Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
84 Cards in this Set
- Front
- Back
What are the indications for intubation |
. As a route for mechanical ventilation . To secure and maintain a clear airway . To clear bronchial secretions . To protect the lungs from aspiration |
|
What can cause a patient to be unable to maintain a clear airway |
.gcs under 8 . Head or facial trauma . Upper airway obstruction / inhalation burns |
|
What types of intubation are there? |
Oral or nasal |
|
When do you avoid oral intubation |
In infants |
|
What type of intubation do you use with infants |
Nasal |
|
What are the problems of prolonged intubation |
. Communication . Nutrition . Oral pressure sores . Uncomfortable . Poor tube security- limits rehab |
|
What is the purpose of the cuff |
.To hold ett in place . To prevent aspiration . Prevent leak of ventilation |
|
Where is the endotracheal tube positioned |
2-3 cm above the carina |
|
What are the indications for a tracheostomy |
. To maintain airway . To help remove secretions . Long term positive pressure ventilation . If patient intubated over 2-10 days . To wean |
|
How does a trachy aid weaning |
Reduces work of breathing by reducing anatomical dead space created by tubing |
|
What are the types of trachy |
.Single or double lumen . Fenestrated or non . Cuffed or non |
|
Problems with single lumen trachy |
. More risk of secretion build up . Changed every seven days due to increased risk of obstruction |
|
Benefit of double lumen trachy |
Can remove inner tube to clean and clear secretions |
|
How often is a double lumen trachy changed |
Once a month |
|
What does fenestrated trachy allow |
Speech |
|
For speech with fen trachy, the cuff should be? |
Deflated |
|
How do you test speech with fenestrated trachy |
Deflate cuff and apply finger occlusion then progress to speaking valve |
|
How does a speaking valve on trachy work? |
A one way valve that allows inspiration but closes on expiration to allow vocalisation |
|
What must you do before suction with a fen trachy? |
Change inner tube to non fenestrated to prevent trauma |
|
When would you use an uncuffed trachy |
. Patient has good swallow . Long term . Paeds |
|
In decannulation how long do you cap off for in initial trial |
4 hours but should be less |
|
When you cap off a trachy for decannulation trial what should you assess for? |
. No increase in work of breathing . Effective cough . Effective swallow . Able to maintain sats |
|
Indications for suction |
If sputum is increasing work of breathing and this is affecting sats |
|
What can suppress ciliary action |
An ett |
|
Why may a patient be unable to cough |
Sedation Paralysing agents Cough dysfunction Ett |
|
How does suction mobilise secretions from distal airways |
By stimulating a cough |
|
What are the different suction routs |
Oral Oropharangeal Nasopharyngeal Endotracheal Trachy |
|
What should you do before suctioning |
Pre and post oxygenate |
|
What is used for oral suction |
Yankauer |
|
How do you avoid damaging anastomoses with suction |
Don't suction below the ett |
|
Problem with distress caused by suction |
Can increase bp and icp Can cause tachycardia |
|
What is the issue with suction causing hypoxaemia |
Cardiac arrhythmias |
|
How much saline would you install |
5-10 mls |
|
When would you install saline |
Prior to suction |
|
Purpose of saline |
Stimulates cough reflex |
|
Caution with saline because |
May cause desaturation and worsen bronchospasm |
|
What is manual hyperinflation |
Manually inflating a patients lungs with tidal volumes greater than that delivered by the ventilator |
|
What is used for oropharyngeal suction |
Guedel airway |
|
When is nasopharyngeal suction used |
In spontaneously ventilating patients |
|
Why is nasopharyngeal better than oral suction |
It's less likely to stimulate the gag reflex |
|
Position for nasopharyngeal suction |
High sit or side lying |
|
How much do you pre oxygenate before suction |
Increase the fio2 by 50% |
|
How can you ensure you place the catheter in the trachea not osophagous |
Ask patient to stick tongue out as insert catheter |
|
What can you do if patient needs frequent nasopharyngeal suction |
Insert an np airway |
|
How can suction decrease hr |
Vagal nerve stimulation |
|
Risks of suction |
. Decrease hr or breathing . Atelectasis . Hypoxaemia . Trauma and infection . Bronchospasm . Distress |
|
What is used for oral suction |
Yankauer |
|
How do you avoid damaging anastomoses with suction |
Don't suction below the ett |
|
Problem with distress caused by suction |
Can increase bp and icp Can cause tachycardia |
|
What is the issue with suction causing hypoxaemia |
Cardiac arrhythmias |
|
How much saline would you install |
5-10 mls |
|
When would you install saline |
Prior to suction |
|
Purpose of saline |
Stimulates cough reflex |
|
Caution with saline because |
May cause desaturation and worsen bronchospasm |
|
What is manual hyperinflation |
Manually inflating a patients lungs with tidal volumes greater than that delivered by the ventilator |
|
What is used for oropharyngeal suction |
Guedel airway |
|
When is nasopharyngeal suction used |
In spontaneously ventilating patients |
|
Why is nasopharyngeal better than oral suction |
It's less likely to stimulate the gag reflex |
|
Position for nasopharyngeal suction |
High sit or side lying |
|
How much do you pre oxygenate before suction |
Increase the fio2 by 50% |
|
How can you ensure you place the catheter in the trachea not osophagous |
Ask patient to stick tongue out as insert catheter |
|
What can you do if patient needs frequent nasopharyngeal suction |
Insert an np airway |
|
How can suction decrease hr |
Vagal nerve stimulation |
|
Risks of suction |
. Decrease hr or breathing . Atelectasis . Hypoxaemia . Trauma and infection . Bronchospasm . Distress |
|
Indications for manual hyperinflation |
. To aid removal of secretions . To reinflate atelectic lung . To improve lung compliance |
|
How does mhi reduce co and bp |
By increasing interthoracic pressures and therefore reducing venous return |
|
How can mhi increase icp |
By increasing interthoracic pressure and therefore reducing venous return from the head |
|
How does mhi reduce respiratory drive |
Less co2 |
|
At what level of peep would you not manually hyperinflate |
Over 10 cm h2o |
|
When would you not use mhi |
. Undrained pneumothorax . Subcutaneous emphysema/ emphysema . Bronchospasm . Cvs instability . Acute head injury . Proximal airway tumour . Rib fractures |
|
Benefits of ventilator hyperinflation |
. No disconnection from the ventilator required so don't loose peep . No manipulation of ett is more comfortable . Less risk of barotrauma or volutrauma |
|
How does giving o2 increase co2 levels in copd patients |
. Reducing drive to breathe . Hb has higher affinity for oxygen . Reversal of hpvc |
|
Why is drive to breathe reduced by giving copd patients o2 |
Chronic hypercapnia means less sensitive to co2 and instead rely on low o2 to stimulate breathing and you are removing this stimulus |
|
What does the manual hyperinflation technique include |
HI breaths Interspersed with tidal volume breaths |
|
What is a HI breath |
A slow inflation that gives a larger than normal tidal volume - an inspiratory pause- then a quick release |
|
How does manual hyperinflation aid airway clearance |
By enhancing expiratory flow and recruiting collateral ventilation |
|
How does manual hyperinflation enhance expiratory flow |
.The quick release produces fast expiratory flow rates and .a bigger tidal volume creates more elastic recoil |
|
How does manual hyperinflation aid lung recruitment |
.Slow inspiration allows slow filling alveoli to inflate . The hold recruits collateral channels . A bigger tidal volume promotes interdependence |
|
What is interdependence |
One Alveoli opening the one next to it |
|
What is used in conjunction with manual hyperinflation |
Acbt Gap Manual techniques Suction and saline |
|
How can you measure pressure given in manual hyperinflation |
A manometer |
|
Potential hazards of mhi |
. Reduced co and bp . Raising icp . Reducing respiratory drive . Barotrauma/ volutrauma |
|
Practical application of ventilator hyperinflation |
. Position for success . Increase the tv you are giving by 200 ml increments until 50% greater than baseline tv . Keep pip under 40 cmh20 . Combine with shakes to replace quick release . Combine with suction and saline |
|
Suction pressure |
15-20 kpa |