Test 1 Ch. 37 Flashcards
1
Q
Where do Pharyngeal airways extend to.
A
extend only into the pharynx
2
Q
Artificial airways are placed…
and are called…
A
through the mouth & nose into the trachea and are called Endotracheal tube
3
Q
Process of placing artificial airway into trachea
A
Intubation
4
Q
When the tube is passed through the mouth on its way to the trachea is called
A
Orotracheal Intubation
5
Q
When the ET tube is passed through the nose
A
Nasotracheal intubation
6
Q
What are the 2 pharyngeal airways
A
Nasopharyngeal
Oropharyngeal
7
Q
This Airway is most often placed to facilitate frequent nasotracheal suctioning
A
Nasopharyngeal
8
Q
This airway should be restricted to unconscious pt to avoid gaging and regurgitation
A
Oropharyngeal
9
Q
This airway Maintains pt’s airways by preventing the tongue from obstructing oropharynx
A
Oropharyngeal
10
Q
What are the 2 types of oropharyngeal airways
A
Geudel and Berman
11
Q
Has a 2 sided channel sizing
A
Berman
12
Q
Has a single center channel
A
Geudel
13
Q
How do you measure an oropharyngeal to fit the pt?
A
From the corner of the pt’s mouth to the angle of the jaw
14
Q
What can happen if an oropharyngeal is to large?
A
It can push the epiglottis against the larynx leading to obstruction
15
Q
If the oropharyngeal airway is to small it
A
may not clear the tongue
16
Q
Oropharyngeal airways must lie at the….. and above……
W/ flange outside
A
base of the tongue above the epiglottis
17
Q
What is another name for nasopharyngeal
A
nasal trumpet or nasal horn
18
Q
What are some indications for Nasopharyngeal airway (2)
A
-Facilitate ventilation
-Removal of secretions by nasotracheal suctioning
19
Q
what is the size used for females in nasopharyngeal airways
A
6
20
Q
what is the size used for males in nasopharyngeal airways
A
7
21
Q
If the nasopharyngeal airway is to short it
A
cannot separate the soft palate from the posterior wall of the pharynx
22
Q
If the nasopharyngeal airway is to large then it may enter the ___________, causing…..
A
larynx, causing laryngeal reflexes or enter the space between the epiglottis and vallecula, leading to potential obstruction
23
Q
Esophageal Oburator Airway is inserted into the
A
esophagus
24
Q
Has an opening at the top (for manual ventilation) small holes in mid-section (divert air to lungs)a blind distal end (prevents air from going to stomach)
A
Esophageal Oburator Airway (EOA)
25
A cuff on top of the distal end prevents
aspiration of stomach contents
26
What are indications for Laryngeal Mask Airway (LMA 2)
-Unconscious pts
-unable to perform ET intubation
27
Contraindications for LMAs
- Does not protect from airway aspiration
-pts who have not fasted
- are not profoundly unconscious
-have severe oropharyngeal trauma
-short term use
28
LMA have unstable
airways and may cause misplacement of mask & gastric distention
29
LMA cannot withstand high airway pressures (20b cm H20) w/o causing
gastric distention
30
Esophageal- Tracheal Combitude (ETC) is inserted ___________.
blindly
31
Esophageal- Tracheal Combitude (ETC) may be inserted into the (2 ways)
Esophagus or tracheal
32
When the tube is in the trachea,a large proximal cuff _______ seals off the _________
100ml seals off the trachea
33
Double-Lumen Endotracheal tube (DLT) indications
- Lung isolation (prevent lung to lung spillage of blood pus)
-surgical procedure on non ventilated lung
34
DLT has
2 connectors, 2 lumens for gas flow, 2 cuffs and 2 distal opening
35
What are 4 Indications for Artificial airways
Relief of airway obstruction
Protection of airway
Suctioning
Support ventilation
36
Endotracheal tube is an oral _____________ for ____________ ______________
intubation for mechanical ventilation
37
Procedure of establishing access to trachea via neck incision
Tracheotomy
38
Opening in the neck is called
Tracheostomy
39
Removal of the larynx "voice box"
Laryngotomy
40
One way valve that allows inspiration but not exhalation through the trachea tube opening
Speaking valve
41
_____________ air is forced to go through the vocal cords making ___________ possible
Exhaled; phonation
42
For a traditional tracheostomy tube to use a speaking valve
the cuff must be deflated
43
For a fenestrated tracheostomy tube the cuff may be ___________, providing the __________ solid canal of the _____________ trachea tube is removed
inflated; inner; fenestrated
44
What supplies do you need for intubation
Laryngoscope
Blade
Miller straight
Macintosh (curved)
ET tube (radiopaque line, pilot ballon)
10-12mL syringe
Water- solube lubricant
Stylet
ET tube securing device
Carbon dioxide (co2) detector
45
How do you use a Mac blade
place at vallecula between the base of the tongue and epiglottis. Lifts up tongue and indirectly the epiglottis
46
How do you use a Miller blade
Lift up epiglottis
47
What are the common blade sizes
size 3 or 4
48
EOT is a
blind insertion
49
LMA sits over the
larynx
50
what is binocular vision
direct vision to the vocal cords
51
Where should the tip of the ET be placed in the body? (Number)
3-5 cm above the carina; between second and fourth tracheal rings
52
what is a bougie?
Long tube that you can place in airway at the exact location of the ET tube
53
______________ requires moving the vocal cords
Phonation
54
ETT prevents __________ ________ movement and _________ through the cords
vocal cord; airflow
55
The goal is to keep capillary perfusion pressure in trachea is
20 mmHg to 30
56
With a Minimal Occusion Volume (MOV) you need to inflate
cuff slowly until no air leaks are heard at end- inspiration
57
Most common injuries to larynx
Glottic edema
Vocal inflammation
Lartngeal/ Vocal ulcerations
Vocal cord polyps or granulomas
58
Endotracheal suctioning should not be done on a
preset schedule
59
Pre oxygenate w/ ______ o2
and use vacuum pressure between
100% o2; 120-150 mmHg
60
Limit duration of suctioning to
<15
61
Suctioning can be preformed via
-The upper airway (oropharynx)
- The lower airway (trachea and bronchi)
62
Two techniques for endotracheal suctioning:
-Open-steile technique that requires disconnecting pt from ventilator
-Closed- technique uses sterile closed in line suction catheter that is etched to ventilator circuit
63
What is needed for Extubation (5)
O2
10-12 ml syringe
Towel
Stethoscope
Intubation box/ cart
64
unplanned extubation may be
self- inflicted or accidental
65
______ of unplanned extubation do not require reintubation
50%
66
From review
Types of oropharyngeal
Berman - 2 sided channel
Guedule- 1 central channel
67
How to insert an oropharyngeal
put it in first parallel with the pallet and twist it 180 degrees
68
what type of pts do we use oropharyngeal airways for and why?
Unconscious pt, if not then pt could gag and aspirate
69
What does an oral airway prevent?
Airway obstruction from the tongue
70
MOST common airway obstruction?
Tongue
71
Why would a pt have swelling in their airway (3)
trauma
post extubation
allergic reaction
72
How should you measure what size of an oral airway you need
mouth to earlobe
73
What kind of pts can we use nasalpharyngeal airways
semi conscious
suctioning pts
relive airway obstruction
74
How to measure for a nasal airway
earlobe to tip of the nose
75
if nasal airway is to short then it can’t
reach to the soft palette
76
if nasal airway is to large it can cause an _______________.
obstruction
77
Most common sizes for nasal airway is
size 6 and 7
78
How do you insert a nasopharyngeal airway
beveled Egde to the septum
79
EOT is what kind of insertion?
blind insertion
80
Combe tube prevents____________ b/c of
aspiration b/c of the cuffs
81
Does LMA prevent aspiration
No
82
LMA sits
over the larynx; it does not insert the trachea or esophagus, therefore it does not prevent aspiration
83
2 different pressures for LMA
cuff pressure is 60
airway pressure is 20
84
Can LMA be autoclaved up to 40 times?
yes
85
What are some reasons why we need to do Independent Lung Ventilation?
To Prevent spillage, infection, bronch one lung ; you close off one lung
86
Airway resistance will be higher
the smaller the tube
87
T or F. Size 7 1/2 or 8 is used for oral intubation
true
88
What can happen to ET tube that can cause increase airway resistance
Secretions
kinks
89
Before you intubate you have to do what to your patient?
preoxygenate (hyper oxygenate)
90
T or F. You must Check equipment first before you begin intubation
true
91
Mac blade is placed in the.....
Miller blade is placed
Vellucula ; below the epiglottis and lift it up
92
How long do you have for an unsuccessful intubation before you have to start over?
30 seconds
93
What vitals do you watch before intubation?
Sats
HR
BP
94
Contraindications of placing nasal airway (2)
nasal Trauma
Bleeding
95
Contraindications of placing oral airway (2)
oral trauma
Bleeding
96
How do you prevent a nasal airway from coming out? And how does it work
Safety pin; prevents from outward inward migration
97
Common reason someone needs to be trached
Long term airway
98
What is kept at the bedside incase trachea comes out?
obturator
99
Parts of a Trachea tube (7)
Inner canula
cuff
obturator
pilot ballon
flange
Outer cannula
Size indicator
100
If a pt has severe stridor then what must we do
Intubate pt
101
If tube comes out of airway, what is the best method to fixing it?
take it out and replace in the correct location
102
What are the cuff pressures for ET tube and trachea
103
Formula for appraise size catheter (F)
ET tube x 2= next size smaller French
example: 8 x2=16 you will use 14 French
104
What has to be done in order for a speaking valve to be placed on a traditional tt?
cuff must be deflated
105
____________ _______ is used so the pt can talk through their tracheotomy tube
speaking valve
106
Cuff Does not have to be deflated to speak thru tracheostomy tube
Fenestrated tt
107
Fenestrated tt could be used for pts who
will not be trached for a long time or can be used to ween
108
What are some things we monitor after EXTUBATION
o2
breath sounds (stridor bbs)
109
What breath cycle do we do extubation on?
end-halation (coughing)
110
How long should you suction for? b/c
15 seconds; trauma
111
What are the parts of an ET tube
Cuff
pilot ballon
Murphy eye
radiopaque line
cliff markings
112
Where do pharyngeal airways extend into?
pharynx
113
Where are oropharyngeal airways inserted?
into the mouth and over the tongue
114
List 4 types of airways
Oropharyngeal
Nasopharyngeal
Endotracheal (ET)
Laryngeal Mask Airway (LMA)
115
What are the four main indications for artificial airways
Relief of airways obstruction
Protection of airway
Suctioning
Support ventilation
116
List the 4 most common injures to the larynx
Glottic edema
Vocal inflammation
Laryngeal/ vocal cord ulcerations
Vocal cord polyps or granulomas
117
How long do you have to complete an intubation before having to stop and preoygenate again ?
30 seconds
118
Inflate cuff unit the leaks stops; remove a small amount of air way slowly until a SLIGHT leak can be heard at end- inspiration. What technique is this?
Minimal leak technique (MLT)
119
What pharyngeal airway would be most appropriate for an unconscious patient?
Oropharyngeal
120
What is the most common cause of airway obstruction?
Tongue
121
List 2 other causes of airway obstruction
Secretions
Inflammation
122
Inflate cuff slowly until NO air leaks are heard at end-inspiration. What technique is this?
Minimal occlusion volume (MOV)
123
What pharyngeal airway would be most appropriate for a patient that is conscious but needs frequent suctioning?
Nasopharyngeal
124
List 2 intraesophgeal airways
Double lumen endotracheal tube (DLT)
Esophageal obturator airway (EOA)
125
Suctioning pressures for infants
80-100
126
Suctioning pressures for adults
120-150
127
Suctioning pressures for children
100-120
128
Suction until you meet_____________ or patient _________
Resistance or coughs
