Test 1 Ch. 37 Flashcards
Where do Pharyngeal airways extend to.
extend only into the pharynx
Artificial airways are placed…
and are called…
through the mouth & nose into the trachea and are called Endotracheal tube
Process of placing artificial airway into trachea
Intubation
When the tube is passed through the mouth on its way to the trachea is called
Orotracheal Intubation
When the ET tube is passed through the nose
Nasotracheal intubation
What are the 2 pharyngeal airways
Nasopharyngeal
Oropharyngeal
This Airway is most often placed to facilitate frequent nasotracheal suctioning
Nasopharyngeal
This airway should be restricted to unconscious pt to avoid gaging and regurgitation
Oropharyngeal
This airway Maintains pt’s airways by preventing the tongue from obstructing oropharynx
Oropharyngeal
What are the 2 types of oropharyngeal airways
Geudel and Berman
Has a 2 sided channel sizing
Berman
Has a single center channel
Geudel
How do you measure an oropharyngeal to fit the pt?
From the corner of the pt’s mouth to the angle of the jaw
What can happen if an oropharyngeal is to large?
It can push the epiglottis against the larynx leading to obstruction
If the oropharyngeal airway is to small it
may not clear the tongue
Oropharyngeal airways must lie at the….. and above……
W/ flange outside
base of the tongue above the epiglottis
What is another name for nasopharyngeal
nasal trumpet or nasal horn
What are some indications for Nasopharyngeal airway (2)
-Facilitate ventilation
-Removal of secretions by nasotracheal suctioning
what is the size used for females in nasopharyngeal airways
6
what is the size used for males in nasopharyngeal airways
7
If the nasopharyngeal airway is to short it
cannot separate the soft palate from the posterior wall of the pharynx
If the nasopharyngeal airway is to large then it may enter the ___________, causing…..
larynx, causing laryngeal reflexes or enter the space between the epiglottis and vallecula, leading to potential obstruction
Esophageal Oburator Airway is inserted into the
esophagus
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)
Esophageal Oburator Airway (EOA)
A cuff on top of the distal end prevents
aspiration of stomach contents
What are indications for Laryngeal Mask Airway (LMA 2)
-Unconscious pts
-unable to perform ET intubation
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
LMA have unstable
airways and may cause misplacement of mask & gastric distention
LMA cannot withstand high airway pressures (20b cm H20) w/o causing
gastric distention
Esophageal- Tracheal Combitude (ETC) is inserted ___________.
blindly
Esophageal- Tracheal Combitude (ETC) may be inserted into the (2 ways)
Esophagus or tracheal
When the tube is in the trachea,a large proximal cuff _______ seals off the _________
100ml seals off the trachea
Double-Lumen Endotracheal tube (DLT) indications
- Lung isolation (prevent lung to lung spillage of blood pus)
-surgical procedure on non ventilated lung
DLT has
2 connectors, 2 lumens for gas flow, 2 cuffs and 2 distal opening
What are 4 Indications for Artificial airways
Relief of airway obstruction
Protection of airway
Suctioning
Support ventilation
Endotracheal tube is an oral _____________ for ____________ ______________
intubation for mechanical ventilation
Procedure of establishing access to trachea via neck incision
Tracheotomy
Opening in the neck is called
Tracheostomy
Removal of the larynx “voice box”
Laryngotomy
One way valve that allows inspiration but not exhalation through the trachea tube opening
Speaking valve
_____________ air is forced to go through the vocal cords making ___________ possible
Exhaled; phonation
For a traditional tracheostomy tube to use a speaking valve
the cuff must be deflated
For a fenestrated tracheostomy tube the cuff may be ___________, providing the __________ solid canal of the _____________ trachea tube is removed
inflated; inner; fenestrated
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
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
How do you use a Miller blade
Lift up epiglottis
What are the common blade sizes
size 3 or 4
EOT is a
blind insertion
LMA sits over the
larynx
what is binocular vision
direct vision to the vocal cords
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
what is a bougie?
Long tube that you can place in airway at the exact location of the ET tube
______________ requires moving the vocal cords
Phonation
ETT prevents __________ ________ movement and _________ through the cords
vocal cord; airflow
The goal is to keep capillary perfusion pressure in trachea is
20 mmHg to 30
With a Minimal Occusion Volume (MOV) you need to inflate
cuff slowly until no air leaks are heard at end- inspiration
Most common injuries to larynx
Glottic edema
Vocal inflammation
Lartngeal/ Vocal ulcerations
Vocal cord polyps or granulomas
Endotracheal suctioning should not be done on a
preset schedule
Pre oxygenate w/ ______ o2
and use vacuum pressure between
100% o2; 120-150 mmHg
Limit duration of suctioning to
<15
Suctioning can be preformed via
-The upper airway (oropharynx)
- The lower airway (trachea and bronchi)
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
What is needed for Extubation (5)
O2
10-12 ml syringe
Towel
Stethoscope
Intubation box/ cart
unplanned extubation may be
self- inflicted or accidental
______ of unplanned extubation do not require reintubation
50%
From review
Types of oropharyngeal
Berman - 2 sided channel
Guedule- 1 central channel
How to insert an oropharyngeal
put it in first parallel with the pallet and twist it 180 degrees
what type of pts do we use oropharyngeal airways for and why?
Unconscious pt, if not then pt could gag and aspirate
What does an oral airway prevent?
Airway obstruction from the tongue
MOST common airway obstruction?
Tongue
Why would a pt have swelling in their airway (3)
trauma
post extubation
allergic reaction
How should you measure what size of an oral airway you need
mouth to earlobe
What kind of pts can we use nasalpharyngeal airways
semi conscious
suctioning pts
relive airway obstruction
How to measure for a nasal airway
earlobe to tip of the nose
if nasal airway is to short then it can’t
reach to the soft palette
if nasal airway is to large it can cause an _______________.
obstruction
Most common sizes for nasal airway is
size 6 and 7
How do you insert a nasopharyngeal airway
beveled Egde to the septum
EOT is what kind of insertion?
blind insertion
Combe tube prevents____________ b/c of
aspiration b/c of the cuffs
Does LMA prevent aspiration
No
LMA sits
over the larynx; it does not insert the trachea or esophagus, therefore it does not prevent aspiration
2 different pressures for LMA
cuff pressure is 60
airway pressure is 20
Can LMA be autoclaved up to 40 times?
yes
What are some reasons why we need to do Independent Lung Ventilation?
To Prevent spillage, infection, bronch one lung ; you close off one lung
Airway resistance will be higher
the smaller the tube
T or F. Size 7 1/2 or 8 is used for oral intubation
true
What can happen to ET tube that can cause increase airway resistance
Secretions
kinks
Before you intubate you have to do what to your patient?
preoxygenate (hyper oxygenate)
T or F. You must Check equipment first before you begin intubation
true
Mac blade is placed in the…..
Miller blade is placed
Vellucula ; below the epiglottis and lift it up
How long do you have for an unsuccessful intubation before you have to start over?
30 seconds
What vitals do you watch before intubation?
Sats
HR
BP
Contraindications of placing nasal airway (2)
nasal Trauma
Bleeding
Contraindications of placing oral airway (2)
oral trauma
Bleeding
How do you prevent a nasal airway from coming out? And how does it work
Safety pin; prevents from outward inward migration
Common reason someone needs to be trached
Long term airway
What is kept at the bedside incase trachea comes out?
obturator
Parts of a Trachea tube (7)
Inner canula
cuff
obturator
pilot ballon
flange
Outer cannula
Size indicator
If a pt has severe stridor then what must we do
Intubate pt
If tube comes out of airway, what is the best method to fixing it?
take it out and replace in the correct location
What are the cuff pressures for ET tube and trachea
Formula for appraise size catheter (F)
ET tube x 2= next size smaller French
example: 8 x2=16 you will use 14 French
What has to be done in order for a speaking valve to be placed on a traditional tt?
cuff must be deflated
____________ _______ is used so the pt can talk through their tracheotomy tube
speaking valve
Cuff Does not have to be deflated to speak thru tracheostomy tube
Fenestrated tt
Fenestrated tt could be used for pts who
will not be trached for a long time or can be used to ween
What are some things we monitor after EXTUBATION
o2
breath sounds (stridor bbs)
What breath cycle do we do extubation on?
end-halation (coughing)
How long should you suction for? b/c
15 seconds; trauma
What are the parts of an ET tube
Cuff
pilot ballon
Murphy eye
radiopaque line
cliff markings
Where do pharyngeal airways extend into?
pharynx
Where are oropharyngeal airways inserted?
into the mouth and over the tongue
List 4 types of airways
Oropharyngeal
Nasopharyngeal
Endotracheal (ET)
Laryngeal Mask Airway (LMA)
What are the four main indications for artificial airways
Relief of airways obstruction
Protection of airway
Suctioning
Support ventilation
List the 4 most common injures to the larynx
Glottic edema
Vocal inflammation
Laryngeal/ vocal cord ulcerations
Vocal cord polyps or granulomas
How long do you have to complete an intubation before having to stop and preoygenate again ?
30 seconds
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)
What pharyngeal airway would be most appropriate for an unconscious patient?
Oropharyngeal
What is the most common cause of airway obstruction?
Tongue
List 2 other causes of airway obstruction
Secretions
Inflammation
Inflate cuff slowly until NO air leaks are heard at end-inspiration. What technique is this?
Minimal occlusion volume (MOV)
What pharyngeal airway would be most appropriate for a patient that is conscious but needs frequent suctioning?
Nasopharyngeal
List 2 intraesophgeal airways
Double lumen endotracheal tube (DLT)
Esophageal obturator airway (EOA)
Suctioning pressures for infants
80-100
Suctioning pressures for adults
120-150
Suctioning pressures for children
100-120
Suction until you meet_____________ or patient _________
Resistance or coughs
