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which pts are at a greater risk of upper airway obstruction
macroglossia- enlarged tongue
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if the pt iis conscious and has a partial airways obstruction, the pt should be
monitored closely and allowed to try to relieve the obstruction on their own
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what should the RT do if the pt is conscious and has a COMPLETE airway obstruction caused by food or a foreign object,
abdominal thrusts CPR
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if the pt is unconscious and has a partial or complete airway obstruction what should the RT do
head tilt and chin lift
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oropharyngeal airway must only be used on what type of pts
unconscious pt
-
oropharyngeal airway maintains a patent airway by lying between the ____ of the tongue and the _____ wall of the pharynx
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measure the oropharyngeal airways from the
corner of the lip to the angle of the jaw
-
nasopharyngeal airway maintains a patent airway by lying btwn the ____ of the tongue and the ____ wall of the pharynx
-
measure the nasopharyngeal airway from the
tip of the nose to the earlobe
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lubricate the airway with a
water-soluable gel
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the nasopharyngeal airway is tolerated with what type of pts
conscious
-
nasopharyngeal airway is most commonly used to facilitate
nasotracheal suctioning
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laryngeal mask airway LMA is designed to be used as an
alternative to a face mask for achieving and maintaining control of the airway during SURGERY when tracheal intubation is not necessary or in emergencies when ET intubation CANNOT be accomplished after several attempts
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LMA are available in which sizes
all sizes in all ages
-
what do you use to advance the LMA until resistance is met
index finger
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indications for esophageal tracheal combitube ETC
- difficult face mask fit
- unsuccessful intubation and difficulty ventilating w/ bag mask
- no one available that has been trained in endotracheal intubation
-
indications for ET tubes
relief of upper airway obstruction resulting from laryngosparm, epiglottitis or glottic edema
-
laryngoscope- miller has what type of blade
straight
-
laryngoscope- mcintosh has what type of blade
curved
-
the curved blad- mcintosh should be inserted ____ the ____ and the ____ of the tongue which is the _____
- btwn
- epiglottis
- base
- vallecula
-
the straight blade- miller should be placed ___ the ____ and lifted upward and forward to expose the _____
- under
- epiglottis
- vocal cords
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end tidal CO2 levels are generally around
6%
-
if the tube is in the esophagus, the end tidal CO2 reading remains near
zerooooooo
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during the resuscitative procedures when cardiac output and blood pressure are low, gas exchange is reduced and the CO2 detector may read near zero even when the ET tube is in the
trachea
-
avg distance from the teeth to the carina is
27cm
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the end of the tube should rest __ to ___ cm above the carina
2 to 5
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what is considered nonemergent tubes
nasotracheal tubes
-
magill forceps are used to facillitate
nasotracheal intubation
-
this tube has a port to allow for continuous or intermittent suctioning of subglottic secretions
high lo evac tube
-
high lo evac tube are used to help prevent
VAP- vent acquired pneumonia
-
if after changing a tracheostomy tube, you observe subq emphysema and resp distress and can auscultate little or no air movement, the tube is
malpositioned and must be revoved immediately; ventilate the pt's lungs by bag-mask
-
this tube is used to aid in weaning the pt from a tracheostomy tube and to allow the pt to talk
fenestrated tube
-
this airway consists of a short, hallow tube that is used to replace the tracheostomy tube but can still maintain a patent stoma in case problems arise
pt has complete use of the upper airway
tracheostomy button
-
this airway is used to wean pts from tracheostmy tubes while maintaining a patent stoma.
they have one way valve on the proximal end of the tube.
kistner tracheostomy tube
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tubes should employ what type of volumes and pressure
-
excessive air in the cuff will act as what type of pressure
high pressure
-
maximum cuff pressure is
25mmHg or 34 cmHg
-
if the cuff is inflated above maximum cuff pressure, continue inflating the cuff using the MLT or MOV it may be that the ET tube is
too small, replace for a larger one
-
another alternate to saline lavage is to instill
- acetylcysteine (mucomyst)
- sodium bicarbonate (2%)
-
what is the acceptable size catheter inside a diameter of the ET tube
1/2
-
formula to estimate proper catheter size
multiply the internal diameter of the ET tube by 2, then use the next smallest catheter size
-
what is the proper size of catheter to use when suctioning an 8.0 mm ETT
8.0 X 2 = 16 = the next smallest size cath which would be 14 Fr
-
closed suction catheter results in less potential for
- cardiac arrhythmias
- desaturating during the suction procedure
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