Lecture Final Flashcards
What are the 2 Pharyngeal Airways
Nasopharyngeal and Oropharyngeal
What’s the size ranges for nasopharyngeal airways
6 for adult women
7 for adult male
Why do we use a nasopharyngeal airway
- frequent suctioning
- facilitate ventilation
If the nasopharyngeal airway is too short then it cannot separate the soft palate from the posterior
wall of the pharynx
If the nasopharyngeal is to long it may enter the
larynx, causing laryngeal reflexes or enter the space between the epiglottis and vallecular, leading to a potential obstruction
How do you measure a nasopharyngeal tube?
earlobe to the tip of the nose
How do you insert a nasopharyngeal airway
Parallel to the nasal floor, beveled edge towards the septum w/ water soluble lube
What are some contraindications with nasopharyngeal airways?
- nose bleed
- infection
How do we keep the nasopharyngeal from sliding out
safety pin
Nasopharyngeal airways should be restricted for what type of pts?
semi conscious
Oropharyngeal airways should be restricted to what type of pts? And why?
unconscious, to prevent gagging and aspiration
2 types of oropharyngeal airway
- Berman
- Geudel
Geudel has a
single center channel
Berman uses a
2 sided channel
How do we insert oropharyngeal airway
upside down and flip it around
Why do we use an oropharyngeal airway?
- to prevent airway obstruction
If Oropharyngeal airway is to small it may not
clear the tongue
If it is to large it can push the
epiglottis against the larynx
If the oral airway is protruding out of the mouth what do we do?
Take it out and replace it
Esopharyngeal- Tracheal Combitube (ETC) may be inserted into the
esophagus or trachea
Combitube is inserted
blindly
ETC is also called a
Double- Lumen airway
Endotracheal Tube is inserted in the
trachea
What are some parts of an ETT
- cuff
- pilot ballon
- pt end
- machine end
- markings
Laryngeal Mask Airways (LMA’s) airway pressure is____ and cuff pressure is ____
airway= 20
cuff pressure= 60
How many times can a LMA be autoclaved?
up to 40 times
Does LMA prevent from aspiration?
No
Contraindications of LMAs
- does not prevent from aspiration
- should not be used on conscious pts
If we need a lower airway resistance (Raw) with ETT what do we need to use?
bigger ETT
What is the most common problem of why a pt may need an airway?
Tongue falling backwards
What are some Indications for airways? (4)
- airway protection (risk for aspiration)
- support of ventilation
- suctioning (coupies amounts of secretions)
- MV
What position do we put pts before intubating them?
Sniffers position
(flexion of cervical spine)
Why do use a Tracheostomy Tube for an airway?
- Long-term airway
- If nasal or oral is not available
When inserting a Tracheostomy for the first time what has to be in the trache? and why?
Obturator
To reduce trauma to mucosa
What do we keep at the bedside for traches?
Same size obturator and one size smaller
What is considered Respiratory Failure on ABG?
pH: <7.30
paCo2: >50
Pao2: <60
Why would a pt need to be on mechanical ventilation?
- Apnea
- Refractory Hypoxemia
- Respiratory failure
- Impending Respiratory failure
- Increased WOB
- Inadequate alveolar ventilation
When the pt needs the vent to do all the work for them, what is that called? And what mode do we use for this?
Full vent support (CMV)
What are some examples of partial vent support?
- SIMV
- IMV
SIMV (2)
- Pts can breathe in between mandatory breaths but won’t allow breath stacking
- Used as a weaning mode
With CPAP mode the pt is…..
What are we setting on CPAP mode?
- doing all the WOB on their own
(we only set PEEP, Pressure support and FIO2)
IMV
Pts can breathe in between mandatory breaths, however does not prevent breath stacking
What does trigger a breath mean
starting a breath
Examples of triggering
- pt
- flow
What does cycling a breath mean?
ending a breath
Examples of cycling
- time
- pressure
What are some modes of ventilation?
- SIMV
- IMV
- CMV
- PSV
- CPAP
- VC- CMV
- PC- CMV
What is the equation for Ideal BodyWeight for Male and Female
M: 106+6(H-60)/ 2.2
F: 105+5(H-60)/ 2.2
What are the initial vent settings
Vt= 6 to 8
RR= 10 to 20
Fio2 = >50
PEEP=5
Pressure Support=5
What are the vent settings for ARDS
Vt= 4 to 6
RR= 15 to 25
PEEP= high
Fio2= high
As airflow resistance increases, what happens to the pv loop?
the pv loop widens
If a vent is in a volume control mode, what was set?
a preset volume
If vent is in a pressure control mode, what was set?
preset pressure and the pt can breathe their own Vt
What is the Peak inspiratory pressure (PAW) alarm set to
10 above PIP
What is the apnea alarm set to?
20 seconds
On the vent what settings can we use to fix the blood gas if a pt is in Respiratory Acidosis (High CO2)?
Increase RR
Increase Vt
What settings can we use on the vent to fix the blood gas if a pt is in Respiratory Alkalosis ( Low Co2)?
Lower the RR
Lower the Vt
What are the weaning parameters? (4)
- RSBI: <105
- NIF: >-20
- VC: >15
- P100: 0 to -2
How do we have a pt perform a VC?
Blow all their air out and the next deep breath in is their VC
How does a pt perform a NIF?
Deep breath in and hold it
What is the RSBI equation
RR/VT
ME should be
less than 10
If a pt’s ME is greater than the normal value, what does this mean?
The WOB is increased. The pt is working to hard to breathe
What is the ME equation?
ME= VT x F
What is a normal ME?
5 to 6
Does a pt have to meet all the weaning parameters to pass SBT?
How fast we can wean a pt depends on?
No;
the protocol set
What is the dead space equation
paco-peco/paco
If a pt is intubated b/c of airway protection or surgery can they be weaned quickly?
yes
What pt population will take a longer time to be weaned from MV?
- COPD
- Static Asthmatic
What is weaning success?
The pt successfully passed SBT and can spontaneously breathe w/o the need for reintubation
What is weaning failure?
Failure of SBT or the need for reintubation
If the loop is shifting towards a pressure access, towards increased PIP what is happening to compliance as the airway pressure gets higher? Which means?
decrease compliance; the lungs become less compliant
B/c of widening of the plvloop decrease of compliance causes an
increased airway resistance
As the pvloop gets smaller, compliance is
increased
Increased compliance in pv loop means
decrease airflow resistance
What causes airway resistance in a pt (3)
- secretions
- tube size
- dead space
Can higer tidal volumes cause an increase PIP?
yes
What can we do if a pt has an increased PIP?
suction
What can cause a high pressure alarm to go off?
- Pt coughs
- secretions
- kinks in tube
What can cause a low pressure alarm to go off?
- Leaks in circuit tubing
- pt disconnection
What does proning help with?
oxygenation
If the tidal volume is low on CPAP mode what can we do to increase Vt?
Increase pressure support
The difference between IPAP and EPAP is
pressure support
What are some NIV
- CPAP
- BiPAP
What can decrease static compliance?
- Tension pneumothorax
- air trapping
What can increase static compliance?
emphysema
