RRT Questions: Airway Care Flashcards
How do you measure an OPA?
From corner of the mouth to the angle of the jaw.
How do you measure an NPA?
From tip of nose to earlobe.
How often should NPA’s be changed?
Every 2 days.
What are the four steps to giving a med via ET tube?
- Pour med down tube.
- Hyperventilate.
- Pour 10ml NS down tube.
- Suction it all out.
What is an MOV? What is an MLT? How are they different?
MOV: Minimal Occulding Volume. Inflate until leak stops.
MLT: Minimal Leak Technique. Inflate until leak stops, then remove a little bit so there is a very small leak.
When you hear “Obtunded”, you should think:
Intubate!
What laryngoscope blade should you use for an adult?
Adult: size 3
ET tubes use a ___ type of cuff.
Carlens tubes use a ___ type of cuff.
ET tubes: Low pressure high volume.
Carlens tubes: High pressure low volume.
Cuff pressures must remain between ___ cm H2O.
25-30 cm H2O.
Can a standard ET tube be inserted directly through the LMA into the trachea?
Yes.
What size LMA should you use?
Adult male: size 5.
Adult female: size 4.
What is a CASS tube? How much suction should you use with it?
Continuous Aspiration of Subglottic Secretions.
20 mm Hg.
If there is post-extubation stridor: First give \_\_\_. Then give \_\_\_. Then give \_\_\_. Last, you should \_\_\_.
First give humidified O2
Second, give racemic epinephrine.
Third, give Heliox 60/40.
Last, re-intubate
What is a tracheal button used for?
Maintains a tracheostomy opening.
If you hear medium rales or crackles, what should you do?
CPT. Do not suction.
If a patient is hypoxic, what position is best for them? (x3)
Fowler’s, semi-fowler’s, or reverse trendelenberg.
If a patient is very obese with air hunger, what position is best for them?
Lateral fowler’s.
If a patient is drunk or unconscious and you’re worried about aspiration, what position is best?
Lateral flat.
If a patient aspirates, what should you do first?
Suction.
How many times per day should you do PEP therapy? How long should the therapy last?
3-4 times per day, 15-20 minutes.
To cough up secretions, huff coughing is most effective in what kind of patients?
COPD and head trauma.
What is a common hazard of suctioning? What should you do about it?
Hypoxemia.
Stop suctioning and oxygenate for 1-2 min.
How do you figure out the size catheter to use?
Catheter size = inner diameter size x 3 divided by 2.
When is q4 suctioning appropriate?
NEVER. Never, never be okay with q4 suctioning even if the test pressures you to be okay with it.
What are the two goals of humidity therapy?
Prevention of mucosal crusting
Compensate for humidity deficit.
What is the biggest hazard of humidity therapy?
Possible contamination source.
What is the optimal aerosol deposition size?
0.5 - 0.3 microns.
What is the proper way to check humidifier function?
Occlude or pinch the connecting tubing and listen for whistling sound.
NBRC likes wick humidifiers because it can deliver ___% body humidity, or ___ mg/L. Also there is a low risk of ___ (___).
100%, 44 mg/L, cross-contamination/nosocomial infection.
HME’s are used during ___ or ___.
Name three reasons to replace them.
Short term ventilation or transport. Replace if: Arway pressure increases During aerosol therapy Thick, bloody secretions are present.
When using a T-piece, you should (increase or decrease) the FiO2 to get more mist. Or you can (increase or decrease) the FiO2 to get less mist.
More FiO2 = more mist.
Less FiO2 = less mist.
What are four reasons why you might not be getting enough mist in the T-piece?
Clogged capillary tube
Low temperatures in heating probe
Low flow
Low water level
When do they use a blender with large volume nebulizers?
When preciseFiO2 is desired.
For COPD’ers, try to keep FiO2 at ___%.
Therapeutic FiO2: ___%.
Emergency FiO2: ___%.
24-28
30-60
100
Vibratory vest therapy should be done at ___ hertz (___ cycles per min) for ___ minutes, up to ___ times per day
5-25 hertz (300-1500)
30 min
6 times per day
When using IPV, the high frequency pulse delivery should be done at a rate of ___ cycles per minute at a pressure of ___.
100-250 cycles per minute
30 psi
When adjusting a vacuum regulator, do it with the tubing (open/occluded).
Occluded
Suction tubing diameter should be no greater than ___ the diameter of the ET tube.
No greater than half the inside diameter of the ET tube
What is the longest amount of time that the suction catheter should be in the airway?
No longer than 15 seconds.
How do you figure out what size ET tube to use?
Pt weight in kg divided by 10.
ex: pt weight is 83 kg, use a size 8 tube.
An ET tube should be secured at ___ at pt’s lips.
If nasally intubated, it should be secured at ___.
Lower 20’s (21-25)
Nasal: 26-29
How do you use a 3way stopcock to measure cuff pressures?
Make it so the 3 way stopcock communicates with the cuffalator, the tube, and a syringe. Then use the syringe to adjust the pressure.
When you check the cuff pressure, the pressure reads zero. What’s the first thing you do?
Check to make sure connections are tight.
What would happen if you pull the inner cannula out of a fenestrated tracheostomy tube?
Pt will be able to speak.
There are three common occasions when you have to replace the ET tube or trach tube.
- Tube is too ___.
- Tube is ___.
- The ET Tube cuff is ___.
Tube too small
Obstructed tube
Ruptured cuff
The cuff on an ET tube leaks. You don’t want to replace it. What an you do?
Place a stopcock in the pilot balloon valve
Insert a blunt needle into the pilot line
or
Clamp the pilot line
If those don’t work, replace the tube.
What should you do if you have to attach a patient with a larry tube to a ventilator?
Remove the larry tube and replace it with an ET tube. Then hook to the ventilator. (Larry tubes don’t have cuffs so they can’t be used with a ventilator.)
When doing PEP therapy, pt should inhale a (larger than, less than, equal to) normal tidal volume and exhale actively but not forcefully. Inspiration:expiration should be ___.
Larger than
1:2 or 3
When doing PEP therapy, expiratory pressures should range from ___ to ___ cm H2O at mid-exhalation.
Should range from 10-20 cm H2O.
What is used during rapid sequence intubation to prevent aspiration?
Cricoid pressure (Sellick’s maneuver)
During an RSI attempts, ___ must be available. (Type of drug.)
Vasopressors.
Prior to an RSI attempt, do a ___ to see how difficult the intubation will be. If it’s going to be difficult, get ___. Then, consider pharmacology. ___ must be available and you must have ___ (drug) available.
Mallampati or thyromental distance
Obtain additional equipment like a glidescope
IV access must be available
Vasopressors must be available
You’ve gathered all the equipment needed and prepared adequately for an RSI attempt. First, ___ the patient and ___ him/her. Next, ___ the patient. After the patient has lost consciousness, you can ___ the patient. Lastly, you need to ___ the intubation was successful.
Position patient Preoxygenate Medicate Intubate Confirm intubation.
To confirm a successful intubation, first the doctor will ___ that it was successful. Next, you should ___ so see if the tube is in the right place. Attach the ___. Lastly, call for a ___.
Observation
Auscultation
End Tidal CO2
Chest Xray
