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Emergency Care EX 1
| Question | Answer |
|---|---|
| What is the purpose of a stylet? | Provide rigidity to the endotracheal tube |
| How often should a patient be suctioned? | Only suction as needed |
| What hazards are associated with intubation? | Tracheal damage, vocal cord damage, right mainstem intubation, cuff rupture, aspiration (due to inadequate sedation), hypoxemia/tachycardia/arrhythmias, nosocomial infection, esophageal intubation, broken teeth, hemorrhage, laryngospasm, vagal stimulation |
| What are the hazards associated with nasal intubation? | Bleeding, ulceration, sinusitis |
| What are the complications associated with intubation? | Kinked airway, ruptured cuff, pilot line cut, patient bites through tube, excessive mucus build up of plugs, continuous coughing |
| What are the hazards and complications associated with extubation? | Tracheal/ vocal cord damage (uninflated cuff), vomiting (NG tube removed too soon), laryngospasm, nose bleeds, self extubation |
| What are the complications associated with suctioning? | Trauma to the mucosa (most common), contamination, hypoxemia (most severe), bradycardia, bleeding |
| What procedures can help avoid suctioning complications? | Only suction when necessary, lubricate catheter, only suction for 15 seconds or less |
| What are the contraindications for nasotracheal suctioning? | Blocked nares, nasal bleeding, croup or epiglottitis, acute head, face, or neck injuries, bleeding disorder, laryngospasm/ bronchospasm, irritated airway |
| Why is it important to use the proper catheter size when suctioning? | Too large of a catheter can cause atelectasis or lung collapse |
| How do you determine the proper catheter size for suctioning? | ETT size x 3 / 2 = maximum catheter size |
| What are the two types of laryngoscopes? | Fiberoptic and bulb |
| What are the two types or laryngoscope blades? | Miller and MacIntosh |
| How does a Miller blade work? | Fits under the epiglottis and lifts directly |
| How does a Macintosh blade work? | Fits into the vallecula and lifts indirectly |
| What is the procedure for intubation? | Prepare equipment, place patient in the sniff position, ventilate and oxygenate the patient, use laryngoscope to visualize cords, place ETT, inflate balloon, remove stylet, confirm placement by check chest rise, breath sounds, or CXR |
| How can you confirm placement of the ETT? | Bilateral chest rise, CXR, auscultate patient, CO2 detector |
| What are the indications for artificial airways? | Protect airway, relieve airway obstruction, facilitate suctioning, protect from aspiration, provide closed system for MV or CPAP |
| What are the two types of OPAs? | Bermann "I" beam - 2 parallel side channels / Guedel - hole in the middle |
| What are the advantages of oral vs. nasal ETT? | Oral ETT is easier to insert, less Raw, can use a larger tube, decreased WOB, no sinus problems, easier to suction, easier to pass bronchoscope, decreased risk of kinking |
| What are the two cuff inflation techniques? | Minimum leak technique (MLT) or Minimum occlusion technique |
| What are the cuff pressures? | 20-25 mmHg or 25-30 cmH2O |
| What are the weaning parameters for NIF or MIF? | > -20mmHg |
| What are the weaning parameters for VC? | > 10ml/kg |
| What are the weaning parameters for VT? | > 5ml/kg |
| What are the weaning parameters for RR? | 8-30 BPM |
| What are the weaning parameters for MV? | < 10 lpm |
| What are the weaning parameters for RSBI? | < 100 |
| What is the equation for RSBI? | RR/VT |
| What is a stoma? | An artificial opening |
| What is a tracheotomy? | Surgical procedure creating an incision in the trachea |
| What is a tracheostomy? | Procedure to create a stoma in the trachea |
| What are the possible complications within the first 24 hours following a tracheostomy? | Bleeding, pneumothorax, air embolism, sub-q emphysema |
| What are the possible complications withing the first 24-48 hours following a tracheostomy? | Infection, hemorrhage |
| What is the purpose of the beveled tip on an ETT? | Prevents occlusion |
| What is the purpose of the murphy's eye on an ETT? | Prevents occlusion |
| What is the purpose of the cuff on an ETT? | Prevents aspiration and maintains seal for MV |
| What is the purpose of the pilot tube on an ETT? | Carries air to/from the cuff |
| What is the purpose of the pilot balloon with one-way valve on an ETT? | Monitors cuff pressure |
| What is the purpose of the radio opaque line on an ETT? | Used to assess the tube position on a CXR |
| What is the purpose of the placement markings on an ETT? | Indicates depth of the tube |
| What is the purpose of the 15 mm OD adapter on an ETT? | Used to attach devices |
| What is the suction pressure for an infant? | -60 to -80 mmHg (-100 max) |
| What is the suction pressure for a child? | -80 to -100 mmHg (-120 max) |
| What is the suction pressure for an adult? | -100 to -120 mmHg (-150 max) |
| What is the procedure used for suctioning? | Set up equipment (sterile), lubricate tube (nasal), place patient in high fowler's position, have patient take a deep breath, insert catheter till you feel obstruction, pull back slightly, begin suctioning, remove tube, auscultate patient, flush tubing |
| What is the maximum time for suctioning? | 15 seconds |
| What size ETT is used for male patients? | 8-9 mm ID |
| What size ETT is used for female patients? | 7-8 mm ID |
| What is the average distance from tip of ETT to lips in an adult? | 21-25 cm at lips |
| What special equipment is required for nasal intubation? | Lubricant and Magill Forceps |
| What is a trach button? | Hard, plastic tube placed into the patient's stoma to keep it open after the trach has been removed |
| What is a fenestrated trach tube? | Fenestrated means window or opening, in trachs, little holes allow air to flow through, used for speaking and weaning, provides decreased WOB |
| What is a jackson trach? | Cuffless, metal trach, made of surgical stainless steel, long term or permanent, no adaptor for ventilation or bagging |
| What is the Passey-Muir Valve? | Speaking valve that can be attached to a trach tube or trach button, one way valve opens when the patient inhales to allow air in and closes on exhalation; cuff must be deflated and inner cannula removed |
Created by:
ashconrad417
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