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62 Cards in this Set

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causes of upper AW obstruction
tongue/soft tissue obstruction-most common, tenacious secretions,laryngospasm,laryngeal or subglottic edema, foreign bodies(food,toys,dentures)
best postion to establish airway if pt has fractured neck??
jaw thrust,or modified jaw thrust
adv & disadv of jaw thrust aw position?
adv:can do on pt with fractured neck.

disadv: difficult to perform and obtain good seal. tiring and no denture control
adv & disadv of chin lift
adv easy to perform, no fatigue. control of loose denture

contraind: fractured neck
adv & disadv of neck lift
adv easy to perform. good for young ones.

dis. not successful on elderly. arm fatigue from neck support.

contraind: fractured neck
Oral Pharyngeal AW
good for unconscious pts

indication:bite block for et tube, oral suctioning,support base of tongue.

complications: gagging,vomit, laryngospasm
Nasal pharyngeal AW
good for conscioius pts

support base of tongue
deep trach suctioning

hazards: trama to mucosa,epistaxis,increase RAW
suctioning indications
accumulated secretions
obstructed AW
depressed cough
inability to swallow
suctioning hazards
trama to mucosa
contamination
hypoxemia-lead to tachycardia and arrhthmias and bradycardia
purpose for suctioning
patent aw,specimen collection and stimulate cough
suction catheter should not be AW no longer than ??? seconds?
15
pre and post oxygenation should be ___% O2 and for how many minutes?
100 % O2 and 1-2 minutes
how often should suctioning be done?
only as needed (prn)
Reason to intubate?
patent aw
access for suctioning
means to mech ventilate
protect aw (aspiration and obstruction)
intubation physiologica and psychological alterations
by pass normal filtration/humidification and warming. less effective cough. disrupts mucus transport. loss of personal dignity and unable to communicate.
complications to intubation
infection
cuff pressure
laryngospasm
right stem bronchus intubation
cuff pressure on entubation tube should be less than
20 torr
how can endotracheal tube postion be assessed?
bilateral chest expansion during inspiration

auscultation

CXR-should be 2-3 cm above carina
ET tube procedure
postion head
hyperoxygenate
laryngescope in left hand,et in right,
insert blade in mouth,lift epiglottis(curve blade in vallecula and straight under epiglottis).
insert tube,inflate,assess tube postion, vent and oxygenate.
cuff pressure is high pressure/low vol or high vol/low pressure
low vol/high pressure
clues of complete obstruction
marked inspiratory effort w/o air movement.

intercostal,sternal, epigastric retraction

contractions of accessory muscles,
anxious pt
unconcious pt may appear dusky or strong ventiltory efforts
clues of partial obstruction
noisy inspiration usually inspiration and low tone.
greater the obstruction the louder the noise.
stridor usually refers to a glottic obstruction and high pitched inspiration sound.
extubation technique
suction tube above and below cuff, have pt inspire deeply,deflate cuff,pull out tube AT PEEK INSPIRATION,have pt cough and clear secretions, observe pt for complications
extubation complications
severe resp distress and or marked inspiratory stridor. (reintubate). modererate distress o2,cool mist aerosol and racemic epi to reduce swelling.
mild distress
provide humidity and O2
post extubation complication
vocal cord polops,mucosal ulceration,tracheomalacia (trach cartilage softening),tracheostenoisis (gradual obstruction narrowing)
tracheostomy indications
preferred for long term intubation or when upper AW obstruction prevents intubation.(should be done under sterile conditions)
tracheostomy adv
adv easier to stabilize,suction & tolerate. some have easy to clean inner cannula. pt able to eat and speak. few hazards and minimal RAW.
trach hazards
first 24 hrs bleeding,pneumothorax,air embloism,subcutaneous emphysema. Later infection, hemorrhage,obstruction,T-E fistula,
inflate trach cuff when
pt is eating
pt is on Postive pressure ventilation
trach tube should not be changed no more than?
once a week
3 reasons trach should be changed
obstruction-can't pass suction catheter

tube too small-very high cuff pressure

punctured cuff-ualbe to seal trach
care after trach removal
don't suture stoma closed
apply steril dressing and antibotic
clean periodically w/ peroxide
have pt cough to clear secretions
laryngoscope straight blade fits
directly under epiglottis and is called miller blad
laryngoscope curved
machintosh-fits into vallecula and indirectly raises epiglottis
one cannula trach tube
shiley
jackson trach tube
silver metal trach tube
comes with an inner cannula and optional cuff
bivona cuff
FOAM FILLED TRACH CUFF
TRACHEAL BUTTON USED?
TO MAINTAIN STOMA, USED IN SOME SLEEP APNEA CASES.
CAUDE TIP CATHETER IS ANGLED TO HELP SUCTION??
LEFT MAIN STEM BRONCHUS
EXTERNAL DIAMETER OF SUCTION CATHETER SHOULD BE NO GREATER THAN?
1/2 INSIDE DIAMETER OF ET OR TRACH TUBE

ET TUBE X 2=CATHERTER NEXT SMALLER SIZE

8ETX2=16 NEXT smaller size 14
olympic trach talk CUFF must be inflated or deflated
DEFLATED
PT CAN'T BREATH AROUND TRACH TUBE!!! W CUFF INFLATED
GAG REFLEX OCCURS WHERE?
PHARYNX
COUGH OCCURS WHERE?
PHARYNX,LARYNX AND TRACHEA AND CARINA
SNEEZE OCCURS WHERE?
UPPER NASAL PASSAGE
SWALLOWING OCCURS WHERE?
PHARYNX
WHAT SHOULD BE MONITORED DURING SUCTIONING
MONITOR CARDIAC STATUS
YANKAUR TONSIL TIP FOR?
ORAL ASPIRATION FOR LRG AMTS OF MATERIAL VOMITES
SWALLOWING OCCURS WHERE?
PHARYNX
WHAT SHOULD BE MONITORED DURING SUCTIONING
MONITOR CARDIAC STATUS
YANKAUR TONSIL TIP FOR?
ORAL ASPIRATION FOR LRG AMTS OF MATERIAL VOMITES
first signs of hypoxia in a pt who is being suctioned
tachycardia
complications to suctioning
change in HR
atelectasis
hypoxia
bronchial bleeding
cardiac arrhyhmias
hr decrease while suctioning due to ?
vagal stimulation
features for manual resuscitators include
peep capabliity
easy to assemble
non slip material for bag
flow inflating bags are
used for anesthesia and peds venting,require gas source, allow user to feel compliance easily
types of valves used on manual resuscitators include
spring disk
diaphragm and leaf valve
diaphragm and duck bill
spring ball
diphragm
complication of manual resuscitation when bag/mask valve is used
gastrci distension
what would increase fio2 being delivered form a laerdal resuscitation bag
add an o2 reservoir to the bag, increase o2 oxygen flow
to make sure a manual ventilator is ready for use
make sure no gas escapes thru outlet port when closed off, squeeze bag & make sure the air/o2 reservoir intake valve closes properly,
self inflating manual resusitator should deliver how many ml of air?
800-1200ml (2 to 3 times Vt)
self inflating manual resusitator flow?
10-15 lpm adult 5-10 kis
85-100% for CPR and suctioning
21-100% for transport-reservior bag should be added to increase fio2.