Chapter 77 - Intubation and Tracheotomy Flashcards
how to estimate ET tube size in kids ages 1-12
Age/4 + 3 if cuffed
Age/4 + 4 if uncuffed
mortality rate of trachea-innominate fistula
73%
Which trach incision can be used in kids to decrease risk of subglottic stenosis: horizontal or vertical?
vertical
which H/N location absorbs the greatest amount of cocaine?
trachea
Which cuff pressure will compromise capillary blood flow to the trachea?
34 cm H2O
How to treat airway fire
Turn off O2 - Saline - remove tube - reintubate - IV steroids/ABx - bronch to remove charred tissue - delayed extubation
ET tube size for neonate
2.5-3
tube size for 1-6 mo and 6-12 mo
3-3.5
3.5-4
tube size for toddler
4-5
tube size for adult female
6-7
tube size for adult male
7-8
Describe Cormack-Lehane airway grades
I- entire glottis
II- partial glottis
III- epiglottis only
IV- can’t see epiglottis
Blockage at what part of the airway would produce stertor
OP/NP
Use of heliox with airway obstruction
21:79 O2:He
less dense –> can get higher flow rate –> less turbulent flow means more air to distal lungs –> also decreases pressure gradient needed to move air across obstruction
Helium is inert, insoluble
how do IV steroids decrease airway inflammation/edema
reduced capillary dilation
decreased plasma extravastation
decreased inflammation
Indications for fiberoptic intubation
h/o prior difficult intubation requiring fiberoptic
micrognathia
C-spine issue (unstable, fused disk)
facial trauma
obstruction above glottis
need awake intubation (cannot mask ventilate)
trismus
Why place trach tube between second and third tracheal rings
higher: erode or fracture cricoid cartilage –> subglot sten
lower: risk to innominate artery
where to make skin incision for trach
two fingerbreadths above sternal notch
Steps to cricothyroidotomy
find CTM (1cm tall) vertical skin incision horizontal CTM incision retract wound open pass tube
can you do a cricothyroidotomy in young patients?
infants and young children do not have a CTM – they need emergent tracheotomy
how to treat subcutaneous emphysema after trach
cut sutures, inflate cuff
stat CXR to evaluate cause
factors contributing to TI fistula
overinflated cuff
poorly fit tube
poor wound healing
TI fistula occurs with erosion of trach tube through tracheal wall into innominate
how to treat urgent post-trach bleed
inflate cuff
if uncuffed, insert 6.0 cuffed and inflate
if innominate artery bleed, stick finger in, compress innominate between finger and sternum –> OR
when to use Bjork flap
if going to have trach long term
helps you keep a patent stoma if accidental decannulation
increases risk of tracheocutaneous fistula after decannulation
theoretically can trach tubes increase aspiration risk?
possibly, due to decreased hyolaryngeal elevation
when to use cuffed trach tube
if need positive airway pressure to ventilate
to slow aspiration
risks/benefits of percutaneous trach
risks: blunt objects –> crush tracheal rings –> stenosis/malacia; transect high-riding innominate
benefits: shorter, cost-effective, similar long term complications
Perc uses dilational/Seldinger technique
