Lab exam 1 Flashcards
2 types of Oropharyngeal airways
Berman and Guedel
Has a single center channel
Guedel
Has a 2 sided channel
Berman
How do you measure an oropharyngeal airway?
Measure from corner of pt’s mouth to angle of the jaw
If an Oropharyngeal airway is to large it can push……. leading to an obstruction
the epiglottis against the larynx, leading to obstruction
If Oropharyngeal airway is to small it may not
clear the tongue above the epiglottis against the larynx
Another name for Nasopharyngeal
- nasal trumpet
- nasal horn
Indications for Nasal airway (2)
- facilitate ventilation
- Removal of secretions by nasotracheal suctioning
Nasopharyngeal airways sizes. Female and male
Female: 6
Male:7
If nasopharyngeal airway is to short it cannot separate
soft plate from posterior wall of pharynx
If nasopharyngeal airway is to long it may enter
the larynx, causing laryngeal reflexes or enter the space between the epiglottis and vallecular
How do you measure a nasalphargeal airway?
from pt’s earlobe to tip of the nose
How do you inset a nasalpharengeal airway?
parallel to the nose floor, beveled edge to the septum
Oropharyngeal airways should be restricted to
unconscious pts to avoid gagging and regurgitation
Esophageal Obturator Airway (EOA) is inserted into the
esophagus
Laryngeal Mask Airway (LMA) provides a seal over the…..
With a max cuff pressure of
larynx; 60 cmH2O
LMA does not protect the
airway from aspiration
LMA is what kind of a insertion?
Blind
Parts of an ET tube
- Pt end
- Murphy eye
- High volume, low pressure cuff
- Internal diameter
- Distance in mm
- Pilot ballon
- Connection to breathing circuit
- Inflation valve
- Machine end
- Radiopaque line
Esophageal-Tracheal Combitube (ETC) is also called ___________ - ____________ airway
Double-Lumen airway
ETC is what kind of insertion
Blind
ETC may be inserted into the
esophagus or trachea
ETC has 2 cuffs
- Distal cuff
- Proximal cuff
Double- Lumen Endotracheal Tube (DLT) indications (3)
- Lung isolation
- prevent lung to lung spillage
- surgical procedure on non ventilated lung
DLT has 2. (4)
- 2 connectors
- 2 lumen for gas flow
- 2 cuffs
- 2 distal openings
Pilot ballon is used to
inflate or deflate the cuff
What are the typical blade sizes
Normally 3 and 4
Describe a Miller blade placed and how it is used
It is a straight blade and placed below the epiglottis
Describe a Mac blade and how it is used
It is a curved blade and Is placed at the vallecula
Indications for Artificial Airways (4)
- Relief of airway obstruction
- Protection of airway
- suctioning
- Support ventilation
Examples of Endotracheal devices
- ET Tube
- Tracheostomy Tube
Oral intubation is described as
uncomfortable, gagging, excessive secretions
Nasal intubation is not as common but is suitable for pts when
- oral route is not available
- facial or oral surgery
Smaller ET tube means
higher airflow resistance
Procedure of establishing access to trachea via neck incision
Tracheotomy
Opening in the neck is called
tracheostomy
Removal of the larynx (voice box)
Laryngotomy
Laryngotomy tube may be inserted into the
stoma to keep it open while it heals
One- way valve that allows inspiration but not exhalation through the tracheostomy tube opening
Speaking valve
To use a traditional tracheostomy tube to speak the cuff
must be deflated
For a fenestrated tracheostomy tube the cuff may be _____________ providing the ___________ cannula of that tube is removed
Inflated; inner
What is an obturator used for?
Used for insertion and is placed within the outer cannula
Where is an obturator kept?
In the pt’s room. Same size tube and 1 size smaller
Esophageal examples
- Esophageal Obturator Airway (EOA)
- Esophageal- Tracheal Combitube (ETC)
Equation on suctioning. First multiple the tubes inner diameter by 2, then use the next smallest size catheter (F)
Example: 6- mm endotracheal tube
2 x 6 = 12
next smallest catheter is 10 F
Contraindications for Oral and Nasal airways
Oral- oral trauma/ bleeding
Nasal- nasal trauma/ bleeding
Flexible suctioning catheter
Red rubber cuddae
Red rubber cuddae is used for pts who need
frequent suctioning b/c is not as hard as a regular suction catheter
Intubation supplies (10)
- laryngoscope
- blade Miller or McIntosh
- ET tube
- 10 or 12 mL syringe
- water soluble lubricant
- stylet
- ET tube securing device
- carbon dioxide detector
- Amboo bag
- Yankauer
What is a Bougie?
A long tube that you can insert in the pt airways so that you can avoid a full reintubation
The ET tube should be placed approximately
3- 5 cm above the carina or between second and forth tracheal rings
Inflate cuff slowly until NO air leaks are heard at end of inspiration
Minium Occlusion Volume (MOV)
Inflate the cuff until the leaks stop, remove a small amount of air slowly until a SLIGHT leak can be heard at the end of inspiration
Minimal Leak Technique (MLT)
Endotracheal suctioning should not be done a
preset schedule but PRN
Prior to suctioning you do what to your adult pt?
Using pressures between
Preoxygenate w/ 100% o2; 120 -150
Limit duration of suction to
<15 seconds
Application of negative pressure to the airways through a collecting tube
Suctioning
Suctioning can be preformed via what airways? (2)
- The upper airway (oropharynx)
- The lower airway (trachea & bronchi)
Steps to suctioning (7)
- Assess Pt for Indications
- Assemble and Check Equipment
- Asses Pt for Hyper-oxygenation
- Inset Catheter
- Apply Suction and Clear Catheter
- Reoxygenate Pt
- Monitor Pt and Assess Outcomes
Steps to Intubation (9)
- Assemble and check equipment
- Position pt
- Preoxygenate and Ventilate Pt
- Insert Laryngoscope
- Visualize Glottis
- Displace Glottis
- Insert tube
- Asses tube position
- Stablize Tube and Confirm Placement
2 techniques for Endotracheal suctioning
- Open- steril technique- requires disconnecting pt form vent
- Closed- technique - uses sterile, closed in line suction catheter, that’s attached to the ventilator
What is needed for Extubation (5)
- Oxygen
- 10 mL syringe
- towel
- stethoscope
- Intubation box
Steps for Extubation (7)
- Assemble Needed Equipment
- Suction ETT and Pharynx
- Oxygenate Patient well After Suctioning
- Deflate Cuff
- Remove Tube
- Apply Appropriate Oxygen and Humidity
- Asses or Reassess Pt
Indications for Mechanical ventilation (6)
- Inadequate alveolar ventilation
- Inadequate lung expansion
- Inadequate muscle strength
- Increased WOB
- Hypoxemia
- Apnea
What are some parts of a Tracheostomy tube
- Inner Cannula
- Cuff
- Obutrator
- pilot ballon
- Flange
LMA requires a large volume of air to inflate the seal to seal the airway. What is the cuff and airway pressures for LMA?
- Cuff pressure is 60 cm H20
- Airway pressure is 20
Suctioning pressures for adults
120-150 mm Hg
Suctioning pressures for children
100- 120 mm Hg
Suctioning pressures for infants
80-100 mm Hg
What is a reason why someone will need to have a trache?
Long term airway
To prevent a nasal airway from being inserted to far, what is needed?
safety pin
Nasopharyngeal are used for what kind of pts?
conscious pts or semi conscious
What does an oral airway prevent?
Tongue from falling backwards into airway
Oral airways are for what kind of pts?
unconscious pts
Is LMA easy to insert?
YES
Can LMA’s be autoclaved?
YES
Direct vison to vocal cords is called
Binocular vision
How long should you preoxygenate?
30 seconds
____% of unplanned or extubations do not require reintubation.
50%
After extubation what should you monitor?
- O2
- Breath sounds
When do you extubate?
on end exhalation ( coughing)
If tube is bigger, then
airway resistance will be lower
EOA has a cuff on top off distal airway end to prevent
aspiration of stomach contents
When tube is in the esophagus on an ETC, a small distal cuff ____ seals off the esophagus
15mL
When tube is in trachea, a large proximal cuff ___ seals of trachea on ETC
100mL
The goal is to keep capillary perfusion in trachea at
20 mmHg to 30
What are the most common injuries to the larynx
- Glottic edema
- Vocal inflammation
- Laryngeal/ vocal cord ulcerations
- Vocal cord polyps
How long should it take to insert ETT before having to preoxygenating again?
<30 seconds
DLT allows
The right or left lung to be ventilated separately
What vitals do you check when intubating?
- Sats
- HR
- BP
This object prevents inward/outward migration of airway
Safety pin
Routes for artificial airways
- Pharyngeal airways- extend only into the pharynx
- Artificial airways- placed through mouth or nose into trachea called ET tube
Process of placing artificial airway into trachea
Intubation
When tube is passed thru the mouth on its way to trachea
Orotracheal intubation
When the tube is passed through the nose
Nasotracheal intubation
A speaking valve is a one way valve that allows
inspiration but not exhalation through the tracheostomy tube opening
Suctioning is the application of
negative pressure to the airways through a collecting tube
Intubation is the process of
placing artificial airway into trachea
Name the 2 pharyngeal airways
- Oropharyngeal airways
- Nasopharyngeal airway
