filter the air

warm the air

humidify the air

4.  Identify 3 unpaired and 3 sets of paired cartilages?

unpaired:

thyroid cartilage

cricoid cartilage

epiglottis

paired:

arytenoids

cunieforms

corniculates

its avascular cricoid membrane is below vocal cords

forms a complete ring

unpaired: 

thyroid

epiglottis

cricoid

paired:

arytenoid

cunieform

corniculates

location of the epiglottis and its function?

location: attached to thyroid cartilage.

function: covers glottic opening when swallowing

prevents food from entering larynx and trachea while swallowing.

describe: head tilt, chin lift, and jawthrust

jaw thrust: patients with spinal neck injury

chin lift/headtilt: recomend patients with spinal trauma

(also recommended for lay persons)

sizing: tip of ear to corner of mouth

placement: in at 90 degree angle upsidedown til resistance is felt then turn 180 degree

use: unconscious, prevent tongue from blocking airway, maintain airway patency

sizing: tip of nares to earlobe

placement: lube with water soluable jelly,insert during insp. distal tip behind uvula, flange against nose. 

use: conscious, facilitate frequent nasal tracheal suctioning. (maintains patency despite swelling)

patient may gag or vomit

patient may bite tube and block airway

can cause nose bleed

irritation may occur

compications: inadvertant insertion into trachea

esphageal lacerations

rupture

asphyxia

prolonged resuscitation

risk of aspirations are high

artificial ventilation is neccessary

patients airway is inadequate

semi rigid tube made of polyvinyl or chloride polymers

proximal end attached to 15 mm adapter

distance markings in cm to distal tip

vendor brand

spring loaded pilot valve or balloon

cuff

manufacturers mark's (IT=tested/Z79=meets standard)

inflation or pilot tube

internal diameter in mm

radiopaque line

beveled tip with murphy's eye

uncuffed, some with tappered distal end

(because airway and cricoid cartilage too small)

14. c) consruction of ETT for indepenent lung ventilation?

contruction: metal handle, curved or straight blade with light bulb

purpose: to move/lift tongue and view airway structures.  

Mac: curved, lifts epiglottis indirectly, placed in vallecula

Miller: straight, lifts epiglottis directly, placed posterior to epiglottis

18.  a thin malleable rod inserted into orotracheal tubes to provide rigidity during intubation?

19.  List epuipment needed for oral intubation?

manual resuscitator

clear mask

suction equipment

yankauer tip

orotracheal tubes

two larygealscopes

straight and curved laryngoscope blades

stylet

tongue depressors

water soluable jelly

syringe

tape

stethascope

20.  equipment and patient prep process for oral ETT placement?

equipment:

verify tube size (make sure cuff will hold volume)

blade of choice attach to handle/larygoscope

check light make sure it working properly

patient: 

head slightly elevated (on folded towel) to align pharynx + larynx (sniffing position).

ventilate to oxygenate patient w/bag + mask

insert blade in right side of mouth.

sweep tongue to left as you bring blade to midline.

if using curved blade advance to vallecula.

if straight advance til distal tip is posterior to epiglottis.

lifting pressure used until cords are visible.

cords should be in view til tube passes through glottis.

(do not use laryngoscope as lever + keep off teeth)

insert tube in right side of mouth.

dont obstruct view down blade.

if not properly placed in 30 sec it should be removed.

ventilate 3 to 5 min before retry.

cuff is inflated w/syring

oscultation under each axilla.

listen for equal bilateral breath sounds.

listen for gurgle sounds in gastric area to ensure tube not in esophagus.

secure tube w/tape.

insert bite block.

use portable chest xray to ensure tube position 2 to 3 cm above carina.

24.  route of choice to establish a tracheal airway in a patient with spinal or jaw injuries?

30.  advantages and disadvantage of nasotracheal in-T?

advantages:

stability enhanced because of tape eplacement

easier to stabiliz

oral hygiene

better tolerated by concious and semi conscious

easier to attach equipment

easier to pass suction catheter

easier to eat or drink

disadvantages:  

airway resistance is higher

necrosis of nasal septum and external nares

nose bleeding (during in-T or ex-T)

oral feeding difficult

Direct site:  

employ laryngoscope or fiberoptic bronchoscope

required spontaneous breathing, same for oral.

2.5 mecidal epinephrine or 2% lidacaine

use magill forceps to insert tube between vocal cords

preoxygenate

lubricate tube to ease pressure

insert inferiorly and posteriorly with lubrication,

depth of insertion 25 cm from external nares

never flex the neck with spinal injuries.

27.  purpose of using magill forcepts during nasal tracheal

in-T

to guide in blind by.

to grasp tube and advance it through vocal cords.

30.  advantages:

quickest and easiest to establish tracheal airway

disadvantages:

patient discomfort and gaging

difficult hygiene

accidental extubation

damage to lip and teeth

disloction of tube

damage to oropharynx

indications:

need to bypass upper airway 

permanent or long term intubation

poor airway protective reflexes

complications:

air embolism

tracheosophageal fistula

laryngeal nerve injury

hemorrhage

infection

subcutaneous emphysema

pneumothorax

swallowing dysfunctions

provide filtered, heated humidified gas

pulmonary toilet to ensure airway patency

cuff monitoring to avoid excessive volume pressure

aerosol to meet humidification needs

33.  list the steps to perform airway suctioning?

assess for secretion presence

check equipment

select proper size catheter

hyperoxygenation and hyperventilation

insert catheter using slight rotating motion

advance catheter till obstruction is felt

remove catheter using slight rotating motion

assess patient

34.  when performing airway suctioning limit aspirations to?

caude catheters - curved lip fro entry into mainstem bronchus

permanent ventilation support required

pemanent tracheostomy

suctioning aspirator

suction kits

oxygen and aerosol therapy equipment

manual resuscitation mask and bag

aerosol nebulizer

racemic epinephrine

normal saline

intubation tray

give patient a large breath with manual resuscitater and remove tube at peak inspire.

have patient caugh remove tube during explosive expiratory phase.

check for good air movement

sample and analize ABGs

monitor with pulse oximeter

check for nosebleeding

check for air movement by auscultation

reintubation may be neccessary

heated mist may cause vasodilation

potentially mucosal swelling

cool mist is recommended

(check answer)

racemic epinephrine

steroid aerosol

damage to anatomic airway

edema, minor bleeding

truama during intubation

movement of tube

friction between ETT and trach wall

reaction to plastic tube material

glottic edema

vocal cord inflammation

horseness

stridor

(difficult swallowing indicate polyps granuloma)

T-piece/briggs adapter

ventilator

T-collar

prevent damage to trachea (pressure necrosis).

maintain lowest pressure possible for a sealed airway.

cuff.

location:  

between the upper and lower airway in the anterior portion of the neck.

function:  

passage way of air

protects against aspirations of solids and liquids

generates sounds for speech

blind method:

patient supine or sitting.

insert through nose

as approaches larynx listen for air movement

harsh cough followed by silence means proper placement.