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10 Cards in this Set
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orotracheal intubation |
Stabilize tube/confirm placement :listen for equal and bilateral breath sounds as patient is being ventilated :observe chest wall for adequate and equal chest expansion :if ETT tube is in airway, chest CO2 levels begin to rise, seen on capnogram During orotracheal intubation, make sure to visualize Tongue, vallecula, epiglottis, vocal cords, glottis, and arytenoid carlage |
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Visualizing intubation |
Conventional battery operated laryngoscope :macintosh :Miller Fiberoptic bronchoscope :also may be used for difficult intubations |
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Videoscope, fiberoptic laryngoscope |
Optical camera attached to the end of the laryngoscope :allows for video of the airway to be shown on a screen :"glidescope" make intubations easy and safe :very expensive |
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Capnometry: CO2 monitoring (brand name easy cap i and easy cap ii |
Colormetric capnometry (used if intubating in the field by EMTs) :For ETT tube placement :CPR, to detect CO2 which shows if circulation is happening. 5% is normal exhaled CO2, which is desired so if your not totally yellow on colorimeter, not getting sufficient compressions.
End tital CO2 or PetCO2 is the most accurate for CO2 measurement because its the most enriched at the end of your breath
760-47= 713x .05 = 35torr which is the torr of CO2 at sea level expired at 5% CO2 so remember 35 torr is the pressure of CO2 exhaled at sea level 5% If they exhale at 3.8% what torr would that be 27.094 torr |
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Endotracheal intubation Potential complications |
Early :esophageal intubation :Mouth, teeth, nose trauma :R mainstem bronchus intubation :Kinded ETT :vomiting/aspiration Late :Vocal cord damage :Tracheal stenosis :Infection |
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Endotracheal intubation indications |
Maintain patent airway Support mechanical ventilation Need airway access |
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Orotracheal intubation to assess endotracheal tube position |
Ausculation of chest and abdomen Observation of chest movement Tube length (cm to teech) esophageal detection device Light wand Capnometry Colorimetry Fiberoptic laryngoscopy or bronchoscopy Videolaryngoscopy |
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Extubation procedure |
Assemble equipment Towel, scissors, gloves, suction, O2 device, syringe Explain procedure to patient Preoxygenate patient, remove ETT tape Suction oropharynx Suction ETT |
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Extubation procedure |
Insert catheter :instruct patient to take a deep breath when instructed to Deflate cuff and remove the tube swiftly :Applying suction throughout withdrawl Apply O2 auscultate lungs and neck for stridor Check Spo2 instruct patient to DB and C (deep breath and cough) |
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Assignment |
Chapter 20 page 423 to 440 |
