Respiratory Flashcards
1
Q
Indications for Artificial Airway
- _______
- Loss or impairment of ___ ___ ___
- Inability to maintain ____
- Need for _________
A
- Upper Airway Obstruction
- Loss or impairment of airway protective reflexes
- Inability to maintain clearance of bronchial secretions
- Need for mechanical ventilatory support
2
Q
Artificial Airways
- 2.
3.
4.
A
- Nasopharyngeal Airway
- Oropharyngeal Airway
- Endotracheal Tube
- Tracheostomy Tube
3
Q
Complications of Intubation
- Complications can occur during or following ____ as well as a result of ____.
- __, ___, __injuries
- ___ injury
- ___ ___
- _____ injury
- ______
- Reduction in ___ ____
A
- Complications can occur during or following intubation as well as a result of extubation.
- Nasal, oral, pharyngeal injuries
- Laryngeal injury
- Subglottic edema
- Tracheal injury
- Laryngospasm
- Reduction in mucociliary transport
4
Q
Tracheostomy Tubes
Cricothyroidotomy
-surgical incision directly into the ____ aspect of the ____ at the junction of the ___ and ____ cartilages
-typically done ____ in cases of ___ ___ ___; faster procedure “in the field”
A
Cricothyroidotomy
-surgical incision directly into the anterior aspect of the larynx at the junction of the thyroid and cricoid cartilages
-typically done emergently in cases of severe airway obstruction; faster procedure “in the field”
5
Q
tracheostomy tubes
Tracheotomy / Tracheostomy
- ____ is the procedure
- ____ is the opening
- surgical incision directly into the _____ aspect of the ____ through the ____
- occupies only ___ of tracheal space
A
Tracheotomy / Tracheostomy
- tracheotomy is the procedure
- tracheostomy is the opening
- surgical incision directly into the anterior aspect of the trachea through the second or third tracheal ring
- occupies only 2/3 of tracheal space
6
Q
Tracheostomy Tubes
Tracheostomy Tubes: Materials
- Hollow ___, goose quills lead, silver, gold, rubber, ____ …
- ____ (stainless steel)
- Jackson , Montgomery
- ____ (polyvinyl chloride)
- ____, Blom
- ____ (polysiloxane)
- Bivona
A
Tracheostomy Tubes: Materials
- Hollow reeds, goose quills lead, silver, gold, rubber, nylon …
- Metal (stainless steel)
- Jackson , Montgomery
- PVC (polyvinyl chloride)
- Shiley, Blom
- Silicone (polysiloxane)
- Bivona
7
Q
Tracheostomy Tubes
Advantages of Tracheostomy Tubes
- ___ ____
- Facilitates weaning from __ ____
- Decreased risk of __ ___
- __ ___ delivery possible
- Options for __ ____
- Improved __ ___
- Increased ___ ____
A
- Pulmonary toilet
- Facilitates weaning from mechanical ventilator
- Decreased risk of laryngotracheal injury
- PO nutrition delivery possible
- Options for oral communication
- Improved oral hygiene
- Increased patient comfort
8
Q
Disadvantages of Tracheostomy Tubes
```
1. Possible complications:
10
2. Reduced ___ ____
3. Diminished ___ and ___
4. ____
5. Increased _____
~~~
A
- Possible complications: hemorrhage, thyroid injury, laryngeal nerve injury, tracheal stenosis, tracheal granulation, infection, tracheoesophageal fistula, tracheomalacia, pneumothorax, tube obstruction
- Reduced cough efficiency
- Diminished taste & smell
- Dysphagia
- Increased secretions
9
Q
Why Reduced Cough?
- _____
- _____
- _____ (intercostals/abdominals)
- _____
- Loss of ability to build-up ___ ___ = limited ___ force
A
Irritation Inspiration Compression (intercostals/abdominals) Expulsion Loss of ability to build-up subglottic pressure = limited expulsion force
10
Q
Why Diminished Taste & Smell?
- On expiration, air will take the path of ___ ___ (tracheostomy tube)
- Thereby reducing ___ through the ___ ___ (nose and mouth)
- Thereby reducing ____
- ~ 90% of taste is dependent upon ___ (orthonasal & retronasal)
- Decreased senses of smell and taste = decreased ___= decreased ___ = decreased ___!
A
- On expiration, air will take the path of least resistance (tracheostomy tube)
- Thereby reducing airflow through the upper airway (nose and mouth)
- Thereby reducing smell
- ~ 90% of taste is dependent upon smell (orthonasal & retronasal)
- Decreased senses of smell and taste = decreased appetite = decreased nutrition = decreased healing!
11
Q
Why Increased Secretions?
- Nasophaynx is natural ___, ___, ___ system
- With air inspired through __ ___ have bypassed ___, ___, ____ system
- Cold, dry, and dirty air is ___ ___
- But remember! Have __ ___ ___
A
- Nasophaynx is natural heating, warming and filtering system
- With air inspired through tracheostomy tube have bypassed warming, filtering, and humidification system
- Cold, dry, and dirty air is pulmonary irritant
- But remember! Have decreased cough efficiency
12
Q
Cuffed vs. Uncuffed Trach. Tubes
Components of Cuffless Tracheostomy Tube
- Outer ____
- Inner _____
- __ ___
- ____
- ____
- ____
- ______ (?)
A
Outer cannula Inner cannula Capping cannula Obturator Flange Shaft Fenestration (?)
13
Q
Cuffed vs. Uncuffed Trach. Tubes
Components of Cuffed Tracheostomy Tube
- ____ cannula
- ___ ____ Cannula
- ____
- ____
- ___/____(?)
- ____
- _____ (?)
A
Outer cannula Disposable Inner Cannula Obturator Flange Pilot balloon/Cuff (?) Shaft Fenestration (?)
14
Q
Cuffed vs. Cuffless Tracheostomy Tubes
- What? _____
- Why? To ____ to control the ___ of inspired and expired air
- Where? At the point where the _____ meets ______
- How? __, ___, ____ via syringe through ___ ___ & tubing
A
- What? Balloon shaped extension on the shaft of an endotracheal or tracheostomy tube
- Why? To separate the upper from the lower airway to control the volume of inspired and expired air
- Where? At the point where the outer most surface of the cuff meets the inner wall of the trachea
- How? Water, air, saline via syringe through pilot balloon & tubing
15
Q
Cuff: Aspiration Prevention?
- Cuff was actually designed to ___
- BUT… aspiration has been reported in -% of patients with ___ __ ___
- Aspirated material sits on ___ ___, eventually ___ cuff, aspirate falls into airway
- CUFF IS NOT ___ ____
- Shiley has introduced new cuffed trach tube with ___ ___ just above cuff; suction prior to cuff deflation
A
- Cuff was actually designed to prevent aspiration
- BUT… aspiration has been reported in 30-70% of patients with fully inflated cuff
- Aspirated material sits on inflated cuff, eventually deflate cuff, aspirate falls into airway
- CUFF IS NOT ASPIRATION PREVENTION
- Shiley has introduced new cuffed trach tube with suction port just above cuff; suction prior to cuff deflation
