CP 2013 Viva study
Card Set Information
CP 2013 Viva study
Week 5 L3
When is a NIV airway used?
- to maintain an airway
-reduce pharyngeal mm tone
What is NIV airways?
- devices that do not end up in your lungs
What type of airway is a guedels?
- Oropharyngeal airway
What is this airway?
- guedels airway
What is the guedels airway used for?
- keep the oropharynx open
- make it easier to suction
Describe how to insert a guedels:
- upside down- to compress the tounge
- twist to sit flt
Name the parts of the guedels!
What is the oropharyngeal airways?
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
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
How do you size a NP airway?
- noone really knows
- but bigger is better
How do you insert a NP airway?
- in nose
- aim for opposite eye
- push in
What are some complications of a NP airway?
- not comfy
- need another person to hold them down
- can cause obstruction
- can cause trauma
What is this?
- NP airway
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
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
What is this?
And name the parts
- pilot tube of ETT- to inflate cuff
How would you ensure the ETT is in the correct position?
- flow chart- the cm that is meant to be at the mouth
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
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
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
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
What happens if the ETT goes too far down?
- goes into the right
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
What is the normal cuff pressure for an ETT?
- check with a manometer
What are the two techniques for intubation?
- direct laryngoscopy
- fibreoptic bronchoscopy- camera and light
Endotracheal intubation important points?
- must preoxygenate
- oxygenation during attempts
- must have suction equipment available
- pt often sedated and paralysed
How do you confirm the position of the ETT?
- direct visualisation of the position with the bronchoscope
- chest wall movement
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
- 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
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
What are some of the complications of the ETT post removal?
- some problems may not become obvious unit pt isextubated
- laryngeal damage
- tracheal stenosis
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
What are some pts symptoms post extubation of the ETT?
- resp distress
- need for reintubation
- sore throat
- paranasal sinusitis
Suctioning with an ETT:
- how often?
- sterile or clean?
- suction as often as needed
- sometimes saline can help- but evidence doesnt support this
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
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
What is this?
What are the parts of a tracheotomy?
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
When is a trachea considered?
- complex decision based on multiple individual factors
- intubated and ventilated longer than 10 days
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
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
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
What are the different types of tracheostomy?
- cuffed and uncuffed
- fenestrated (hole in it)/ unfenstrated
- talking/ speaking traches
When would you use cuffed or uncuffed tracheas?
- as for ETT
- implications in tracheal damage
- used in children
- used for weaning from ventilation and prior to removal of trache
- may be used for those requiring suctioning but mechanical ventilation
What is a fenestrated tracheostomy?
-holes along the length of the tube above the cuff
- allow air to pass thru the URT
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
What can a trachea be attached to?
- Ladells bag
- inline suction
- trachea bag
- monitor cuff pressure
- dont pull it out
-dont stand in front of a pt when they cough
How to assess a pt with a trachea or ETT
- as per usual resp assessment
- no ability to talk
- no ability to cough but huff??