Mod 5 Airway Managment Flashcards
When should a alternative airway be considered in neonates?
ETT and Laryngeal tubes improve ventilation efficacy and ease of assisted ventilation
- If PPV w/face mask does not improve after a few mins.
What are the PROS of using a endotracheal tube (ETT) and when would you use it?
Provides reliable airway access for/when:
- Stablization of a newborn w/diaphragmatic hernia
- Surfactant admin
- Direct tracheal suction if airway obstructed
AND
- If Chest compressions are necessary
Airway anatomy: label the following figure
Airway Anatomy: List the following diagram for the glottis
Airway Anatomy: List the following diagram for the glottis
What size Laryngoscope blade would you select for a term newborn?
1
What size Laryngoscope blade would you select for a preterm newborn?
0
What size Laryngoscope blade would you select for a very preterm newborn?
00
What criteria is used for selecting a endotracheal tube (ETT) sized at 2.5 mm ID?
Weight < 1000 g’s
Gestational age < 28 weeks
What criteria is used for selecting a endotracheal tube (ETT) sized at 3.0 mm ID?
Weight = 1000-2000 g’s
Gestational age = 28-34 weeks
What criteria is used for selecting a endotracheal tube (ETT) sized at 3.5 mm ID?
Weight > 2000 g’s
Gestational age > 34 weeks
How long do you have for each intubation attempt?
30 seconds
which position is correct when intubating a newborn?
edit
If the tongue is obstructing the view of structures in the mouth/glottic region when intubating a neonate, what corrective action can you take?
Advance the blade farther
If the esophagus is the only visible structure in the mouth/glottic region when intubating a neonate, what corrective action can you take?
Withdraw the blade the blade slowly until the epiglottis and glottis are seen
How do you determine the insertion depth of a endotracheal tube [ETT] for neonates?
Estimated ETT depth = Weight in Kgs + 6
- or follow the chart
When assisting w/intubation, what are the things you need to do from start to finish?
- Ensure equipment function (safety checks)
- Ensure Pt. stable prior to intubation attempt (HR & SpO2)
- Ensure plan and roles establish for team (Effective bagging transitions, ETT securing, ETT assessment)
- Timing of intubation attempt (30 s and bag between attempts)
- Confirm effective ETT placement
How can you confirm correct ETT position placement?
- Audible and equal breath sounds near axillae during PPV
- Symmetrical chest movement w/each breath
- Little or no air leak from mouth during PPV
- Decreased or absent air entry over the stomach
What is the bare minimum you can check to confirm ETT placement?
- color change
- chest movement or breath sounds over chest
- No breath sounds over the stomach
- Maintain ventilation (check HR and SpO2)
What should you do if ETT placement if wrong or suspected?
- Communicate w/team
- pull out and continue mask ventilation
How do you secure ETT for newborns?
Tape and Neobar
What is the suction pressure of neonates?
60-80 mmHg
What suction pressures are used for large infants & children?
80-100 mmHg
Absolute indications for suctioning newborns?
- Secretions visible in ETT
- Aspiration of gastrointestinal or oropharyngeal contents
- Inadvertent water aspiration from vent. circuit
What are some relative indications for suctioning?
- Rhonchi noted during auscultation (bubbling sounds), might indicate retained secretions
- Changes in compliances
- Increase in WOB
- Decrease in SpO2 w/same or increased FiO2
What is the suction pressure of the Meconium Aspirator?
80-100 mmHg
What is a meconium aspirator used for?
- how do you operate it?
Used for thick secretions that may obstruct the airway.
- Needs to be attached directly to ETT
- Needs to occluded w/finger
What guideline should you follow if a intubated pt suddenly deteriorates after intubation?
DOPE
What are the 2 sizing options of a laryngeal mask?
1500 and 2000gs
Pediatric intubation guidelines?
Same as adults.
- sizing will dependant on the where the child fits on the Broselow tape
