Intubation / Mechanical Ventilation Flashcards
indications for using intubation or 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
why does an ET tube have a radio-opaque line on it?
verify placement via xray
why does a an ET tube have a baloon outside and inside?
balloon outside tells us how much air is in the cuff inside
3 functions of an artificial airway?
• Provide a patent airway
• Provided a means to supply oxygen/ ventilate
• Provide a way to clear secretions
how long can a person have an ET tube in?
<10-14 days
can you put an ET tube in your nose?
sure betchya
how far down do we want the ET tube to be?
2 inches above the carina
who can put in an ET tube?
◦ Anesthesiologist, Critical Care Provider, Hospitalist (and more)
◦ Respiratory Therapist
◦ Certified Nurse Anesthetist
in other terms- NOT YOU. not for RN!
doctor says- lets intubate! what are you going to do my new nursing school grad?
• Provide oxygen
• Lift head of bed
• **Keep talking to your patient **
• Call for help/ Coordinate care
• Gather supplies
• Assess, assess, assess
3 meds we are giving for intubation- sedation, anaglesics, and paralytics: which one do we give first?
sedation
*not everyone gets a paralytic
how long do we limit the intubation attempt time to?
30 seconds
how often do we monitor the BP during intubation?
every 5 minutes at least
how do we verify ET tube placemnt?
xray
waveform capnography
auscultation
bronchoscope
esophageal detector
priority for maintaining ET tube function after palcement
frequently check that it is in the correct place –> look at number
being intubated puts patients at risk for ______ later in life
delirium
do we put restraints on all intubated patients?
nope! only if they needs
–> consider using a mitt instead
DOPE is an acronym for complications from intubations, what does it stand for? whats the last thing you check for?
• Dislodgement
• Obstruction (sputum)
• Pneumothorax
• Equipment failure (last thing you should be checking for)
which side is more common for ET tube misplacement ?
right side- most common, bigger and straighter
• 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
mechanical ventilation allows us to _____ the underlying process
fix
re mechanical ventilation FiO2 % should be between
21-100
Vent resp rates should be
10-14
what is the tidal volume?
air going in or air goig out (7-10 mL/kg)
the higher the peep the ____ the risk of damaging the alveoli
the > the risk
