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Emergency Care Final
| Question | Answer |
|---|---|
| What is an oropharyngeal airway? | Used on unconscious patients, supports the base of the tongue, also used as a bite block for oral ETT patients, facilitates suctioning |
| What is a nasopharyngeal airway? | AKA nasal trumpet, inserted through one of the nares and sits in the pharynx above the trachea, can be used to facilitate suctioning |
| What is an oral endotracheal airway? | Tube is passed through the oropharynx into the trachea |
| What is a nasal endotracheal airway? | Passed through the nares into the nasopharynx and into the trachea |
| What is a tracheostomy tube? | A tube placed into an artificial opening (stoma) in the trachea |
| How does a MacIntosh blade work? | Fits into the vallecula and lifts indirectly |
| How does a Miller blade work? | Fits under the epiglottis and lifts directly |
| What is the difference between a Miller and a MacIntosh blade? | Miller blade is straight / MacIntosh blade is curved |
| What is the appropriate cuff pressure? | 20-25 mmHg / 25-30 cmH2O |
| What are the hazards and complications associated with endotracheal intubation? | Poorly tolerated in conscious patients, difficult to stabilize; prone to self-extubation, vagal stimulation, tube obstruction (biting), oral hygiene difficult, inability to talk or eat, risk of right mainstem/esophageal intubation, oral/tracheal injury |
| What are the hazards and complications associated with nasotracheal intubation? | Bleeding, ulceration, necrosis of nares from pressure, obstruction, cuff rupture, vagal stimulation, more difficult, problems with suctioning and kinking, difficult bronchoscopy |
| What is the FIRST thing that should be done when finding a person "down"? | Determine if the patient is conscious ("ARE YOU OKAY?" Sternal rub) |
| What are the hazards and complications associated with OPA's? | Gagging, vomiting, aspiration, laryngospasm, incorrect placement, can displace tongue |
| What are the indications for OPA's? | Restore airway patency and maintain adequate ventilation in unconscious patients, supports base of the tongue, bite block for oral ETT, facilitate oral suctioning |
| What are the complications and hazards associated with NPA's? | Trauma to mucosa, epistaxis, increased Raw |
| What are the indications for NPA's? | Provide airway (better tolerated in conscious patients), guide for suctioning or bronchoscope, used for patients seizing with tightly clinched jaw |
| When is an OPA a better choice than an NPA? | Unconscious patients |
| When is an NPA a better choice than an OPA? | Conscious patients |
| When is it appropriate to suction a patient? | Only when necessary |
| What signs and symptoms will you see/hear, that will help you determine if a patient needs to be suctioned? | Visible secretions, rhonchi, crackles |
| Where is the best place to check for a pulse during CPR? | Carotid on adults and children / Brachial on infants |
| What is a Passy Muir Valve? | Speaking valve used on trach patients |
| How does a Passy Muir Valve work? | One way valve open on inspiration and closes on expiration; cuff must be deflated and inner cannula removed |
| What is the suctioning procedure? | Set vacuum pressure, place PT in semi fowlers or sniff position, pre-oxygenate, use sterile technique to prep equipment, test vacuum, disconnect vent/O2, suction PT, re-oxygenate, clear catheter, assess patient, repeat if needed |
| How do you recognize right mainstem intubation? | Right sided chest rise (Assymetrical) or diminished breath sounds on the left side |
| How do you correct right mainstem intubation? | Pull tube back and reassess chest rise and breath sounds |
| What equipment is needed for oral intubation? | Laryngoscope, metal stylet, ETT tubes, 10 ml syringe, yankauer and suction source, bag/mask unit, CO2 detector, sedation meds, stethoscope, tape/tube holder, tongue depressor/OPA/bite block, sterile suction catheter, manometer |
| What is the procedure for intubation? | Prepare equipment, check proper function, place patient in “sniff” position, ventilate and oxygenate patient, use laryngoscope to visual cords, insert ETT & metal stylet, inflate cuff, remove metal stylet, ventilate patient to confirm placement, tape tube |
| What equipment is need for nasal intubation? | ETT tubes, 10 ml syringe, lubricant, yankauer and suction source, magill forceps, bag/mask unit, CO2 detector, sedation meds, stethoscope, tape/tube holder, tongue depressor/OPA/bite block, sterile suction catheter, manometer |
| What is the procedure for nasal intubation? | Prep equipment, check for proper function, place patient in “sniff” position, ventilate/oxygenate patient, lubricate tube, insert tube through nare, visualize tube in PT throat, use magill forceps to guide tube, inflate cuff, confirm placement, tape tube |
| What is the procedure for CPR on a victim with suspected neck injury? | Jaw thrust |
| What signs would a patient with an airway obstruction present? | Universal choking sign, distended veins in forehead, turning red/blue |
| When should trach patients have a spare "tube" next to their bed? | During trach care |
| What is the procedure for obtaining a sputum sample? | Suction the patient and use a Luken’s trap to collect sample; Hypertonic saline can also be used to obtain a sputum sample without suctioning |
| What is a Yankauer suction tube? What is it used to clear? From where? | A hard, plastic suctioning tube, used to clear secretions/vomit from the mouth and oral cavity |
| When suctioning via ETT, how would you calculate what size suction catheter to use in comparison to the ETT? | ETT size x 3 / 2 |
| What is an obturator? What is it used for and why? | Intubation tube that can be placed in the esophagus or trachea; used in emergency situations because it can be inserted blindly |
| What are the indications for oral intubation? | Secure patent airway for MV/CPAP, facilitate suctioning, prevent aspiration, maintain airway, relieve airway obstruction, instill medications |
| What are the indications for nasal intubation? | Same as oral intubation; used for intubation when oral intubation is not possible |
| What are the indications for suctioning? | Obstructed airway, accumulated secretions, depressed cough, inability to swallow, specimen collection |
| What is the "optimal" type of cuff? | High volume, low pressure |
| What is the purpose of the beveled tip on an ETT? | Prevent occlusion |
| What is the purpose of the Murphy's eye on an ETT? | Prevent occlusion |
| What is the purpose of the cuff on an ETT? | Prevent aspiration and maintains seal for MV |
| What is the purpose of the pilot tube on an ETT?` | Carries air to and 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 view ETT on CXR |
| What is the purpose of the 15 mm OD adapter on an ETT? | Used to attach devices |
| What is a Shiley Trach commonly used for? | Mechanical Ventilation |
| What is a Portex Trach commonly used for? | Long term use (lifetime) |
| What is a Jackson Trach commonly used for? | Cuffless metal trach; long term or permanent |
| What is a Biovana Trach? | Foam cuff, needs to be aspirated every 12 hours |
| What is a Kistner Trach Button? | Used to hold stoma open |
| What is the procedure for cleaning a trach tube? | Removed soiled gauze, put on sterile gloves, remove inner cannula, soak in 50/50 sterile water hydrogen peroxide mixture, clean around trach, dry area, clean inside of inner cannula, rinse inner cannula and dry, replace inner cannula, apply new gauze |
| What is MLT? | Minimal Leak Technique; used to set trach pressure, deflate cuff till small air leak occurs to determine adequate inflation |
| What is MOV? | Minimal Occluding Volume; used to set trach pressure, inflate cuff till the minimal occluding volume is reached |
| What are the hazards and complications associated with suctioning? | Trauma to mucosa, contamination, hypoxemia, bradycardia, bleeding |
| What can be done to prevent hazards and complications with suctioning? | Limit suctioning to 15 seconds, only suction when necessary |
| What is the appropriate suction pressure for an infant? | -60 to -80 mmHg (-100 max) |
| What is the appropriate suction pressure for a child? | -80 to -100 mmHg (-120 max) |
| What is the appropriate suction pressure for an adult? | -100 to -120 mmHg (-150 max) |
| What is the technique for open an airway? | Head tilt, chin lift / Jaw thrust |
| What things can cause a laryngoscope to malfunction? | Batteries, bulb |
| What are the hazards and complications associated with high cuff pressure? | Mucosal ischemia, inflammation, hemorrhage, ulceration, tracheomalacia, stenosis, necrosis |
| Where should the top of the ETT be after intubation? | 2-5 cm before the carina / 21-25 cm at the lips / 26-29 cm at the nares |
| How is the "Carlen's" tube different? What is it used for? | Two tubes, allows for separate ventilation of each lung or MV of one lung |
| What are the indications for artificial airways? | Protect airway, relieve obstruction, facilitate suctioning, protect from aspiration, provide a closed system for MV/CPAP |
| What are the problems associated with prolonged intubation attempts? | Inadequate oxygenation |
| What is the procedure for extubation? (Before, During, After) | Explain procedure, place in high fowler, suction airway/mouth (above/below cuff), cut/remove tape, deflate cuff, PT take a deep breath, remove tube(peak inspiration), cough to clear secretions, O2/humidity, observe ,monitor, chart, NEVER leave till okay |
| What can alter the delivered FIO2 of a manual resuscitator? | Inadequate RR, poor seal on mask |
| Why is cuff volume so important? | Ensure proper seal for MV / limit tracheal trauma |
| What type of endotracheal tube would be used for unilateral lung disease? | Carlen's tube |
| What is the procedure for a bronchoscopy? | Prep patient, NPO 8 hours prior, pre medicate patient, place patient in supine or semi fowlers position, insert bronchoscope, obtain desired samples/administer meds/lavage, remove scope, monitor patient, NPO till gag reflux returns |
| What meds are used for bronchoscopy? | Sedatives (Benzodiazepines), pain medications, numbing agents, mucomyst, topical vasoconstrictors |
| What is a precordial thump? When should it NEVER be used? | Using a closed fist to hit the left side of the chest of a cardiac arrest victim in an attempt to restore a normal rhythm; NEVER perform on children |
| What is an LMA? | An inflatable mask that is positioned directly over the opening of the trachea |
| When is an LMA most often used? | Most often used in situations where an oral ETT is difficult to insert |
Created by:
ashconrad417
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