Module 3 Flashcards
Intubation: a procedure to maintain the ? urgent: can occur planned: -for known ?
upper airway
in field
surgery
decline in medical status (COVID 19)
Reasons for intubation: respiratory failure: inadequate inadequate ... (usually ?)
apnea
oxygenation (hypoxia)
ventilation (hypercarbia - too much carbon dioxide)
surgery (planned)
Endotracheal tubes: various ? number of the tube refers to the ? tube has markings in ? note the ? the tube is ? can check for ? distal tip should be approx?
sizes
inner diameter of tube
2 cm increments / depth of tube ending at teeth or lips
radiopaque / adequate placement on X-ray
4 cm in adults
Inflant epiglottis:
… shaped
configuration
narrow, tubular/omega shaped
changes / opens with growth (age)
COVID-19 considerations/precautions for intubation:
… procedures
-
-
aerosol generating procedures
- suctioning (prior to intubation)
- intubation itself
Goal - extubation:
the patient can breathe ? and can be?
work toward extubation with ?
less ? more ?
adjustment to ?
decrease ?
-potential
independently/ taken off ventilator and be extubated
ventilator weaning trials
vent support/ spontaneous breaths
-sedation
-sedative medications
vicious circle
potential for injury: placing having removing need for ?
endotracheal tube
endotracheal tube in place
tube (self-extubation)
re-intubation and then exudation another time
Post-intubation injury:
research findings and versus common sense
duration of intubation
size of ETT
type of ETT
patient age , weight, height
did not correlate to degree of laryngeal injury
Laryngeal injury from prolonged intubation:
how many had degree of laryngeal injury
most common:
other injuries included
vocal process
vocal fold
…
95%
arytenoid edema, arytenoid erythema an dinterarytenoid tissue edema
granuloma
immobility
subglottic edema/narrowing
Laryngopharyngeal reflux:
GERD is an important factor in ?
-
exposure to acid results in?
laryngeal and tracheal injury in intubated patients in both Operating room or ICU
Nasal gastric tube (NGT)
mucosal injury to larynx and reduced mucocillary flow in trachea
Right versus left injury with intubation:
left sided vocal fold injury is more?
this is attributed to
prevalent
right-sided insertion of orotracheal tube and left-handed hold of laryngoscope
VF paralysis:
considerations:
surgical-cardiothoracic/thoaracic :
ETT cuff/tracheostomy tube cuff
RLN compression between ? with cuff inflated ?
left RLN more susceptible due to court - lower through chest around aorta
ETT cuff and lamina of thyroid cartilage/ RLN can sustain damage
Post-extubation dysphagia risk: consistent risk factors for dysphagia found by ? - - - -
of these factors it is not fully established which factor increases
ICU and length of hospital stay
multiple intubations
sepsis
poor functional status
increases risk for post-extubation dysphagia
How long should a patient be intubated before consideration for tracheostomy placement ?
optimal time frame is not ?
varies from ?
also considerations for ?
average time oral intubation is about ? before consideration for completion of tracheotomy
set in stone
case to case
covid-19
10-14 days (in non-covid scenario)
Tracheotomy:
procedure whereby
tracheostomy: surgically created
incision made into tracheostomy through neck
opening that remains in neck
Tracheotomy: indications: relief of bypass a ? provides means of enables efficient after initial management with endotracheal intubation , if prolonged airway or ventilator assistance required, covert to ?
upper airway obstruction compromised upper airway assisted mechanical ventilation tracheobronchial toilet tracheotomy early to prevent laryngeal or tracheal injury
tracheotomy: surgical technique
.. position , neck ?
in children vertical entry into trachea through the? without removal of ?
in adults some surgeons remove ?
some surgeons create a ? just below levels of
supine/ extended
2nd,3rd, 4th tracheal rings/ cartilage
anterior portion of 3rd 4th tracheal rings
surgical flap/ TVFs
Cricothyrotomy:
used in ? scenario
preferred over
convert to ?
cannot intubate cannot ventilate
tracheotomy for emergency airway management
tracheotomy early to prevent subglottic stenosis
Percutaneous dilation tracheotomy completed in the ICU :
reduced
for patients too?
cost and reduced operating room resources
unstable to transport to OR
PDT patient selection: adult ? contraindications: -anatomic differences including -circoid -midline -high -
uncorrectable ? PEEP > non-intubated patients with .. patients morbidly ?
personnel ?
intubated patients ICU
below sternal notch
neck mas
brachiocephalic artery
goiter
coagulopathy (bleeding) 15cm water acute airway obstruction pediatric obese patients
2 critical care doctors, respiratory therapist, nurse
Tracheotomy procedure percutaneous tracheostomy placement -small incision in series of ? used to ? a specialised ? placed done at takes ?
trachea dilators/ increase size of tracheostoma tracheostomy tube bedside 20-30
Tracheostomy tubes sizes:
a properly fitted tube should not occupy more than ?
sized on any variety of ?
2/3rds of inner diameter of trachea
classification system
Flange or neck plate: attached to rests on provides support for has printed info about
proximal end of outer cannula
skin of patients neck
tracheostomy tube
size, type, manufacturer of tube
Obturator:
tool used to
has a ? that protrudes beyond the end of the outer cannula to ease?
insert trach
rounded tip/ ease insertion
Universal connector: standard size connection site for ? attachment point for inner cannula is
15mm
inline suctioning if on ventilator
speaking valve
attached to this
cuff is fully inflated if
must be deflated for
on ventilator support
speaking valve use
outer cannula:
larger ?
may be ? or?
length and diameter of outer cannula ? depending on
diameter than inner
fenestrated or non-fenestrated
varies/ size of tracheotomy tube
cuff: assists in providing a ?
types ?
closed ventilatory system / patient on ventilator or has copious secretions
air filled
foam
fluid filled
