Airway Mangaement Key Points

Front 1

How are foreign bodies or tissue masses that are beyond the main stem bronchi removed?

Back 1

Bronchoscopy

Front 2

Key factors to avoid or minimize complications associated with suctioning

Back 2

1. preoxygenate
2. limit neg. P & sx time
3. use sterile technique

Front 3

Primary indications for an artificial tracheal airway

Back 3

1. relieve airway obstruction
2. facilitate secretion removal
3. protect against aspiration
4. provide PPV

Front 4

What are the two basic types of tracheal airways

Back 4

endotracheal (translaryngeal)
tracheostomy

Front 5

preferred route for establishing an emergency tracheal airway

Back 5

visualized oral endotracheal

Front 6

How can endotracheal tube position be confirmed?

Back 6

laryngoscopy

Front 7

Serious complications of emergency airway management

Back 7

acute hypoxemia, hypercapnia, bradycardia and cardiac arrest

Front 8

Primary indication for tracheotomy

Back 8

continuing need for artificial airway after prolonged period of nasal or oral intubation

Front 9

most common laryngeal injuries associated with ET intubation

Back 9

glottic edema, vocal cord inflammation, laryngeal/vocal cord ulcerations, and vocal cord polyps or granulomas

Front 10

In what type of artifical airways can laryngeal lesions occur

Back 10

Only with oral or nasal intubation

Front 11

In what type of artificial airways can tracheal lesions occur

Back 11

In any type of artificial airway

Front 12

What are the most common tracheal lesions

Back 12

granulomas, tracheomalacia, and tracheal stenosis

Front 13

to minimize or prevent trauma due to tracheal airways

Back 13

1. select correct airway size
2. avoid tube movement or action
3. limit cuff pressure
4. use sterile technique

Front 14

To minimize risk of infection

Back 14

1. use closed suction devices
2. use passive humidification
3. monitor cuff pressure
4, use subglottic sx
5. keep head of bed elevated

Front 15

Endotracheal tube obstruction can be caused by:

Back 15

1. kinking or biting of tube
2. herniation of cuff over tip
3. jamming of tube orifice over tracheal wall
4. mucus plugging

Front 16

what are the steps if a tracheal airway appears completely obstructed

Back 16

1. reposition pt. head & neck
2. deflate tube cuff
3. try passing sx catheter
4. try removing tracheostomy inner cannula
5. remove airway & provide BVM ventilation & oxygenation

Front 17

A patient is ready to extubate if he or she:

Back 17

1. can maintain adequate ventilation & oxygenation
2. is at minimal risk for upper airway obstruction
3. has adequate airway protective reflexes
4. can adequately clear secretions

Front 18

Tracheostomy decannulation can be accomplished by:

Back 18

using fenestrated tubes, progressively smaller tubes, or tracheostomy buttons

Front 19

When can a laryngeal mask airway or combitube be used

Back 19

if a difficult intubation is encountered

Front 20

when is cricothyroidotomy performed

Back 20

when patient cannot be intubated or ventilated

Front 21

Key points in planning & conducting fiberoptic bronchoscopy include:

Back 21

premedication, equipment preparation, airway preparation, and monitoring

Front 22

How do you determine proper sx catheter size to use with a given tracheal tube

Back 22

Multiply ET tubes inner diameter by 2 and then use the next smallest size catheter

Front 23

To avoid possible obstruction by catheter when sx:

Back 23

the size of the sx tube catheter outer diameter should never be greater than 1/2 to 2/3 of the size of the inner diameter of the tracheal airway

Front 24

With CNS depression, what order are the reflexes lost?

Back 24

from top to bottom
pharyngeal (gag)
laryngeal
tracheal
carinal (cough)

Front 25

What happens when the pharyngeal reflex is stimulated?

Back 25

Gag & swallow reflex

Front 26

How far should the ET tube be advanced?

Back 26

2-3 cm past the vocal cords

Front 27

What size must the airway be in order for stridor to be present

Back 27

5 mm or less in diamter

Front 28

What is an absolute containdication of nasotracheal suctioning

Back 28

epiglottitis and croup

Front 29

In what type of tracheal airways can a foam cuff be used?

Back 29

Only in tracheostomy tubes

Front 30

the tip of an endotracheal tube should ideally be how far above the carina

Back 30

5 cm or a range of 3-5
1 1/2 inches above carina or
2-3 cm beyond vocal cords

Front 31

What is the average measurement at the teeth of an ET tube

Back 31

22 cm
Range 21-23 cm

Front 32

What is indicated when there is marked stridor?

Back 32

Artificial airway is usually needed; Mild requires racemic epinephrine

Front 33

What are 2 techniques used to reduce the likely hood of tracheal dilation

Back 33

MOV - minimum occlusion volume
MLT - minimum leak technique

Front 34

What is the ideal cuff pressure

Back 34

25 mmHg or less

Front 35

what is laryngeal stenosis

Back 35

normal laryngeal tissue is replaced by scar tissue, causes stricture & decreased mobility

Front 36

what are the most common tracheal lesions

Back 36

granulomas
tracheomalacia
tracheal stenosis

Front 37

why do tracheal tubes increase incidence of pulmonary infections

Back 37

1. bypassed UA filtration 2.
aspiration of pharyngeal material 3. contaminated equipmemt or solutions
4. impaired mucociliary clearance in trachea 5. increased mucosal damage from tub or sx 6. ineffective cough

Front 38

What is the optimal cuff pressure? What is the acceptable range?

Back 38

optimal is 25 mmHg or less
range 25-30 mmHg

Front 39

Bedside methods to assess ET Tube placement

Back 39

auscultation of chest/abdomen
watch chest rise
tube length (cm at teeth)
esophageal detection device
light wand
capnometry
colorimetry
fiberoptic laryngoscope

Front 40

Factors to consider in switching from ET tube to tracheostomy

Back 40

projected time AA needed
tolerance to ET tube
pt. overall condition
able to tolerate surgery
risk/benefit ratio

Front 41

approximate tracheostoy tube inner diameter for adult

Back 41

6-11 mm

Front 42

In general the tracheal tube size is correct if:

Back 42

it occupiesbetween 2/3 to 3/4 of the internal trachea diameter

Front 43

what is tracheomalacia

Back 43

softening of the cartilaginous rings of the trachea which causes collapse on inspiration

Front 44

what is tracheal stenosis

Back 44

narrowing of the tracheal lumen due to fibrous scarring

Front 45

The passy muir valve can be used with what type of patients

Back 45

spontaneously breathing or ventilator dependants; (cuff must be deflated)

Front 46

partial airway obstruction in a spontaneously breathing patient will exhibit

Back 46

decreased breath sounds
decreased airflow through tube

Front 47

partial airway obstruction in a pt. receiving VCV will exhibit

Back 47

rise in PIP, often causing high pressure alarm to sound

Front 48

What are clinical signs of complete airway obstruction

Back 48

pt. exhibit severe distress
no breath sounds
no gas flow through tube

Front 49

a cuff leak in a pt receiving MV will cause

Back 49

system leak resulting in loss of delivered volume, and/or decreased inspiratory pressure

Front 50

define bronchoscopy

Back 50

general term to describe insertion of an endoscope into the bronchi

Front 51

What is the purpose of bronchoscopy

Back 51

inspect airway
remove objects from airway
collect sample
place device into airway

Front 52

What procedures is a rigid bronchoscope is used

Back 52

to advance to and view segmental bronchi; lg. diameter allows for sx of thick inspissated secretions & lg. mucus plugs; biopsy of tumors and removal of foreign bodies can also be done

Front 53

what is the standard port size on a resucitation device and mask:

Back 53

22 mm port