Term
| What causes airway obstruction? |
|
Definition
| "Retained Secretions, Foreign bodies, Structural changes" |
|
|
Term
| What structural changes cause airway obstruction? |
|
Definition
|
|
Term
| Retained secretions increase what? |
|
Definition
| Airway resistence and Work of breathing |
|
|
Term
| Retained secretions cause which problems? |
|
Definition
| "Hypoxemia, Hypercapnea, Atelactasis, Infection" |
|
|
Term
| What would cause a patient to have difficulty clearing secretions? |
|
Definition
| "Thickness of secretions, Amount of secretions, Patient's inability to generate an effective cough" |
|
|
Term
| How can a RT remove retained secretions or other semi-liquid fluid? |
|
Definition
| Mechanical aspiration/suctioning |
|
|
Term
| What does suctioning involve? |
|
Definition
| application of negative pressure (vacuum) to airways through a collecting tube |
|
|
Term
| "What is required for removal of foreign bodies, secretions, or tissue masses beyond the mainstem bronchi?" |
|
Definition
|
|
Term
| Which part of the airway is suctioning performed? |
|
Definition
| Upper airway (oropharynx) or lower airway (trachea and bronchi) |
|
|
Term
| What is used for suctioning secretions or fluids from oropharynx? |
|
Definition
|
|
Term
| How is the lower airway accessed for suctioning? |
|
Definition
| "Flexible suction catheter, Through the nose, Artificial airway" |
|
|
Term
| Why should tracheal suctioning be avoided? |
|
Definition
|
|
Term
| What is the most common suctioning procedure? |
|
Definition
|
|
Term
| What are the 7 steps in Endotracheal Suctioning? |
|
Definition
| "Assess for indications, Assemble and check equipment, pre-oxygenate and hyperinflate, Insert Catheter, Apply suction/clear catheter, Re-oxygenate and hyperinflate, monitor patient and assess outcome." |
|
|
Term
| "Even though suctioning should never be done by a preset schedule, why should you still pass a suction catheter occasionally even with clear breath sounds?" |
|
Definition
| To make sure that the tip of the tube is not plugged and/or very thick secretions may not move with airflow and therefore not create adventitious sounds |
|
|
Term
| What are the indications for suctioning? |
|
Definition
| "Course breathing, inability to generate effective cough, radiograph changes consistent with retained secretions, Visible secretions in the airway, suspected aspiration, increased work of breathing, deterioration in ABG values, need for sputum specimen, need to stimulate cough due to changes in mental status or influence of medication, presence of pulmonary atelactasis or consolidation due to secretions" |
|
|
Term
| What equipment is needed for suctioning? |
|
Definition
| "Adjustable suction source/collection system, Sterile suctio catheter with thumb port, Sterile gloves, Goggles mask and gown, sterile basin, sterile bulk water or saline, Sterile saline for instillation, Oxygen delivery system" |
|
|
Term
| What should the suction pressure be set to? |
|
Definition
| "as low as possible, yet high enough to effectively clear secretions, -100 to -200 mmHg in adults and -80 to -100 mmHg in children and -60 to -80 with infants" |
|
|
Term
| What feature does a suction catheter have to minimize mucosal damage? |
|
Definition
|
|
Term
| How long are most general purpose suction catheters? |
|
Definition
| 22 inches long and sized in French Units |
|
|
Term
| What type of catheter is available to increase likelihood of left mainstem bronchial access? |
|
Definition
|
|
Term
| What happens if a suction catheter is too long? |
|
Definition
| It can obstruct the tracheal since application of negative pressure can quickly evacuate lung volume and cause atelactasis and hypoxemia |
|
|
Term
| How can problems of a too long catheter be avoided? |
|
Definition
| never suction a patient with a catheter whose outer diameter is greater than one half the internal diameter of the tracheal tube |
|
|
Term
| What type of catheter is preferred with patients receiving ventilatory support? |
|
Definition
| A closed system multiuse suction catheter since it can be incorporated directly into the ventilator circuit and used repeatedly over 24-48 hours. |
|
|
Term
| What are some benefits of being able to suction a patient through a closed system that is incorporated into ventilator circuit? |
|
Definition
| "You can perform suctioning without disconnecting the patient from the ventilator, high FIO2 and positive end-expiratory pressure (PEEP) can be maintained, cross contamination is less likely and cost is lower" |
|
|
Term
| What are some of the downfalls to suctioning with a closed system incorporated into vent? |
|
Definition
| "Extra weight an in-line catheter adds to a ventilator circuit may increase tension on trach tube, presence of catheter in airway increases resistence and can alter volumes delivered by vent, reduced airway pressure during suctioning can cause the vent to inadvertently trigger on" |
|
|
Term
| Why is standard use of saline irrigation before endotracheal suctioning discouraged? |
|
Definition
| "Unclear if this aids In removing secretions, may increase incidence of nosocomial pneumonia by displacing bacteria from walls of the airway" |
|
|
Term
| What is more effective than saline for extremely tenacious secretions? |
|
Definition
| Instillation of acetylcystein or sodium bicarbonate although it may require a physician's orders |
|
|
Term
| "After connecting catheter to suction source, how is the level of suction pressure checked?" |
|
Definition
| By closing the catheter thumb port and aspirating some sterile water or saline from the basin |
|
|
Term
| If no vacuum is generated when checking suction pressure what is checked? |
|
Definition
| "leaks in the tubing, at the collection container or at the suction regulator or if the collecting bottle is full, the float-valve will close and prevent vacuum transmission" |
|
|
Term
| How can the patient be hyperinflated during suctioning? |
|
Definition
| "With a Bag-valve-mask (BVM) or manual resuscitatoror if the patient is on a ventilator, you can use a machine breath however be sure to avoid breath stacking of insufficient expiratory time" |
|
|
Term
| How long should the patient receive 100% oxygen when pre-oxygenating prior to suctioning? |
|
Definition
| For 30 seconds and it can be delivered via BVM or ventilator |
|
|
Term
| What must be modified during pre-oxygenation prior to suctioning a COPD patient? |
|
Definition
| hyperinflate them without increasing the FiO2 |
|
|
Term
| What is the procedure for inserting the catheter during endotracheal suctioning? |
|
Definition
| Insert the catheter carefully until it can go no farther and then withdraw a few centimeters before applying suction |
|
|
Term
| What is the technique/procedure for applying suction during ET suction? |
|
Definition
| "Apply suction while withdrawing the catheter using a rotating motion. Keep suction time less than 10 to 15 seconds and after removing the catheter, clear it using the sterile basin and bulk water/saline." |
|
|
Term
| What must be assessed when clearing an ET suction catheter with saline via adapter for saline vials? |
|
Definition
| The fact that saline may be drawn into the airway and not the catheter |
|
|
Term
| How is the patient reoxygenatated and hyperinflated after suctioning? |
|
Definition
| By reapplying oxygen and repeating initial hyperinflation technique and incresed FIo2 must be maintained for one minute |
|
|
Term
| When is nasotracheal suctioning indicated? |
|
Definition
| For patients who retain secretions but do not have an artificial tracheal airway |
|
|
Term
| What equipment in addtion to that used for ET suctioning is required for nasotracheal suctioning? |
|
Definition
| "sterile water-soluble lubricating jelly to aid catheter passage through the nose, consider using nasopharygeal airway to reduce mucosal trauma for those requiring long-term nasotracheal suctioning" |
|
|
Term
| What is the key aspect of nasotracheal suctioning? |
|
Definition
| "catheter insertion - After the catheter is lubricated, insert It gently through the nostril directing it toward the septum and floor of the nasal cavity without applying negative pressure. If resistence is felt, gently twist the catheter and if this does not help, withdraw the catheter and try inserting it through the other nostril. As the catheter is moved into the lower pharynx, have the patient assume the sniffing position. Continue to advance the catheter until the patient coughs or resistance is felt much lower in the airway." |
|
|
Term
| "If a nasotracheal suctioning catheter is pushed into the oropharynx or esophagus, what may happen?" |
|
Definition
|
|
Term
| How can the risk of regurgitation during nasotracheal suctioning be minimized? |
|
Definition
| By avoiding suctioning too soon after a meal or tube feeding which can be accomplished by working closely with nursing personnel. |
|
|
Term
| "After nasotracheal suctioning, what does the presence of blood in the catheter or patient's nose or mouth suggest ?" |
|
Definition
| Airway trauma or tissue damage which can occur as you pass the catheter through the upper airway and may be seen as simple mucosal bleeding or laceratio of nasal turbinates and pharyngeal perforation. |
|
|
Term
| How is airway trauma minimized during the suctioning procedure? |
|
Definition
| "Avoid using excessive force when advancing the catheter, lubrication of the catheter eases its passage, placement of nasopharyngeal airway can help minimize nasal trauma when repeated access is needed" |
|
|
Term
| What helps minimize contamination of the lungs with bacteria from the upper airway during nasotracheal suctioning? |
|
Definition
| Sterile technique and gentle insertion |
|
|
Term
| The presence of the catheter in the lower airways during nasotracheal suctioning may stimulate what? |
|
Definition
| "Normal protective mechanisms resulting in coughing, laryngospasm, or bronchospasm" |
|
|
Term
| "During nasotracheal suctioning of the lower airways, when might the bronchospastic response may be particularly strong and what should the patient be assessed for?" |
|
Definition
| Those patients with hyperactive airway disease and they should be monitored for wheezes associated with suctioning. |
|
|
Term
| How is a sputum sample generally obtained? |
|
Definition
| By attaching a specimen container which consists of a plastic tube or cup with a flexible hose on one end to attach to the suction catheter and the other outlet is a stiff plastic nozzle that connects to the suction tubing from the wall vacuum unit |
|
|
Term
| How is sterile technique maintained while collecting a sputum sample during suctioning? |
|
Definition
| "If a closed suction system is in use, a new catheter should be placed just prior to suctioning the patient for the sample and once an adequate sample is obtained, the container is removed from the suction catheter and suction tubing. The flexible tubing on the container is attached to the open nozzle which will make a closed container." |
|
|
Term
| What are the routes for establishing an artificial airway? |
|
Definition
| through the pharynx or directly into the trachea |
|
|
Term
| How do pharyngeal airways prevent airway obstruction? |
|
Definition
| By keeping the tongue pulled forward and away from the posterior pharynx |
|
|
Term
| When is an airway obstruction due to the tongue falling into the posterior pharynx common? |
|
Definition
| In unconscious patients or as a result of a loss of muscle tone. |
|
|
Term
| When is a nasal pharyngeal airway most often placed in a patient? |
|
Definition
| In a patient who requires frequent nasotracheal suctioning because it minimizes nasal mucosa damage. It is also indicated for patients who were recently extubated following facial surgery because it helps maintain the patency of the airway |
|
|
Term
| How are oropharyngeal airways inserted? |
|
Definition
| Into the mouth and over the tongue |
|
|
Term
| When should oropharyngeal airways be restricted? |
|
Definition
| In conscious patients due to gagging and regurgitation |
|
|
Term
| "Aside from maintaining airway patency, what is a secondary use for a orpharyngeal airway in an intubated patient?" |
|
Definition
| Prevents them from biting down on the intubation tube |
|
|
Term
| What is the difference in a tracheal airway versus pharyngeal airways? |
|
Definition
| They extend beyond the pharynx into the trachea |
|
|
Term
| What are the two basic types of tracheal airways? |
|
Definition
| Endotracheal Tubes and Tracheostomy tubes |
|
|
Term
| Where are endotracheal tubes inserted? |
|
Definition
| In either the mouth or nose through the larynx and into the trachea |
|
|
Term
| how are tracheostomy tubes inserted? |
|
Definition
| through a surgically created opening directly into the trachea |
|
|
Term
| What are some advantages of oral intubation? |
|
Definition
| "Faster insertion, larger tube is tolerated, easier suctioning, less airflow resistance, decreased work of breathing, easier passage of bronchoscope, reduced risk of tube kinking, avoidance of nasal and paranasal complications" |
|
|
Term
| What are some disadvantages of oral intubation? |
|
Definition
| "Aesthetically displeasing, greater risk of self-extubation, greater risk of mainstem intubation, risk of tube occlusion by biting/trismus, risk of injury to lips, teeth, tongue, palate, and oral soft tissues, may require additional use of oral airway, great risk of retching, vomiting and aspiration" |
|
|
Term
| What are some advantages of nasal intubation? |
|
Definition
| "Less retching and gagging, greater comfort in long-term use, less salivation, improved ability to swallow, improved communication, improved mouth care/oral hygiene, avoidance of occlusion by biting, eaiser nursing care, avoidance of oral route complications, less posterior laryngeal ulceration, Less chance of accidental extubation, less risk of mainstem intubation, ability to swallow liquids, blind nasal intubation does not require muscle relaxants or sedatives, may avert ""crash"" oral intubation" |
|
|
Term
| What are some disadvantages of nasal intubation? |
|
Definition
| "Pain and discomfort, nasal and paranasal complications, difficult to perform, spntaneous breathing is required, smaller tube is necessary, Greater suctioning difficulty, increased work of breathing, difficulty passing bronchoscope, smaller risk of transient bacteremia" |
|
|
Term
| What are some advantages of Tracheotomy? |
|
Definition
| "Avoidance of laryngeal and upper airway complications, greater comfort, aids feeding oral care suctioning and speech, psychological benefit, easier passage of fiberoptic bronchoscope, easier reinsertion, aesthetically less objectionable, facilitation of weaning from vent, elimination of riskof mainstem intubation, reduced work of breathing, reduced risk of decannulation, iproved ability to place a curve-tipped suction catheter in left bronchus. improved mobility" |
|
|
Term
| What are some disadvantages of Tracheotomy? |
|
Definition
| "Greater expense, Requirment for use of OR, Need for general anesthesia, permanent scar, More severe complications, Greater mortality rate, delayed decannulation, Increased frequency of aspiration, Greater bacterial colonization rate, Persistent open stoma after decannulation." |
|
|
Term
| The proximal end of an ET tube is attached to a standard adapter with what size diameter? |
|
Definition
|
|
Term
| "What does the ""murphy eye"" accomplish and what is it?" |
|
Definition
| It is a side port of the ET tube and it ensures gas flow if the main port should become obstructed. |
|
|
Term
| How is mucosal damage minimized with an ET tube? |
|
Definition
| By having an angle to the bevel at the opening of the tip |
|
|
Term
| What does the tube cuff of an ET tube accomplish? |
|
Definition
| It is permanently bonded to the tube body and inflation of the cuff seals the lower airway for protection against aspiration or to provide positive pressure ventilation |
|
|
Term
| "In an ET tube, what is used to monitor cuff status and pressure once the tube is in place?" |
|
Definition
| A small filling-tube that leads from the cuff to a pilot balloon. |
|
|
Term
| What allows for inflation and deflation of the cuff on an ET tube? |
|
Definition
| A spring-loaded valve with a standard onnector for a syringe |
|
|
Term
| What requires the use of a double lumen ET tube? |
|
Definition
| "When unilateral lung disease occurs, independent lung ventilation may be needed which is when a double lumen ET tube is required" |
|
|
Term
| What are the features of a double lumen ET tube? |
|
Definition
| "Two proximal ventilator connectors (15 mm adaptor) two inner lumens for gas flow, two cuffs, and two distal opening." |
|
|
Term
| What is the purpose of the two cuffs of a double lumen ET tube? |
|
Definition
| The larger cuff seals the tracheal lumen and allows gas to flow into one bronchus and the smaller cuff seals the opposite bronchial lumen |
|
|
Term
| What are the important points to consider when using double lumen endotracheal tubes? |
|
Definition
| "They are stiffer and bulkier to insert and must be rotated during insertion to align with the proper bronchus and fiberoptic bronchoscopy should be performed to ensure the proper placement, resistance to flow is incraseased since tube sizes are smaller, longer suction catheter will be needed to access the bronchial tube" |
|
|
Term
| What are the material choices for tracheostomy tubes? |
|
Definition
|
|
Term
| What forms the primary structural unit of a Trach tube? |
|
Definition
|
|
Term
| What is attached to the outer cannula of a trach tube? |
|
Definition
|
|
Term
| What does the flange of the trach tube accomplish? |
|
Definition
| prevents slippage into the trachea and provides the means to secure the tube to the neck |
|
|
Term
| What is normally kept in place within the outer cannula of a trach tube but can be removed for routine cleaning or if it becomes obstructed? |
|
Definition
| A removable inner cannula with a standard 15 mm adapter |
|
|
Term
| How is the inner cannula of a trach tube locked in place |
|
Definition
| At the proximal end of the outer cannula to prevent accidental removal |
|
|
Term
| What is included on a trach tube that is similar to an ET tube? |
|
Definition
| An inflation tube that that leads from the cuff to a pilot balloon and spring-loaded valve. |
|
|
Term
| How is a trach tube stabalized at the stoma site? |
|
Definition
| With cotton tape whih attaches to the flange ad is tied around the neck |
|
|
Term
| What is used for tube insertion of a trach tube? |
|
Definition
| "An obturator with a rounded tip and prior to insertion, it is placed within the outer cannula with its tip extending just beyond the far end of the tube" |
|
|
Term
| "What minimizes mucosal trauma during insertion of trach tubes, particularly the snowplowing effect that a rough tube edge can exert on the tracheal wall" |
|
Definition
| An obturator with a rounded tip |
|
|
Term
| What is a Jackson trach tube? |
|
Definition
| A silver trach tube with an inner and outer cannula and there is no cuff at the distal end or a 15-mm adapter and is found in patients with long-term need who do not require a seal to protect the airway from aspiration or to facilitate positive pressure ventilation |
|
|
Term
| What is the preferred route for establishing an emergency tracheal airway? |
|
Definition
|
|
Term
| Why is orotracheal intubation the preferred route for establishing an emergency tracheal airway? |
|
Definition
| "Because oral passage is the quickest and easiest route in most cases and can be safely performed by any appropriately trained physician, nurse, RT or paramedic" |
|
|
Term
| What are the steps for oral endotracheal intubation? |
|
Definition
| "assemble and check equipment, position the patient, preoxygenate the patient, insert the laryngoscope, visualize the glottis, displace the epiglottis, Insert the tube, Assess tube position, Stabilize the tube and confirm placement" |
|
|
Term
| What equipment is required for oral ET intubation? |
|
Definition
| "SOAPME - suction equipment, oxygen, airway equipment, position the patient, monitors, and esophageal detectors" |
|
|
Term
| What do you do if the light on the laryngoscope does not function? |
|
Definition
| "Check that the bulb is tight, check the batteries or replace the bulb" |
|
|
Term
| What size ET tube would be used for an adult? |
|
Definition
| 8.0 females 9.0 males and make sure have one size larger available |
|
|
Term
| What step comes after checking correct size of ET tube? |
|
Definition
| Inflate the cuff and check for leaks |
|
|
Term
| How is the cuff on the ET tube checked for leaks? |
|
Definition
| done with eithr a pressure manometer or by submerging the inflated cuff in a cup of sterile water |
|
|
Term
| How is a cuff leak detected on an ET tube inflated in a cup of sterile water? |
|
Definition
| bubbles escape under water |
|
|
Term
| Does the cuff stay inflated or is it deflated prior to intubation? |
|
Definition
|
|
Term
| How is an ET tube prepared to ease insertion? |
|
Definition
| lubricated with water soluble gel |
|
|
Term
| What is added to the tube to add rigidity and what must it never do? |
|
Definition
| A stylet and it must never extend beyond the ET tube tip! |
|
|
Term
| How is the glottis visualized? |
|
Definition
| "By aligning the mouth, pharynx, and larynx" |
|
|
Term
| "How is alignment of the mouth, pharynx and larynx achieved?" |
|
Definition
| "By combining moderate cervical flexion with extension of the atlantooccipital joint. Placement of towel under pt head helps, flex neck and tilt backward with your hand" |
|
|
Term
| How is the patient pre-oxygenated prior to intubation? |
|
Definition
| bag and mask with 100% oxygen which provides the patient with a reserve during the intubation period |
|
|
Term
| How long should any intubation attempt last? |
|
Definition
|
|
Term
| How long should the patient be ventilated and oxygented before a repeat attempt at a failed intubation? |
|
Definition
|
|
Term
| Which hand is the laryngoscope held in? |
|
Definition
| Laryngoscope is held with the left hand while the right hand is used to open the mouth |
|
|
Term
| What is used to displace the tongue to the left during intubation? |
|
Definition
| the laryngoscope inserted into the right side of the mouth |
|
|
Term
| How is the epiglottis visualized during insertion of laryngoscope? |
|
Definition
| By advancing the tip of the blade along the curve of the tongue until you visualize the epiglottis |
|
|
Term
| What is seen as the laryngoscope blade reaches the base of the tongue? |
|
Definition
| You will begin to see the arytenoid cartilage and epiglottis |
|
|
Term
| What happens if you do not see the arytenoid cartilage and epiglottis when advancing the laryngoscope? |
|
Definition
| You have probably advanced the blade too far and may be in the esophagus in which case you should maintain upward force on the laryngoscope and slowly withdraw it until you see the larynx |
|
|
Term
| How is the epiglottis displaced while using a MacIntosh blade? |
|
Definition
| displace the epiglottis indirectly by advancing the tip of the blade into the vallecula (at the base of the tongue) and lifting the laryngoscope up and forward |
|
|
Term
| How is the epiglottis displaced while using a Miller blade? |
|
Definition
| Displace the epiglottis directly by advancing the tip of the blade over its posterior surface and lifting the laryngoscope up and forward |
|
|
Term
| How can levering the larygoscope against the teeth be avoided during intubation? |
|
Definition
| keep the wrist fixed and move the handle of the laryngoscope in the direction it is pointing when you visualize the glottis |
|
|
Term
| After the glottis is visualized which side of the mouth is the tube inserted? |
|
Definition
| The right side of the mouth and advance it without obscuring the glottic opening and once you see the tube tip pass through the glottis advance it until the cuff has passed the vocal cords. |
|
|
Term
| "During intubation after the tube is in place, how is it stabalized?" |
|
Definition
| Stabalize with the right hand while using the left hand to remove the laryngoscope and stylet then inflate the cuff to seal the airway and immediately provide ventilation and oxygenation. |
|
|
Term
| Where should the ET tube be ideally positioned in the trachea? |
|
Definition
| About 5 cm above the carina. |
|
|
Term
| What method is used to verify proper ET tube placement? |
|
Definition
| "fiberoptic laryngoscopy, listening for equal and bilateral breath sounds, air movement or gurgling sounds over epigastrium indacate possible esophageal intubation, Observe the chest wall for equal expansion, esophageal detection device, if a light wand is used a characteristic jack-o-lantern effect will show, exhaled CO2 analyzer, colorimetric CO2 analysis" |
|
|
Term
| What is the only method that can absolutely confirm placement of the ET tube? |
|
Definition
|
|
Term
| What does an esophageal detection device consist of? |
|
Definition
| squeeze-bulb aspirtor attached to a standard 15 mm adapter. |
|
|
Term
| How does an esophageal detection device work? |
|
Definition
| "After you create a negative pressure by squeezing the bulb, you attach it to the positioned endotracheal tube. If the tube is placed correctly the bulb quickly reexpands upon release because the trachea has cartilaginous rings whereas the esophagus does not therefore it will not reinflate because the esophagus collapses around the ET tube." |
|
|
Term
| "With an esophageal detection device, what can be used instead of a squeeze bulb?" |
|
Definition
| A large syringe with a 15-mm adaptor |
|
|
Term
| "if the ET tube is in the esophagus, what will you feel when you try to aspirate air into an esophageal detection device?" |
|
Definition
| Strong resistance because when you try to aspirate air the barrel will actually tend to recoil if released |
|
|
Term
| How much CO2 does inspired air contain? |
|
Definition
|
|
Term
| How much does end tidal gas contain of CO2? |
|
Definition
|
|
Term
| What happens to CO2 levels if the ET tube is in the respiratory tract vs in the esophagus? |
|
Definition
| CO2 will rise abruptly during expiration if ET tube is placed in the respiratory tract but will remain near zero if tube is in the esophagus |
|
|
Term
| How does a colorimetric CO2 detection device work? |
|
Definition
| Inexpensive and portable and will change colors (like PH paper) when exposed to different CO2 levels. |
|
|
Term
| How is the ET tube secured after confirming placement? |
|
Definition
| Hold tube in position and secure the tube to the skin above the lip and on the cheeks using tape. |
|
|
Term
| What is the most common complication of emergency airway management? |
|
Definition
|
|
Term
| What are the most serious complications of emergency airway management? |
|
Definition
| "Acute hypoxemia, hypercapnia, bradycardia and cardiac arrest" |
|
|
Term
| How can complications of emergency airway management be avoided? |
|
Definition
| "By using proper technique, providing adeqate ventilation and oxygenation (before during and after) and strictly adhering to intubation time limits." |
|
|
Term
| When is nasotracheal intubation indicated? |
|
Definition
| "situations where oral route is unavailable, such as maxillofacial injuries or oral surgery" |
|
|
Term
| What must the patient be doing in order to do a blind nasotracheal intubation? |
|
Definition
|
|
Term
| What may be used to provide local anesthesia and vasoconstriction of the nasal passage during nasotracheal intubation? |
|
Definition
| Sprays of .25% racemic epinephrine and 2% lidocaine |
|
|
Term
| "During nasotracheal intubation, what equipment is used in addition to what is standardly used in orotracheal intubation?" |
|
Definition
|
|
Term
| What is successful passage of nasotracheal intubation indicated by (what is heard)? |
|
Definition
| "harsh cough, followed by vocal silence and if the sounds disappear then the tube is moving toward the esophagus. You can correct a malpositioned tube by manipulating the tube and repositioning the patient's head and neck." |
|
|
Term
| What might help ensure proper tracheal placement during blind nasotracheal intubation? |
|
Definition
|
|
Term
| What is the procedure for establishing access to the trachea via neck incision? |
|
Definition
|
|
Term
| How is a tracheotomy performed? |
|
Definition
| By a regular surgical procedure or by a special dilator kit |
|
|
Term
| What is the preferred primary route for overcoming upper airway obstruction or trauma and for long-term care of patients with neuromuscular disease? |
|
Definition
|
|
Term
| What are some factors to consider in switching from endotracheal tube to tracheotomy? |
|
Definition
| "projected time the patient will need an artificial airway, patient's tolerance to the ET tube, The patient's ability to tolerate a surgical procedure, The relative risks of continued endotracheal intubatio vs tracheotomy" |
|
|
Term
| What techniques are commonly used to diagnose airway damage after extubation? |
|
Definition
| "physical examination, air tomography, fluroscopy, laryngoscopy, bronchoscopy, MRI, and pulmonary function testing" |
|
|
Term
| What are the most common laryngeal injuries associated with endotracheal intubation? |
|
Definition
| "glottic edema, vocal cord inflammation, laryngeal/vocal cord ulcerations and vocal cord polyps or granulomas" |
|
|
Term
| What are transient changes that occur as a result of pressure from the endotracheal tube or trauma during intubation? |
|
Definition
| glottic edema and vocal cord inflammation |
|
|
Term
| What are the primary symptoms of glottic edema and vocal cord inflammation? |
|
Definition
|
|
Term
| What is the serious complication of stridor after extubation treated? |
|
Definition
| racemic epinephrine via aerosol and/or a steriod and is most often used in children |
|
|
Term
| What may be given 24 hours prior to extubation to reduce laryngeal edema in patients who have had prolonged intubation or those who have had failed prior extubation due to glottic edema? |
|
Definition
|
|
Term
| When does laryngeal stenosis occur? |
|
Definition
| When the normal tissue of the larynx is replaced with scar tissue which causes stricture and decreased motility |
|
|
Term
| Where can tracheal lesions occur? |
|
Definition
|
|
Term
| What are the most common tracheal lesions? |
|
Definition
| "granulomas, tracheomalacia and tracheal stenosis" |
|
|
Term
|
Definition
| Softening of the cartilaginous rings which causes collapse of the trachea during inspiration |
|
|
Term
| What is tracheal stenosis? |
|
Definition
| narrowing of the lumen of the trachea which can occur as fibrous scarring causes the airway to narrow. |
|
|
Term
| "In patients with ET tubes, tracheal stenosis most often occurs where?" |
|
Definition
|
|
Term
| "In patients with tracheostomy tubes, what is the most common site of stenosis?" |
|
Definition
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