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Mrs. Emro - RET1264C > Exam 1 - Airway Management 🫀🫁 > Flashcards

Exam 1 - Airway Management 🫀🫁 Flashcards

1
Q

Pharyngeal airway extend only into ______________.

A

Pharynx

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2
Q

What are the two types of oropharyngeal airways?

A
  • Berman
  • Guedel
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3
Q

Which oropharyngeal airway uses a single center channel? Which one uses two?

A
  • Guedel uses 1
  • Berman uses 2
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4
Q

Nasopharyngeal airway is also called what?

A

Nasal trumpet or nasal horn

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5
Q

What are indications for nasopharyngeal airways?

A
  • Facilitate ventilation
  • Removal of secretions by nasotracheal suctioning
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6
Q

What are some indications for double-lumen endotracheal tube?

A
  • Lung isolation (prevent lung-to-lung spillage of blood pus)
  • Surgical procedure on nonventilating lung
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7
Q

Removal of the larynx (voice box) is also known as _______________.

A

Laryngectomy

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8
Q

What are some indications of artificial airways?

A
  • Relief of airway obstruction
  • Protection of airway
  • Suctioning
  • Support ventilation
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8
Q

Opening in the neck is called _________________.

A

Tracheostomy

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9
Q

Laryngeal Mask Airway (LMA) provides a seal over the larynx with maximum cuff pressure of _____ centimeters of water.

A

60 centimeters of water

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10
Q

The process of placing an artificial airway into the trachea.

A

Intubation

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11
Q

Oropharyngeal airway must lie _____________________.

A

At the base of tongue above epiglottis with flange outside teeth.

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12
Q

Artificial airways placed through mouth and nose into trachea are called ______________.

A

Endotracheal tubes

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13
Q

What may occur if EOA enters the trachea?

A
  • Tracheal damage
  • Asphyxia
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14
Q

Indications for LMA

A
  • Airway during CPR in profoundly unconscious patients without glossopharyngeal and laryngeal reflexes
  • Unable to perform ET intubation
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15
Q

Contraindications of LMA

A
  • It goes over the pharynx so it does not protect airway from aspiration
  • Shouldn’t be used on patients who have not fasted, require emergency resuscitation drug instilled directly into the airway, have severe oropharyngeal trauma, are not profoundly unconscious
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16
Q

Esophageal Tracheal Combitude may be inserted where?

A

Esophagus or trachea

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17
Q

What are some limitations of LMA? (5)

A
  • Unstable airway may cause misplacement of a mask and gastric insufflation
  • Cannot withstand high airway pressures (20 cmH2o without gastric distention)
  • Not meant for long term use
  • Does not protect airway from aspiration
  • Requires steam autoclave for reusable LMA (seldomly used)
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18
Q

Which medical device is inserted blindly?

A

Esophageal Tracheal Combitude

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19
Q

Selection of tracheotomy tubes depends on things like:

A
  • Patient’s age, height, airway anatomy
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20
Q

The two basic types of tracheal airways are:

A
  • Endotracheal tubes
  • Tracheostomy tubes
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21
Q

_______________ is most often placed in a patient who requires frequent nasotracheal suctioning.

A

Nasopharyngeal airway

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22
Q

How does pharyngeal airways prevent airway obstruction?

A

By keeping tongue pulled forward and away from the posterior pharynx. This type of obstruction is common in an unconscious patient as a result of loss of muscle tone.

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23
Q

The use of oropharyngeal airway should be restricted to what type of patients?

A

Unconscious patients to avoid gagging and regurgitation.

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24
Q

What type of airways extend beyond the pharynx into the trachea?

A

Tracheal airways

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25
Q

____________ tubes are inserted through a surgically created opening in the neck directly into the trachea.

A

Tracheostomy tubes

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26
Q

An ___________ with a rounded tip is used for tube insertion.

A

Obturator

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27
Q

What are the two major limitations of the LMA?

A
  • It cannot be used in a conscious or semicomatose patient because of stimulation of the gag reflex
  • If ventilating pressures greater than 20 cmH2O are needed, gastric distention may occur. This device does not protect against aspiration should regurgitation occur.
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28
Q

Before insertion of the LMA, the posterior surface of the mask must be lubricated and the cuff must be ______________.

A

fully deflated

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29
Q

What is used to guide the insertion of the LMA along the palate and down into the oropharynx?

A

Index finger

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30
Q

LMAs range in size from size _____ for adults and size ______ for infants.

A
  • 5 for adults
  • 1 for infants
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31
Q

When intubation is difficult, the patient cannot be positioned for intubation or when the intubator is inexperienced, what would you use?

A

Laryngeal Mask Airway (LMA)

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32
Q

When the LMA cuff is in place, it is inflated to a maximum of __________. Inflation causes the mask to rise slightly out of the mouth.

A

60 centimeters of water

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33
Q

The classic LMA can be used to facilitate intubation because _______________.

A

The opening faces the glottis.

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34
Q

What is this?

A

LMA

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35
Q

What is the tracheotomy tube made of stainless steel called?

A

The Jackson Tracheostomy Tube

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36
Q

What is indicated for patients who retain secretions but do not have an artificial airway in place?

A

Nasotracheal suctioning

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37
Q

As the catheter is enters the lower pharynx, the patient should assume what position?

A

“Sniffing” position

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38
Q

________________ is when the ET tube is passed through the nose first.

A

Nasotracheal intubation

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39
Q

________________ is when the ET tube is passed through the mouth on its way to trachea

A

Orotracheal intubation

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40
Q

___________ maintains patient airway by preventing tongue from obstructing oropharynx.

A

Oral pharyngeal airway

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41
Q

What can be used as a bite block for patients with oral tubes?

A

Oral pharyngeal airway

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42
Q

Procedure of establishing access to trachea via neck incision

A

Tracheotomy

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43
Q

What is usually done to treat laryngeal cancer, trauma and radiation necrosis and also be done to treat severe trauma, such as a gunshot wound?

A

Laryngectomy

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44
Q

Uses and precautions of Nasopharyngeal Airway

A
  • Inspect nares for obstructions
  • Use local anesthetic spray
  • Use water-soluble lubricant on airway
  • Size 6 for adult female; Size 7 adult male
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45
Q

How do you properly insert a nasopharyngeal airway?

A

Insert airway parallel to the nasal floor, beveled edge towards septum

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46
Q

What medical device cannot be used as an airway for PPV?

A

Esophageal Obturator Airway

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47
Q

____________ resembles a short ET tube with a small cushioned oblong-shaped mask at the distal end.

A

Laryngeal Mask Airway

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48
Q

_____________ is also called a double lumen airway.

A

ETC - Esophageal-Tracheal Combitude

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49
Q

What happens when ETC tube is in the esophagus?

A

A small distal cuff (15 mL) seals off the esophagus

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50
Q

Retained secretions increase airway resistance and the work of breathing and can cause _______________________. (4 things)

A
  • Hypoxemia
  • Hypercapnia
  • Atelectasis
  • Infection
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51
Q

What is the application of negative pressure (vacuum) to the airways through a collecting tube (flexible catheter or suction tip)?

A

Suctioning

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52
Q

Difficulty in clearing secretions may be due to what?

A

Thickness and the amount of the secretions or pt’s inability to generate effective cough

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53
Q

Suctioning can be performed by way of either __________________.

A
  • The upper airway (oropharynx)
  • Lower airway (trachea and bronchi)
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54
Q

Why should tracheal suctioning through the mouth be avoided?

A

It causes gagging

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55
Q

There are two techniques for endotracheal suctioning, What are they?

A

Open and closed.

OPEN: Sterile technique requires disconnecting the pt from ventilator.

CLOSED: Uses a sterile, closed, in-line suction catheter that is attached to the ventilator circuit so that the suction catheter can be advanced into the patient’s endotracheal airway with disconnecting the patient from the ventilator

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56
Q

What type of suctioning is when the catheter is inserted in the artificial airway until resistance is met and then withdrawn approximately 1 cm before applying suction?

A

Deep suctioning

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57
Q

Pharyngeal airways prevent airway obstruction by keeping the tongue pulled forward and away from the ___________.

A

Posterior pharynx

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58
Q

In adults, the use of deep tracheal suctioning is being questioned because of what?

A

The effects of lung volume and oxyhemoglobin saturation

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58
Q

Describe shallowing suctioning.

A

When the catheter is advanced to a predetermined depth, which is usually the length of the airway plus the adapter

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59
Q

Suctioning done with lack of clinical indication can lead to unnecessary complications including:

A
  • Hypoxemia
  • Bronchospasm
  • Mucosal irritation
  • Patient discomfort
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60
Q

Suction pressure should always be checked by ____________.

A

Occluding the end of the suction tubing before attaching the suction catheter. The suction pressure should be set at the lowest effective level.

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61
Q

What suction pressures are recommended for neonates and adults?

A

Neonates: Negative pressure of 80 mm Hg
Adults: Less than 150 mm Hg

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62
Q

How long are most suction catheters for adults?

A

22 inches and sized in French units

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63
Q

A curved-tip catheter, or catheter coude helps direct access to the ______________.

A

Left mainstream bronchus

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64
Q

What does a too large a suction catheter combined with negative pressure do?

A

Evacuates lung volume and can cause atelectasis and hypoxemia

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65
Q

In infants and children, the diameter of the suction catheter should be less than _______________________.

A

70% of the internal diameter of the artificial airway

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66
Q

In adults, the diameter of the suction catheter should be less than _______________________.

A

50% of the internal diameter of the artificial airway

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67
Q

What type of suction catheter can be used for patients receiving ventilatory support?

A

An in-line suction catheter

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68
Q

In-line catheters have no effect on risk for ventilator-associated pneumonia. T or F?

A

True

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69
Q

What are some indications for the closed suctioning technique?

Box 37.2
Pg. 751

A

Mechanically ventilated patents with:
- Positive end expiratory pressure ≥ 10 centimeters of water
- Mean airway pressure ≥ 20 centimeters of water
- Inspiratory time ≥1.5 s
- FiO2 ≥0.60
- Frequent suctioning (≥6 times/day)
- Hemodynamic instability associated with ventilator disconnection
- Respiratory infections requiring airborne or droplet precautions
- Inhaled agents that cannot be interrupted by ventilator disconnection

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70
Q

What are potential complications of endotracheal suctioning?

A
  • Hypoxemia
  • Cardiac dysrhythmias
  • Hypotension or hypertension
  • Atelectasis
  • Mucosal trauma
  • Increased intracranial pressure
  • Bacterial colonization of lower airway
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71
Q

What can occur with repeated nasotracheal suctioning?

A

Mucosal trauma and bleeding.
Soft suction catheters and/or nasopharyngeal airway/trumpet is recommended to prevent these complications

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72
Q

During nasotracheal suctioning, what happens if you feel resistance during insertion?

A

Gently twist if any resistance is felt. If twisting does not help, withdraw catheter and insert through the other nostril.

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73
Q

__________________ helps maintain the patency of the upper airway despite swelling.

A

Nasopharyngeal airway

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73
Q

Where are oropharyngeal airways inserted?

A

Into the mouth over the tongue

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74
Q

What ensures gas flow if the main port should become obstructed?

A

a side port, Murphy’s eye

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75
Q

Why does the inflation of the cuff seal off the lower airway?

A

For protection from gross aspiration or to provide positive pressure ventilation

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76
Q

Included with most ETTs is a radiopaque indicator that is embedded in the distal end of the body. What is it for?

A

It’s an indicator that allows easy identification of the tube position on the CXR.

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77
Q

How often should a small amount of air be injected into the suction port to ensure tube and tubing are not clogged?

A

Every 4 hours

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78
Q

What prevents tube slippage into trachea and provides the means to secure the tube around the neck?

A

Flange

79
Q

What tracheostomy made of stainless steel with an inner and outer cannula?

A

Metal Jackson TT

79
Q

When is the metal Jackson TT generally used?

A

For patients with a long-term need for an airway but who doesn’t require a seal to protect airway from aspiration or to facilitate positive pressure ventilation

80
Q

What does a laryngectomy tube do?

A

Keeps stoma open until it heals

81
Q

What is the preferred route for establishing an emergency tracheal airway?

A

Orotracheal intubation

82
Q

What are the basic steps for orotracheal intubation?

A

Step 1: Assemble and check equipment - Vaccum is pressure checked because vomitus or secretions may obscure the pharynx or glottis. Laryngoscope/light source is checked for secured attachment and brightness. Inflate the cuff and check for leaks
Step 2: Position patient - The RT flexes the patient’s neck and tilts the head backwards, placing the patient into the sniff position
Step 3: Preoxygenate and Ventilate patient Providing ventilation and oxygenation helps ensure the patient tolerates the procedure
Step 4: Insert Laryngoscope
Step 5: Visualize Glottis
Step 6: Displace Epiglottis
Step 7: Insert tube
Step 8: Assess tube position
Step 9: Stabilize tube and confirm placement

83
Q

ETTs are sized by their ______________________.

A

Internal diameter (in millimeters)

84
Q

To ease insertion of orotracheal insertion, the outer surface should be lubricated with a _______________.

A

Water-soluble gel

85
Q

What should be inserted in the ETT to add rigidity and maintain the shape during insertion?

A

Stylet

86
Q

The tip of the stylet should NEVER _____________________.

A

It should never extend beyond the ETT tip

87
Q

No more than _________ should be devoted to any intubation attempt.

A

30 seconds

88
Q

If intubation fails, immediate ventilation and oxygenation of the patient for ___________ before the next should occur.

A

3-5 minutes

89
Q

What hand should the patient use to hold the laryngoscope?

A

Left hand to hold the laryngoscope and the right hand to open the mouth

90
Q

Explain how the laryngoscope inserted.

A

It is inserted into the right side of the mouth and moved toward the center

91
Q

Which blade displaces the epiglottis by advancing the tip of the blade into the vallecula (the base of the tongue)?

A

MacInstoch blade

92
Q

When the tube tip is seen passing through the glottis, it is advanced until ______________.

A

Until the cuff has passed the vocal cords

93
Q

Which blade displaces the glottis directly by advancing the tip of the blade over its posterior surface and the laryngoscope is lifted up and forward?

A

Straight blade, Miller

94
Q

Ideally, the tip of an ETT tube should be positioned in the trachea approximately _____________ above the carina.

A

3-5 cm

95
Q

Air movement or gurgling sounds over the epigastrium indicate what?

A

Esophageal intubation

96
Q

The combination of decreased sounds and decreased chest wall movement on the left side indicates ______________.

A

Right main stem intubation

97
Q

How is right main stem intubation corrected?

A

By slowing withdrawing the tube while listening for the return of left-side breath sounds

98
Q

What is the average length from the teeth to the tip of a properly positioned oral ETT in men and women?

A

Men: 21 cm
Women: 23 cm

99
Q

In patients with _____________, expired CO2 levels may be near zero because of poor pulmonary blood flow, yielding a false-negative result.

A

cardiac arrest

100
Q

What is the most common complication of emergency airway management?

A

Tissue trauma

101
Q

What are the most serious complications of emergency airway management?

A
  • Acute hypoxemia
  • Hypercapnia
  • Bradycardia
  • Cardiac arrest
102
Q

Nasotracheal intubation can only be performed by direct visualization. T or F?

A

False, it can be inserted blindly as well.

103
Q

Blindly inserting a nasotracheal tube will only work if the patient is _____________.

A

Breathing spontaneously

104
Q

During nasotracheal intubation, they use _________ with the right hand to grasp the tube just above the cuff and direct it between the vocal cords.

A

Magill forceps

105
Q

For blind nasal intubation, describe the breath sounds when the passes through the larynx?

A

Becomes louder and more tubular

106
Q

Successful passage of the tube through through the larynx is usually indicated by what?

A

Harsh cough followed by a vocal silence. If the sounds disappear, the tube is moving toward the epiglottis

107
Q

What is the preferred, primary route for overcoming upper airway obstruction or trauma for patients with poor airway reflexes?

A

Tracheotomy

108
Q

A small opening between the posterior wall of the trachea and esophagus

A

Tracheoesophageal puncture (TEP)

109
Q

If a patient still needs an artificial airway after 7 to 14 days, what is commonly considered?

A

Tracheostomy

110
Q

What are some benefits of the tracheostomy tube versus the oral or nasal intubation?

A
  • Elimination of vocal injury
  • Increased patient comfort
  • Less need for deep sedation
  • Easier removal of secretions
  • Decreased work of breathing
  • Potentially shorter weaning time
111
Q

What are some factors to consider in switching from endotracheal tube to tracheostomy?

A
  • Projected time patient will need artificial airway
  • Pt’s tolerance of endotracheal tube
  • Pt’s overall condition (nutritional, cardiovascular, infection status)
  • Pt’s ability to tolerate surgical procedure
112
Q

In traditional surgical tracheotomy, the surgeon makes an incision in the neck over the ____________.

A

second or third tracheal ring

113
Q

Before the removal of the larynx, the surgeon does what?

A

Creates a hole in the neck (stoma) and attaches the trachea to the stoma. The patient will breathe through that permanent stoma

114
Q

If a patient who’s had a full laryngectomy loses the artificial airway, what is the job of th RT?

A

Apply bag-mask ventilation over the stoma, usually a pediatric mask

115
Q

If a patient who’s had a partial laryngectomy loses the artificial airway, what is the job of th RT?

A

RT would cover the stoma with a gauze pad and apply bag-mask ventilation over the nose and mouth with standard adult mask

116
Q

Artificial airways do not conform exactly to patient anatomy, which may result in pressure on soft tissues that can result in _______________________.

A

Ischemia and ulceration

117
Q

Artificial airway tend to shift positions as the patient’s head and neck move or as the tube is manipulated. This shifting can cause what?

A

Friction-like injuries

118
Q

What are the most common laryngeal injuries associated with endotracheal intubation?

A
  • Glottic edema
  • Vocal cord inflammation
  • Laryngeal or vocal cord ulcerations
  • Vocal cord polyps
  • Granulomas

Less common and more serious:
- Vocal cord paralysis
- Laryngeal stenosis

119
Q

What are the primary symptoms of glottic edema and vocal cord inflammation?

A

Hoarseness and stridor

120
Q

What is the treatment goal of epinephrine used for stridor?

A

Reduce glottic edema or airway edema by mucosal vasoconstriction

121
Q

To reduce laryngeal edema in patients who have had prolonged intubation or patients who have failed prior extubation because of glottic edema, what is given 24 hours before extubation?

A

IV steroids and/or diuretics

122
Q

________ is likely in extubated patients with hoarseness and stridor that does not resolve with treatment or time.

A

Vocal cord paralysis

122
Q

What occurs when the normal tissue of the larynx is replaced by scar tissue?

A

Laryngeal stenosis

122
Q

What is the most common way to secure ETTs?

A

With tape

122
Q

What is one of the most frustrating aspects of caring for a tracheal tube?

A

His or her inability to talk

123
Q

_____________ can help keep patients comfortable and decrease the likelihood of self-extubation.

A

Sedation

123
Q

____________ are easier to stabilize and may move less than orotracheal tubes.

A

Nasotracheal tubes

124
Q

What should be done to minimize vocal cord closure around ETTs?

A

Patients should be discouraged from unnecessary coughing or efforts to talk.

125
Q

Tracheal wall injury from the endotracheal tube can be reduced by maintaining pressures of __________.

A

20 to 30 centimeters of water

126
Q

What can be used to minimize tube traction whenever the RT equipment is attached to tracheostomies?

A

Swivel adapters

127
Q

If there is significant drainage from the stoma, it is better to use _______ rather than standard gauze, which would keep the skin wet when moist.

A

Foam dressing

128
Q

What are the 7 critical responsibilities of airway maintenance?

A
  1. Securing the tube and maintaining proper placement
  2. Providing for patient communication
  3. Ensuring adequate humidification
  4. Minimizing possibility of infection
  5. Aiding in secretion clearance
  6. Proving appropriate cuff care
  7. Troubleshooting airway-related problems
129
Q

_________ allow vocal cord movement but prevents air flow.

A

Standard TTs

130
Q

What TT has special speech cannula that allows ventilator-dependent patients with the cuff fully inflated?

A

the Blom fenestrated TT

131
Q

What patient would be a good candidate for the speaking valve?

A

Medically stable patient with low risk of aspiration

132
Q

During the initial placement of the speaking valve, the patient’s ability to exhale around the TT should be assessed by measuring ________________.

A

Tracheal pressure during exhalation with the valve in place

133
Q

A speaking valve can aid in communication and can be safely used if tracheal pressures are less than what?

A

5 cm H2O

134
Q

What does tracheal pressure greater than 5cmH2O indicate?

A

Increased resistance during exhalation

135
Q

What are the most common causes for a tracheal pressure greater than 5 cmH2o?

A

Relative to the size of the trachea, tube position, inadequate cuff deflation or a upper airway abnormality

136
Q

Rule of thumb: The tracheostomy tube cuff must be completely deflated before a speaking valve is placed on the tracheostomy tube.

A

Know this.

137
Q

Selection of a humidification device ultimately should be based on :

A
  • Patient needs
  • Assessment of airway
  • Volume and thickness of secretions
  • History of mucous plugging or tube occlusion
138
Q

Patients with tracheal airways are very susceptible to bacteria colonization and infection of the _________________.

A

Lower respiratory tract

139
Q

To guard against infection, the clinician first should avoid introducing organisms into the airway. How does the clinician do this?

A
  • Adhering to sterile technique during suctioning
  • Ensure that only aseptically clean or sterile respiratory equipment is used for each patient
  • Consistently performing hand hygiene between patient contacts
140
Q

What is the most common cause of airway obstruction in critically ill patients?

A

Retained secretions

141
Q

What is this called?

A

Yankauer suction tip

142
Q

What are tracheal tube cuffs used for?

A

Mechanical ventilation or to prevent or minimize aspiration

143
Q

What are some techniques that decrease the consequences of pharyngeal aspiration?

A
  • Use of medications for stress ulcer prophylaxis, such as sucralfate, that maintain normal gastric pH
  • Positioning the patient with the head of the bed elevated 30 degrees or more to decrease reflux
  • Continuous aspiration of subglottic secretions
144
Q

To decrease the possibility of aspiration with feedings, the head of the bed should be elevated ________ or more when possible.

A

30 degrees

145
Q

What are some things that can cause tube obstruction?

A
  • Kinking of the tube or patient biting the tube
  • Herniation of the cuff over the tip
  • Obstruction of the tube orifice against tracheal wall
  • Mucous plugging
146
Q

If tubing is kinked or positioned against the tracheal wall, how can this be reversed?

A

Moving the patient’s head and neck and repositioning the tube. If this action does not relieve the obstruction, a herniated cuff may be blocking the airway

147
Q

An ETT that is positioned ___________ can mimic a cuff leak.

A

Too high in the trachea and near the glottic opening

148
Q

What is the process of removing an artificial airway called?

A

Extubation (ETT) or decannulation (TT)

149
Q

A patient is ready to be extubated when __________________.

A

When the need for the artificial airway no longer exist

150
Q

How does the cuff-leak test help predict the occurrence of glottic edema or stridor during extubation?

A

The clinician totally deflates the tube cuff and assesses the leak around the tube during positive pressure ventilation in a volume-controlled mode. The pressure of the leak should be 15% or greater.

151
Q

In what type of patients is the cuff-leak test most useful in what kind of patients that are at greater risk of postextubation stridor?

A
  • Children
  • Women
  • Patients intubated for more than 6 days
152
Q

What is the set suction pressure for adults?

A

120-150 mm Hg

153
Q

What is the set suction pressure for children?

A

100-120 mm Hg

154
Q

What is the set suction pressure for infants?

A

80-100 mm Hg

155
Q

What are the list of things you need for extubation?

A
  • Oxygen
  • 10cc syringe
  • Towel
  • Stethoscope
  • Intubation box/cart
156
Q

___% of unplanned extubation do not require reintubation.

A

50 percent

157
Q

Total suction time should be kept to _________________.

A

Less than 15 seconds

158
Q

Removal of foreign bodies, secretions, or tissue masses beyond the mainstem bronchi requires what?

A

Bronchoscopy

159
Q

What technique would you use to suction a trach patient?

A

Open sterile technique is often used.

160
Q

Using shallow rather than deep suctioning is recommended in infants and in adults the us of deep tracheal suctioning is being questioned because of what?

A

Its effects on lung volume and oxyhemoglobin saturation

161
Q

Most suction catheters for adults are _____ inches long.

A

22

162
Q

Before suctioning, delivery of 100% oxygen for _____________ is suggested.

A

30-60 seconds

163
Q

What are the steps for suctioning?

A
  1. Assess patient for indications
  2. Assemble and check equipment
  3. Assess patient for hyperoxygenation
  4. Insert catheter
  5. Apply suction and clear catheter
  6. Reoxygenate patient
  7. Monitor and assess outcomes
164
Q

What happens if any outward response occurs during suctioning?

A

Catheter should be removed immediately and the patient should be oxygenated

165
Q

What are some complications of nasotracheal suctioning?

A

- Gagging and/or regurgitation
- Airway trauma (bleeding)
- Contamination of the lungs
- Bronchospasm or laryngospasm

166
Q

What is used to monitor cuff status and pressure when the tube is in place?

A

Pilot balloon

166
Q

On a TT, what prevents tube slippage into the trachea and provides means to secure the tube to the neck?

A

Flange

167
Q

What is this called?

A

Laryngectomy tubes

168
Q

Which hand do you hold the laryngoscope with?

A

Left!

169
Q

The laryngoscope is inserted into which side of the mouth?

A

Right side of the mouth and moved toward the center, displacing the tongue to the left

170
Q

As the laryngoscope reaches the base of the tongue, the RT looks for what?

A

The arytenoid cartilage and epiglottis

171
Q

If a light wand is used during intubation, as the stylet and ETT pass into the larynx, a characteristic glow is seen under the skin, just above the _______________.

A

Thyroid cartilage

172
Q

How is the patient positioned for blind nasal intubation?

A

Supine or sitting position

173
Q

What are some risks associated with laryngectomy?

A
  • Hematoma
  • Wound infection
  • Fistulas
  • Stomal stenosis
  • Leaking around tracheoesophageal prosthesis
  • Difficulty swallowing and eating
  • Problems speaking
174
Q

What is binocular vision?

A

Direct vision of the vocal cords and NOT losing the sight of it until the tube is inserted

175
Q

What is the “safety pin” used for?

A

To prevent nasal airway from advancing too far or migrating outward

176
Q

During which part of the breathing cycle do we extubate?

A

End-expiration

177
Q

What is kept at the bedside for trach patients in case or reinsertion?

A

Obturator

178
Q

How do you measure oropharyngeal airways?

A

Measure from the corner of the patient’s mouth to angle of the jaw

179
Q

Too large of an airway can do what?

A

Push the epiglottis against the larynx, leading to airway obstruction

180
Q

Too long of a nasopharyngeal tube may do what?

A

Enter the larynx, causing laryngeal reflexes or enter the space between the epiglottis and vallecula, leading to potential airway.

181
Q

How do you measure nasopharyngeal tubes?

A

By going from the patient’s ear lobe to the tip of the nose

182
Q

Too short of a nasopharyngeal tube _______________________.

A

Cannot separate soft palate from posterior wall of pharynx

183
Q

ET intubation may be done with an EOA in place. True or False?

A

True

184
Q

What happens when ETC tube is in the trachea?

A

A large proximal cuff (100 mL) seals off trachea

185
Q

What are the two types of endotracheal tubes?

A

Oral and nasal

186
Q

One-way valve that allows inspiration but not exhalation through tracheostomy tube opening

A

Speaking valves

187
Q

What supplies do you need for intubation?

A
  • Laryngoscope
  • Blade (Mac or Miller)
  • ET tube
  • 10-mL syringe
  • Water-soluble lubricant
  • Stylet
  • ET tube securing device
  • CO2 detector
188
Q

How can partial displacement of airway out of trachea be detected?

A
  • Decreased breath sounds
  • Decreased airflow through tube
  • Decreased ability to pass catheter past end of tube
189
Q

______________ is the softening of the cartilaginous rings, which causes collapse of the trachea during inspiration and expiration.

A

Tracheomalacia

190
Q

A narrowing of the lumen of the trachea, which can occur as fibrotic scarring, causing the airway to narrow.

A

Tracheal stenosis

191
Q

Stenosis at the stoma site is associated with what?

A
  • Too large a stoma
  • Infection
  • Movement of the tube
  • Frequent tube changes
  • Advanced age
192
Q

Dyspnea at rest may not be seen until the diameter of the trachea is less than ________.

A

5 mm

193
Q

What is this?

A

Blom fenestrated trach tube with speech cannula

Mrs. Emro - RET1264C (4 decks)

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