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Critical Care: Hewitt > Quiz 1: Airways/Intubation > Flashcards

Quiz 1: Airways/Intubation Flashcards

1
Q

What type of deadspace is associated with the upper airways?

A

Anatomical airways

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2
Q

Anatomical airways means there is no _______ in the upper airways.

A

Gas exchange

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3
Q

Artificial airways bypasses where what occurs exactly?

A

Where filtering, humidification, and warming occurs

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4
Q

What is the standard positioning for opening the airway?

A

Head tilt/chin lift aka “sniffing position”

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5
Q

What are some appropriate circumstances for head tilt/chin lift?

A

Emergency - LOC
Patients airway is obstructed by tissue
Manual ventilate patient

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6
Q

You should NEVER use the sniffing position when:

A

Patient has a suspected or confirmed head/neck/spine injury

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7
Q

What position should you use when neck trauma or injury is suspected?

A

Jaw thrust maneuver

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8
Q

What are the airways that only reach the pharynx called?

A

Pharyngeal airways

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9
Q

T/F: Endotracheal tubes can go through both the nose and the mouth.

A

True

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10
Q

Which of the following are indications for artificial airways?

I. Protect airway patency
II. Decreased LOC
III. Facilitate suctioning
IV. Mechanical Ventilation (PPV)
V. Bronchoscopy/Surgery
A

All of the above are indications for artificial airways

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11
Q

Which of the following are conditions that commonly need artificial airways?

I. Pierre Robin syndrome 
II. Treacher Collins
III. Trisomy 21
IV. Cleft Palates
V. Guillan Bierre
A

I. Pierre Robin syndrome
II. Treacher Collins
III. Trisomy 21
IV. Cleft Palates

all except V

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12
Q

Which of the following are ways we can keep an airway patent?

I. Heat and humidification
II. Proper coughing technique
III. Hyperinflation/CPT
IV. Suction airway

A

All of the above

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13
Q

Which of the following are risks associated with suctioning?

I. Decreased risk of infection
II. Increased saturation
III. Arrythmias
IV. Mucosal trauma 
V. Increased ICP
A

III, IV, and V

Possible complications include 
***increased risk of infection
***desaturation
arrhythmias
mucosal trauma
hypotension
atelectasis
increased ICP
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14
Q

What are the 2 types of oropharyngeal airways?

A

Berman and Guedel

Berman - channels on the side
Guedel - channel down the middle

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15
Q

T/F: You should only place OPAs on patients who are unconscious without a gag reflex.

A

True

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16
Q

How is an OPA fitted?

A

Measured from teeth/gums to angle of jaw

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17
Q

T/F: You should always tape OPAs in place.

A

False

Never tape in place - if patient regains consciousness, take it out

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18
Q

T/F: NPAs are used to facilitate NT suctioning.

A

True

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19
Q

How often do NPAs need to be switched to the other side in order to prevent sinus infection or blockage?

A

24 - 48 hours

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20
Q

How are NPAs measured?

A

Measured from tip of nose to earlobe (length most important)

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21
Q

If NPA is placed too far what can happen to the patient?

A

They will start coughing/gagging

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22
Q

You should NEVER use NPAs if:

A

Patient has suspected or confirmed basilar skull injury.

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23
Q

T/F: You should always lubricate when inserting a nasal airway.

A

True

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24
Q

What are some risks associated with endotracheal tubes?

I. Higher risk of self extubation
II. Left mainstem intubation
III. Occlusion from biting
IV. Injury to tissue

A

I, III, and IV

***Right mainstem intubation is a risk, not left

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25
Q

How do you identify an endotracheal tube on CXR?

A

Radiopaque line

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26
Q

T/F: Endotracheal intubation is for short term use, while tracheal airways are for long term use.

A

True

Tracheal airways:
Long term airway
More stable and tolerated better then ETT
May or may not be used for mechanical ventilatory support
Size is usually the internal diameter but can be in mm or F
Aids feeding, speech and oral care
Less risk of decannulation

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27
Q

T/F: Patient must be be conscious, able to follow commands, and protect airway on their own in order to qualify for extubation.

A

True

Pt should be able to manage and clear secretions, have good cough and gag reflex, and can maintain oxygenation and ventilation

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28
Q

T/F: Negative leak tests are ideal prior to extubation.

A

False

Listen for leak around cuff, Positive leak test indicates airway is not as likely to swell shut after airway removal BUT patient still may have stridor

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29
Q

T/F: You should always hyperoxygenate the patient prior to suctioning and attempting extubation.

A

True

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30
Q

When should you pull the tube during suctioning?

a. during exhalation
b. during inhalation

A

b. during inhalation

inhalation allows airway to open up more and prevent damage

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31
Q

How soon after extubation can edema develop?

a. 1 hour
b. 6 hours
c. 2 hours
d. 12 hours

A

c. 2 hours

32
Q

T/F: You should always consider steroids before attempting re-extubation.

A

True

33
Q

Which of the following are the proper treatments for laryngospasm?

I. FiO2
II. Bronchodilator
III. Possible re-intubation
IV. Steroids

A

I, II, and III

I. FiO2
II. Bronchodilator
III. Possible re-intubation

Laryngospasm = spasm of the vocal cords = increased WOB / distress

34
Q

Your patient is experiencing moderate post-extubation laryngeal edema. Your treatment would be:

a. racemic epinephrine
b. cool bland aerosol 12-24 hours
c. re-intubation
d. corticosteroids

A

a. racemic epinephrine

35
Q

T/F: Patients are allowed to have new pulmonary infections for decannulation.

A

False

Criteria for decannulation:

  • strong cough / muscle strength
  • NO new pulmonary infections
  • manageable secretions
  • patent upper airway
  • adequate swallow strength
36
Q

Fennestrations in tracheostomies are useful for:

A

Phonation and air flow to upper airway

37
Q

T/F: You should always have spare trach equipment nearby during decannulation.

A

True

38
Q

If patients voice sounds hoarse for more than one week, you can suspect:

a. vocal cord paralysis
b. tracheal stenosis
c. laryngotracheal web
d. vocal cord ulcers

A

d. vocal cord ulcers

39
Q

If your patient has recurrent laryngeal nerve damage, you can suspect:

a. vocal cord paralysis
b. tracheal stenosis
c. laryngotracheal web
d. vocal cord ulcers

A

a. vocal cord paralysis

40
Q

If your patient has necrotic tissue at glottis, leading to excessive fibrin formation, the patient will have stridor and needs to be suctioned out. You suspect this patient has:

a. vocal cord paralysis
b. tracheal stenosis
c. laryngotracheal web
d. vocal cord ulcers

A

c. laryngotracheal web

41
Q

You should always keep cuff pressures at:

a. 20 - 30 cmH2O
b. 30 - 40 cmH2O
c. 25 - 35 cmH2O
d. 10 - 20 cmH2O

A

c. 25 - 35 cmH2O

42
Q

If your patient has a lesion at the cuff site and a narrow airway, you can suspect this patient has:

a. vocal cord paralysis
b. tracheal stenosis
c. laryngotracheal web
d. tracheal malacia

A

b. tracheal stenosis

Tracheal stenosis refers to abnormal narrowing of the trachea that restricts your ability to breathe normally.

43
Q

Your patient’s cartilaginous tissues in the trachea are lost, they are at risk for airway collapse due to loss of support. you can suspect this patient has:

a. vocal cord paralysis
b. tracheal stenosis
c. laryngotracheal web
d. tracheal malacia

A

d. tracheal malacia

Tracheomalacia occurs when the cartilage in the windpipe, or trachea, has not developed properly or was damaged, so instead of being rigid, the walls of the trachea are floppy or flaccid.

44
Q

T/F: The Combitude ET tube is a model that is deisgned to be inserted blindly.

A

True

45
Q

Suction should be set at:

a. 10 - 15 cmH2O
b. 20 - 30 cmH2O
c. 35 - 45 cmH2O

A

b. 20 - 30 cmH2O

46
Q

Laryngeal Mask Airway (LMA) is ideal for ventilation when intubation is not possible.

A

True

47
Q

Laryngeal Mask Airway (LMA) cuff should be inflated to MAX:

A

60 cmH2O

48
Q

Laryngeal Mask Airway (LMA) pressure over 20 cmH2O can cause risk of:

A

Gastric inflation

49
Q

Laryngeal Mask Airway (LMA) should NEVER be used on conscious patients.

A

True

50
Q

Preferred method of intubation:

a. oropharyngeal
b. orotracheal
c. nasopharyngeal
d. tracheostomy

A

b. orotracheal

51
Q

T/F: You should always test the tube cuff prior to intubation.

A

True

52
Q

T/F: During intubation, the RT should always have endotracheal tubes at least one size smaller and 1 size larger nearby.

A

True

53
Q

All attempts to intubate should be no longer than:

A

30 seconds

54
Q

T/F: You should always ventilate the patient while checking placement.

A

True

55
Q

T/F: There should be an absence of gastric bubbling during breath delivery.

A

True

56
Q

Once you secure the endotracheal tube, you should note the depth at:

A

Teeth/gum

57
Q

Tip of endotracheal tube should be __ to ___ cm from carina.

A

3-5 cm

58
Q

T/F: If RT is performing a blind nasal intubation, the patient must be breathing spontaneously.

A

True

59
Q

If you do not hear any air movement during intubation, or visualize the vocal cords, what is most likely the problem?

A

You’re in the esophagus

60
Q

T/F: Direct nasal intubation needs magill forceps to place tube along with laryngoscope.

A

True

61
Q

Tracheostomy tube incision is placed:

a. 2nd or 3rd tracheal ring
b. 3rd or 4th tracheal ring

A

a. 2nd or 3rd tracheal ring

62
Q

Perc dilation is indicated during emergency cases for tracheostomy procedures.

A

False

Pec Dilation is for non emergent cases and people >12 years old

63
Q

Cuff must be deflated on Passy Muir speaking valve in order for patient to phonate

A

True

64
Q

If your patient appears to be in respiratory distress while the ventilator pressure alarm is sounding in the middle of a trach change, you should leave the trach tube in.

A

False

Pull tracheostomy tube out! If the second attempt is not successful, cover the stoma with clean gauze and bag mask the patient

65
Q

In order to keep tongue from blocking airway, you would use a(n):

A

oropharyngeal airway

Measured from lip to ear lobe

66
Q

If you want to facilitate suctioning in a way that decreases trauma to nasal mucosa when catheter is passed you would use what type of airway?

A

Nasopharyngeal airway

Measured from tip of nose to earlobe

67
Q

T/F: Tracheal airways must only be used if patient needs mechanical ventilatory support.

A

False

May or may not be used for mechanical ventilatory support
aids feeding, speech and oral care
less risk of decannulation

68
Q

Which of the following are cons associated with tracheal airways?

I. Costly and requires OR
II. Risk of infection
III. Impaired cough
IV. Granulomas

A 
I. Costly and requires OR
II. Risk of infection
III. Impaired cough 
IV. Granulomas 
ALL of the above
69
Q

Physician wants to insert tube blindly that is specifically for independent lung ventilation, you would use a:

a. CASS
b. double lumen combitude
c. LMA
d. Cuffed

A

Double-lumen tube “Combitude”

Has two inner cuffs, lumens, openings

70
Q

You want to suction secretions that accumulate above the cuff, you would use the:

a. CASS
b. double lumen combitude
c. LMA
d. Cuffed

A

a. CASS - continuous aspiration of subglottic secretions

SET SUCTION TO 20 - 30 cmH2O
Helps prevent VAP

71
Q

The physician is inexperienced and the patient has a difficult airway. We need something that is ideal for ventilation when intubation is now not possible. You would use a:

a. CASS
b. double lumen combitude
c. LMA
d. Cuffed

A

c. LMA

Cuff inflated max 60 cmH2O
Dont use on conscious pt and beware of gastric inflation >20 cmH2O

72
Q

A Mallampati score of III or IV indicates:

A

Need additional assistance during intubation. Possible need for specialty airways, video laryngoscope, awake intubation, or changing the procedure to a surgical route.

73
Q

Which of the following are indications for a tracheostomy?

I. Obstruction/trauma
II. Continued need for artifical airway after intubation >7-14 days
III. Long term

A

All of the above

74
Q

A cap on a trach is used for:

A

Weaning

75
Q

Trach button is for:

A

Plugging stoma

Critical Care: Hewitt (2 decks)

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