Critical Care Techniques

Front 1

Egans book and workbook, equipbook by white and basic clinical competencies by white

Back 1

Score 20% tests, 20%quizzes homework, lab skills 10%, PPS 5%, 45% final

Front 2

Assignment 1 white clinical lab competencies

Chapter 21 page 450 to 455

Back 2

Egan fundamentals of respiratory care

Chapter 9 page 189 to 197

Chapter 36 page 737 to 743

Egan workbook

Chapter 36 page 245 to 246

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WHat is critical care

Back 3

Critical care: the specialized care of patients whose conditions are life threatening and who require comprehensive care and constant monitoring, usually in intensive care units, also know as intensive care

ICU, SICU, NICU, PICU, CICU

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Rapid Response or CODE BLUE

Back 4

Immediate help

Front 5

picture of facial with bones and sinuses

Back 5

cross section of head and upper airway

Concha is a space or cavity, its cartilage material that lightens up the head

For example middle nasal concha or turbinate

Front 6

Upper respiratory Tract (URT)

Back 6

Defined as airways starting at the nose, extending to the trachea

URT is composed of

:Nasal cavities and sinuses

:Oral cavity

:Pharynx

:Larynx

Front 7

Nasal cavity

Back 7

External nares give entrance into cavities

Vestibules contain gross hairs working as filter

Concha or turbinates: 3 shelf like bones projecting from the lateral walls of the septum

:Function: increase surface area of filtering

:Warming

:humidifying of inhaled gases

Front 8

Nasal cavity

Back 8

Contain olfactory Cells providing sense of smell

Surface fluid is provided by goblet cells and submucosal glands(produce most) in cavity and sinuses

Front 9

SInuses

Back 9

Hollow spaces in the facial bones

Four sets of sinuses

:Frontal, ethmoid, sphenoid, maxillary

Function of sinuses

:Reduce weight of head

:Strengthen skull

:Modify voice during phonation

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Oral Cavity (part of the URT upper respiratoory tract)

Back 10

Forms common passage for air, food and fluids

Tip of soft palate, uvula, marks posterior aspect of cavity

:Posterior portion of tongue has nerve endings triggering gag reflex to protect airway

Front 11

Picture of oral cavity

Back 11

Palatine tonsil, tounge, lips and more, need to be able to visualize these

Front 12

Pharynx

Back 12

Oral and nasal cavities open into the pharynx:Nasopharynx (from nasal cavity to uvula)::Adenoids lie right where many particles impact

::Eustachian tubes link to middle ear

:Oropharynx (from uvula to tip of epiglottis)

::Palatine tonsils (removed in tonsillectomy)

Front 13

Pharynx

Back 13

Oral and nasal cavities open into the pharynx

:Laryngopharynx (tip of epiglottis to larynx)

::anatomic location where respiratory and digestive tracts divide

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Larynx

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Contains nine cartilages

:Thyroid (adams apple) (largest one)

:Cricoid cartilage fall just below thyroid cartilage

Epiglottis attaches to the thyroid cartilage

:Closes laryngeal opening during swallowing

:Creates tight seal to prevent liquids and food from entering respiratory tract

:Swallowing

::Muscular contractions resulting in early vocal cord closure and downward epiglottis movement

Front 15

Larynx

Back 15

Epiglotting attaches to thyroid cartilage

:Folds connecting epiglottis and tongue form space called "vallecula"

::Key landmark for oral intubation

3 paired cartilages involved in phonation (speaking)

are the arytenoid, corniculate, and cuneiform

Front 16

Patent(open) Upper airway

Back 16

Relative positions of oral cavity, pharynx, and larynx and major determinant of patency, particularly in unconscious patient

:Head tilts forward, partial or total occlusion can occur

:Extend head into "sniff position" to open airway and facilitate artificial airway insertion

Front 17

Lower respiratory tract

Back 17

Everything distal to larynx

Made up of conducting airways and respiratory airways

Conducting airways: first 15 generations

:purpose: convey or transport gas from the URT to area of gas exhange (lung parenchyma)

Front 18

Lower respiratory Tract

Back 18

Respiratory airways

:MIcroscopic airways distal to conducting zone

:Participate in gas exchange with blood

:respiratory bronchiole

:Terminal bronchiole

:Alveolar duct

:Alveolar sacs (clusters)

Front 19

Trachea and bronchi

Back 19

Trachea: extends below cricoid cartilage to sternal angle(where main stem bronchi bifurcate)

Anterior and sides supported by 16 to 20 C shaped cartilaginous rings

Trachealis muscle connects tips of C shaped cartilage and form posterior wall

Front 20

Trachea and bronchi

Back 20

Right and left mainstem bronchi bifurcate at carina

Right bronchus branches at 20 to 30 degree angle

:Due to angle, most foreign aspirate goes to the right lower lobe

Left bronchus branches at 45 to 55 degree angle

Front 21

Lobar and segmental pulmonary anatomy

Back 21

Each lung is divided into lobes and segments

Right lung has 3 lobes and 10 segments

Left lung has 2 lobes and 8 or 10 segments

Front 22

Lobar segmental pulmonary anatomy

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Each segment is supplied by segmental brochus

These further divide numerous times until conducting airways end in terminal bronchioles

:All airways up to this point constitute anatomic deadspace (or conducting airways)

::2 ml/kg of lean body weight, typically 150 ml (quiz)

Front 23

Airway Care The adult trachea is 12 inches, not 12 cm like book says

Back 23

Tracheobronchial aspiration

Intubation

Artificial airways

:Nasopharyngeal

:Oropharyngeal

:Esophageal obturator laryngeal airway

:Endotracheal tube

:tracheostomy tube

Front 24

Tracheobronchial aspiration

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Suctioning: subatmospheric pressure is applied to the trachea, mainstem bronchi, or oropharynx for the evacuation of secretions

Gas is evacuated from the airway and is replaced with room air

Front 25

Goals for suctioning or (tracheal bronchial aspiration)

Back 25

Aid bronchial hygiene (number 1 goal)

Therapeutic support for patients with artificial airways(cant cough and we secrete more mucous/sputum so need to suction it out)

Improve the efficiency of ventilation

Front 26

Indications for suctioning

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Endotracheal or tracheostomy tube placement that interferes with normal clearance mechanisms

Inability to cough effectively and clear rhonchi(breath sound caused by secretions in the upper airway)

Dysphagia(difficulty swallowing)

Obstruction of airway by secretions

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Hazards of suctioning

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Hypoxemia (number 1) Sucks out O2 rich air and pulls in room air

Mucosal damage

Arrhythmias

Hypotension

Atelectasis (airway collapse)

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Hazards of suctioning: hypoxemia

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O2 rich Gas is evacuated from the airway and is replaced with room air

Room air enters around the catheter: bernoulli

Apnea during suctioning may lead to hypoxemia and arrhythmias

Front 29

Hazards of suctioning: mucosal damage

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Excessive mucosal Pressure

Suctioning elevates and tears the mucosa

Causes hemorrhage and erosion

1.36cm per mmhg

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Hazards of suctioning arrhythmias

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Vagal stimulation caused by tracheal irritation

Hypoxemia leading to myocardial hypoxia leading to arrhythias

Front 31

Hazards of suctioning hypotension

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Bradycardia resulting from vagal stimulation (hitting the carina)and prolonged coughing

High intrathoracic pressure

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Hazards of suctioning hypotension

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Decrease venous return (pre load)

:Leads to decrease cardiac output (starlings law)

:Decrease blood pressure

:Increase ICP

Front 33

Hazards of suctioning Atelectasis(collapsed airway)

Back 33

With atelectasis you also have lower FRC

Suctioning applied during catheter advancement or not retracted a bit following full insertion

Catheter is too large for the artificial airway

:Too large for diameter of airway(not enough entrainment of bernouli, or replacement gas)

:Results in inadequate room air entrainment around catheter

Front 34

Hazards of suctioning

Back 34

Hypoxemia, mucosal damage, arrhythmias, hypotension, atelectasis

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Techniques for suctioning

Back 35

Sterile technique should always be used with an artificial airway (below the trachea)

For oral care, you can use aseptic technique

:Double glove

:dispose of catheter and gloves in lined container: red

Aseptic techniques for oropharyngeal or nasopharyngeal suctioning

Front 36

Techniques for suctioning

Back 36

Suction should never be applied when the catheter is being advanced

Following full advanced of the catheter, retract it a short distance before suction is applied

Intermittent suction should be applied as the catheter is withdrawn

Procedure should never exceed 15 secs

Front 37

Suctioning

Back 37

Application of negative pressure to airways through collecting tube

Suctioning of trachea and bronchi usually done through endotracheal tube or tracheostomy tube

Two types

Normal suction catheter, thin catheter with a thumb control valve and connector for vacuum

The other has a tip, its hard non pliable plastic, yankaur suction apparatus or tonsil tip suction apparatus, its used for larger secretions such as vomit