Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

accs > kettering section b: airway care > Flashcards

kettering section b: airway care Flashcards

1
Q

Kettering’s 8 points on cough control techniques.

A
  1. Postion — sitting upright or leaning slightly forward
  2. Relaxation — between efforts to reduce fatigue
  3. Volume building — multiple inhalations
  4. Multiple coughs, single inhalation — double/triple cough method
  5. Avoid coughing too hard or too long — to forestall fatigue, wheezing, air trapping
  6. Serial coughs — small breath and cough, larger breath and cough, then deep breath and hard cough
  7. Huff coughing — coughing with open glottis
  8. Splinting — press pillow over incised area to enhance strength of cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Who does Kettering feel should do huff coughing?

A

• May be more effective in patients with COPD
• May be more effective with patients with head trauma to prevent elevations in intracranial pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Kettering’s purposes of bronchial hygiene therapy.

A

• Mobilize secretions
• Prevent accumulation of secretions
• Improve ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Kettering’s indications for bronchial hygiene therapy

A

• Accumulated or retained secretions
• Ineffective cough
• Ciliary dysfunction/ciliary dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Conditions Kettering says call for bronchial hygiene therapy.

A

• Bronchiectasis
• Cystic fibrosis
• COPD
• Acute atelectasis
• Lung abscess
• Pneumonia
• Post-operative condition
• Prolonged bedrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Kettering’s points for hazards and contraindications for bronchial hygiene therapy.

A

• Unstable cardiovascular system
• Unstable pulmonary system
• Unstable post-operative status
• Untreated tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What position for bronchial hygiene best suits a post-craniotomy patient? (K)

A

Supine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What position for bronchial hygiene best suits patients with very low blood pressure?

A

Trendelenburg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

These body positions—Fowler’s, some-Fowler’s, or reverse Trendelenburg
—best serve which patient groups?

A

• Hypoxic patients
• Obese patients with dyspnea
• Post-operative abdominal surgery patients
• Patients with pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

K: What body position serves very obese patients with air hunger?

A

Lateral Fowler’s.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

K: What body position is best to prevent aspiration?

A

Lateral flat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should a therapist do if a patient aspirates in a certain body position?

A

Suction airway
—and then place patient in opposite position for postural drainage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

K: What body position best serves a patient with unilateral consolidation?

A

Position affected lung up—
To allow it to drain
To direct perfusion to the unaffected lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

K: Hazards and contraindications to chest percussion for secretion clearance.

A

• Soft tissue trauma
• Rib cage trauma/fractured ribs
• Hemoptysis/pulmonary hemorrhage
• Metastatic conditions
• Pulmonary emboli
• Pleural effusion
• Tuberculosis
• Untreated pneumothorax—absolute contraindication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

K: Describe technique of chest percussion for secretion clearance.

A

• Cup hands with thumbs next to fingers, wrists relaxed
• Percussion rhythmically over area to be drained
• Prefer mechanical percussion or vibration devices if patient does not tolerate manual percussion
• Change methods when a mechanical device malfunctions—use manual percussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe Positive Expiratory Pressure therapy.

A

Applying expiratory positive airway pressure using a one-way inspiratory valve and a one-way expiratory flow resistor. The expiratory valve prevents end-expiratory pressures from falling to zero. (K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How should PEP therapy be set?

A
  • Set expiratory pressures to range from 10-20cmH2O at mid-exhalation.
  • Have patient use fro 15-20-minute intervals 3-4 times/day. (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What should be the effects of PEP therapy?

A
  • May improve secretion expectoration
  • May reduce residual volume (decrease hyperinflation)
  • May improve airway maintenance (i.e. cystic fibrosis, pneumonia) (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What conditions should prompt therapist to discontinue PEP therapy?

A
  • Sinusitis
  • Epistaxis
  • Middle ear infection (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How should therapist instruct patient to perform PEP therapy?

A
  • Inhale larger-than-normal tidal volume
  • Exhale actively but not forcefully
  • Make exhalation 2-3 times longer than inhalation. (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do vibratory/oscillatory PEP devices do, mechanically?

A

Combine positive expiratory pressure therapy with high-frequency oscillations at the airway. (K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the goal of OPEP therapy?

A

To remove secretions from the airways. (K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name examples of OPEP therapy.

A
  • Flutter
  • Acapella
  • Quake
  • Aerobika (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is autogenic drainage?

A

A set of breathing exercises used to improve mucus clearance.v

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How should a therapist instruct a patient in autogenic drainage?

A
  • Breathe at low lung volumes (ERV range) to loosen secretions from small airways.
  • Increase volume by breathing in normal Vt range but exhaling to ERV (to accumulate secretions in the middle airways).
  • Breathe at high lung volumes. (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What patient population is best suited to use autogenic drainage?

A

Primarily patients with cystic fibrosis and bronchiectasis. (K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the purpose of suctioning?

A
  • Maintain patent airway
  • Collect specimens
  • Stimulate cough (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are indications for suctioning?

A
  • Accumulated secretions
  • Obstructed airway
  • Depressed cough
  • Inability to swallow (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the hazards of suctioning, and how should they be countered?

A
  • Trauma/bleeding in mucosa (most common) (lubricate catheter (in the case of ENT suctioning), use gentle technique
  • Contamination (use aseptic technique)
  • Hypoxemia (leading to tachycardia, arrhythmias [most severe])
  • Bradycardia (from stimulation of vagus nerve) (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Describe procedure for suctioning ETT.

A
  • Oxygenation with 100% oxygen–1-2 minutes–required before and after suctioning.
  • Monitor EKG to detect problems caused by iatrogenic hypoxemia.
  • Use sterile catheter, solutions, and gloves each time.
  • Suction ETT first; then suction mouth. Discard catheter.
  • Suction ETT with fresh catheter. (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does practitioner set vacuum regulator pressure for suctioning?

A
  • Set 100-120mmHg for adult
  • Set pressure with tubing occluded. (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is a vacuum regulator?

A

A built-in shut-off device in the collection bottle that prevents aspirated secretions from entering the regulator and vacuum system when the bottle is full. (K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How should an airway suction catheter be designed?

A
  • Must have a beveled tip with at least 2 openings to decrease tracheal damage
  • Must have a thumb port to provide intermittent suctioning (K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Formula for ideal catheter size for ETT suctioning.

A

(internal diameter in mm / 2) X 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Kettering’s points for proper use of Lukens trap.

A
  • Use to collected sputum specimen
  • Place in upright position between suction catheter and suction tubing
  • Flush catheter with sterile water or isotonic saline
  • No not flush with bacteriostatic of hypertonic saline
  • Use saline for cytology samples
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Kettering–If suctioning is not working, how can it be modified?

A
  • Change size and type of catheter
  • Alter negative pressure
  • Alter frequency of suctioning
  • Alter duration of suctioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Kettering–How can size and type of catheter be altered for difficulty in suctioning?

A
  • Verify that catheter size is appropriate for endotracheal tube
  • Change to Coude catheter to direct suctioning to left mainstem bronchus
  • Change to closed suction catheter if patient has infection, PEEP therapy, or desaturates during suctioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Kettering: How can negative pressure be altered when suctioning needs to be modified?

A
  • Increase negative pressure to remove thick, tenacious secretions
  • Do not exceed recommended vacuum pressures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Kettering: How can suctioning frequency be altered when suctioning needs to be modified?

A

Suctioning, because it is hazardous, should be performed only when necessary (and therefore scheduled as PRN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Kettering: How should duration of suctioning be altered when suctioning needs to be altered?q

A
  • Suction catheter should be in the airway no longer than fifteen seconds
  • If cardiac arrhythmias occur, stop suctioning and decrease amount of time in the airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Kettering: How should be suctioning be handled when adverse effects occur?

A
  • Suctioning should be stopped
  • Reduce level of suctioning
  • Continue suctioning more gently and in less time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Kettering: What troubleshooting should be kept in mind for difficulty suctioning?

A
  • Check catheter for patency
  • Assure vacuum system is working
  • Change or empty a full collection bottle
  • Check all connections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Kettering guidelines for sizing endotracheal tubes.

A
  • Adult males: 7.5-8.5 mm
  • Adult females: 6.5-8 mm
  • Adult: weight in kilograms / 10 = approximate size
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Kettering on approximate tube depths for oral and nasal intubation.

A

Oral: approximately 21-25 cm at the lip
Nasal: approximately 26-29 at the naris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Kettering’s old school cuff pressure measurement system.

A

Three-way stopcock, syringe, pressure manometer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Kettering notes on Cufflator for measuring cuff pressures.

A
  • Eliminates manometer/syringe/stopcock clumsiness
  • Calibrated in cmH2O
  • Set cuff pressure below 25 cmH2O or 20 mm Hg to allow circulation to tracheal mucosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

If cuff pressure measures zero, what should operator do?

A

Check tightness of connection between manometer and pilot balloon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Indications for tracheostomy (Kettering).

A
  • Requirement for long-term ventilation
  • Upper airway obstruction (preventing intubation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Advantages of tracheostomy (Kettering).

A
  • Easier to stabilize, suction, tolerate than ET tubes
  • Allows patient to eat and to speak
  • Reduces airway resistance relative to oral/nasal ET tubes
  • Offer fewer hazards
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Immediate complications of tracheostomy tubes (Kettering)

A
  • Bleeding (major hazard)
  • Pneumothorax
  • Air embolism
  • Subcutaneous emphysema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Late complications of tracheostomy tubes (Kettering)

A
  • Infection
  • Hemorrhage
  • Obstruction
  • T-E fistula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

When should cuff of tracheostomy tube be inflated? (Kettering)

A
  • When patient is eating
  • When patient is on positive pressure ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Kettering’s points on fenestrated tracheostomy tubes.

A
  • Have opening in outer cannula above the cuff
  • Used for weaning, allowing, with an inner cannula, temporary mechanical ventilation
  • Not used for code or in emergencies
  • Allows patient to breath through upper airway and speak
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How does operator cap fenestrated tracheostomy tube? (Kettering)

A
  • Deflate cuff
  • Remove inner cannula
  • Then cap the tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Kettering’s points for tracheal button.

A
  • Used to maintain stoma (tracheostomy opening)
  • Used in some patients to treat sleep apnea
  • Allows tracheal suction and phonation with least amount of airway resistance
  • Cannot be used for resuscitation because uncuffed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Kettering’s points for extended tracheostomy tubes

A
  • Adjustable flanges allow adjustment of horizontal distance
  • Indicated for patients who are obese or use cervical collars
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Kettering’s points for Jackson tracheostomy tubes

A
  • Metal trach tube
  • Comes with inner cannula
  • Not for resuscitation or positive pressure ventilation
  • Does not have a cuff
  • No mri (Johns Hopkins)
  • Need to alert airport personnel for metal detectors (Johns Hopkins)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are those self-inflating cuff tracheostomy tubes called?

A

Kamen-Wilkinson Foam / Bivona Cuff tracheostomy tube.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Kettering–features of bivona cuff tracheostomy tube.

A
  • Foam-filled cuff
  • Evacuate air prior to insertion
  • Pilot tube is open to the atmosphere and foam expands to seal trachea
  • Air must be evacuated to extubate patient
  • Do not inflate cuff with a syringe
  • Has no inner cannula
  • Does not have a pilot balloon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Kettering points for laryngectomy

A
  • To treat upper airway carcinoma, patient’s larynx is removed surgically.
  • Surgery leaves no connection between patient’s upper and lower respiratory tract.
  • Patient cannot be orally or nasally intubated.
  • Patient breathes through a laryngectomy tube initially.
  • Laryngectomy tube is removed after 3-6 weeks, leaving patient with a permanent stoma.
61
Q

Kettering: What is the purpose of a laryngectomy tube?

A

To maintain a patent airway after a laryngectomy has been performed.

62
Q

How do laryngectomy tubes compare to tracheostomy tubes?

A
  • Laryngectomy tubes are made of soft, pliable material
  • Laryngectomy tubes, while available in various sizes, are generally shorter in length than standard tracheostomy tubes
  • Laryngectomy tubes may have an inner cannula
  • Laryngectomy tubes do not have an inflatable cuff
63
Q

Kettering: Name the generic class of ETT with lumen for subglottic suctioning.

A

Continuous Aspiration of Subglottic Secretions (CASS)

64
Q

Kettering: Trade names for CASS ETTs.

A
  • Hi-Lo Evac
  • Sealguard Evac
    *TaperGuard Evac
65
Q

Kettering: Where is additional lumen in CASS ETT located?

A

To opening just above ETT cuff.

66
Q

Ketttering: How are CASS tubes managed?

A

Continuous suction is applied via separate pilot tube connected to a vacuum pressure of 20 mmHg.

67
Q

Kettering: What is indication for CASS ETT?

A

Risk of Ventilator Acquired/Associated Pneumonia (VAP)

68
Q

Kettering: How does CASS ETT reduce risk of VAP?

A
  • Minimizes microaspiration
    *Reduces tracheal colonization
69
Q

Kettering: How does size of CASS compare to size of standard ETTs?

A

CASS is 1 mm larger than standard tube–e.g, 7.5 ID is same size as standard 8.5 ID.

70
Q

Kettering: What is disadvantages of CASS ETTs?

A

Their larger diameter may increase risk of airway trauma.
They cost about 15 times more than standard ETTs.

71
Q

Kettering: What are the supposed advantages of silver-coated/antibacterial-coated endotracheal tubes?

A
  • Limit bacterial colonization
  • Limit biofilm formation on lumen of ETT
  • Reported to decrease VAP–with little objective evidence
72
Q

Kettering: What is the disadvantage of silver-coated/antibacterial-coated endotracheal tubes?

A
  • They cost approximately 100 times more than the standard tube.
73
Q

What ETTs are promoted to decrease cuff channel formation? What are their commercial names?

A

Polyurethane cuffed endotracheal tubes with brand names Microcuff and Sealguard.

74
Q

Per Kettering qualities of polyurethane cuffed endotracheal tubes.

A
  • Designed to prevent cuff channel formation
  • Cuff channels allow microaspiration
  • Promoted to decrease VAP, though RC 201008 found “insufficient evidence”
  • Cost approximately 4x more than standard ETT
75
Q

What endotracheal tubes are promoted as limiting bacterial colonization?

A

Silver-coated antibacterial-coated endotracheal tubes.

76
Q

Qualities of the silver-coated antibacterial coated endotracheal tube, per Kettering.

A
  • Silver-coated/impregnated material
  • Limits biofilm formation in lumen of ETT
  • Limits bacterial colonization
  • Reported to decrease VAP/little objective evidence
  • Costs approximately 100 times more than standard tube
77
Q

Names applied to endotracheal tubes with two lumens.

A

Double-lumen / endobronchial / Carlens

78
Q

Kettering notes on design of double-lumen endotracheal tubes.

A
  • Two separate lumens each of different length
  • Longer lumen is placed into right mainstem bronchus
  • Shorter lumen is paced in trachea above carina to access left mainstem bronchus
  • Lumens allow ventilation of each lung independently or, with wye attachment, two lungs together
  • Bronchial cuff has radiopaque line to confirm correct placement
79
Q

Indications for double-lumen endotracheal tube (Kettering)

A
  • Uncontrolled unilateral hemoptysis
  • Need to protect airway of unaffected lung in certain cases of unilateral lung disease (e.g., lung abscess)
  • Need to improve ventilation or oxygenation of patient with unilateral lung disease
  • Bronchopleural fistulas
  • Tracheobronchial tree disruptions
  • Surgical opening of a large airway to stop or promote healing and ventilate other areas of the lung
  • Select surgeries: pneumonectomy; lobectomy; esophageal resection; aortic aneurysm repair
80
Q

Kettering’s 9 indications for endotracheal intubation

A
  1. Acute airway obstruction: trauma to mandible or larynx
  2. Inhalation injury: smoke, noxious chemicals, foreign bodies
  3. Infection: retropharyngeal abscesses
  4. Hematoma, tumor
  5. Laryngeal edema, laryngeal spasm (anaphylactic response)
  6. Need for access for suctioning: debilitated patients, copious secretions
  7. Loss of protective reflexes; head injury, drug overdose cerebrovascular accident
  8. Severe hypoxemia: ARDS, atelectasis, secretions, pulmonary edema
  9. Hypercapnea: Hypoventilation, neuromuscular failure, drug overdose
81
Q

How would Kettering have one approach intubating patient with head or neck injury?

A
  • Use advanced intubation tools, such as bronchoscopy
  • Avoid head tilt, chin lift by using modified jaw thrust
82
Q

Kettering’s assessment notes for thyromental distance.

A
  • Distance between mandible and anterior neckline
  • Normal: 6.5 cm
  • Abnormal: < 5 cm – indicating difficult airway
  • Common anesthesia technique is 3 fingers between jawline and larynx
83
Q

Describe the classes in the Mallampati classification

A

Class 1: Soft palate, uvula, fauces, pillars visible
Class 2: Soft palate, uvula fauces visible
Class 3: Soft palate, base of uvula visible
Class 4: Hard palate only visible

84
Q

Which classes in Mallampati classification are considered difficult airways?

A

Class 3 and 4.

85
Q

What do you call the application of cricoid pressure while intubating?

A

Sellick maneuver

86
Q

Kettering list of major ways to confirm endotracheal tube placement.

A
  • Visualization
  • Auscultation–listen for bilateral breath sounds
  • CO2 detection (capnogaph; colormetric or etCO2 monitor–AHA recommends quantitative waveform capnography during resuscitation)
  • CXR: top of properly placed ETT will be at lease 1 inch above carina, at the level of aortic knob
87
Q

Kettering list of minor ways to confirm endotracheal tube placement

A
  • Visualization of cords during insertion of tube
  • Ease of manual ventilation
  • Expiratory fogging of endotracheal tube
  • Palpation of the larynx
  • Coughing through endotracheal tube
  • Loss of voice
  • Absence of progressive abdominal distension
  • Squeeze bulb syringe–empty bulb, attach to ETT–if fails to re-fill, then ETT is in the easily collapsible esophagus
88
Q

Kettering’s five areas of complications from endotracheal intubation.

A
  • Trauma from forceful use of laryngoscope and tube placement
  • Formation of granulation tissue ulcers from excessive cuff pressure
  • Reflex glottic closure and laryngospasm
  • Right mainstem bronchus intubation
  • Gastric aspiration
89
Q

Kettering: details of endotracheal intubation–Trauma from forceful use of laryngoscope and tube placement

A
  • Injury to laryngeal, nasal, & pharyngeal tissue
  • Dental trauma (e.g., dislodged tooth)
  • Mandibular dislocation
  • Spinal injury
90
Q

Kettering: details of endotracheal intubation–Formation of granulation tissue ulcers from excessive cuff pressure

A
  • Mucosal ischemia
  • Tracheal stenosis
  • Tracheal malacia
  • Tracheoesophageal fistula
91
Q

Kettering: details of endotracheal intubation–Reflex glottic closure and laryngospasm

A
  • Prevents intubation
  • Limits spontaneous ventilation
  • Ventilate via bag/mask until spasm subsides
  • Topical lidocaine can minimize risk
  • Administer succinylcholine if situation becomes urgent
  • Repeated spasms may result in intubation failure
92
Q

Kettering: details of endotracheal intubation–Right mainstem bronchus intubation

A
  • Assessment reveals: asymmetrical chest movement; breath sound diminished or absent on left; decreased SpO2
  • Deflate cuff and withdraw ET tube
93
Q

Kettering: details of endotracheal intubation–Gastric aspiration

A
  • May occur during intubation procedure from stimulation of oropharynx
  • May be prevented by application of cricoid pressure (Sellick maneuver) to seal esophagus and improve visualization of vocal cords
  • Risk may be reduced by administration of ranitidine (Zantac) and/or metoclopramide (Reglan)
94
Q

Kettering’s list of supraglottic airways:

A
  • King tube
  • Laryngeal mask airway
  • Combitube
95
Q

Kettering’s notes for King tube.

A
  • Color-coded s/m/l
  • Easy insertiom
  • Short learning curve
  • Allows positive pressure ventilation
96
Q

Kettering description of LMA

A

An inflatable mask that is positioned directly over the opening into the trachea (hypopharynx)

97
Q

Kettering virtues of LMA

A
  • Insertion does not require a laryngoscope
  • A standard ETT can be inserted directly through some LMAs into the trachea if necessary
  • Spontaneous breathing through the airway is possible
  • The low-pressure seal of the LMA around the laryngeal opening is insufficient to stimulate the larynx to spasm
    *
98
Q

Kettering disadvantages of LMA

A
  • High-pressure assisted ventilation has been shown to create gastric insufflation
  • Contraindicated if a risk of aspiration exists
99
Q

Kettering–procedure for LMA insertion

A
  • Place patient in sniffing position
  • Administer sedation to same level used for elective intubation
  • Hold jaw of patient open
  • Advance mask and cuff along hard palate using the index finger and position at the back of the tongue
  • Advance tube until resistance if felt as mask settles over the esophagus and larynx
  • Inflate cuff around laryngeal opening–a small amount of movement (1-2 cm) is felt in the cricoid cartilage
  • Inflate the cuff just enough air to obtain a seal, corresponding to a cuff pressure of approximately 60 cmH2O
  • Frequently only half of the maximum volume is requires to achieve an adequate seal. Do not over-inflate the cuff.
  • The airway can be removed when the patient is alert enough to open mouth on command
100
Q

Indications for LMA (Kettering)

A
  • Need for short-term ventilation where more invasive intubation is not merited
  • When intubation is not possible by oral or nasal route (e.g., facial or nasal injuries)
101
Q

Contraindication for LMA (Kettering)

A

Risk of aspiration

102
Q

Kettering: Describe the construction of the Combitube.

A
  • Distal end: A tracheal lumen and an esophageal lumen are combined into one tube
  • Proximal end: Two lumens are separated and color-coded.
  • A large cuff is attached to the proximal end
  • A smaller cuff is attached to the distal end
  • The single tube has apertures between the two tubes
  • Below the cuffs, the end of the tube is open
103
Q

Kettering instructions for Combitube use.

A
  • Place device blindly–it will enter trachea or esophagus.
  • If device enters esophagus, as is more common, the esophagus will be occluded by the distal balloon.
  • Ventilation will be supplied through the longer, blue-colored #1 tube. Gas will be forced through apertures in the side of the tube between the two cuffs.
  • If the device enters the trachea, ventilation is provided directed into trachea using the shorter, clear-colored #2 tube. This #2 tube will work like a standard oral endotracheal tube.
104
Q

How should patient be assessed after intubation with Combitube?

A

Careful assessment of bilateral breath sounds and gastric sounds so that proper tube for ventilation will be selected.

105
Q

Kettering advantages of Combitube.

A
  • Can be inserted rapidly
  • Does not require visualization of the larynx
106
Q

Kettering disadvantages of Combitube

A
  • Placement of ETT is difficult with Combitube in place
  • Cannot be used in patients with a gag reflex
107
Q

Kettering on use of flexible fiberoptic bronchoscope for intubation.

A
  • Useful in cases where upper airway anatomy is distorted by trauma or tumors or when cervical spinal injury prevents manipulation of the neck
  • Allows visualization of the vocal cords
  • Allows ETT to slide over scope into trachea with visual confirmation
108
Q

Kettering: three styles of videolaryngoscopes

A
  • Illuminated stylet/light wand
  • Guide channel
  • Video laryngoscope
109
Q

Commercial names of illuminated stylet/light wands

A
  • Bonfils
  • Video RIFL (rigid flexible laryngoscope)
110
Q

Kettering points on illuminated stylet/wands

A
  • Illuminates skin as it enters larynx
  • Little light is seen if it enters esophagus
  • Used in blind intubation
  • Limited success with patients with bull neck and/or obesity
111
Q

Commercial names of guide channel video intubation devices

A
  • AirTraq
  • Pentax Airway Scope (AWS)
    (Pieters 2016)
112
Q

Kettering points on guide channel video intubation devices

A
  • Holds ETT within a guide channel
  • Screens are very small
  • Very portable
113
Q

Commercial names of video laryngoscopes

A
  • Storz C-MAC
  • GlideScope
    (Pieters 2016)
114
Q

Kettering points on video laryngoscopes

A
  • MacIntosh blade with video
  • View screen and enhanced view
  • Advantage to skilled intubators
  • Glidescope offers disposable blades and flexible video bundle
  • Pre-formed rigid stylet used to facilitate intubation
115
Q

Kettering notes on needle cricothyrotomy

A
  • May be indicated when intubation has failed
  • Insert large-bore (14-gauge) needle through cricothyroid membrane
  • Can be attached to a high frequency jet ventilator
  • 3 mL syringe can be attached to the needle
    –Connect to a 7 mm ID ETT adaptor for ventilation
    –High airway resistance will make conventional ventilation difficult
116
Q

Kettering notes on airway exchange catheter.

A
  • Small diameter tube
  • Allows oxygenation and ventilation
  • Acts as stylet
  • Endotracheal tube slides over it and into trachea
  • Used to replace damaged ETTs
  • Decreases re-intubation time and risks
117
Q

Kettering notes on gum elastic bougie

A
  • Small diameter semi-flexible tube
  • Acts as stylet
  • Endotracheal tube slides over it and into trachea
  • Facilitates difficult intubation
  • Used to replace damaged ETTs
  • No oxygenation or ventilation possible through bougie
  • Decreases re-intubation time and risks
118
Q

Kettering on older technology of tube introducer. When was it used? How did it work?

A
  • “Used when vocal cord defy intubation”
  • Flexible guidewire was inserted into cricothyroid membrane and fed through the mouth
  • Wire was inserted into ETT
  • ETT was slid down wire into trachea
  • “Seldom used since new technologies now available”
119
Q

Kettering on percutaneous dilation tracheostomy

A
  • Performed at bedside
  • Bronchoscope used to secure trachea channel and guide needle puncture
  • Series of dilators used to expand puncture until sufficient for tracheostomy tube
  • Frequently performed as a non-emergent procedure
120
Q

Kettering: The major complication of intubation.

A

Hemodynamic instability, as the introduction of positive pressure ventilation provokes hypotension.

121
Q

Kettering: What should induction agents used prior to intubation do?

A
  • Produce unconsciousness
  • Optimize intubation conditions
  • Minimize hemodynamic response
122
Q

Ketterings list of induction agents

A
  • Propofol
  • Etomidate
  • Ketamine
  • Midazolam
  • Fentanyl
123
Q

Kettering notes on propofol as an induction agent for intubation

A
  • Rapid onset
  • Short duration of action
  • Superior to etomidate or thiopental
  • Major disadvantage is hypotension
124
Q

Kettering notes on etomidate as induction agent for intubation

A
  • Fast onset
  • Rapid recovery from a single dose
  • Maintains hemodynamics: does not affect heart rate, blood pressure, cardiac output
125
Q

Kettering notes on ketamine as an induction agent for intubation

A
  • Little effect on respiratory or cardiovascular system
  • Central nervous system effect which increases ICP, CPP, cerebral oxygen consumption
  • Used since 1965
126
Q

Kettering notes on midazolam as an induction agent for intubation

A
  • Sedative
  • Intermediate on set (15 minutes)
  • Moderate duration (2-3 hours)
  • Complications include PVC, tachycardia, bigeminy
127
Q

Kettering notes on fentanyl as an induction agent for intubation

A
  • Opioid analgesic
  • Complications include: bradycardia, cardiac arrest, hypo- or hypertension, respiratory depression
128
Q

Kettering notes on neuromuscular blocking agents for intubation

A
  • Improve effectiveness of bag/mask ventilation and intubation conditions
  • Helpful in emergent or difficult intubation
  • Rapid response is crucial
129
Q

Kettering notes on succinylcholine as an induction agent for intubation

A
  • Depolarizing NMBA
  • Fast onset (30 seconds)
  • Short duration of action (5-10 minutes)
  • Commonly used in rapid sequence intubation
  • Major complication is hyperkalemia
  • Limited use in patients with bradycardia & arrhythmias
130
Q

Kettering notes on rocuronium as an induction agent for intubation

A
  • Non-depolarizing NMBA
  • Rapid onset (60-90 seconds)
  • Intermediate duration (30-60 minutes)
  • Best alternative when succinylcholine is contraindicated
131
Q

Kettering on rapid sequence intubation

A
  • Indicated when risk of aspiration is high
  • Consists of pre-oxygenation followed by induction agent and muscle relaxant in rapid sequence
  • Induction is performed after waiting 45-60 seconds (while induction agent and muscle relaxant take effect) without mask ventilation
132
Q

Kettering’s description of preparation for rapid sequence intubation procedure

A
  • Evaluate airway (mallampati, thyromental distance
  • Difficult airway suspected? Obtain additional equipment (videolaryngescope, bronchoscope)
  • Ensure adequate IV access
  • Ensure vasopressors available to treat hypotension
133
Q

Kettering’s description of rapid sequence intubation procedure

A
  • Position patient and pre-oxygenate
  • Give induction medications
  • Perform intubation
  • Confirm intubation: observation, auscultation, PetCO2, CXR
134
Q

What’s the generic name for Vest therapy?

A

High Frequency Chest Wall Compression

135
Q

What does K note for therapy with HFCWC?

A

“5-25Hz for 30 minutes, 1-6 times daily” (Egans 11th p. 967)

136
Q

What does IPV stand for again?

A

Intrapulmonary Percussive Ventilation

137
Q

What is the brand name for the IPV device named in K?

A

Percussionaire IPV-1

138
Q

How does K describe IPV’s unique therapy?

A

A combination of high-frequency pulse delivery (100-250 cycles/min) of sub-tidal volume and a dense aerosol.

139
Q

How does K describe the therapeutic virtues of IPV?

A

*Percussive ventilation improves ventilation past obstructions in the airway, thereby delivering more aerosol to distal airways
* (Coughing helps facilitate removal of retained secretions and further improves ventilation.)
*Dense aerosol delivery promotes bronchial hygiene, reduces edema, and relieves bronchospasm with the appropriate medication

140
Q

What tip does K offer for initial setting on IPV?

A

Start source pressure (the control that regulates the velocity of the percussive pulses) for most patients at 30 psi.

141
Q

What are Kettering points for modifying bronchial hygiene therapy?

A
  • Positioning: Avoid Trendelenburg in patients with head injury
  • Duration: Gauge by patient need and/or tolerance
  • Special conditions: Consider modifying technique for patients with chest tubes or bone fractures
  • If CPT is done by another person or department, coordinate other respiratory care with person delivering CPT.
142
Q

Kettering: by what criteria does a practitioner evaluate effectiveness of bronchial hygiene therapy?

A
  • Auscultation: Changed/improved breath sounds
  • Inspection: Color, chest expansion
  • Cough: Volume and characteristics of sputum
  • Toleration: Fatigue, WOB, pain
  • Vital signs: HR, RR, BP, EKG
  • CXR: Improved pattern
  • All but CXR should be observed after every treatment. Based on obtained data, limit or do only the involved segments
143
Q

Kettering: By what criteria should bronchial hygiene therapy be discontinued?

A
  • Clear breath sounds
  • Clear CXR
  • Ambulating well
  • Strong cough
  • Afebrile for 24 hours
  • Therapy provokes adverse effects: dizziness, SOB, cyanosis, etc.
144
Q

Kettering: Describe speaking devices for tracheostomy tubes.

A
  • One-way valve that attaches to tracheostomy tube
  • During inspiration, valve opens and air enters the lungs through the tube
  • During exhalation, valve closes and air passes around cuff and through the vocal cords
  • Cuff must be deflated
145
Q

Kettering description of procedure for tracheostomy care.

A
  • Assemble and check equipment
  • Explain procedure to patient
  • Suction patient to ensure patent airway
  • Clean inner cannula by soaking it in a solution of hydrogen peroxide and water–then rinse with sterile water
  • Clean the stoma site with using cotton applicators dipped in the water-hydrogen peroxide solution. Replace gauze dressing
  • Change trach ties
  • Replace inner cannula
  • Reassess patient and record the procedure
146
Q

Kettering: How should tracheostomy be cared for after removal of tracheostomy tube?

A
  • Do not suture closed the stoma
  • Apply sterile dressing and/or antibiotic to site
  • Clean periodically with hydrogen peroxide
  • Have patient cough to clear secretions
147
Q

Kettering: When should tracheostomy tube be changed?

A
  • When tube is obstructed (If unable to pass a suction catheter, remove the tube, ventilate, and insert a new tube)
  • When tube is too small (i.e., very high cuff pressures [>20 mmHg] needed to seal cuff)– change to larger tube
  • When cuff of tube is punctured (unable to seal cuff)–replace the tube if a seal is required.
  • All other problems can be treated without replacing the endotracheal or tracheostomy tube
148
Q

Kettering: What actions should practitioner take in response to leak in cuff, pilot balloon or pilot valve

A
  • Place stopcock in pilot balloon valve
  • Insert blunt needle into pilot line
  • Clamp pilot line
  • Replace the tube
149
Q

Name video intubation scopes with screen built onto the blade.

A

Coopdech VLP-100
McGrath
(Pieters 2016)

accs (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions