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indications for pharyngeal airway- oropharyngeal
- unconscious pt
- support base of tongue
- bite block
- facilitate oral suctioning
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indications for pharyngeal airway- nasopharyngeal
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complications of oropharyngeal airways
- gagging
- vomiting
- laryngospasm
- obstruction
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complications of nasopharyngeal airways
- trauma to mucosa (most common) use soluble or water based lube
- epistaxis - nasal bleeding
- inc airway resistance
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indications for oral and nasal intubation
- provide patent airway
- access for suctioning
- means for mech vent
- protect airway- aspiration, obs
- direct installation of medication
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direct instillation of med
think NAVEL
- narcan- narcotic overdose
- atropine- bradycardia
- valium/versed- sedative
- epi- asystole
- lidocaine- pvc
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when administering med through the ett, you should always flush with
double the normal iv dose, and flush with 10ml of saline
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how should therapist respond to by passing normal filtration, humidification and warming
provide adequate humidity
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complications of intubation
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cuff pressure in mm hg and cmh20
- equal or less than 20 mm hg
- equal or less than 25 cmh20
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listen for air leak as cuff is inflated during positive pressure vent; stop at min volume necessary to eliminate air leak via trach or ett
MOV- minimal occluding volume
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slowly infect air into the cuff during pos pressure ins until leak stops; a small amouth of air is remoced to allow a slight leak during peak inspiration
MLT- minimal leak technique
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chest x ray is the best way to determine
tube position
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the tip of the tube should be
2 cm or 1 inch ABOVE the carina or at the aortic knob/notch
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tube maintenance
- suctioning
- humidification- 100% humidity @ 37C
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what type of pressure cuffs to use
high vol/pressure cuffs
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laryngoscope is always held in
left hand
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fits into vallecula, indirectly raises the epiglottis
curved/macintosh blade
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fits directly under the epiglottis- preferred for infant intubation
straight/miller blade
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blade size for term infant
1
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blade size for pre term
0
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stylet is used only to aid in
oral intubation
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the end of the stylet has to be recessed ___ above tip of ett
1cm
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magil forceps used only to ain in
nasal intubation- inserted through the mouth
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ett size full term
3.0-3.5mm
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ett size adult males
8.0-9.0 mm
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ett size adult females
7.0-8.0
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tube markings on oral intubation should be
21-25 cm mark on pt lips
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if the tube is on 29 cm at the lip then its on the
right main stem
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tube markings on nasal intubation should be
26-29 cm mark at pt nare
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Double lumen ett (DLT)/ Endobronchial tube / Carlens tube
- each lumen can ventilate one lung seperately
- independent lung ventilation
- used during surgery
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LMA consists of an inflatable mask that is positioned directly over the
opening into the the trachea
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a standard ett can be inserted directly through
the LMA
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insertion of the LMA does not require the use of
laryngoscope
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LMA is indicated for
- short term vent
- when intubation is not possible by oral or nasal route (facial or nasal injuries)
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this tube is indicated for the use of oral or nasal ett that requires CONTINUOUS ASPIRATION of subglottic secretions
hi-lo evac tubes
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hi-lo evac tube has a separate suction port into the ett just above the
cuff
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hi-lo's cont suctions is provided via separate pilot conneected to a vacuum pressure of
20 mm hg
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CASS has been shown to reduce the incidence of
VAP
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before you extubate the pt you must FIRST
suction airways below and then above cuff and mouth
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you must deflate the cuff and have the pt inspire deeply and must remove the tube at
PEAK inspiration- to prevent vocal damage
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after removing the tube, you must have the pt
- cough to clear any secretions
- administer o2
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after extubation, observe for any complications
- laryngeal edema-stridor
- resp obstruction
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if the pt has SEVERE resp distress and a marked stridor then you must
REINTUBATE
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if the pt has MODERATE or MILD stridor or sore throat then you must give
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ett is replaced with a trach after how many weeks
1 week- long term ventilation
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the cuff should be kept inflated whenever pt is
- eating
- on pos pressure vent
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trach should be changed if
- obstructed
- too small
- punctured cuff
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when the trach is obstructed, you are unable to pass a suction cath, you should then
- remove tube
- ventilate
- insert new tube
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if the tube is too small a very high
cuff pressures >20 mm hg needed to seal cuff
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which trach tube has opening in outer cannula above the cuff
fenestrated tube
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fenestrated tubes are used for
- weaning
- temp mech vent w/ inner cannula
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when plugging the fenestrated tube, be sure to
- deflate cuff
- remove inner can
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fenestrated tubes allows pt to breath through
upper airways and speak
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which tube is used to maintain stoma (tracheostomy opening)
tracheal button
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which tubes has a feature adjustable flanges that allow adjustments of horizontal distance
it is also an indication for pt who are obese or use cervical collars
extended tracheostomy tubes
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trach tube that is metal/ and is not for resuscitation or positive press vent/ for pt with trachea stenosis/ trach is cuffless
jackson
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trach that is foam filled cuff/ do not inflate the cuff with a syringe
kamen-wilkinson foam/ bivona cuff
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when using a tracheal speaking device, don't forget to
deflate the cuff
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clean all inner cannula by soaking it in a solution of
- hydrogen peroxide and water
- rinse with sterile water
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indication of a laryngectomy
surgical removal of the pts larynx (top portion of the trachea)
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laryngectomy tubes will be removed after
3-6 weeks, pt will then have a permanent stoma
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laryngectomy tubes are made of
soft pliable material
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laryngectomy tubes do NOT have a
inflatable cuff
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