• Internal - food, vomitus, blood clots, foreign object; do heimlich on conscious pt, abdominal thrusts on unconscious
• External - goiter, lymph nodes, hematoma, tumor
• Enlargement/edema of airway tissue
• Altered LOC - should be SIDE LYING

• Oral airway - used only on unconscious; require freq mouthcare; inserted upside down, then inverted
• Nasal airway - "trumpet;" Protects nasal mucosa fm suctioning; conscious or unconscious; monitor nare for necrosis
• ET tube - oral or nasal
• Tracheostomy

For:

• A/W obstruction
• Pt inability to clear secretions
• Delivery of accurate O2 level
• Mechanical ventilation

• Various sizes in diameter - 7 1/2-8 for adult
• Inserted into trachea via mouth or nose
• Positioned above carina
• Radiopaque - visible on x-ray
• Depth markings - norm = 22 @ teeth; record routinely, note displacement
• Cuff
• Pilot balloon - should be inflated
• Universal adaptor - fits any ambu bag

• End-tidal carbon dioxide detector - yellow to purple is good!
• Breath sounds- should be heard bilaterally
• Auscultate stomach (will be distended if ET tube is inserted there)
• CXR

Assess:

• Tube placement
• Cuff patency - if not fully inflated, you will hear audible air mvmt or speech
• Breath sounds - assess for rhonchi (gurgling), heard when there's an obstruction
• Chest wall mvmt

Restraints

Sedation/paralytics - only used when pt unable to breathe on ventilator; if paralytics used, you must use sedation

Suctioning - sterile

Freq oral hygiene - prevents infection

Repositioning of ET tube

Position changes q 2 hrs to prevent pulmonary stasis

Communication - priority bc you take their speech away