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PHTY3250 > L14: Airway management > Flashcards

L14: Airway management Flashcards

1
Q

What are the 2 causes of inadequate airways?

A
  1. Impaired Laryngeal reflexes
    1. Weakness or flaccidity eg
      1. CVA, head injury
      2. Guillian Barre
  2. Obstruction eg
    1. tumour
    2. secretions
  3. Mucosal inflammation and thickening
    1. Chronic reactions
    2. Acute reactions
      1. Laryngospasm
      2. Anaphylactic reaction
      3. Diphtheria
      4. Burn injury
      5. Acute respiratory failure
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2
Q

Whayt are the 6 indications of upper airway obstruction?

A
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3
Q

What are the 6 different major indications of upper airway obstruction?

A
  1. Congenital
  2. Infective
  3. Trauma
  4. Neoplasm
  5. Foreign body
  6. Vocal cords
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4
Q

What are 8 signs of inadequate airway?

A
  1. Voice alteration, hoarseness
  2. Tachycardia, Tachypnea, sweating
  3. Anxiety, confusion, lethargy
  4. Gurgling
  5. Drooling
  6. Choking, gagging
  7. Inspiratory stridor, crowing
  8. Hypercarbia and hypoxaemia

Upper airway transmitted sounds, inability to cough

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5
Q

What are the 7 methods of maintaining clear airway?

A
  1. Positioning – upright side lying
  2. Jaw position
  3. Nebulized Adrenaline (laryngospasm)
  4. Suctioning
  5. Oropharyngeal/nasopharyngeal airway
  6. Endotracheal tube
  7. Tracheostomy
    1. cricothyroidectomy
    2. percutaneous
    3. surgical
    4. minitracheotomy
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6
Q

What are the 3 characteristics of positioning?

A
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7
Q

What are 5 artificial airways?

A
  1. Oropharyngeal/Guedels
  2. Nasopharyngeal
  3. Endotracheal/Nasotracheal
  4. Tracheostomy
  5. Minitracheotomy
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8
Q

What are 7 characteristics oropharyneal or “guedels” airways?

A
  1. Short plastic tube - to pharynx only
  2. Keeps airway patent
  3. Facilitates suction
  4. Inserted by medical, nursing or PT staff
  5. Can cause patient to gag, vomit
  6. Pt in side lying - gag reflex
  7. Care with loose teeth, bite reflex

RULE: IF PATIENT CAN TOLERATE IT THEY NEED IT

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9
Q

What are the methods of insertion- upside down and then twist?

A
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10
Q

What are 4 characteristics of nasopharyngeal airway?

A
  1. Soft silastic tube to pharynx
  2. Inserted with lubricant
  3. Changed several times a day
    1. Usually changed once every 24hrs
  4. Inserted by medical, nursing or PT staff

Once it is in –> not irritating (except for getting it in)

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11
Q

What are 4 precautions of nasopharyngeal airways?

A
  1. Nasal/facial fractures, CSF leak, torn dura (For people with head injuries)
  2. Coagulopathy (Bleed easily –> might have a severe nose bleed)
  3. Anticoagulant therapy
  4. Hypotension
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12
Q

What are 6 characteristics of intubation? What are 2 considerations?

A
  1. “Definitive” or formal airway ie
    1. Nasotracheal/Endotracheal
    2. Tracheostomy
  2. Tube to just above carina
  3. Inserted by medical staff/advanced paramedics (very hard to intubate)
  4. Only access to ventilation
  5. Often require sedation to tolerate it
  6. Condition must be reversible
    • If someone had terminal cancer –> could not be appropriate

This is the only airway (must make sure equipment is safe)

Considerations:

  • Unable to talk (think about QoL)
  • must be intensive care –> beds are scarce (need to know have good prognosis)
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13
Q

What is the position of endotracheal tube?

A
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14
Q

What are the 7 indications for “intubation”?

A
  1. Airway obstruction
  2. Inadequate oxygenation
  3. Inadequate ventilation
  4. Elevated work of breathing
  5. Airway protection ie protection from oral or gastrointestinal secretions
  6. Facilitation of tracheobronchial suctioning
  7. Facilitation of mechanical ventilation
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15
Q

What are 2 types of tubes?

A
  1. Endotracheal/nasotracheal
  2. Tracheostomy-
    1. Surgical
    2. Minitracheotomy
    3. Percutaneous tracheostomy
    4. Cricothyroidectomy
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16
Q

What are 4 types of tracheostomy tubes?

A
  1. Surgical
  2. Minitracheotomy
  3. Percutaneous tracheostomy
  4. Cricothyroidectomy
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17
Q

What are 4 characteristics of Endtracheal tube?

A
  1. Larger tube
  2. Less well tolerated by patient
  3. Tube occlusion by biting
  4. Damage to patients teeth
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18
Q

What are 4 characteristics of Nasotracheal tube?

A
  1. Oral hygiene easier
  2. Easier to insert
  3. Smaller tube, but easier to block with secretions
  4. Sinus infections, nose bleeds
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19
Q

What are the 4 grades of airways?

A
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20
Q

What are some predictors of a difficulty airway?

21
Q

What are 4 functions of cuff in tubes for intubation?

A
  1. Prevents aspiration of gastrointestinal contents
  2. Provides good seal for ventilation
  3. Prevents movement/holds tube in
  4. Low pressure, high volume
22
Q

What does a cuff and uncuffed tube look like?

23
Q

What are the 4 indications of a cuffed tube?

A
  1. Unconscious
  2. Unable to swallow
  3. Requires full mechanical ventilation
  4. Can potentially cause trauma to vocal cords
    • If tube is removed –> cuff must be not be inflated = can damage larynx…etc
24
Q

What are the 4 indications of an uncuffed tube?

A
  1. Awake or able to swallow
  2. Pediatric use
  3. Patient able to speak with uncuffed tube
  4. Uncuffed tube may cause ↑ secretions due to irritation and movement
25
Q

What are 6 complications due to intubation?

A
  1. Trauma
    • Teeth, insertion, movement
  2. Malposition
    • (R) main bronchus, oesophagus
    • Check R=L and length of insertion
  3. Obstruction
    • Biting, kinking, increased secretions
  4. Disordered physiology (foreign body –> irritating –> More risk of infection (eg. pneumonia))
    1. Increased secretions
    2. Decreased cilial activity
    3. Inability to cough
    4. Tendency towards infection
    5. Inability to talk or swallow –> Can be distressing
    6. Lack of humidification or filtering of air
  5. NB NEED TO HUMIDIFY ALL ARTIFICAL AIRWAYS
    • ​Can be very damaging to the lungs​
  6. Sinus infections from Nasal Intubation
  7. Laryngeal damage and tracheal stenosis
26
Q

What is the problem with this picture?

27
Q

What are 4 indications of tracheotomy?

A
  1. Long term intubation >7 days
  2. Prevent laryngeal damage and oedema from ETT
  3. ETT not well tolerated if patient not sedated
  4. Head an neck injury
28
Q

What are 3 characteristics of Tracheostomy?

A
  1. Short tube inserted through cricoid cartilege in neck
  2. Reaches carina
  3. Reduces anatomical dead space
29
Q

What do Tracheostomies in situ look like?

30
Q

What are 8 complications of tracheostomy?

NOT EXAM QUESTION

A
  1. Risks of operative procedure, eg bleeding
  2. Placement in pre-tracheal tissues
  3. Haemorrhage of inominate artery
  4. Tracheal stenosis ie due to cuff
  5. Tracheomalacia
  6. Tracheo-oesophageal fistula
  7. Surgical emphysema
  8. Blockage with secretions
31
Q

What are 4 characteristics of surgical tracheostomy?

A

More careful

  1. in OT,
  2. actual dissection
  3. ± removal of cricoid cartilege
  4. For patients with “difficult airways” or obese eg short thick necks
32
Q

What are 4 characteristics of percutanous tracheostomy?

A
  1. In ICU
  2. Dilatation technique- Add larger to keep airways open
  3. No scar
  4. Avoid transport of critically ill patient
33
Q

What does the 5 steps of tracheotomy?

34
Q

What are 5 characteristics of minitracheotomy?

A
  1. Inserted for retained secretions or UAO
  2. Paediatric size tracheotomy
  3. Maintain own airway, eat, talk
  4. No need for humidification, may need NaCl 0.9% during suction
  5. Use size 8 or 10 FG catheter to suction ie clean tube
35
Q

What is suctioning?

A

Involves insertion of a polyvinyl tube and negative pressure applied to remove secretions ie “sterile vacuum cleaning”

36
Q

What are the 3 indications of suctioning?

A
  1. artificial airway ie if “intubated”
  2. Unconscious
  3. Inability to cough & expectorate effectively with retained secretions
37
Q

What are 4 routes available of suctioning?

A
  1. Oropharyngeal with/without Guedels airway
  2. Nasopharyngeal with/without nasal airway
  3. Via an ETT
  4. Trachea via tracheostomy or minitracheotomy

Ineffective cough or gurgling –> must be done or will go into resp. failure

38
Q

What are 6 precautions for suctioning?

A
  1. Pulmonary oedema
  2. Haemoptysis: Bleeding of lungs (usually do bronchoscopy)
  3. Respiratory burns
  4. Head injuries: Might increase pressure in head
  5. High levels of PEEP, FiO2: Ventilation or oxygenation
  6. Severe infection: Don’t wait the rest of the staff infected
39
Q

What are 11 effects of suctioning?

A
  1. Hypoxaemia: Not getting enough ventilation when suctioning (must be done quick and efficient) –> turn FiO2 to 100% while suctioning
  2. Cardiac arrhythmias
  3. Haemodynamic alterations
  4. Increased intracranial pressure
  5. Gastric aspiration
  6. Trauma
  7. Distress
  8. Pneumothorax (in neonates)
  9. Atelectasis
  10. Reflex bronchoconstriction: Makes them cough (reflex)
  11. Infection
40
Q

What are 6 alternatives to prevent hypoxaemia and side effects?

A
  1. Increase FiO2 on ventilator: 100% (while suctioning)
  2. Manual hyperinflation
  3. Premeasured catheter (neonates)
  4. Efficient technique, reassurance
  5. No disconnection, suction through Bodai
  6. Closed suction systems **
41
Q

What are 4 characteristics of closed suction systems?

A
  1. Almost 100% use
  2. Prevents disconnection from ventilator, loss of FRC and O2 during suction
  3. Prevents pathogens sprayed into air
  4. Not always effective if very thick secretions

Push catheter down and do not need to disconnect from ventilator macchine

42
Q

What does a catheter and value look like?

43
Q

What are 9 characteristics of weaning from tracheotomy?

A

Can’t just take off suddenly

  1. Airway clearance techniques
  2. Huffing: Able to cough once trachae taken out
  3. Smaller size of tracheostomy
  4. Spiggotting: Block for a minute (make sure they are breathing from moouth)
    • Start with 10mins with patient –> 1 hr –> 1/2 day
  5. Swallow assessments
  6. Fenestrated tracheostomy tubes
  7. One way valves eg Passy-Muir
  8. Stomal button
  9. “Trachae teams”
    • Go every day –> assess patient –> make decision to take out trachae
44
Q

What are 7 characteristics of Passy Muir Value of speaking values?

A
  1. Oxygenation
  2. Restores positive airway pressure
  3. Weaning/Decannulation
  4. Improved swallowing
  5. Secretion management
  6. In-line Ventilator Use & Interchangeability Olfaction
  7. Infection Control
45
Q

What is the indication of Passy Muir Valve of speaking values?

A
  • Weaning from normal trachae to this
  • Unable to talk with a trachae (if been in ICU for a long time) –> good stepping stone
46
Q

What are 3 characteristics of Inner Cannula?

A
  1. Pediatric Speech/Language Development
  2. Voice/Speech Production
  3. ? Improves balance/rehabilitation
47
Q

What is the importance of Inner Cannula?

A

Never suction without inner cannula

48
Q

AD is a 59 year old gentleman admitted with exacerbation of COPD

O/E: Difficult to arouse,

Ausc: Transmitted sounds throughout

Cough: poor, moist, ineffective

SpO2 84% on 2L/min O2 via Hudson mask

ABGs: pH 7.31 PaO2 65 PaCO2 50 HCO3 29

How could you manage this patient?

49
Q

Create a table listing all complications due to intubation and insertion of tracheostomy and then note down any techniques the physiotherapist can do to prevent these.

EXAM QUESTION

PHTY3250 (20 decks)

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