Exam 1: Intubation and Mechanical Ventilation (MV) Flashcards
What are some indications for intubation and mechanical ventilation?
- Hypoxemia/unable to oxygenate with other oxygen delivery
- Respiratory Acidosis
- Surgery or procedures (peri or post)
- Inability to protect airway (obtunded or in coma)
- Tachypnea
- Neuromuscular Disease
In order to mechanically ventilate, you need a/an ___________________?
An artificial airway
What are 3 functions of an artificial airway?
- Provide a patent airway
- Provided a means to supply oxygen/ ventilate
- Provide a way to clear secretions
When is an endotracheal tube used?
When anticipated artificial airway is needed for no longer than 10-14 days
Where are endotracheal tubes inserted?
Inserted into the mouth or nose
With and ET tube, once inserted, the tip should lie ____ cm above _________.
2, the carina
Who can insert an ET tube?
- Anesthesiologist, Critical Care Provider, Hospitalist (and more)
- Respiratory Therapist
- Certified Nurse Anesthetist
- Matt
- Carrie
Where is the cuff located?
On the distal end of the ET tube
What is the purpose of the cuff?
Creates a seal
On an ET tube, the pilot balloon is at the__________ end of the tube.
proximal
You are at Mission. Someone yells, “LET’S INTUBATE THIS PATIENT.”
What do you do?!
- Provide oxygen
- Lift head of bed
**Keep talking to your patient ** - Call for help/ Coordinate care
- Gather supplies
- Assess, assess, assess
Your provider has given you medications to deliver to your patient. What should you do as you give them?
Announce it as you give them!
What are some general types of meds you give when it is intubation time?
Sedation
Analgesic
Paralytic
Limit time of intubation attempts to ____________. Then, _________________.)
30 seconds, bag-valve-mask
How often should you check BP with intubation?
A minimum of every five minutes
What about tele and SpO2?
Continuous telemetry and SpO2
How do you confirm ET tube placement?
X-ray
Other ways to confirm placement of an ET tube?
- Waveform capnography
- Auscultation
- Bronchoscope
- Esophageal detector
The provider has shouted, “THE TUBE IS IN!”
What do we do now, frends?
Listen…
• Over lungs
• Over stomach
Look…
• Breathing
Order an x-ray
Monitor
How do we secure the ET tube?
- Assess and document where the tube is ”26 cm at the lips”
- Tape
- Bite block?
- Place tube holding device (often called by brand name)
- Reassess and document tube placement
- Assess and maintain airway
What will it sound like if there is a cuff leak?
Gurgle-y sound
Assess for potential dislodgement
Does everyone get sedated with ET tubes?
- Not everyone needs sedation!
- NOT having sedation can help with delirium and getting off vent quicker to wake up more
Does everyone need restraints when intubated?
- Not everyone needs restraints!
- Good to do temporarily until you know if they are more aware
Acronym for the most common reasons things are going wrong with MV:
DOPE!
Dislodgement (of tube)
Obstruction (often sputum)
Pneumothorax (listen → MV can cause)
Equipment failure
Where are some common misplacements – places the ET tube travels that ain’t right?
- Esophagus
- Right mainstem (more common – bigger, straighter shot)
- Left mainstem
- Too high
Your patient is intubated and is becoming agitated, moving around the bed a lot. You notice that he becomes tachypneic and tachycardic and his SpO2 falls from 94% to 87%. Upon your assessment, he has diminished breath sounds on the left. You check the ET tube placement and note that the ET tube is no longer 24 cm, as you documented this morning. It is now 27 cm at the lips. Your first action is to
- Notify the provider
- Notify respiratory therapy
- Order a PRN x-ray
- Move the tube back to where it was on your morning assessment
Notify the provider → need an order. Before and after x-ray is gold standard
How long should someone be on MV?
ONLY UNTIL THE UNDERLYING PROCESS IS FIXED
What are the 2 main things MV helps with?
- Improved gas exchange
- Reduced work required for effective breathing
What should you try before you move patient to MV?
- Try bipap first
After that, if not doing well, move onto MV
What are some ventilator types?
- Positive Pressure
- Push air into lungs at a set pressure (all else varies)
- Time-Cycled
- Push air into the lungs at a set time
- Volume Cycled
- Push air into the lungs at a set volume (limit pressure)
- Microprocessor
- Positive Pressure
What is FiO2?
The fraction of inspired oxygen. Range: 21-100%.
This is the concentration of oxygen in the gas mixture. The gas mixture at room air has a fraction of inspired oxygen of 21%, meaning that the concentration of oxygen at room air is 21%.