chapter 65: artificial airways and mechanical ventilation Flashcards
Indications for artificial airway
upper airway obstruction
apnea
high aspiration risk
can’t clear secretions
respiratory distress
ET vs tracheotomy
ET for short period of time (under 2 weeks)
tracheotomy for longer time
oral vs nasal ETs
Oral
-bigger tube
-use laryngoscope or bronchoscope
-easier to get things out
-reduces WOB
-sedation, bite block, and/or oropharyngeal airway
Nasal
-done blindly
-less common –> only if oral route is inaccessible
ET intubation process
- consent
- self inflating BVM (Ambu bag) nearby
- premedicate
- put patient in supine (“sniffing”) position
- spray throat with anesthetic and vasoconstrictors
- preoxygenate with BVM 3-5 mins
- insert tube –> you’ve got 30 s
- inflate cuff
- check placement with EtCO2 detector and resp assessment
- connect ET tube to mech ventilator
- suction
- check position again with xray –> 2-6 cm above carina
- get ABGs 15-30 mins later
Rapid sequence intubation
-knock ‘em out with sedative, opioid, and paralytic drug for immediate intubation
-reduces risk of aspiration and injury
-don’t do if cardiac arrest or difficult airway
disldged ET tube
MED EMERGENCY
-RISK OF PNEUMOTHORAX
maintaining cuff inflation
-check every 8 hrs
-make sure it’s bt 20-25 cm H2O –> use manometer
-MOV = inflate until no air sound at trachea after inhale
-MLT is same except you deflate a little
check o2 status
ABGs, SpO2 = direct
ScvO2, SvO2, CVP/PA catheters = indirect
signs of hypoxemia
-confusion
-dusky skin
-dysrhythmias
check ventilation
-PaCO2
-continuous partial pressure of end-tidal CO2 (PETCO2)
-RR and rhythm
-accessory muscle use
Maintaining patency
Don’t routinely suction
Assess for suctioning needs
-visible secretions in ET tube
-resp distress
-aspiration
-increased RR or cough
-drop in SpO2
-increased peak airway pressure
-adventitious breath sounds
open suction method and closed suction method
CST
-catheter in a sleeve connected to patient-ventilator circuit
-maintains oxygenation and ventilation while decreasing exposure to secretions
potential complications of suctioning
hypoxemia + bronchospasm
increased intracranial pressure
dysrhythmias
increase or decrease in BP
mucosal damage
bleeding, pain, infection
how to prevent hypoxemia and dysrhythmias during suctioning
hyperoxygenate before and after
limit each pass to 10 s or less
monitor ECG and SpO2 before, during, and after suctioning
how to prevent tracheal mucosal damage while suctioning
limit suction pressure to under 120
avoid vigorous catheter insertion
managing thick secretions
hydrate
humidify
turn patient
antibiotics
