devices Flashcards
Two types of airway devices
tracheal and pharyngeal
examples of tracheal airway devices
endotracheal tube and tracheostomy tube
Examples of pharyngeal airway devices
nasopharyngeal airway
oropharyngeal airway
laryngeal mask airway
combitude airway
two most common type of artificial airway are
endotracheal tube and tracheostomy tube
Indication of tracheal intubation
to bypass an upper airway obstruction
to protect the airway from aspiration
to apply positive pressure breathing
to aid clearance of secretion
to deliver high oxygen concentrations
It is a flexible plastic tube that is inserted to the patients mouth into the trachea to help sustain spontaneous breathing
Endotracheal tube
The process of inserting et tube into the airway of the patient is called
endotracheal intubation
The et tube can be determine by the
inner diameter or ID
Requires injection of pressurized air into the balloon to create a seal onto the inside walls of the airways.
Cuffed et tube
It is recommended for children less than 8 years old to prevent narrowing of the trachea
uncuffed et tube
This indicate the placement of the et tube
Centimeter marking of et tube
The average distance from the tip to the carina in male is______ female is______
27 cm, 25 cm
Tape the tube at what cm in males and females (taping mark)
males- 22-25 cm, female-20-23 cm
The tip of the et tube must rest _____above the carina
2-5cm
In auscultation to confirm position of the et tube you should hear what sounds
bilateral breath sounds of right and left lung
Protects the patient from aspiration and help to give the patient positive pressure ventilation
Cuff
Use to inflate and deflate et tube cuff and connected to _____
pilot balloon, manometer
Use to inflate and deflate et tube cuff and connected to _____
pilot balloon, manometer
What is the normal cuff pressure
25-35 cm H2O
Indication of endotracheal intubation
To relieve upper airway obstruction
To protect the airway
Facilitation of tracheal suctioning
Assistance in manual ventilation//mechanical ventilation
What are 4 airway protective reflex
pharyngeal reflex
laryngeal reflex
tracheal reflex
carinal reflex
What reflex that is responsible in preventing choking
Gag reflexes
Other term for carinal and tracheal reflex
cough reflex
How reflexes are obtunded
paralysis
anesthetized patient
unconscious patient
neuromuscular disease
What are the hazards in endotracheal intubation
Loss of patient ability to talk
Loss patient ability to eat using mouth
Tube occlusion with inspissated secretion
Damage vocal cord
How intubated patient ingest foods that turns solid food to liquid
NGT nasogastric tube
What are the complication of et intubation
- Poorly tolerated by the conscious and semi-conscious patient
- Gagging caused by the tube irritation
- Harder for the patient to communicate
- Patient may bite the tube which may cause occluding airflow and a mechanical ventilator airflow alarm is triggered.
- Erodes, corner of patient’s mouth
- Stimulates oral secretions
Used to shape the et tube to be easier to be inserted. Gives rigidity and prevents et tube to bend.
stylet
It is a surgical opening in the neck and trachea that provides access for the insertion of an artificial airway known as_______
tracheostomy, tracheostomy tube
Hole in the trachea without the tube in place
Stoma
How many cm of incision of the neck for stoma
3-4 cm
Tracheostomy tube are placed on what tracheal ring
Between second and third tracheal ring
How many percent of tracheal diameter to occupy the tracheostomy placement
65-75%
Inserted directly to the trachea via stoma
tracheostomy tube
Indication of tracheostomy intubation
- the patient will require mechanical ventilation for more than one or two weeks.
- the patient can’t manage their own secretions and require frequent tracheal suctioning
- The patient has a difficult airway or sudden trauma/swelling in their upper airway and attempts to intubate via the endotracheal have failed
Risk and complication of tracheostomy
- Obstruction to the tracheostomy tube from secretions or blood clot that prevents ventilation
- Infection
- Accidental decannulation of the tracheostomy tube
How does tracheostomy tube work
By allowing the patient to breathe via tracheostomy that has been inserted into their stoma, bypassing their upper airway completely
These are developed for patient that require positive ventilator and airway protection
Cuffed tracheostomy tube
These are used when patient no longer needs to positive pressure ventilation and has no significant aspiration risk
Uncuffed tracheostomy tube
Tracheostomy tube sizes
1. preemie under 2 kg:
2. Infant:
3. 6-18 months old:
4. 18 months old to 5 year old:
5. 4year old- 10 year old:
6. 10 year old- 14 year old:
7. 14 year old and up:
- 2.5 mm ID
- 3.0-3.5 mm ID cuffless neonatal size
- 3.5-4.0 mm ID neonatal or pediatric size
- 4.0-4.5 mm ID pediatric size
- 4.5-6.0 mm ID pediatric size
- 5.0-6.5 mm ID pediatric size
- 6.0-9.0 mm ID adult size
It can restore airway patency and maintain adequate ventilation , in particular, when using bag-mask device.
Pharyngeal airways
It can restore airway patency and maintain adequate ventilation , in particular, when using bag-mask device.
Pharyngeal airways
Nasopharyngeal airway a.k.a
Nasal horn/ nasal trumpet
It is inserted through one of the nares and past the turbinates
Nasopharyngeal airway
Nasopharyngeal airway advantage:
It can be used in ________ victims with potential problems with the self-control of the airway. It can be used in situations where the victims have_______. It can also be used in victims with _______. It does not require ______ during insertion. Patient with _____
semi-conscious, extensive injury to mouth/lower jaw, intact gag reflexes, hyperextension of the neck, seizure
The disadvantage of nasopharyngeal airway
should not be used if:
Severe nasal bleeding
If: suspected basilar skull fractures, trauma to the nose if present, resistance is met when attempting to advance the device.
What are the advantages of oropharyngeal airway
Prevent airway obstruction by the tongue
To be used as a bite block
To increase the effectiveness of bag/mask ventilation
Contraindication of oropharyngeal airway
A conscious patient with gag reflex
What are the two techniques to insert oropharyngeal airways
- The tongue is displaced away from the roof of the mouth with a tongue depressor. The curved portion of the airway is slipped over the tongue, following the curve of the oral cavity. the oropharyngeal airway is rotated 180 degrees before insertion.
- jaw-lift technique displaces the tongue
Laryngeal mask airway
a small, triangular-shaped inflatable mask that is secured to a tube, similar in size to an ETT
Advantages of LMA
a. this airway can be quickly inserted to provide ventilation when bag-mask ventilation is not adequate and ET intubation cannot be accomplished
b. LMA ventilates equally as well as an et tube
c. training is simpler than for an et intubation
d. there is no risk of esophageal or bronchial intubation
e. there is less risk of trauma to the airway than with ET intubation.
Contraindication for LMA
Patient is conscious or resist placement of LMA
Patient is known to have or might have food in the stomach
Patient has GERD
A double-lumen airway that is inserted blindly into the oropharynx and advanced into the esophagus or trachea. It has feature similar to ETT
Combitude
The combitude has been used effectively in____
cardiopulmonary resuscitation
It has been used successfully in patients with ____________________where there was an ability to visualize the vocal cord.
difficult airways secondary to severe facial burns, trauma, upper airway bleeding, and vomiting
The combitude can only be used in the adult population as no pediatric sizes are available. T/F
T
Tracheostomy tube is made usually of _______
silicon and polyvinyl material
how much pressure use in cuff tracheostomy tube
20-30 cm h2O
If pressure in the cuff is too high it can_____
cut off mucosal blood flow, tracheal stenosis
If pressure in the cuff is too high it can_____
cut off mucosal blood flow, tracheal stenosis
if the pressure is the cuff is too low it can_____
affect the delivery of positive pressure ventilation, airway is not protected from aspiration
It is a special type of tracheostomy tube that has an opening above the cuff which allows the airflow to pass so that the patient is able to talk when an airway is place
Fenestrated tracheostomy tube
Hole or opening in the shaft of the tube
fenestration
The outside diameter of the airway should be equal to the inside diameter of your _______.
patient-external nares
How to determine the size of nasopharyngeal airways by____
measuring the tip of your earlobes into your center of the nostrils
indication of oropharyngeal airway
conscious and non-responsive patient
difficulty in maintaining patent upper airway
how to determine the size of oropharyngeal airway
Measuring from the angle of the jaw to the tip of the chin
What are the two common oropharyngeal airway design
Guedel airway and Berman airway
Has two horizontal plates connected by one ridge in the center of the airway. Each side of this ridge serves as the channel to pass a _________ to the laryngopharynx. The horizontal plates provide a flat surface for the teeth to contact. the smooth rounded tip to prevent the _______
Berman airway, suction catheter, trauma to the soft tissue of the upper airway
Design with one smooth channel through the center
Guedel airway
What is the purpose of laryngeal mask airway
to prevent gastric aspiration while providing a patent airway
To determine with should to ventilate through attach your combitude into a ______ To determine where the combitude lies, use_______
resuscitator bag/ bvm, carbon dioxide detector
