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Laryngeal Mask Airway:
1. What two parts does it consit of?
2. Where is it inserted into?
3. Ventilation is directed to the ___.
4.Can it be used in concious or semicomatose patients? and why?
1. Short tube and a small mask that is inserted deep into the oropharynx
2. Open surface of the mask faces the laryngeal opening.
4. No, it can stimulate gag refelx
When the Laryngeal Mask Airway (LMA) is correctly inserted the tip of the mask should rest against the ____ ____ _____, allowing the upper border of the mask to rest against the base of the _____.
-upper esophageal sphincter
What are the normal adult sizes for Laryngeal Mask Airways?
4 & 5
Laryngeal Mask Airway:
1. What must the upper cuff tip not enter?
2. What age groups are the LMA's avaliable for?
3. What is the name of another LMA that you may come across?
4. What is convienent about LMAS?
1. The glottic opening
2. Infant - adult
3. King LAD (larngeal airway device)
What are the two basic types of Tracheal airways?
1. Endotracheal tubes (1/2)
2. Tracheostomy tubes (1/3)
1. What are endotracheal tubes designed to do?
2. What do they increase and reduce?
3. What 4 things can it cause trauma to?
1. To circumvent the nose, mouth, larynx, and pharynx reducing anatomic deadspace.
- 2. Increase: airway resistance
- Reduces: cough efficacy
3. Trauma: Nose, mouth, larynx and trachea
How do you produce a cough?
vocal cords make a seal over the glottic
Name the 7 parts of the endotracheal tube structure.
- 1. Polyvinyl chloride tube material
- 2. Cuff
- 3. Pilot line
- 4. Pilot balloon
- 5. Murphy eye
- 6. 15 mm connector ( 15 & 22 in resp care)
- 7. Radiopaque line
1. What is the name of the side port on the endotracheal tube? and what is it used for?
2. The cuff must have high ____ & low ____.
3. What is the radiopaque line for?
1. "Murphy eye" - it ensures gas flow if the main port becomes obstructed.
2. High VOLUME & low PRESSURE
3. To help identify location of tube position on the radiograph.
What are the 5 endotracheal tube markings?
- 1. words "oral" or "nasal"
- 2. ID in mm or Fr size
- 3. ED in mm or Fr size
- 4. "IT" or "Z79" (American National Standards Institute aka ANSI)
- 5. tube length in cm
What are the recommended tube endotracheal tube length for men and women (lip placement) ? nasal? tube diameter?
Males 21-23 ( -2 females, +2 nasal )
diameter: 7-8 females & 8-9 males
Are endotracheal tubes for long term or short term use?
short term, 7-10 days
What are the advantages of oral endotracheal tubes ? (4)
1. Best for emergency use
2. Best for short term intubation
3. Larger diameter can be tolerated
4. Avoid trauma/complications to the nasal cavity
What are the disadvantages of oral endotracheal tubes? (6)
1. Poorly tolerated in a conscious patient
2. Prone to obstruction by biting
3. Difficult to stabilize/inadverent extubation
4. Oral hygiene difficult
5. Inability to talk or eat
6. Increased risk of right mainstem intubation
What are the advantages of nasal endotracheal tubes? (4)
1. Easier to stabilize
2. Better tolerated by the patient
3. Improved communication
4. Blind nasal intubation is possible
What are the disadvantages of nasal endotracheal tubes? (4)
1. Nasal/paranasal sinus complications
2. More difficult to perform
3. Increased airway resistance and suctioning is more difficult
4. Difficult to scope
What are the two ways to perform a nasaotracheal intubation?
1. Direct visualization with a standard or fiberoptic laryngoscope.
2. Blindly, but the patient must be breathing spontaneously.
What are two unique endotracheal tubes? explain.
- Pediatric/ Neonatal
- - do not have cuffs
- - cole
- - triple lumen High-Lo ET Tube for jet ventilation
- Carlens Double Lumen ET Tube
- - "carlens goes into the left, and white goes in the right"
Why are endotracheal tubes in small children uncuffed?
because of the anatomic differences of the larynx.
In children the cricoid ring is the narrowest portion, and its circular lumen stabalizes the tube without the need for a balloon cuff.
Why do adult endotracheal tubes need a cuff?
the volcal cords form the narrowest portion of the larynx and trachea, necessitating stabalization of the tube with a cuff.
What are the hazards and complications that a oral endotracheal tube can cause to the larynx (2) and to the cuff site(2) ?
- -vocal cord edema
- -vocal cord paralysis
- *Cuff Site
- - Stenosis (narrows due to scar tissue)
- - Fistula (opening between two structures that shouldnt normally be there)
what are the hazards and complications that a naso endotracheal tube can cause to the nasal cavity (4), larynx (3), and tube tip (2) ?
- *Nasal Cavity
- -Epistaxis(bloody nose)
- -Otitis (ears)
- -Pressure necrosis at tip of nares
- -Vocal cord granuloma
- -Glottis edema
- *Tube Tip
What are the first 5 steps to do a orotracheal intubation?
1. Assemble and check equipment
2. Position patient
3. Preoxygenate the patient
4. Insert the laryngoscope
5. Visualize the glottis
What equipment is needed to perform a oral intubation? (12)
- 1. O2/ventilation equipment
- 2. Suction equipment
- 3. Laryngoscope w/blades
- 4. Stylet
- 5. Magill forceps
- 6. Tape/syringe
- 7. Local anesthetic/lubricant jelly
- 8. Stethoscope
- 9. CDC barrier protection
- 10. ET tubes
What are the ET tube sizes for:
2. 6mo - 5 yrs
3. 5 yrs - 12 yrs
infant 2.2-4 mm ID
6mo-5yrs 4.5-5 mm ID
5-12yrs 5-7 mm ID
Adolescent 6.5-7.5 mm ID
Female 7-8 mm ID
Male 8-9 mm ID