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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