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critical care test 1
willwallace crit care test 1
| Question | Answer |
|---|---|
| What is the function of the upper airway | conduct air, prevent foreign material from entering tree, involved in speech and smell |
| What is the primary function of the nose | filter, humidify and warm inspired air, smell, resonance chamber for speech |
| Vibrissae | hair follicles of the nares that filter particles, trees first line of defense |
| Turbinates, | 3 bony protrusions on lateral walls of nasal cavity, churn air, help with humidity |
| choanal atresia | an incomplete opening in the nasal passages |
| Choanae | nasal cavity passageways between the nares and nasopharynx |
| The 3 divisions of the pharynx are | nasopharynx, oropharynx, laryngopharynx |
| Nasopharynx | is at the top of the pharynx, behind the nasal cavity, above the soft palate and at the back of the oral cavity, the pharyngeal tonsils are located there as are the Eustachian tubes |
| Pharyngeal tonsils | adenoids |
| Eustachian tubes | auditory canal, connects nasopharynx to middle ear to equalize pressure in middle ear |
| Oropharynx | soft palate to base of tongue |
| Laryngopharynx | base of tongue to entrance to esophagus, epiglottis (anterior to laryngopharynx) and aryepiglotic fold form sides of laryngopharynx |
| Larynx | voicebox, base of tongue to upper end of trachea, opening into trachea from pharynx, functions as passageway for air between pharynx and trachea, protection from aspiration, generates sounds for speech |
| Where and what is the Cricoid cartilage | shaped like a signet ring, it is below the thyroid cartilage and forms the large part of the posterior wall of the larynx. It is also the smallest part of the infant airway |
| Interior of the larynx | lined with mucous membrane in 3 pairs of fold upper and lower. Upper are the false vocal cords, lower are true vocal cords |
| Glottis | space between the vocal cords, narrowest point in adult larynx |
| Ventilator function of the larynx | ensures free flow of air to and from lungs, secondary valsalva maneuver |
| What is the secondary function of the larynx | valsalva maneuver |
| Vocal folds abduct when | during quiet inspiration (open) |
| Vocal folds adduct when | during exhalation (move together but always maintain opening) |
| Valsalva maneuver | effort closure during exhalation aka bearing down w/o letting air out, larynx tightly sealed, prevents air escape during heavy lifting, vomit, defecation |
| Causes of upper airway obstruction | foreign matter in the pharynx like vomit, blood dentures or food, loss of muscle tone, lesions edema, tumors and bleeding |
| What should an RT do if an oropharyngeal airway produces a gag reflex | remove it if not tolerated well as it my produce vomiting and or laryngospasm too |
| Signs of upper airway obstruction | breathing pattern intercostals retractions, skin indications like cyanosis, pallor, diaphoresis, or cold damp clammy feel, resp sounds ie no sound, snoring for partial block by tongue or high pitch like stridor |
| Treatment of upper airway obstruction | hyperextension of the neck, inspect mouth for foreign body, aerosol Rx with racemic epi for stridor if due to swelling |
| Oropharyngeal airway function | hold tongue in place, away from posterior pharynx, in order to maintain a patent upper airway |
| Oropharyngeal airway (fbrc) is inserted | upside down along tongue then rotated into place |
| Oropharyngeal airway clinically is inserted | sideways and rotated into place |
| Where is the oropharyngeal airway positioned | between the base of the tongue and posterior pharynx |
| What should an RT do if an oropharyngeal airway produces a gag reflex | remove it if not tolerated well as it my produce vomiting and or laryngospasm too |
| Which patients can use an oropharyngeal airway | comatose and semiconscious if tolerated |
| The 2 kinds of oropharyngeal airways are | Berman I-beam and cath-guide guedel |
| Berman I-beam oropharyngeal airway can facilitate suctioning by | passing a catheter along side |
| Cath-guide Guedel oropharyngeal airway can facilitate suctioning | by passing a catheter through the middle |
| First responders in a medical emergency use what to establish and maintain a patent upper airway | oropharyngeal or nasopharyngeal airway |
| Oropharyngeal airways are measured | from the corner of the mouth to the corner of the jaw |
| The hazard of an oropharyngeal airway that is to long | pushes epiglottis posterior, obstructing airway |
| The hazard of an oropharyngeal airway that is to short is | pushes tongue back obstructing airway |
| The purpose and position of a nasopharyngeal airway is | to divide the tongue and posterior pharynx in order to maintain patent airway |
| What type of patients can best tolerate a nasopharyngeal airway | conscious patients who need repeated nasotracheal suctioning |
| Nasopharyngeal airways are measured | from the tip of the nose to the meatus (middle of the ear opening) |
| How often should a nasal trumpet be alternated | nbrc says every 8 hours, clinically we should twist it to keep it from sticking to tissue and alternate nares every 2 or 3 days |
| Indications for ETT/trach | relief of upper airway obstruction and maintain a patent airway, protection of the airway when reflexes are malfunctioning, facilitate suction of the lower airway, vent support |
| Normal airway protective reflexes are | pharyngeal reflex aka gag and swallow, laryngeal vagovagal aka laryngospasm, tracheal vagovagal aka cough due to irritation of trachea, carinal vagovagal aka cough due to irritation of carina |
| Hazards of artificial airways | 1bacterial contamination of lower airway 2 removes effective cough (no compression) 3 removes ability to communicate 4 failure to intubate or recognize esophageal intubation 5 trauma 6 aspiration, pneumonia 7 ett tube problems 8 arrhythmias 9 bleeding et |
| Which endotrach tube has no cuff | infant tube |
| What are endotrach tubes made of | PVC aka polyvinylchloride |
| How far is the distal end of an endotracheal tube inserted | clinically 4-6 cm above the carina or NBRC 2 cm above the carina |
| What are cuffs on an ETT tube designed for | to seal against trach wall to allow for positive pressure ventilation through the tube |
| What is a hi-volume low pressure cuff | the most commonly used cuff of today, because it allows for a larger balloon with more air volume over a greater area, it exerts less pressure |
| What is the greatest hazard of ETT tracheotomy tube cuffs | occlusion of the tracheal mucosal bloodflow |
| Hazards of endotracheal/tracheostomy tube cuffs | occlusion of tracheal mucosal bloodflow, herniation of cuff over tube end and overinflating |
| Herniation of cuff over tube end can be prevented by | inflating cuff to test it prior to intubation |
| Tracheal mucosal lymph flow | 5 mmHg |
| Pressure on tracheal wall to create an edema | greater than 5 mmHg |
| Pressure in cuff that will occlude venous flow in trach wall | 18-22 mmHg (25-30 cmH2o) |
| Pressure in cuff that will occlude arterial flow in trach wall | 25-30 mmHg (34-42 cmH2o) |
| Rule of 25 | keep press under 25 mmHg/cmH20 in order to keep tracheal blood flow in tact |
| Can you tell cuff press by looking at or feeling the pilot balloon? | no way |
| What can cause a high cuff pressure? | 1 tube to small, 2 trying to seal it may have caused it to over inflate and become a high pressure cuff, 3 high press of mech vent can cause distention of lumen of the tube causing it to push on trach causing trach to dilate over time |
| mmHg to cmH2O conversion | mmHg is cmH20/1.36 or cmH20 is mmHgx1.36 |
| MOV | minimal OCCLUDING volume- listening to pts neck with steth during positive press breath, slowly inflate cuff until the leak stops |
| MLT | minimal leak technique-slowly inflate cuff during positive press breath until the leak stops, then remove a small amount of air, just enough to allow a slight leak at peak inflation pressure |
| Which technique is deemed better for cuff inflation minimal occluding volume or minimal leak technique | both are deemed acceptable |
| Pilot balloon | small balloon attached to a line, with spring loaded valve where syringe is attached, used to add or remove air from cuff |
| If the pilot balloon line gets cut by a nurse what can we do | seal it with a needle or pilot balloon repair kit |
| I.T. marking on an ETT tube means what | implantation tested and material is non toxic |
| Z79 marking on an ETT tube means what | conforms to standards of the American national standards institutes and is non toxic |
| What markings will we usually see on an ETT tube | IT, Z79, Manufacturer, oral/nasal, length in cm’s, ID mm and OD mm |
| ID mm OD mm | inside diameter and outside diameter in mm of a ett, ntt or trach tube |
| What is the average size of an adult female oropharyngeal airway | 8 |
| What is the average size of an adult male oropharyngeal airway | 9 |
| What is the normal length that an adult female ETT tube is inserted | 19-21 cm |
| What is the normal length of an adult male ETT tube is inserted | 21-23 cm |
| What is the normal length of an adult female NT tube is inserted | 26 |
| What is the normal length of an adult male NT tube is inserted | 28 |
| How long is an adult NT tube | 29 cm |
| What is the average length in cm’s of an adult from teeth to carina | 27 |
| What is a Murphy eye | small opening on the side of the distal end of an ett tube that is an alternate pathway for gas flow if tip becomes occluded |
| Radiopaque line | imbedded wire in the side of ett tube, runs the length of the tube and absorbs x-rays, allows tube to be seen on film |
| 15 mm adapter | standard confection, allow connection to manual resuscitators and other vent equipment |
| What is the emergency airway of choice | ett |
| EOA | esophageal obturator airway, combo mask and airway that seals the esophagus and vent is done thru oropharynx |
| How does an EOA work | blunt ended tube with cuff is inserted into esophagus and sealed by cuff to prevent aspiration, mask to seal face and vent via bag |
| How long can an EOA be used for | usually less than 24 hours, mostly seen in ER, used by untrained first responders in the field |
| What are the drawbacks to EOA | must seal to vent, air trapped in stomach stays and can cause diaphragm problems later |
| Hazard of ETO and EGTA | endotracheal intubation and poorly tolerated in semi conscious patients |
| What is an EGTA | esophageal gastric tube airway |
| What is the function of an esophageal gastric tube airway | it does not have a blunted end, so the NG tube can go down to relieve gastric distension |
| What is a combi-tube and what is its function | pharyngotracheal lumen airway or PTL, a double lumen airway with an esophageal tracheal airway and an ett, an alternative airway device that is blindly inserted, vented depending on where in ends up |
| Combi-tube is in esophagus, how do you vent | vent via long tube because esophagus is a long word |
| Combi-tube is in the trach, how do you vent | vent via short tube because trach is a short word |
| Laryngeal mask airway | short tube with a small mask on the end that covers the esophagus, mostly for surgery |
| Carlens tube | double lumen double cuff, used for pts to stop air to one lung for surgery, or in ards pt to put pt on two vents |
| What are the two types of emergency surgical airways | cricothyroidotomy and percutaneous dilatational tracheostomy |
| What is a cricothyroidotomy | emergency opening of the airway placed through the space between the thyroid and cricoid cartilages |
| What is a percutaneous dilatational tracheostomy | while ett tube is inserted, dr inserts needle and sheath beween cricoid and first trach ring or first and second trach ring, then adds larger dilators until opening (stoma) is large enough for trach tube. |
| SOAPME | equipment for ETT, Sxn equipment, Oxygen, Airway equipment, Position the Pt, Monitors, Esophageal detectors |
| ETT procedure | assumble and check equip, sxn equip, laryngoscope, largest ETT, test cuff, lubricate, insert stylet, position pt in sniffing, pre o2, insert laryngoscope, visualize glottis, insert tube, assess placement |
| What is a miller laryngoscope | a straight blade scope that directly lifts the epiglottis |
| What is a macintosh laryngoscope | a curved blade scope that indirectly lifts the epiglottis, by using a forward motion |
| How do we assess the tube placement of an ETT | listen for breath sounds bilaterally over chest wall and over stomach, observe for chest wall or stomach movement, check tube length at teeth, esophageal detection device (bulb), light wand, capnometry, cxr |
| What is an esophageal detection device | bulb and syringe with 15 mm adaptor, deflated bulb is attached to ett tube, if bulb does not re-expand ett is in esophagus, if it does reexpand, it is in trach |
| What is tube ave length at teeth for a male ETT | 21-23 cm |
| What is tube ave length at teeth for a female ETT | 19-21 cm |
| What is capnometry | etco2 monitor, wave graph or digital monitor that checks exhaled co2 to assess tube placement |
| What is the percent of co2 in room inspired air | .03-.04 percent |
| What is the percent of co2 in expired air | 4-6 percent |
| What number does a ETCO2 give | whole number that approximates PaCO2 |
| What is colorimetry | CO2 detector that uses litmus paper purple-bad yellow- good |
| What is the gold standard for ett placement | cxr |
| When is a nasotracheal intubation done and why | when oral rt is not available, because it is more difficult |
| What is the biggest hazard of nasotracheal intubation | otitis media |
| What is otitis media | ear infection caused by eustation tube being blocked by NT tube |
| What do we give pt for comfort during intubation of an NT tube | spay of racemic epi .25 percent or lidocane 2 percent for vasoconstriction and succinylcholine as a sedation |
| What is a tracheotomy | process of cutting the trachea to establish an airway |
| What is a tracheostomy | the opening into the trachea for placement of the artificial airway |
| What is the primary indication for a tracheostomy | continuing need for an artificial airway |
| What is the primary complication of tracheostomy procedure | bleeding |
| What do we clean the inner canulla of trach with | sterile h2o and peroxide |
| nasal trumpet is measured how | from the tip of the nose to the meatus (middle of the ear opening) |
Created by:
williamwallace
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