A pt has just been intubated, and the CO2 detector placed on the proximal end of the ET tube reads 1.5%. The RT should suspect which of the following?
A) If th eET tube is in the trachea, the CO2 detector should read approximately 5% to 6%. A level of only 1.5% indicates that the tube cannote be in the trachea but is in the esophagus
2. Opening the pt's airway using a oropharyngeal airway ismost beneficial when which of the following causes the obstruction?
A) Tongue. In an unconscious patient, the most common cause of upper airway obstruction is the tongue falling against the posterior wall of the pharynx. The oropharyngeal airway will pull th etongue forward, relieving the obstruction. The oropharyngeal airway should be used in unconscious patients only.
McGill forceps are used during which of the following procedures??
B) Magill forceps are curved insrument used to grasp the ET tube and advance it through the vocal cords during nasotracheal intubation
They physician wants to begin weaning a patient from tracheostomy tube. How may this best be accomplished?
D) A fenestrted trach tube has a hole in the outer cannula that the pt may breathe through when the inner cannla is removed, the cuff is deflated and the prximal end of the tube is plugged. This allows for the pt to begin inhaling through the nose or mouth and through the fenestration and upward through the vocal cords just as in normal breathing.
You care called to the pt's room bc a ventilator alarm is sounding. You hear an audible lead aroudn the pt ET tube during a ventilator breath and notcie the exhale vt is reading 150mL less than the set VT. You check the cuff pressure anf idn that it is 12 mmHg. Which of the following is the appropriate action to take?
D) Although a cuff pressure of 12 mmHg may be adequeate in some instances to seal the airway effectively, in this sitch, 12 mmHg is inadequate and leak is present around the cuff. Increasing pressure in the cuff slowly and stopping just at the point where a small leak is heard ensures that th least amount of pressure is being placed on the wall of the trachea with only a minimal leak. this is referred to as the minimal leak technique. Generally, it is safe to use cuff pressures of up to 20 mmHg (27cwp) without causing pressure damage to tracheal wall.
You want to pass a suction catheter into the pt left lung to obtain a sputum specimen. What is the most appropriate method of accomplishing this?
C) although having a pt turn his or her head to the right may increase the chances of advancing a suction catheter into the left mainstem bronchus, the most effective method is to use an angle tip catheter known as a coude catheter. The distal end is angled to the left to increase the potential for entering the left mainstem bronchus os that the left lung may be suctioned.
To prevent venous congestion on the trachea wall, the ET tube cuff should be maintained below what level of pressure?
20 mmHg (27 cwp)
Inspiratory stridor is a major clinical sign of what airway condition?
what is the name of the speaking valve that may be attached to a ventilator patient's tracheostomy tube that allow the patient to talk?
Passey-Muir speaking valve
Describe the purpose of an oropharyngeal airway.
To prevent upper airway obstruction, mainly from the tongue, in unconscious patients only. It may be used as bite block for unconscious intubated patients
What is the purpose of a fenestrated trach tube?
it is used to wean a pt from a conventional trach tube and allow the pt to speak
List problems associated with the use of oral ET tubes.
-poorly tolerated by conscious or semi conscious pt
-biting the tube
-increased productin of oral secretions
-easier inadvertent extubation
-harder to communicate
-gagging, tube not stable
-difficulty passing sx cath bc of curvature of tube
How do you determine that an ET tube is resting in the right mainstem bronchus before a chest xray is obtained?
diminished bs in left l ung, asymmetrical chest movement
what is a yankauer sx device used for?
to sx orophaynx
what is the maximaum amoung of sx pressure that may be used to sx an adult pt airway
when extubating a pt, the et tube should be withdrawn at what point in breathing cycle?