Lindsey Jones 3A4 - Therapeutics : Airway Maintenance
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| show | 1. Natural airway. 2. Artificial Airways. 3. General consideration of airways. 4. Nasal and oral (pharangeal airways). 5. Tracheostomy. 6. Airway clearance.
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| What are the causes/types of obstruction in a Natural airway? | show 🗑
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| What are the 2 signs of obstruction in a Natural airway? | show 🗑
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| show | 1. Softened cough 2. Inspiratory stridor. 3. Paradoxical chest movement (chest moves inward upon inhalation) 4. General age of Resp. distress. (cyanosis, retraction etc.)
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| show | 1. Paradoxical chest movement. 2. Inability to vocalize and no air movement sound at all. 3. Marked use of accessory muscles. 4. Marked nasal flaring, retraction etc. 5. Severe/marked anxiety, agitation.
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| show | 1. Modified Jaw thrust. 2. Head-tilt/chin-lift.
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| show | 1. It is modified to avoid head-extension-good for suspected neck trauma patients. 2. Done by pushing the mandbular process to extend the haw and open the airway.
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| What is a Head-tilt/chin-lift in natural airway? | show 🗑
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| show | 1. Use if patient is not alert, unconscious, not awake. 2. Use stylet (not magill forceps).3.Tube sizes should be (pt. wt. in kg/10). A. tube should be inserted to the markings in the low 20cm. Tube should be secured toa non-moving part of the face.
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| What is the procedure for an oral intubation? | show 🗑
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| What happends after oral tube insertion? | show 🗑
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| show | Use nasal intubation if patient will remain awake, alert. Use Magill forceps (no stylet).
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| show | Extubation may be combined with the discontinuance of mechanical ventilation, but does not exclude it. Since someone can be ventilated with a mask the term, extubation, should never be substituted w/discontinuing mech.ventilation.
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| show | 1. There must be little/no inflammation in the airway around the tube. 2. Pt. should be alert, oriented and able to follow commands.
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| show | 1. Clear airway by suctioning below&above airway. 2.Explain to the pt.3.Evacuate the cuff.Have pt. inhale&hold.Remove the tube while pt. holding max. inspiration.5.Instruct pt. to cough&expectorate-facilitate w/a tonsil suction device if needed.
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| show | 1. Severe stridor - Immediately re-intubate the pt. 2. Moderate stridor - Consider racemic epinephrine aerosol treatment. 3. Mild-stridor- Cool mist and close observation.
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| show | .
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| show | 1.Facilitates ventilation2.Protect airway(aspiration,inflammation)3.Profound,persistent hypoxemia 4.Facilitates bronchial hygine(marked secretion5.Sedate w/ativan(Iorazepam6.Deliver medications V-valium/versed,L-lidocaine,A-atropine,N-narcan,E-epinephrine
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| what is the assesment of positioning in an artificial airway? | show 🗑
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| What are the 4 potential problems during an artificial airway? | show 🗑
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| What is the loss of dignity problem in an artificial airway? | show 🗑
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| show | Keep cuff pressure less than 20 mmHg. If it is high it causes necrosis,
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| show | Use the MLT and MOV tecniques. Use High-volume, low-pressure cuffs.
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| What does the natural humidification do when it is bypassed in an artificial airway? | show 🗑
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| show | Suction-PRN. Teach ways to stimulate the cough. (forceful, explosive exhalation)
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| show | This is worst of all the complications. Never extubate until this is resolved.
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| show | To remove secretions. Promote expectoration of secretions(cough) Collect a specimen.
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| What is the suctioning procedure during an artificial airway? | show 🗑
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| show | Bleeding/trauma to the mucosa so be gentle and use lubricant. Cardiac changes can occur due to vagal reflex(bradycardia) and hypotension from vagal nerve stimulation. Tachycardia due to hypoxemia. Use sterile technique.
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| What should be done when a thick secretion situation occurs during an artificial airway? | show 🗑
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| show | called as nasal trumphet. Helps in suctioning &remal of secretions.Opens airway for better ventilation. Not good for mech. ventilation.Used on consious pt. Less mucosal trauma. Use largest diameter possible to decrese RAW. Change often to prevent bleeding
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| What is a oral pharyngeal airway in an artificial airway? | show 🗑
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| What are the genral considerations Tracheostomy in an artificial airway? | show 🗑
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| show | 1. During PPV support.2.During IPPB treatment.3.when pt. is eating.4.when there is an established risk for aspiration and if there is anything in the stomach.Inother cases deflate the cuff.When removing use sterile method.
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| show | it is cleaned with topical sterile dressing.
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| When is a tracheostomy done in an artificial airway? | show 🗑
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| show | Do not attempt to close the stoma w/a tape or gauze. All dressing should be lose and breathable and Do not suture stoma closed.
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| What are the 4 reasons to change a tracheostomy in an artificial airway? | show 🗑
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| What are the 10 airway clearance procedures in natural and artificial airway? | show 🗑
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| What is Postural drainage in a patient during airway clearance? | show 🗑
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| What are the 4 general positions during airway clearance? | show 🗑
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| What is the supine position during airway clearance? | show 🗑
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| What Prone position during airway clearance? | show 🗑
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| show | Manage hypotension (support blood perfusion in the brain). Contraindicated for head trauma/ brain surgery. Drain lingular, lateral and medial segments.
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| show | Used to drain the lower lobes basal segments anterior basal, lateral basal , posterior basal segment. May be dificult for dyspenic pt. to tolerate.
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| show | Untreated Tb. Poor/unstable cardiovascular system. Over incision sites.
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| show | often combined w/postural drainage. Facilitates mechanical mobilization of secretions.
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| What is chest percussion procedure during airway clearance? | show 🗑
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| In using a chest mechanical device what all should we consider during airway clearance? | show 🗑
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| show | 1. Facilitates mobilization of secretions. 2.Done by placing hand over the area to be drained while vibrating hands.3. Compression and vibration is done during exhalation.
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| show | 1.Untreated pneumothorax. 2.Chest trauma (fractured ribs and bones) 3. TB and assosiated hemoptysis. 4.Pulmonary emboli.
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| show | 1. Multi-stage method of breathing. 2. Start w/breathing at ERV range. 3. Next,include VT range, but exhalating to ERV. 4. Finally, patient breathes at high lung volume (VT and IRV).
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| show | 1. Mask allows easy inhalation. 2. Restricts exhalation-causing expiratory airway pressure to exist. 3.Use 3-4 times per day. 4.Expiratory pressure from 10-20 cmH20. 5. Avoid during epitaxis,middle ear infection&sinus problems.
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| What is the flutter valve in airway clearance? | show 🗑
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| show | 1. Also called High-frequency chest wall compression devive. 2. Eg. Device is VEST.
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| show | 1. Done by delieviring inhalation w/oscillation.2. Causes vibration of the lungs. 3.Helps gases penetrate deeper levels of the pulmonary airway system.4.can be combined w/aerosol delivery.5. Good start Frequency is 30 PSI.
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| What is Teaching a cough during airway clearance? | show 🗑
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| show | 1. Visual inspection-chest excursion. 2. Better vital signs-BP,HR & RR. 3. Auscultaton-Improvement of breath sounds. 4.Cough-Forcefulness and sputum production. 5. WOB-decreased. 6.Chest X-ray-Not done after every treatment but periodically.
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