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What are the two types of laryngoscope blades?
What are the 6th through 9th step of orotracheal intubation?
6. Displace the epiglottis
7. Insert the tube
- 8. Assess the tube position
- -The tip of the tube should be about 2-5 cm above the carina (on NBRC exam!)
9. Stabilize the tube/confirm placement
What are the 8 beside methods to assess endotracheal tube position?
- 1. Auscultation of chest and abdomen
- 2. Observation of chest movement
- 3. Tube length (cm to teeth)
- 4. Esophageal detection device
- 5. Light wand
- 6. Capnometry
- 7. Colorimetry
- 8. Fiberoptic laryngoscope
What sounds will you hear if the tube is inserted into the abdomen?
What are light wands for?
they are inserted into a endotracheal tube to help with blind intubations of the trachea.
How many centimeters should the tube be above the carina?
2 - 5 cm
Explain what the "Capnometry analysis" device is used for?
- Assess esophageal intubation using exhaled carbon dioxide. Insipred air only contains about 0.04% CO2, and end tidle gas contains about 5% CO2. Placement of an endotracheal tube in the resp. tract causes CO2 levels to increase abruptly during expiration. Increase is evident on the capnographic display. If tube is in esophagus, CO2 levels will remain near zero.
- (air % 0, exhaled 4-6%)
Explain what the "Colorimetry" device is used for?
Used to confirm esophageal tube placement during intubation. Its cheaper than Capnometry and disposable. Functions similar to pH paper, a colorimetric system has a indicator that changes colors when exposed to different levels of CO2.
What may happen if you use a colorimetry or capnometry device with a cardiac arrest patient?
Their expired CO2 levels may be near zero due to poor pulmonary blood flow, which may result in a false-negative result.
What is the process of removing and artificial tracheal airway called?
When is a patient ready for extubation?
1. when the original problem is no longer present
2. mechanical vent. is no longer needed
3. adequate reversal of neuromuscular blockade must be established
4. demonstrate adequate spontaneous resp. function w/a vital capacity of greater than 15mL/kg and a negative inspiratory force of greater than 20-30 cm H20 (-30 in CPG)
5. minimal risk of aspiration
6. can clear pulmonary secretions
What is the procedure to extubate a patient? (7)
- 1. Assemble equipment
- 2. Suction ET tube, then pharynx to cuff
- 3. Oxygenate patient w/bag
- 4. Deflate cuff at peak of inspiration
- 5. Remove tube at peak of inspiration
- 6. Apply oxygenation/humidity
- 7. Assess/Reassess (good air movement?)
What are 2 hazards with extubating a patient?
1. Glottic edema
2. Sub-glottic edema
What is the name of the procedure that involves establishing access to the trachea via neck incision?
Who performs this procedure?
2.By a surgeon in the surgical setting
After a tracheotomy is perfromed, what is the name of the opening in the neck?
Explain "Percutaneous Dilation Tracheotomy" procedure
Requires the use of larger and larger dilators to stretch the stoma until its large enough for a regular trach tube. This procedure is rapid, requires no OR and lower incident of post OP complications
Explain what a "Fenestrated" trach tube is, and what are the benefits of it?
Its similar to other trach tubes but it has one or more holes in the outer cannula. The holes allow air to pass from the lungs up through the vocal cords and out through the mouth or nose.
It allows the patient to breath normally as if they didnt have a trach tube, speak using their vocal cords, and cough out secretions through their mouth.
Name 3 special tracheostomy tubes.
1. Fenestrated trach tube
2. Talking trach tube
3. Trach button
what is a trach button used for?
used to hold the stoma open. It doesnt provide positive-pressure ventilation.
What is the "Passy Muir Valve"?
Device used by tracheostomy and ventilator patients. When placed on the hub of the tracheostomy tube or in-line with the ventilator circuit, it redirects air flow through the vocal folds, mouth and nose enabling voice and improved communication due to the CLOSED POSITION "NO LEAK" system.
What are the benefits of the "Passy Muir Valve"?
*Restores Positive Airway Pressure: louder voice, improved swallow, stronger cough, and increased oxygenation.
*Superior Voice/Speech Production: Patients can produce clearer voice with more normal phrasing, better vocal quality and increased volume because all exhaled airflow is redirected up past the vocal cords.
*Improves Swallow & May Reduce Aspiration
*Restores Subglottic Pressure: Only the closed position "No Leak" design of the Passy-Muir Valve reestablishes a closed respiratory system and restores subglottic pressure, which improves swallowing and may reduce aspiration.
Name the 8 parts of a trach tube
- 1. Flange
- 2. Outer cannula
- 3. Inflation tube
- 4. Pilot balloon
- 5. Hollow Inner cannula w/ 15 mm adapter
- 6. Cuff
- 7. Obturator w/ rounded tip
- 8. Tracheostomy tie strings
What is the obturator used for ? and how do you use it ?
It is used for tube insertion. Place it in the outer cannula with the rounded tip extending just beyond the far end of the tube, this minimizes mucosal trauma during insertion.
Explain the "Jackson tracheostomy tube". What type of patients is it normally used with?
Made out of stainless steel. It has a inner and outer cannula. There is no cuff at the distal end or 15 mm adapter at the proximal end.
Used in patients w/a long term need for an airway but who do not require a seal to protect the airway from aspiration or to facilitate positive pressure ventilation.
What is a "talking trach/pitt tube" (vocalaid portex)
not available in the US.
For patients that unable to sustain unaided ventilation, an extra port of the trach tube is used to provide gas flow though the larynx. The speech with it usually is only a whisper.