Chapter 13

Question 1

1. Intubation Indications

Answer 1

1. Pulmonary Function (disease)
2. Provide an airway (obstruction)
3. Protect the airway (aspiration)
4. Pulmonary hygiene (secretion removal)

Question 2

2. What are the Equipment needed for intubation? ETT

Answer 2

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

Question 3

3. How many Blades and handles are there? Two

Answer 3

1. Straight and curved

2. Straight used the most

Question 4

4. LMA

Answer 4

1. Back-up airway for difficult intubations
2. Short term ventilation
3. Low pressure ventilation

Question 5

5. What are Suction equipments? Two

Answer 5

1. Yankauer (tonsil tip)

2. Catheters etc. Sx 80-100

Question 6

6. What are the Procedure Orotracheal intubation?

Answer 6

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

Question 7

7. What are the equipment for Nasotracheal intubation?

Answer 7

One size smaller than oral

Magill forceps Blind (don’t do)

Question 8

8. Oral vs nasal

Answer 8

1. Comfort not really an issue

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

Question 9

9. Neonatal intubation

Answer 9

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

Question 10

10. Difficult

Answer 10

Flexible fiberoptic
Emergency trach
Epiglotittis, take to surgery

Question 11

11. Airway management (Intubated patient)

Answer 11

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

Question 12

12. What are the Extubation Accidental?

Answer 12

Accidental

 - Not secure
 - Not enough sedation 
 - Not restrained 
 - During procedures

Question 13

13. Extubation Equipment

Answer 13

1. Suction
2. Ambu/mask
3. Oxygen/humidity device
4. All intubation equipment

Question 14

14. Procedure for extubation.

Answer 14

1. Take air out of cuff
2. Remove tape (hang on to tube)
3. Withdraw during manual inspiration at peak if possible

Question 15

15. Complications extubation

Answer 15

1. Sore throat
2. Hoarseness
3. Edema- leading to stridor – treat with racemic epi, steroids, heliox

Question 16

16. Failure for extubation

Answer 16

1. Either airway or lung function

2. NIPPV

Question 17

17. Tracheostomy

Answer 17

1. Airway obstruction (congenital)
2. Long term ventilation
3. Pulmonary hygiene

Question 18

18. Procedure and technique (Tracheostomy)

Answer 18

More than you need to know!

Question 19

19. Complications Tracheostomy

Answer 19

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

Question 20

20. Trach changes how many people.

Answer 20

Two people

Prepare for the worst

Question 21

21. Homecare Teach changes

Answer 21

• Train parents and caregivers
• Suction
• Humidity
• Trach changes

Decannulation 
Methods
- Remove
-Down size and cap 
-surgery

Question 22

22.What are the Suction Procedure?

Answer 22

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

Question 23

23. Nasotracheal

Answer 23

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