Mechanical Ventilation Chapter 6
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| (Tracheostomy, Tracheotomy), is a surgical procedure that creates an airway opening by cutting into the trachea. | -Tracheotomy
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| Compared to an ET tube, Tracheostomy tube is much (shorter,longer) and it provides closer access to the lower airways and has (more dead space, lower dead space). | -shorter
-lower dead space
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| 1._____Relief of airway obstruction 2._____Protection of the airways 3._____Facilitation of suctioning 4._____Support of ventilation A.loss of swallow or gag reflex B. Excessive secretions C. epiglottis D. Mechanical ventilation | 2,A.loss of swallow or gag reflex
3,B. Excessive secretions
1,C. epiglottis
4,D. Mechanical ventilation
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| Which of the following conditions may obtund the protective reflexes of the airway? 1. paralysis 2.drugs 3.loss of consciousness 4. neuromuscular disease A. only B. 1,2, & 3 only, C. 1,3,& 4 only D. 1,2,3, &4 | D. 1,2,3,& 4
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| Nasal intubation may be preferred for: trimus (lockjaw), oral trauma deformities short necks and________ | -mandible fracture
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| In long-term mechanical ventilation tracheostomy replaces ET tube that has been in place for _____or longer | -21 days
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| Mallampati classification ranges from class (1-3, 1-4) where class (1,3,4) predicts maximum difficulty during oral intubation when (soft palate only, soft palate and base of uvula) is visible seek anesthesia | -1 to 4
-4 maximum difficulty
-soft palate only
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| What is the purpose of the radiopaque line implanted along the length of an ET tube? | for the verification of the tube location and depth of intubation by chest radiograph
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| Special forceps used to perform nasal intubation under direct vision is called? | -Magill forceps
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| If an intubation attempt is not successful after ______, the ET tube and laryngoscope should be removed immediately and the patient ventilated with bag/mask system. | -30 sec
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| Procedure for oral intubation : tilt the head back and place in the? | -sniffing position
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| The MacIntosh blade is a (curved, straight) blade, and its tip is placed in an area called the ____during intubation. | -vallecula
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| Indications of successful and proper placement of an ET tube include all the following except: A. presence of the bilateral breath sounds B. presence of CO2 in expired gas C. presence of condensation D. presence of vocal sounds | D. presence of vocal sounds
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| The best way to confirm ET tube placement is to: A. listen for bilateral breath sounds B. ET tube is taped between 21-23cm C. obtain chest radiograph D. ensure the end-tidal CO2 level is greater than 6% | C. obtain a chest radiograph
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| Etomidate(Amidate) is used for (neuromuscular blockade, sedation, pain control) in RSI | -sedation
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| For adults, (2,20,200) mg of etomidate may be given intravenously over (1 to 10sec, 30 to 60 sec) prior to RSI | -20mg
-30 to 60 sec
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| Succinylcholine is used to provide(neuromuscular blockade, sedation, pain control) in RSI because it has a rapid onset and(long, short) duration of action | -neuromuscular blockade
-short
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| The adult dosage of succinylcholine is about ____mg or ____mg/kg | -100mg
-1.5mg/kg
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| Indications for Rapid Sequence Intubation (RSI) are | -inability to maintain patent airway
-Glasgow coma scale of 8 or less
-severe hypoxemia FIO2 (P/F) ratio of less than 250mm hg
-deteriorating hemodynamic values
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| The ET tube cuff pressure should be 25mm Hg (greater, less) to minimize pressure-induced injuries to the trachea that may cause ischemic injury and tissue necrosis | -25 or less
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| The closed inline suction system helps reduce suction-induced hypoxemia, because the ventilator circuit is not disconnected and the system maintains all ventilator settings such as FIO2 & PEEP (True/False) | True
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| For endotracheal suctioning, the optimal vacuum pressure for most adults is about (100,150,200)mm Hg | -100mm Hg
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| ET suctioning should be done regularly and frequently because it seldom causes mucosal damage, suction-induced hypoxemia, & arrhythmias. (True/False) | -False
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| Proper management of ET tube includes: A. maintaining a cuff pressure greater than 25cm H2O B. limiting the duration of suction fron 10 to 15 sec for adults C. keeping the head of the bead less than 30 degrees D. suction Q2 hrs | B. limiting the duration of suction from 10 to 15 sec for adults
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| ET Suctioning procedure | -insert catheter into ET tube (sterile hand) and advance until resistance is met. Withdraw catheter slightly
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| A speaking valve is a (one-way, two-way) valve put on a tracheostomy tube that allows the patient to breath (in and out, in only) | -one way
-in only
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| A speaking valve (allows, blocks) the exhaled air from going through the tracheostomy tube opening and (directs, blocks) the air through the vocal cords. | -blocks
-directs
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| In mechanically ventilated patients, an air leak may require careful and periodical adjustments of the _____, PEEP, and alarm setting. | -tidal volume (VT)
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| Criteria that are useful for predicting a successful extubation outcome include:spontaneous minute ventilation less than___L/min, vital capacity greater_____ml/kg, and no distended_____ | -10 l/min
-greater than 15mL/kg
-stomach
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| Before ectubation, the procedure is explained to the patient and the patient is positioned in a ______ (semi-sitting) position. | -Fowler's
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| Complications of extubation include all the following, except: A. laryngospasm B. glottic edema(stridor) C. increased SpO2 D. vocal cord paralysis | C. Increased SpO2
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| list 3 Complications related to use of Endotracheol tube during intubation | -vomiting
-aspiration
-arrhythmias
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