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RTH 132 > Endotracheal Tubes > Flashcards

Endotracheal Tubes Flashcards

1
Q

general indications for endotracheal tube

A

failure to oxygenate/ventilate
failure to maintain/protect airway
predation of decompensation

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2
Q

intubation criteria

A 
ventilatory failure - hypoventilation 
relief of an obstructed airway
protection of the airway (four reflexes)
clearance of secretions
direct instillation of medication
bronchoscopic examination
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3
Q

whats the minimum endotracheal tube

A

7.5 tube

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4
Q

causes of ventilatory failure

A

drugs
midbrain abnormalities (head injuries, stroke injuries)
peripheral nervous system abnormalities
diseases of the respiratory muscles

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5
Q

ventilatory failure cont’d

A

disease of the myoneural junction - myashtenia gravis
acute or chronic lung disease
damage, inflammation, infection, or collapse of a lung
cardiovascular collapse
inhalation burns

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6
Q

relief of an obstructed airway

A 
airway obstruction (foreign body, loss of muscle tone, bleeding, and airway edema)
traumatic injury (infection allergic reaction)
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7
Q

obstructed airway symptoms

A

stridor and muscle exertion, a slight coughing, and vocal hoarseness
more severe, accessory muscles, intercostal retractions, and a tracheal tug
facial burns - causes severe inflammation

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8
Q

protection reflexes

A

pharyngeal reflex, laryngeal reflex, tracheal reflex, carinal reflex, altered LOC, aspiration, higher risks of vomiting

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9
Q

clearance of secretions

A

access for suctioning, chronic lung disease, chronic bronchitis, pneumonia

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10
Q

how does direct instillation of medication work

A

during emergencies medicine can be directly instilled down endotracheal tube

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11
Q

name the parts of the endotracheal tube

A

body, bevel, murphy eye, cuff, inflation tube, pilot balloon, one way valve, 15mm adapter, radiopaque line

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12
Q

why does the endotracheal tube have a beveled end

A

less chance to attach to tissue

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13
Q

what is the murphys eye for

A

to make sure the pt can always breath

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14
Q

why do the cuff and pilot balloon mirror each other

A

so you know if the cuff is inflated or deflated based off of the pilot balloon

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15
Q

what connection do the vocal cords and the bevel have in common

A

helps visualize the vocal cords easier and makes it easer to insert through them

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16
Q

what can low volume and high pressure of a cuff lead to

A

tracheal tissue necrosis

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17
Q

what is the best choice for cuff inflation

A

high volume and low pressure

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18
Q

what is the internal and outer diameter on the et tube measured in

A

millimeter or french measurement

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19
Q

why are the centimeter marks on the et tube

A

to measure and mark how deep the tube is in the trachea

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20
Q

where do you measure and mark the tube

A

at the lip or teeth line

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21
Q

what 3 things do you check to make sure you properly inserted an ET tube

A
  1. XRAY
  2. bilateral breath sounds
  3. easy cap
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22
Q

why is a neonatal tube uncuffed

A

bc the cricoid bone is the smallest part of airway and it seals around the cuff

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23
Q

complications of tubes

A

friction, reaction to materials, infection, poor humidification, poor secretion removal, right mainstem bronchus, increased RAW b/w 5-7, filtering, no talking, no effective cough

24
Q

what are 3 things that block airways

A

muscle, secretions, swelling

25
Q

what is MLT or minimal leak technique

A

listen to breath sounds around cuff and during peak inspiration pressure if air goes around the cuff then it is ok to inflate past 30 mmHg bc blood flow is possible during that time

26
Q

what is a major clinical sign for laryngeal complication

A

inspiratory stridor

27
Q

laryngeal stenosis

A

as the laryngeal heals it tightens and the airway can close after removing the tube

28
Q

what is tracheal mylagia

A

trachea muscles becomes flappy and no muscle control so airway collapses

29
Q

what happens when cuff pressure greater than 25 occurs

A

it inhibits lymphatic flow

30
Q

what happens when cuff pressure is greater than 35

A

obstructs venous flow

31
Q

what happens when cuff pressure is greater than 30

A

causes arterial blood flow to stop and tissue necrosis to develop

32
Q

what happens if the cuff pressure is not great enough

A

the weight of the secretions will be to heavy for the cuff and they will be able to fall down into the lungs

33
Q

how does vocal cord paralysis happen

A

caused by damage to the recurrent laryngeal nerve

34
Q

how does glottic/subglottic edema work

A

edema that occurs below the cricoid cartilage

35
Q

if hoarseness lasts for more than one week after ET tube removal what causes it

A

traumatic intubation, tight fitting tube, allergic reaction, excessive movement

36
Q

what is the maximum time an ET tube can be in

A

2 weeks

37
Q

laryngeal web

A

occurs several days after extubation, and caused by necrotic tissue around glottis, stridor and acute airway obstruction occur along with fibrin forming

38
Q

what helps with a tracheal stenosis and what is it

A

MLT and its a lesion that constricts the airway

39
Q

what can happen specifically with oral tubing

A

erosion of the corners of the mouth, pt may bite tube, harder to attach equipment, harder to communicate

40
Q

how do you prevent accidental changes in tube position

A

routine assessment and marking cm marks at teeth or gums or nare

41
Q

average cm marks for adult

A

oral male: 21-23 cm
oral female: 19-21
nasal: 26-29

42
Q

how do you secure an ET tube

A

with tape or ET collar

43
Q

what do you look for in a chest xray of ET tube

A

radiopaque line, 2-4 cm above carina, around T2-T4 vertebrae

44
Q

what happen if there is a cuff leak

A

causes reduced delivery of tidal volume and requires extubation and reintubation

45
Q

how can you tell if there is an accidental extubation

A

decreased breath sounds, decreased airflow through tube, difficulty passing a catheter past the end of tube

46
Q

what should patient have and be able to do in order to be ready for extubation

A

clear airway secretions (cough) and have intact gas reflex

47
Q

steps of extubation

A

get equipment, suction above the cuff and pharynx, oxygenate the pt, deflate cuff, remove tube, apply more oxygen, assess pt, check for good air flow

48
Q

what is a bronchoscopy used for

A

inspect airway, collect samples, remove foreign objects, and place devices into the airway

49
Q

what are the specialized endotracheal tubes

A

double lumen tubes, tubes with special adaptors for jet ventilation, tubes with subglottic suction ports

50
Q

double lumen tubes

A

also called carlens tube, unilateral lung disease, independent lung ventilation

51
Q

what is the carlens tube essentially

A

2 ventilators for each lung

52
Q

high frequency jet ventilation

A

gas goes in and out of lungs all the time

53
Q

what does the CASS tube help with

A

reducing VAP

54
Q

laryngeal mask airway

A

consists of a short tube and a small mask that is inserted deep into oropharynx

55
Q

can the LMA be used in conscious or semicomatose pt’s

A

no due to stimulation of the gas reflex

56
Q

combitube

A

double lumen airway that will ventilate lungs if put into esophagus or trachea

RTH 132 (11 decks)

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