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53 Cards in this Set

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How are foreign bodies or tissue masses that are beyond the main stem bronchi removed?
Bronchoscopy
Key factors to avoid or minimize complications associated with suctioning
1. preoxygenate
2. limit neg. P & sx time
3. use sterile technique
Primary indications for an artificial tracheal airway
1. relieve airway obstruction
2. facilitate secretion removal
3. protect against aspiration
4. provide PPV
What are the two basic types of tracheal airways
endotracheal (translaryngeal)
tracheostomy
preferred route for establishing an emergency tracheal airway
visualized oral endotracheal
How can endotracheal tube position be confirmed?
laryngoscopy
Serious complications of emergency airway management
acute hypoxemia, hypercapnia, bradycardia and cardiac arrest
Primary indication for tracheotomy
continuing need for artificial airway after prolonged period of nasal or oral intubation
most common laryngeal injuries associated with ET intubation
glottic edema, vocal cord inflammation, laryngeal/vocal cord ulcerations, and vocal cord polyps or granulomas
In what type of artifical airways can laryngeal lesions occur
Only with oral or nasal intubation
In what type of artificial airways can tracheal lesions occur
In any type of artificial airway
What are the most common tracheal lesions
granulomas, tracheomalacia, and tracheal stenosis
to minimize or prevent trauma due to tracheal airways
1. select correct airway size
2. avoid tube movement or action
3. limit cuff pressure
4. use sterile technique
To minimize risk of infection
1. use closed suction devices
2. use passive humidification
3. monitor cuff pressure
4, use subglottic sx
5. keep head of bed elevated
Endotracheal tube obstruction can be caused by:
1. kinking or biting of tube
2. herniation of cuff over tip
3. jamming of tube orifice over tracheal wall
4. mucus plugging
what are the steps if a tracheal airway appears completely obstructed
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
A patient is ready to extubate if he or she:
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
Tracheostomy decannulation can be accomplished by:
using fenestrated tubes, progressively smaller tubes, or tracheostomy buttons
When can a laryngeal mask airway or combitube be used
if a difficult intubation is encountered
when is cricothyroidotomy performed
when patient cannot be intubated or ventilated
Key points in planning & conducting fiberoptic bronchoscopy include:
premedication, equipment preparation, airway preparation, and monitoring
How do you determine proper sx catheter size to use with a given tracheal tube
Multiply ET tubes inner diameter by 2 and then use the next smallest size catheter
To avoid possible obstruction by catheter when sx:
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
With CNS depression, what order are the reflexes lost?
from top to bottom
pharyngeal (gag)
laryngeal
tracheal
carinal (cough)
What happens when the pharyngeal reflex is stimulated?
Gag & swallow reflex
How far should the ET tube be advanced?
2-3 cm past the vocal cords
What size must the airway be in order for stridor to be present
5 mm or less in diamter
What is an absolute containdication of nasotracheal suctioning
epiglottitis and croup
In what type of tracheal airways can a foam cuff be used?
Only in tracheostomy tubes
the tip of an endotracheal tube should ideally be how far above the carina
5 cm or a range of 3-5
1 1/2 inches above carina or
2-3 cm beyond vocal cords
What is the average measurement at the teeth of an ET tube
22 cm
Range 21-23 cm
What is indicated when there is marked stridor?
Artificial airway is usually needed; Mild requires racemic epinephrine
What are 2 techniques used to reduce the likely hood of tracheal dilation
MOV - minimum occlusion volume
MLT - minimum leak technique
What is the ideal cuff pressure
25 mmHg or less
what is laryngeal stenosis
normal laryngeal tissue is replaced by scar tissue, causes stricture & decreased mobility
what are the most common tracheal lesions
granulomas
tracheomalacia
tracheal stenosis
why do tracheal tubes increase incidence of pulmonary infections
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
What is the optimal cuff pressure? What is the acceptable range?
optimal is 25 mmHg or less
range 25-30 mmHg
Bedside methods to assess ET Tube placement
auscultation of chest/abdomen
watch chest rise
tube length (cm at teeth)
esophageal detection device
light wand
capnometry
colorimetry
fiberoptic laryngoscope
Factors to consider in switching from ET tube to tracheostomy
projected time AA needed
tolerance to ET tube
pt. overall condition
able to tolerate surgery
risk/benefit ratio
approximate tracheostoy tube inner diameter for adult
6-11 mm
In general the tracheal tube size is correct if:
it occupiesbetween 2/3 to 3/4 of the internal trachea diameter
what is tracheomalacia
softening of the cartilaginous rings of the trachea which causes collapse on inspiration
what is tracheal stenosis
narrowing of the tracheal lumen due to fibrous scarring
The passy muir valve can be used with what type of patients
spontaneously breathing or ventilator dependants; (cuff must be deflated)
partial airway obstruction in a spontaneously breathing patient will exhibit
decreased breath sounds
decreased airflow through tube
partial airway obstruction in a pt. receiving VCV will exhibit
rise in PIP, often causing high pressure alarm to sound
What are clinical signs of complete airway obstruction
pt. exhibit severe distress
no breath sounds
no gas flow through tube
a cuff leak in a pt receiving MV will cause
system leak resulting in loss of delivered volume, and/or decreased inspiratory pressure
define bronchoscopy
general term to describe insertion of an endoscope into the bronchi
What is the purpose of bronchoscopy
inspect airway
remove objects from airway
collect sample
place device into airway
What procedures is a rigid bronchoscope is used
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
what is the standard port size on a resucitation device and mask:
22 mm port