Endotracheal Intubation Flashcards

1
Q

Why do we intubate? (Name 3 reasons)

A
  • Maintain airway (anaesthesia removes voluntary control of the airway )
  • Anaesthesia abolishes protective airway reflexes e.g. coughing
  • Prevent aspiration pneumonia
  • Prevent laryngospasm
  • Reduce environment pollution
  • Allow IPPV
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2
Q

Why is mask airway not as good as ET? Name 3 reasons

A
  • Mask increases pollution
  • Never direct regardless of how hard you try
  • Not particularly efficient
  • Doesn’t secure an airway
  • may find sizes difficult?
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3
Q

What kind of animals is mask airway most commonly used on?

A

exotics, birds, small furries

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4
Q

Explain 2 ways to get the correct ET tube?

A
  • Tip of incisor to spine of scapula compare to palpable width of trachea
  • Palpate trachea to feel how wide it is
  • Look at space between the nostrils
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5
Q

What equipment is required?(7 things)

A
  1. Suitable sized ET tube
  2. Tube tie
  3. Mouth gag
  4. Syringe to inflate cuff
  5. Lubricant
  6. Laryngoscope
  7. Local anaesthetic spray
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6
Q

Name the 4 kinds of ET tubes

A
  • Red rubber
  • PVC
  • Silicone
  • Murphy eye tubes
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7
Q

Name 3 benefits of using a PVC over a red rubber ET tube?

A
  • Red rubber is not see through (PVC is transparent so can see for any obstructions)
  • Red rubber has a low volume high pressure cuff which is more likely to cause damage to the trachea (PVC is high volume low pressure cuff)
  • Even if you over inflate the cuff the PVC is less likely to cause tracheal damage than Red Rubber
  • PVC lasts longer
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8
Q

What kind of ET tube is recommended in cats?

A

Uncuffed

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9
Q

Why must you be careful when inflating an ET tube cuff?

A
  • tracheal damage

- high mortality incidence with ET intubation

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10
Q

What checks should you do prior to use of an ET tube?

A
  • ensure it is the correct size
  • Make sure it is clean
  • Make sure the cuff is operational
  • Make sure it is not damaged / perished / is in date
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11
Q

For ‘Gold standard’ how long should you leave the cuff inflated for prior to use?

A

30 minutes then deflate

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12
Q
Generally what tube size is used for the following: 
Cat 
Dogs 10kg 
Dogs 20kg 
Dogs 30kg
A

cat - 4.5-5
Dog 10kg - 8
Dog 20 kg - 10
Dog 30 kg - 12

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13
Q

Name the two types of laryngoscope:

A

Miller (straight)

Macintosh (curved)

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14
Q

Name 2 reasons why it is dangerous if the patinet is not adequately anaethetised prior to intubation?

A
  • Could be bitten

- Could bite ET tube and section lodged in trachea

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15
Q

Explain the steps of intubating a patient

A
  • Assistant holds animals head / restrains
  • Ensure the anaesthetic depth is adequate
  • Visualise glottis (with or without a laryngoscope)
  • Insert tip of bevel then rotate to follow curve of trachea
  • Use topical anaesthetic if required ( spray)
  • Check placement and secure
  • Inflate cuff if apt
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16
Q

How do you know if the patient is intubated correctly?

A
  • Palpate within the trachea
  • Ausculate both lung fields
  • Observe movement in reservoir bag
  • check for air movement
17
Q

Name 4 disadvantages of intubation/

A
  • Increased airway resistance if tube too narrow
  • Kinking or occlusion of tube
  • Iatrogenic trauma to larynx
  • Irritation to mucosa if tube not rinsed
  • Over inflation of cuff causing tracheal damage
  • Endo-bronchial intubation
  • Misplacement
18
Q

Give 2 reasons why a patient may be difficult to intubate:

A
  • patient too light
  • Anatomical problems e.g. brachycephalics
  • Trauma
19
Q

What should you do prior to intubating if you think a patient may be difficult to intubate?

A

Pre-oxygenate for at least 5 minutes

20
Q

Name 3 potential ET tube problems?

A
  • Tube in oesophagus
  • Tube lodged in bronchus
  • Laryngospasm in cats
  • Tube blocked or kinked
  • Tracheal rupture
21
Q

What could a tube in the oesophagus cause?

A
  • Patient doesn’t stay asleep
22
Q

What would tube lodged in bronchus cause?

A
  • Patient wakes up
23
Q

How do you tell if tube is lodged in oesophagus?

A
  • patient wakes up
  • Low spO2 on pulse oximeter
  • Low/little movement of reservoir bag
24
Q

How do you tell if tube is lodged in bronchus?

A
  • spO2 is greatly reduced
  • Unilateral breath sounds
  • patient wakes up
25
Q

How do you prevent laryngospasm in cats?

A
  • Use 1 spray of local anaesthetic and wait
  • Use laryngoscope
  • If problems oxygenate and wait
26
Q

How do you tell if there is a blocked or kinked ET tube?

A
  • spO2 very low
  • Little movement of reservoir bag
  • Cyanosis
27
Q

How do you tell if there is a tracheal rupture?

A
  • Sub-cut emphysema

- Reduced breath sounds

28
Q

How do you extubate your patient?

A
  • Wait until pharyngeal reflexes have returned
  • Make sure the oropharyngeal area is free of debris/blood
  • Wait until patient coughs/chews if brachycephalic and monitor oxygen
29
Q

What may the patient suffer from if reflexes are delayed?

A

Megaoesophagus