-Bleeding
-Secretions
-Cuff rupture
-Accidental extubation 
-Laryngeal edema Sub-glottic stenosis Sinusitis
-Nosocomial pneumonia
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12
Q
  1. What are the Extubation Accidental?
A

Accidental

 - Not secure
 - Not enough sedation 
 - Not restrained 
 - During procedures
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13
Q
  1. Extubation Equipment
A
  1. Suction
  2. Ambu/mask
  3. Oxygen/humidity device
  4. All intubation equipment
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14
Q
  1. Procedure for extubation.
A
  1. Take air out of cuff
  2. Remove tape (hang on to tube)
  3. Withdraw during manual inspiration at peak if possible
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15
Q
  1. Complications extubation
A
  1. Sore throat
  2. Hoarseness
  3. Edema- leading to stridor – treat with racemic epi, steroids, heliox
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16
Q
  1. Failure for extubation
A
  1. Either airway or lung function

2. NIPPV

17
Q
  1. Tracheostomy
A
  1. Airway obstruction (congenital)
  2. Long term ventilation
  3. Pulmonary hygiene
18
Q
  1. Procedure and technique (Tracheostomy)
A

More than you need to know!

19
Q
  1. Complications Tracheostomy
A
  1. Most common complications leading to death
    • Plugging of airway with mucus
    • Accidental decannulation

Others

  • Bleeding
  • Granulation
  • Erosion
  • Tracheomalacia
  • Speech and phonation (Passy-Muir)
  • Swallowing
20
Q
  1. Trach changes how many people.
A

Two people

Prepare for the worst

21
Q
  1. Homecare Teach changes
A
  • Train parents and caregivers
  • Suction
  • Humidity
  • Trach changes
Decannulation 
Methods
- Remove
-Down size and cap 
-surgery
22
Q

22.What are the Suction Procedure?

A
  1. O2
  2. Bag and mask
  3. Sterile catheters and gloves Lavage
  4. Stethoscope

Regulator

60-80 infant
80-100 child 1
00-120 adults

  • Pass catheter just past tip of ETT do not hit the carina Measure tube and go depth indicated
    Catheter size less than 1⁄2 the ID of tube
    Steps.
  • Pre-oxygenate (10-20% higher or 100% if needed) -
  • Manually ventilate using same peak pressures and PEEP Moisten tip of catheter
  • Go in predetermined depth
  • Pull back 0.5 to 1.5 cm
  • Apply suction intermittently
  • 10 seconds total, 5 seconds with suction on
  • Lavage controversial
    NaCl ( see algorithm page 241)
    Use small amounts, 0.5 to 1 ml for neonates
23
Q
  1. Nasotracheal
A
  1. No airway
  2. Advance on inspiration
  3. Watch for vagal stimulation (bradycardia)
  4. Bulb-be gentle
  5. Closed system
  6. Ideal
    - Maintain ventilation Maintain PEEP
    - Less drops in SpO2 Less spray, etc

Disadvantages
- Catheter not pulled all the way back occluding airway - Suction left on

Neonate Class 2019 (10 decks)

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