Term
T or F
Nasotracheal Intubation is preferred for longer intubation(>72hrs) |
|
Definition
|
|
Term
| Name some advantages of Nasal Intubation |
|
Definition
. better tolerated
. cannot bitten or moved with tongue
. fixation is easier |
|
|
Term
| Name some disadvatages of nasaltracheal intubation. |
|
Definition
. more difficult to insert
. more traumatic, pts are usually awake
. size of tube is limited to size of is
naris
. Sx catheter is more difficult to
insert
. increased Raw
. risk of obstructions by secretions
. intro of nasal bacteria in to the TB
tree during procedure
. pressure necrosiss |
|
|
Term
| Equipment u may need for an intubation |
|
Definition
. Laryngoscope
. handle with batteries
. lamp
. blade(miller-straight)(curved-MAC)
. Stylet-wire
. MAgill forceps
. suction equipment
. O2 equipment
. Syringes
. bite blocks
. Tape
. topical anesthetic |
|
|
Term
| Name some things to check after intubation |
|
Definition
. make sure theres bilateral,equal
breath sounds that correspond to bag inflation
. air movement from ETT
. misting of ETT
. no breath sounds over stomach(2-chest,
2-sides and 1 stomach)
. improvement of SPo2
. adjust advices
. Chest x-ray |
|
|
Term
T or F
If there is CO2 in the lungs, the colorimetric CO2 detector will turn yellow |
|
Definition
|
|
Term
T or F
the colorimetric CO2 detector will not turn maroon if has low CO2 in the lungs |
|
Definition
|
|
Term
| What to do after extubation |
|
Definition
. put on O2 and cool aerosol
. Observe patient for respiratory distress
. donot be fooled by sound of stridor
. listen to breath sounds on neck |
|
|
Term
|
Definition
. to maintain an airway
. if needs mechanically ventilated, u need a low pressure cuff filled with sponge |
|
|
Term
T or F
The Fome cuff seals the airway with ambient pressure, exerts 0 mmHg pressure |
|
Definition
|
|
Term
| Prv(pressure regulated valve) |
|
Definition
. regulates pressure in cuff to < 25mmHg
. valve vents air >25mmHg to Atmosp air
. If syringe is on- pressure can exceed
25mmHg
. cannot get anymore that 25 mmHg
because of safety valve |
|
|
Term
|
Definition
. cannot measure cuff pressure on this
. small balloon is filled with air
. Big balloon is filled by syringe, and
air comes out of little balloon
. cuff pressure is 16-18 mmHg |
|
|
Term
|
Definition
. thought that alternating cuff inflation would reduce incidence of mucosal dmg
. each pressure now becomes a high pressure cuff |
|
|
Term
|
Definition
. intentionally intubate RMSB
. used to ventilate lungs independently
. hook 2 ventilators with it, one rate
run both of them
. ventilates ea. lung
. pressure that reaches the Alveolus is
what will blow the lung
. pressure that drives the gas will not
reach there |
|
|
Term
Sizes for ETT would be ________mm ID.
ID means___________. |
|
Definition
2.5-10.0
internal Diameter. |
|
|
Term
T or F
in reference to ETT tubes, if you reduce the diameter by 1/2, Praw goes up 16 times. |
|
Definition
|
|
Term
T or F
when choosing a tube, choose the biggest one you can get in. |
|
Definition
|
|
Term
| name some cons to choosing a ETT tube too small |
|
Definition
. cuff may not seal even with a large volume of air
. Incr Praw
. Hard to suction catheter
. occludes easily by secretions |
|
|
Term
| whats the narrowest part of the airway for infants? |
|
Definition
| below the vocal cords on infants if doing orally and nares if doing nasal |
|
|
Term
| Whats the narrowest part of the airway for adults? |
|
Definition
|
|
Term
| Whats a con if the tube is too large |
|
Definition
| . even small volumes of air in cuff creates high pressures leading to mucosal necrosis |
|
|
Term
Single Cannula
example: jackson tube, no cuff |
|
Definition
. low pressure cuff
. lack of inner cannula, risk of obstruction
. has obturator |
|
|
Term
| Fenestrated Tracheostomy tube |
|
Definition
. cuffed or uncuffed
. hole in posterior wall of outer cannula
. with inner cannula inserted, works like single or double cannula
. allows patient to talk when using passa meir valve or cap
. allows us to ween him off the trach tube.
. with inner cannula removed, connector plugged during exhalation, exhaled air passes through the vocal cords and pt can talk!
. used for weaning
- outer cannula capped
- cuff deflated
- pt breathes through normal airway but still leaves access for suctioning, emergency airway |
|
|
Term
|
Definition
– Hollow, plastic cannula
– Inserted through stoma
– With cap or inner
cannula inserted -- distal
end of outer cannula
spreads open holding
button in place in
trachea
– Rings are spacers |
|
|
Term
|
Definition
– Hollow, plastic cannula with
flange on distal end
– Has 1-way valve
– Clamp inserted into tube
past valve to pinch flanged
portion from inside
– Inserted into stoma
– Clamp released - flanges
spreads
– Allows patient to speak |
|
|
Term
| Communitrach Talking Tube |
|
Definition
– 2 channels - 1 for breathing,
1 for speaking air
– Gas flow from air supply
connector escapes through
fenestrations & is directed
through vocal cords even with
cuff inflated |
|
|
Term
|
Definition
– 1-way valve
– Placed on trach
tube to allow
patient to speak
Trach tube cuff must be deflated |
|
|
Term
| Esophageal Tracheal Combitube |
|
Definition
– 2-lumen tube that is inserted non-visually
– Will go in either trachea or esophagus
when orally
inserted blind
– Markings on
tube at level of teeth |
|
|
Term
|
Definition
• Pharyngeal balloon - 100 ml air
• Tracheal balloon - 10-15 ml air
• First ventilate longer, blue tube (distal) -
lungs+, GI Ø =
ventilate here
• GI+, lungs- =
ventilate clear
tube (proximal) |
|
|
Term
| Combitube Contraindications |
|
Definition
– Patients under 5'
– Patient < 16
– Known esophageal order
– Conscious patients
– Patient with |
|
|
Term
|
Definition
– Used prehospital & in surgery
– Used after failed intubation attempts
– 6 sizes available (1-6)
• Size 4 for
• Size 5 for
– Disposable & non-disposable
– Short-term use |
|
|
Term
|
Definition
• Large bore tube with distal inflatable molded
mask
• Mask placed above laryngeal inlet to direct gas
into lungs
• Triangular mask easily inserted into
hypopharynx
• Mask inflated, fills hypopharynx & covers
tracheal opening
• Distal tip rests in esophagus |
|
|
Term
|
Definition
• Fully deflate
balloon/cuff
• Lubricate the
dorsal surface of
the cuff
• Hold LMA
like a pencil
• Patient in “sniffing” position
• Flatten mask tip against hard
palate before sliding
downward
• Curved portion of
LMA points toward
the patient & away
from the operator
• Advance LMA until tip is in esophagus
• Use index finger at the junction of the tube &
the mask to push
• Avoid epiglottis by pressing
downwards & backwards
(towards post. pharynx)
• Stop when resistance is felt
• Black line on posterior
surface should not be
twisted
• Verify correct position by direct
visualization or by using a laryngoscope
• Inflate cuff with about 20 ml of air
• Soft tissue over
larynx should rise
• Attach bag &
ventilate
• Secure tube |
|
|
Term
|
Definition
– Increased ease & speed of placement
– Requires no laryngoscope, face mask
– Less hand fatigue
– Improve oxygen saturation
– Less trauma to larynx
– Few hemodynamic changes |
|
|
Term
|
Definition
– Cannot be used in conscious or semiconscious
patient
– Cannot be used with ventilating pressures
>20 cmH2O (low CL)
– Presence of an NG tube
– Airway obstruction at or below pharynx
– Full stomach or incr risk of aspiration |
|
|
Term
|
Definition
– Air leakage around LMA
– Little protection for airway from
aspiration of vomitus
– Laryngospasm
– Oropharyngeal bruising |
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