Lecture Final Flashcards by Kiesha Alexis

What are the 2 Pharyngeal Airways

Nasopharyngeal and Oropharyngeal

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What’s the size ranges for nasopharyngeal airways

6 for adult women
7 for adult male

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Why do we use a nasopharyngeal airway

frequent suctioning
facilitate ventilation

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If the nasopharyngeal airway is too short then it cannot separate the soft palate from the posterior

wall of the pharynx

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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

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How do you measure a nasopharyngeal tube?

earlobe to the tip of the nose

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How do you insert a nasopharyngeal airway

Parallel to the nasal floor, beveled edge towards the septum w/ water soluble lube

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What are some contraindications with nasopharyngeal airways?

nose bleed
infection

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How do we keep the nasopharyngeal from sliding out

safety pin

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Nasopharyngeal airways should be restricted for what type of pts?

semi conscious

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Oropharyngeal airways should be restricted to what type of pts? And why?

unconscious, to prevent gagging and aspiration

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2 types of oropharyngeal airway

Berman
Geudel

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Geudel has a

single center channel

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Berman uses a

2 sided channel

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How do we insert oropharyngeal airway

upside down and flip it around

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Why do we use an oropharyngeal airway?

to prevent airway obstruction

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If Oropharyngeal airway is to small it may not

clear the tongue

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If it is to large it can push the

epiglottis against the larynx

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If the oral airway is protruding out of the mouth what do we do?

Take it out and replace it

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Esopharyngeal- Tracheal Combitube (ETC) may be inserted into the

esophagus or trachea

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Combitube is inserted

blindly

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ETC is also called a

Double- Lumen airway

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Endotracheal Tube is inserted in the

trachea

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What are some parts of an ETT

cuff
pilot ballon
pt end
machine end
markings

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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?

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