Medical SLP - Final Flashcards
Tracheotomy
emergency procedure; opening the trachea at any level.
Flail Chest
- When diaphragm contracts (muscles of respiration) without rigid framework of ribs/spine/sternum, they collapse the chest. Chest doesn’t expand it gets smaller; no air comes in. skeletal structure of respiration is destroyed.
When do you need to insist an intubation tube is removed by?
Day 7
Indications for tracheostomy
length of time on ventilator, difficulty mobilizing secretions, airway trauma that won’t resolve quickly.
surgical indications: skull/dural surgeries, head and neck cancers and TBI.
Tracheostomy
create stoma/semi-permanent opening.
O2 Saturation Levels
should be above 95%; if below, STOP WHAT YOU’RE DOING.
Pulse Oximeter (pulse ox)
records how much red is in the blood going through your finger
What is the biggest job you have in the hospital?
wash your hands
Managing Secretions
suction, clean technique (doesn’t need to be sterile), doesn’t hurt, know size of catheters, CHART EVERYTHING.
suitability for a speaking valve is determined by the patient’s ability to tolerate a speaking valve, which is judged by…
the patient’s ability to maintain reasonable oxygen saturation levels in the blood.
Types of tracheostomy tubes
single cannula, cuffed double cannula, cuffed metal cannula, non-cuffed single cannula, non-cuffed fenestrated, cuffed
Why does the cannula need to be smaller than the trachea?
So Air can go around cannula and get into the larynx so the patient can speak
Branchoscopy
An examination of the inside of the trachea and of the large air passages leading to the lungs. Usually done as a way of assessing the degree of narrowing of the trachea and the overall general condition of the trachea and the air passageways.
Why does the cannula need to be centered in the airway?
It lessens the risk of aspiration and it helps to keep the tube from rubbing the airway which can lead to tracheal deterioration.
Feeding/eating
decannulation
removing the tracheostomy tube
Dysphagia
swallowing disorder
Extrinsic Muscles
one attachment is outside the larynx which supports larynx in its position
- suprahyoids and infrahyoids
Suprahyoids
elevators; muscles attach to hyoid from above
- digastricus
- mylohyoid
- stylohyoid
- genoihyoid
Digastricus
2 bellies (anterior & posterior)
elevates hyoid and larynx superiorly and anteriorly
Mylohyoid
floor of mouth
elevates hyoid, tongue and floor of mouth. may depress mandible is hyoid is fixed.
Stylohyoid
long and slender.
elevates and retrates hyoid and larynx.
same as digastricus posterior bellly.
Geniohyoid
pulls hyoid superiorly and anteriorly, like anterior belly of digastricus
Structures of the larynx (bottom to top)
true VFs, false VFs, aryepiglottic folds and epiglottis
Spaces and places in the larynx
Valleculae, pyriform sinuses, aditus laryngeus (aditus or vestibule), anterior and posterior commissure.
Pharyngeal constrictors
superior, middle and inferior
Infrahyoid muscles
depressors, to hyoid from below
- sternohyoid
- omohyoid
- thyrohyoid
- sternothyroid
Sternohyoid
pulls hyoid down or holds it in place when mandible is forcefully opened against resistance
Omohyoid
On contraction it pulls the hyoid inferiorly and dorsally.
Thyrohyoid
On contraction it raises the larynx and decreases the distance between the thyroid and hyoid.
Sternothyroid
On contraction it depresses the thyroid cartilage.
Risk for dysphagia
lack of muscle function, sensation or cough/clear reflex
Aspiration
entry of food or liquid into the airway below the true vocal folds.
Penetration
entry of food or liquid into the larynx down to but not below the level of the true vocal folds. Food or liquid in the additus.
Residue
food or liquid that is left behind in the mouth or pharynx after the swallow.
Backflow
food from the esophagus into the pharynx and/or from the pharynx into the nasal cavity.
screening identifies ____ the patient is aspirating but not ___
that; why
Signs and symptoms of aspiration
coughing after swallow
history of pneumonia
food squirting out the tracheostomy
diagnoses that put patient at greater risk for dysphagia
laryngeal damage
stroke
head injury
neurological disorder or disease that leads to paralysis/paresis and/or lessened sensation
Videoflouroscopic procedure
modified barium swallow
modified barium swallow focuses on…
oral structures, upper trachea and larynx
barium swallow test goes all the way to…
the stomach
2 purposes of the barium swallow test
determine the abnormalities in A and P causing patient’s symptoms
identify and evaluate treatment strategies
3 consistencies of material used in barium swallow test
thin liquid, thick liquid, barium on a cracker.
Laryngeal strategies/swallowing maneuvers
head positioning, laryngeal manipulation, food alterations, multiple swallows, swallow-cough, food then a sip of liquid to clear.
Practicalities of treatment strategies for swallowing maneuvers
- Is your patient cognitively capable of following instructions?
- If someone has to be there with the patient during feeding times, will the caregiver follow instructions? (Is mama a little senile too? Is the patient in a nursing home and the duty will fall to an aide, etc.)
Multidisciplinary Dysphagia intervention team
SLP Physician Nursing staff Dietician OT PT Pharmacist Radiologist
