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When is a NIV airway used?
- - to maintain an airway
- -reduce pharyngeal mm tone
- - suctioning
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What is NIV airways?
- - devices that do not end up in your lungs
- - Oropharyngeal
- - Nasopharyngeal
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What type of airway is a guedels?
- - NIVairway
- - Oropharyngeal airway
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What is this airway?
- guedels airway
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What is the guedels airway used for?
- - keep the oropharynx open
- - make it easier to suction
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Describe how to insert a guedels:
- - upside down- to compress the tounge
- - twist to sit flt
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Name the parts of the guedels!
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What is the oropharyngeal airways?
- guedels
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What are some complications with the oropharyngeal airways?
- - muscosal trauma
- - obstruction if airway is too small
- - posterior displacement of the tongue- obstruction
- - gagging and vomiting- aspiration
- - biting on the tube
- - patient distress
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What is the nasopharyngeal airway?
- - airway inserted into the nose to the trachea
- - used for suctioning
- - good for when a pt needs to be suctioned a number of times
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How do you size a NP airway?
- - noone really knows
- - but bigger is better
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How do you insert a NP airway?
- - lube
- - in nose
- - aim for opposite eye
- - push in
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What are some complications of a NP airway?
- - not comfy
- - need another person to hold them down
- - can cause obstruction
- - can cause trauma
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What is this?
- - NP airway
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What is Endotracheal intubation?
- - the insertion of the ETT tube either oro or naso
- - can get naso ones for kids
- - this is the gold standard for airway management
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When should an ETT be inserted?
- - acute airway obstruction
- - facilitation of suctioning
- - protection of airway
- - resp failure requiring ventilatory support and need an increase in O2 requirements
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What is this?
And name the parts
- - cuff
- - pilot tube of ETT- to inflate cuff
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How would you ensure the ETT is in the correct position?
- - Xray
- - flow chart- the cm that is meant to be at the mouth
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What is this and where do the parts sit?
- Swan Ganz Catheter
- A = right atrial lumen
- B = thermistor
- C = mixed venous oximeter
- D = pulmonary artery lumen
- E = balloon inflation/deflation
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How do they intubate a pt?
- - with the use of laryngoscope or fibreoptic bronchoscopy
- - head in ext
- - ETT to sit 3-4 cm about the carina
- - inflate cuff
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What is the role of the cuff in an ETT?
- - secures the ETT in place
- - ensures there is a closed system
- - NOTE with kids dont use cuffs
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ETT and sizes- why important?
- - different sizes based on inside diameter- for girls 8mm
- - too big can cause necrosis
- - too small cuff wont seal- you will hear a gurgle
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What happens if the ETT goes too far down?
- goes into the right
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What happens if the cuff has too much or too little pressure in it?
- - too much- may cause necrosis
- - too little- wont secure it in place
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What is the normal cuff pressure for an ETT?
- 25- 30mmHg
- - check with a manometer
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What are the two techniques for intubation?
- - direct laryngoscopy
- - fibreoptic bronchoscopy- camera and light
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Endotracheal intubation important points?
- - must preoxygenate
- - oxygenation during attempts
- - must have suction equipment available
- - pt often sedated and paralysed
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How do you confirm the position of the ETT?
- - direct visualisation of the position with the bronchoscope
- - auscultation
- - chest wall movement
- CXR
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What are some of the complications of the ETTs during intubation?
- - injury to mouth or nose
- - dental injury
- - mucosal damage
- - laryngeal injury
- - injury to the recurrent laryngeal nerve
- - oesophageal intubation
- - aspiration
- - hypoxaemia
- - tracheal rupture
- - oesophageal perforation
- - stimulation of the resp tract- can result in triggering of cardiac, airway, cerebral, neuromuscular responses
- - stimulation of vagus nerve
- - drugs used to intubate can also trigger haemodynamic responses
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What are some complications of ETT while tube is in mouth?
- -migration of tube
- - blockage of tube
- - loss of normal URT defence mechanisms
- - loss of URT heating and humidification
- - damage to vocal cords- reduction in adductor activity of the laryngeal mms- poor glottic closure
- - damage to airway from tube and cuff
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What are some of the complications of the ETT post removal?
- - some problems may not become obvious unit pt isextubated
- - laryngeal damage
- - tracheal stenosis
- - aspiration
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What are complications of the ETT associated with?
- - emergency intubation
- - pt position- head needs to be tilted back
- - pt anatomy- obese people are hard to intubate
- - experience of the operator
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What are some pts symptoms post extubation of the ETT?
- Acute:
- - stridor
- - resp distress
- - need for reintubation
- Other
- - sore throat
- - hoarseness
- - paranasal sinusitis
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Suctioning with an ETT:
- how often?
- saline?
- sterile or clean?
- - suction as often as needed
- - sometimes saline can help- but evidence doesnt support this
- -
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What do you need to be careful of when treating someone with an ETT?
- - dont pull it out
- - dont move it too much
- - when moving pt ensure someone is watching the head
- - when percs and vibes always suction
- - check for pressure areas
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What is a tracheostomy?
- - accessing the airway through the trachea below the level of the vocal cords
- - Has become more common as materials have improved
- - Hx 2-3000yrs
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What is this?
- trachestomy
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What are the parts of a tracheotomy?
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Why would you perform a trachea?
- - provide airway access for anyone who has been intubated/ ventilated for a long period of time
- - bypass any obstruction above the glottis
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When is a trachea considered?
- - complex decision based on multiple individual factors
- - intubated and ventilated longer than 10 days
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What are the benefits of a tracheostomy?
- - reduced airway resistance (shorter tube)
- - quicker weaning off mechanical ventilation
- - easier clearance of secretions
- - easier facilitation of normal swalowing, speech
- - increased patient mobility
- - increased patient comfort
- - less sedation required
- - more secure airway
- - easier to reinsert
- - nothing in mouth
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What are some of the disadvantages of a tracheostomy?
- - surgical technique with associated complications
- - tracheal damage
- - permanent scar
- - bypass normal URT defences
- - infection at site of stoma/ hole
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What are the ways to insert a trachea?
- - hole = stoma
- - percutaneous- in unit and intensivists do it
- - surgical- people with huge necks and you cant get a visual of the anatomy
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What are the different types of tracheostomy?
- - cuffed and uncuffed
- - fenestrated (hole in it)/ unfenstrated
- - talking/ speaking traches
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When would you use cuffed or uncuffed tracheas?
- Cuff
- - as for ETT
- - implications in tracheal damage
- Uncuffed tubes:
- - used in children
- - used for weaning from ventilation and prior to removal of trache
- - may be used for those requiring suctioning but mechanical ventilation
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What is a fenestrated tracheostomy?
- -holes along the length of the tube above the cuff
- - allow air to pass thru the URT
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How can you speak with a trachea?
- - cuff down/ fenestrated tube
- - finger over the end
- - special speaking valves- valves open during inspiration and closes during expiration
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What can a trachea be attached to?
- - HME
- - Ladells bag
- - inline suction
- - trachea bag
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Tracheostomy care
- - monitor cuff pressure
- - suctioning
- - dont pull it out
- -dont stand in front of a pt when they cough
- - goggles
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How to assess a pt with a trachea or ETT
- - as per usual resp assessment
- - Differences
- - no ability to talk
- - auscultation
- - no ability to cough but huff??
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