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Sim Lab > Lung Isolation (Exam 4) > Flashcards

Lung Isolation (Exam 4) Flashcards

1
Q

Anatomy: Trachea

A

C-shaped rings anteriorly
Trachealis muscle posteriorly (longitudinal lines)
Esophagus posteriorly (no rings)

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2
Q

Anatomy: Bronchus

A

Right and Left
Left: more acute angle
Right: larger in diameter and has short takeoff (easy to occlude)
–some takeoff from trachea!

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3
Q

Anatomy: Right Lung

A

3 Lobes
-Upper
-Middle
-Lower

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4
Q

Anatomy: Left Lung

A

2 Lobes
-Upper
-Lower

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5
Q

Anatomy: Going Down from Trachea

A

Conducting System
-Trachea
-Primary Bronchus (Left or Right)
-Secondary Bronchus
-Tertiary Bronchus
Gas Exchange
-Bronchioles
-Alveoli

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6
Q

Bronchopulmonary Segments

A

Trachea
Right Mainstem Bronchus (1-2.5cm)
–Right Upper Lobe (Mercedes Sign)
–Bronchus Intermedius
–Right Middle Lobe
–Right Lower Lobe
Left Mainstem Bronchus(5cm)
–Left Upper Lobe
–Lingula
–Left Lower Lobe

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7
Q

Indications for Lung Isolation (Conditions)

A

Infection
Bleeding
-Biopsy that won’t stop bleeding
-Can tamponade a bleed
–Protect unaffected lung
Cyst
Bronchopleural Fistula
Hypoxia due to unilateral lung process

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8
Q

Hypoxic Pulmonary Vasoconstriction

A

Blood shunts away from areas with low 02 to areas with higher O2
-capillaries constrict in places with low O2 and blood gets diverted away from there

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9
Q

Indications for Lung Isolation (Procedures)

A

Thoracic Aortic Aneurysm Repair
Lung Resection
Thoroscopy
Esophageal Surgery
Single Side Pulmonary Xplant
Rib Fixation
Thoracic Spine Surgery (Anterior approach)

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10
Q

Contraindications for Lung Isolation

A

None
–Just make sure you know if you have a R or L sided double lumen tube

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11
Q

DLT (Double Lumen Tube)

A

Left: 95% of the time
-Standard method of lung isolation
-35-41Fr (31 has difficult scope passage and 41 is really big)
–Females 37Fr
–Males 39 Fr
Right: 5% of the time
-Oblique bronchial cuff allows for RUL ventilation
-Do not use in left side

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12
Q

Right Double Lumen Tube Types (4)

A

Mallinckrodt
Portex
Sheridan
Rusch

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13
Q

DLT Kit Contents

A

DLT
-2 Lumens, 2 Cuffs, 2 Pilot Balloons
–Blue = Bronchial
–Clear = Tracheal
Stylet (Preformed)
Adapter
-dual tubes allow for clamping
-dual caps allow for bronchoscopy
Y-Piece
-Connects dual lumen to circuit
Suction Catheter
Need to get Tube Clamp elsewhere

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14
Q

DLT Process

A
  1. Get Equipment
    -Correct side DLT (a size up and down as well)
    –Setup and lubed
    -Tube Clamp
    -Bronchoscope
    –Adapters
    –Defog
    -Stethoscope
    -Tube Holder (ICU trach holder)
  2. Pre-Oxygenate
    -Do extra here, this takes longer and pts have respiratory issues
  3. Induce normally
  4. DL or CMAC/Glidescope
    -Verbalize Cormack & Lehane view
  5. Once DLT tip is past cords remove stylet
  6. Exaggerated 90 degree counter clockwise rotation
  7. Inflate CLEAR cuff (5-10mL) and connect to circuit for EtCO2 verification
  8. Advance bronchoscope down tracheal (CLEAR) lumen
    -Identify posterior trachealis and carina
    -Go down R bronchus, identify Mercedes sign in RUL
    -Retract and view carina again
    -Inflate bronchial cuff (3mL) and make sure no herniation of balloon
  9. Clamp tracheal tube, listen for lung isolation
  10. Clamp bronchial tube, listen for other lung isolation
  11. All good? Secure tube
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15
Q

4 types of Bronchial Blockers

A
  1. Cohen (Has a wheel that moves tip)
  2. EZ-Blocker (crows foot and two balloons)
  3. Arndt (Lasso)
  4. Uniblocker (special ETT with own passageway)
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16
Q

Bronchial Blocker ETT sizes

A
  1. Cohen: 8.0 (9Fr)
  2. EZ-Blocker: 7.0 (7Fr)
  3. Arndt: 4.5 (5Fr), 7.0 (7Fr), 8.0(9Fr)
  4. Uniblocker: 8.0 (9Fr)
17
Q

Bronchial Blocker Process (Initial 5 steps)

A
  1. Intubate with correct size ETT for selected blocker
  2. Confirm placement and connect to circuit
  3. Secure ETT, keep 100% FiO2
  4. Lower bed all the way
  5. Get bronchoscope
18
Q

Process: Cohen (8.0 ETT)

A
  1. Place adapter and reconnect circuit to the 90 degree side port
  2. Place bronchoscope in vertical port, have blocker already placed in 45 degree port
  3. Test cuff and wheel for movement
  4. Advance blocker until seen by scope
  5. Rotate Cohen and bend towards the correct bronchus
  6. Advance to correct position
  7. Inflate under visualization and lock adapter mechanism
19
Q

Process: Arndt (4.5, 7.0, 8.0 ETT)

A
  1. Test cuff and loop
  2. Have Arndt already fed into adapter
  3. Feed scope through adapter and lasso
  4. Connect adapter to ETT and reattach circuit
  5. Advance scope to desires bronchus while maintaining tractions
  6. Release wire and advance while pulling back on scope
  7. Inflate cuff under visualization
20
Q

Process: Uniblocker (8.0 ETT)

A

Same as Cohen, just no wheel for movement

21
Q

Process: EZ-Blocker (7.0 ETT)

A
  1. Place adapter, reconnect circuit
  2. Test Cuff and lube
  3. Insert blocker and scope into adapter
  4. Advance under visualization until at carina
  5. Seat and inflate desired cuff

Sim Lab (4 decks)

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