Day 5 - Airway Management

Question 1

What are some complications of oxygen therapy?

prevention?

Answer 1

Oxygen toxicity
* excess free radicals, neutralizing enzymes are tired
* causes ARDS

Absorption atelectasis AA
* excess O2 washes nitrogen out of the alveoli and they begin to collapse
* cannot breathe with closed alveoli; no gas exchange

Prevention
* maintain lowest concentration of O2
* increase FiO2 gradually
* limit 100% oxygen to 24 hours, starts within 30 mins

Question 2

Why is it important to limit oxygen delivery to a patient with COPD?

Answer 2

COPD patients retain CO2 and abnormally breath with a Hypoxic drive
* if we bring up their O2/CO2 levels the patients chemoreceptors will not respond and they wont breathe
* peripheral chemoreceptors breathe for them ONLY once they are hypoxic
* if we keep them below 92% they will breathe on their own
* could develop hypercapnic respiratory failure

Question 3

When would you consider using an artifical airway?

Answer 3

Indications
* impaired gas exchange
* ineffective breathing pattern
* retained secretions
* patient anxiety related to breathing
* decreased level of consiousness

Question 4

What are the two types of pharyngeal airways?

indications

Answer 4

Oropharyngeal - intubated
* thick plastic
* measurement mouth to ear

Nasalpharygeal - awake or jaw/neck precautions
* flexible and soft
* lube ++
* nose to ear measurement

Question 5

What are the components of an ETT?
Indications for one..

Answer 5

Components
* ETT size and markers
* ETT cuff / balloon
* pilot valve - to inflate
* universal adaptor for ambu bag

Indications:
* airway maintenance
* airway protection
* secretion
* control
* oxygenation
* mechanical ventilation

Question 6

How do you properly use a manual resusitation bag?

Answer 6

Set flow meter for 15 L, ensure bag inflated
Bag with one hand every 5-6 seconds

Question 7

What are the nurses roles before, during, and after intubation?

Answer 7

Prior
* confirm emergency line available
* ensure pulse ox is monitoring
* ensure ambu bag is set up
* confirm medications required

During
* monitor vital signs and cardiac monitor

After
* monitor O2
* get chest xray for placement
* watch for end tidal detector
* listen to bilat lungs

Question 8

What is the importance of ETT/trach cuff? How do we monitor cuff pressures?

Answer 8

Keeps the tube in the patients airway

RT monitors cuff pressures through cuff leak techniques/vent for less than 20 mmHg

Question 9

What are some complications of airways and their interventions?

Answer 9

Trauma to oral/nasal cavity
Gagging, vomiting
Laryngospasm
Obstruction of airway