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resp 131
airway management
| Question | Answer |
|---|---|
| write the 4 needs for artificial airways | Relief of airway obstruction, facilitation for suctioning, protection of airway, prolonged artificial ventilation |
| what is the most common cause of upper airway obstruction? | soft tissue obstruction |
| what sounds are made with upper airway obstruction? | Stridor or snoring |
| write 6 other causes of upper airway obstruction | bleeding, edema, foreign body, lesions, tumor, vomitus |
| How do you provide temporary relief from upper airhead? | Head tilt or jaw thrust |
| reflexes pharyngeal- | gag and swallowing |
| Laryngeal reflexes | closure of epiglottis |
| tracheal-reflexes | cough |
| carinal- | cough |
| action for which the pharyngeal is responsible | gag and swallowing |
| action for which the laryngeal reflex is responsible | closure of epiglottis |
| what type of patient would a oropharyngeal airway be indicated | unconscious patient only-Don't use if gag reflex is present may be used with bag-mask patients |
| what type of patient would a nasopharyngeal airway be indicated | semi-conscious who gag with an oropharyngeal airway conscious patients unconscious patients with clenched jaws or traumatic damage to the mouth or mandible |
| steps on determining an airway cuff's minimal occlusive volume or MLV | using a stethoscope (on the neck where the cuff is located) and a positive pressure breath (self inflating bag or manual breath from a mechanical ventilator), determine if there is a leak during inspiration at peak airway pressure. If no leak is heard, s |
| advantages of using a nasotracheal tube over an orotracheal tube | easier to stabilize easier to suction equipment is more stable when attached |
| consideration that must be taken account when one places an artificial airway that will allow direct access to the lower airway | circumvents the normal mechanisms to keep the lower airway sterile effectiveness of cough lost because of loss of functioning vocal cords can't communicate upper airway humididfication is lost-need to use a humidifier |
| complications related to the placement of an endotracheal tube | vocal cord damage: A. superficial damage-Granuloma damage B. Trauma during intubation |
| Tracheal stenosis and tracheomalacia | too much pressure in cuff or too large of a tube |
| complication related to E T tube placement | Obstruction due to secretions tracheoesophageal fistula leak due to broken cuff tracheal necrosis |
| complication related to E T tube placement | displacement into main stem bronchi |
| problem associated /overinflated cuff 18 torr or greater causes | venous flow obstruction (congestion) |
| physical characteristics and markings found on orotracheal, nasotracheal, and tracheostomy tubes and their specific meanings and/or function | made from PVC or silicone standard 15mm endotracheal tube adapter inserted into machine end pilot line (inflating tube for cuff) Pilot balloon -palpate to see how much air in cuff by feel body-top of cuff to bottom of endotracheal tube adaptor cuff |
| why is a water soluble lubricant used for inserting a nasal airway | ease of insertion and prevent toxic reax from petroleum products |
| what complications might arise from the use of a nasopharyngeal airway | sinusitis, epistaxis, gagging, air way obstruction |
| complications from improperly sized oropharyngeal airway | gagging vomiting airway obstruction, septoperforation |
| what type of airway should be used on a semi consciousness patient in the recovery room | nasopharygeal |
| what type of airway should be used to an elderly-nonintubated patient who requires frequent suctioning | nasal trumpet |
| what type of airway should be used to a patient in cardiac arrest in the ER receiving BLS | oropharyngeal and endotracheal tube |
| proper sequence for replacing the ETC | 1. suction pharynx expose vocal chords with laryngoscope intubate w/endotrach tube insure proper placement and inflate cuff deflate ET cuff and remove ETC Be prepared for vomiting if pt vomits |
| what equip would employ when setting up a pt to receive 40% O2 w/a laryngeal airway in place | O2 flow meter, nebulizer set at 40% corrugated tubing from nebulizer to water trap, from water trap corrugated tubing to a briggs T which hooks to the15mm adapter of the LMA |
| pt regaining consciousness and the laryngeal airway the patient has been removed. what should you do with the device | put in biohazard bag and send to central supply for sterilization. or dispose of single patient use laryngeal airway. |
| what type of artificial tracheal would you use: Cardiac arrest | oropharyngeal for bagging and endotracheal tube if pt came in wi combitube use that for bagging |
| C-1 fracture what kind of artifical tracheal would you use | nasopharygeal for bagging followed by nasal intubation If not poss try cricothryroidotomy |
| you are changing a trache tube in pt w/no spont. resp. who is mech vent. you can't get tube in? | take a pair of kellys and dilate the stoma and slip the tube in, or change the size of the tube, ventilate patient |
| 16yr old quadriplegic with C7 fracture | the cuff needs to be deflated and changed to a non cuffed type endotracheal tube |
| what type of artificial tracheal would you use?Cardiac Arrest | Oro. for gagging and ET tube if pt came in w/combitube use that for bagging |
| 3 yr old with epoiglottitis | ET tube in surgery for controlled environ, or if unable to pass ET, then trach, tube or emergency cricothyroidotomy or percutaneous tracheotomy |
| pt with paralyzed vocal cords | cuffed or uncuffed unfiniestrated trach tube |
| fractured jaw | Nasopharygeal, if risk of aspiration use trach tube w/cuff |
| alert stroke pt who cannot cough | nasal trumpet, if chronic use ET tube if very long term use trach tube or trach button |
| safety precautions that one should be taken during oral hygeiene of the intubated pt. | 2 caregivers present, 1 for mouth care and 1 support of tube to prevent accidental extubation. Need manual resuscitator w/mask as we;; as intubation equipment |
| mrs. king, open heart surgery and is 20 hours post op describe how would assess her readiness | mental status current vent settings vitals ECG Pulse Ox Vital capacity spont tidal volume H MIP Hemodynamic stability |
| mr. is intubated... | tube is too small-need larger size increase fiO2 and increase volume on vent |
| pt with paralyzed vocal chords | cuffed or uncuffed unfinestrated trach tube |
| pt w/dysphagia and chronic aspiration | cuffed unfinestrated trach. tube |
| fractured jaw | nasopharygeal, if rish of aspiration use trach tube w/cuff |
| mr kee is intubated ...... | tube is too small need a larger size. Increase FIO2 and increase volume on vent |
| biggest problem associated w/ overinflated cuff 30 torr or greater? | stops arterial capillary blood flow (ischemia) |
| problem associated with overinflated cuff of 5 torr or greater cuases | lymphatic flow obstruction (edema) |
| what is the formula to convert ID to ODmm to French | MM X 3.14 |
| formula to determine catheter size in French | {(IDmm X 3)/2}+2 |
Created by:
rislas1
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