icu 3b

Question 1

Possible
complications
of intubation

Answer 1

§Hypotension
§Dysrhythmias
§Regurgitation and aspiration of
gastric contents
§Electrolyte disturbances,
especially hyperkalaemia after
suxamethonium
§ Infection >sepsis (nosocomial
pneumonia)

Question 2

Preparation for
intubation
patient preparation

Answer 2

§ IV access
§ BP monitoring
§ Continuous SpO2 monitoring
§ ECG monitoring
§ NG tube
§ Position supine in ‘sniff’ position

Question 3

Preparation for
intubation Drugs

Answer 3

§ Sedative (e.g. midazolam or
propofol)
§ Muscle relaxant/paralysing agent
(e.g. suxamethonium chloride)
§ Pain relief +/- (e.g. fentanyl)

Question 3

Preparation for
intubation equipment

Answer 3

Equipment (checked and in working
order)
§ Oxygen supply and Ambu-bag
§ Suction supply (with Yankauer and ysuction catheter
§ Laryngoscope blades and holder
(light working)
§ Facemask, goggles and gloves
§ ETT cuff inflated in sterile water
§ Water based lubricant
§ Capnopraphy
§ Circuit and ventilator checked and
attached to test bag
§ Resus trolley

Question 4

Preparation
for intubation others

Answer 4

§ Secure the ETT
§ Ensure/maintain correct tube
placement
§ Ensure/maintain ETT patency
§ Open/semi-open/closed suction
§ Monitor oxygenation and ventilation
§ Humidification
§ Cuff and pilot tube management
§ Communication
§ Oral care
§ Appropriate ventilator setting

Question 5

Mechanical
Ventilation

Answer 5

§ Application of positive or negative
pressure breaths using noninvasive or invasive techniques
§ Negative Pressure ventilation
§ Positive pressure ventilation is
the primary method used with
critically ill patients in the ICU

Question 5

Mechanical
Ventilation

Answer 5

§ Application of positive or negative
pressure breaths using noninvasive or invasive techniques
§ Negative Pressure ventilation
§ Positive pressure ventilation is
the primary method used with
critically ill patients in the ICU

Question 6

Mechanical
Ventilation
complications

Answer 6

§Patient/ventilator dis-synchrony
§Barotrauma
§Haemodynamic changes
§Oxygen toxicity
§Misplaced tube
§Trauma (tracheoesophageal
fistula)

Question 7

Two categories of
PPV

Answer 7

Volume ventilation
pressure ventilation
Either of these categories can be delivered
in either Mandatory modes or as Assist
modes

Question 8

Volume ventilation

Answer 8

predetermined tidal
volume is delivered with each inspiration.
The amount of pressure that is needed to
deliver this volume varies dependent on
the resistance factors of the patient and the
system. The same volume of breath is
delivered with each inspiration

Question 9

Pressure ventilation

Answer 9

– predetermined
peak inspiratory pressure is delivered with
each inspiration. The amount of volume that
is delivered depends on the compliance
and resistance of the patients lungs and the
ventilator system. Once the determine
pressure is reached, the remaining volume
is ‘dumped’ by the machine to avoid
barotrauma

Question 10

removal of presusre ventilation

Answer 10

1. Remove patient from ventilator
2. Initiate manual ventilation
3. Check patency of airway
4. If death is imminent, consider
   and treat most likely causes
5. Once pt is stabilised, undertake
   more detailed assessement and
   management and return to
   mechanical ventilator