Question Answer
What is the function of the upper airway conduct air, prevent foreign material from entering tree, involved in speech and smell
What is the primary function of the nose filter, humidify and warm inspired air, smell, resonance chamber for speech
Vibrissae hair follicles of the nares that filter particles, trees first line of defense
Turbinates, 3 bony protrusions on lateral walls of nasal cavity, churn air, help with humidity
choanal atresia an incomplete opening in the nasal passages
Choanae nasal cavity passageways between the nares and nasopharynx
The 3 divisions of the pharynx are nasopharynx, oropharynx, laryngopharynx
Nasopharynx is at the top of the pharynx, behind the nasal cavity, above the soft palate and at the back of the oral cavity, the pharyngeal tonsils are located there as are the Eustachian tubes
Pharyngeal tonsils adenoids
Eustachian tubes auditory canal, connects nasopharynx to middle ear to equalize pressure in middle ear
Oropharynx soft palate to base of tongue
Laryngopharynx base of tongue to entrance to esophagus, epiglottis (anterior to laryngopharynx) and aryepiglotic fold form sides of laryngopharynx
Larynx voicebox, base of tongue to upper end of trachea, opening into trachea from pharynx, functions as passageway for air between pharynx and trachea, protection from aspiration, generates sounds for speech
Where and what is the Cricoid cartilage shaped like a signet ring, it is below the thyroid cartilage and forms the large part of the posterior wall of the larynx. It is also the smallest part of the infant airway
Interior of the larynx lined with mucous membrane in 3 pairs of fold upper and lower. Upper are the false vocal cords, lower are true vocal cords
Glottis space between the vocal cords, narrowest point in adult larynx
Ventilator function of the larynx ensures free flow of air to and from lungs, secondary valsalva maneuver
What is the secondary function of the larynx valsalva maneuver
Vocal folds abduct when during quiet inspiration (open)
Vocal folds adduct when during exhalation (move together but always maintain opening)
Valsalva maneuver effort closure during exhalation aka bearing down w/o letting air out, larynx tightly sealed, prevents air escape during heavy lifting, vomit, defecation
Causes of upper airway obstruction foreign matter in the pharynx like vomit, blood dentures or food, loss of muscle tone, lesions edema, tumors and bleeding
What should an RT do if an oropharyngeal airway produces a gag reflex remove it if not tolerated well as it my produce vomiting and or laryngospasm too
Signs of upper airway obstruction breathing pattern intercostals retractions, skin indications like cyanosis, pallor, diaphoresis, or cold damp clammy feel, resp sounds ie no sound, snoring for partial block by tongue or high pitch like stridor
Treatment of upper airway obstruction hyperextension of the neck, inspect mouth for foreign body, aerosol Rx with racemic epi for stridor if due to swelling
Oropharyngeal airway function hold tongue in place, away from posterior pharynx, in order to maintain a patent upper airway
Oropharyngeal airway (fbrc) is inserted upside down along tongue then rotated into place
Oropharyngeal airway clinically is inserted sideways and rotated into place
Where is the oropharyngeal airway positioned between the base of the tongue and posterior pharynx
What should an RT do if an oropharyngeal airway produces a gag reflex remove it if not tolerated well as it my produce vomiting and or laryngospasm too
Which patients can use an oropharyngeal airway comatose and semiconscious if tolerated
The 2 kinds of oropharyngeal airways are Berman I-beam and cath-guide guedel
Berman I-beam oropharyngeal airway can facilitate suctioning by passing a catheter along side
Cath-guide Guedel oropharyngeal airway can facilitate suctioning by passing a catheter through the middle
First responders in a medical emergency use what to establish and maintain a patent upper airway oropharyngeal or nasopharyngeal airway
Oropharyngeal airways are measured from the corner of the mouth to the corner of the jaw
The hazard of an oropharyngeal airway that is to long pushes epiglottis posterior, obstructing airway
The hazard of an oropharyngeal airway that is to short is pushes tongue back obstructing airway
The purpose and position of a nasopharyngeal airway is to divide the tongue and posterior pharynx in order to maintain patent airway
What type of patients can best tolerate a nasopharyngeal airway conscious patients who need repeated nasotracheal suctioning
Nasopharyngeal airways are measured from the tip of the nose to the meatus (middle of the ear opening)
How often should a nasal trumpet be alternated nbrc says every 8 hours, clinically we should twist it to keep it from sticking to tissue and alternate nares every 2 or 3 days
Indications for ETT/trach relief of upper airway obstruction and maintain a patent airway, protection of the airway when reflexes are malfunctioning, facilitate suction of the lower airway, vent support
Normal airway protective reflexes are pharyngeal reflex aka gag and swallow, laryngeal vagovagal aka laryngospasm, tracheal vagovagal aka cough due to irritation of trachea, carinal vagovagal aka cough due to irritation of carina
Hazards of artificial airways 1bacterial contamination of lower airway 2 removes effective cough (no compression) 3 removes ability to communicate 4 failure to intubate or recognize esophageal intubation 5 trauma 6 aspiration, pneumonia 7 ett tube problems 8 arrhythmias 9 bleeding et
Which endotrach tube has no cuff infant tube
What are endotrach tubes made of PVC aka polyvinylchloride
How far is the distal end of an endotracheal tube inserted clinically 4-6 cm above the carina or NBRC 2 cm above the carina
What are cuffs on an ETT tube designed for to seal against trach wall to allow for positive pressure ventilation through the tube
What is a hi-volume low pressure cuff the most commonly used cuff of today, because it allows for a larger balloon with more air volume over a greater area, it exerts less pressure
What is the greatest hazard of ETT tracheotomy tube cuffs occlusion of the tracheal mucosal bloodflow
Hazards of endotracheal/tracheostomy tube cuffs occlusion of tracheal mucosal bloodflow, herniation of cuff over tube end and overinflating
Herniation of cuff over tube end can be prevented by inflating cuff to test it prior to intubation
Tracheal mucosal lymph flow 5 mmHg
Pressure on tracheal wall to create an edema greater than 5 mmHg
Pressure in cuff that will occlude venous flow in trach wall 18-22 mmHg (25-30 cmH2o)
Pressure in cuff that will occlude arterial flow in trach wall 25-30 mmHg (34-42 cmH2o)
Rule of 25 keep press under 25 mmHg/cmH20 in order to keep tracheal blood flow in tact
Can you tell cuff press by looking at or feeling the pilot balloon? no way
What can cause a high cuff pressure? 1 tube to small, 2 trying to seal it may have caused it to over inflate and become a high pressure cuff, 3 high press of mech vent can cause distention of lumen of the tube causing it to push on trach causing trach to dilate over time
mmHg to cmH2O conversion mmHg is cmH20/1.36 or cmH20 is mmHgx1.36
MOV minimal OCCLUDING volume- listening to pts neck with steth during positive press breath, slowly inflate cuff until the leak stops
MLT minimal leak technique-slowly inflate cuff during positive press breath until the leak stops, then remove a small amount of air, just enough to allow a slight leak at peak inflation pressure
Which technique is deemed better for cuff inflation minimal occluding volume or minimal leak technique both are deemed acceptable
Pilot balloon small balloon attached to a line, with spring loaded valve where syringe is attached, used to add or remove air from cuff
If the pilot balloon line gets cut by a nurse what can we do seal it with a needle or pilot balloon repair kit
I.T. marking on an ETT tube means what implantation tested and material is non toxic
Z79 marking on an ETT tube means what conforms to standards of the American national standards institutes and is non toxic
What markings will we usually see on an ETT tube IT, Z79, Manufacturer, oral/nasal, length in cm’s, ID mm and OD mm
ID mm OD mm inside diameter and outside diameter in mm of a ett, ntt or trach tube
What is the average size of an adult female oropharyngeal airway 8
What is the average size of an adult male oropharyngeal airway 9
What is the normal length that an adult female ETT tube is inserted 19-21 cm
What is the normal length of an adult male ETT tube is inserted 21-23 cm
What is the normal length of an adult female NT tube is inserted 26
What is the normal length of an adult male NT tube is inserted 28
How long is an adult NT tube 29 cm
What is the average length in cm’s of an adult from teeth to carina 27
What is a Murphy eye small opening on the side of the distal end of an ett tube that is an alternate pathway for gas flow if tip becomes occluded
Radiopaque line imbedded wire in the side of ett tube, runs the length of the tube and absorbs x-rays, allows tube to be seen on film
15 mm adapter standard confection, allow connection to manual resuscitators and other vent equipment
What is the emergency airway of choice ett
EOA esophageal obturator airway, combo mask and airway that seals the esophagus and vent is done thru oropharynx
How does an EOA work blunt ended tube with cuff is inserted into esophagus and sealed by cuff to prevent aspiration, mask to seal face and vent via bag
How long can an EOA be used for usually less than 24 hours, mostly seen in ER, used by untrained first responders in the field
What are the drawbacks to EOA must seal to vent, air trapped in stomach stays and can cause diaphragm problems later
Hazard of ETO and EGTA endotracheal intubation and poorly tolerated in semi conscious patients
What is an EGTA esophageal gastric tube airway
What is the function of an esophageal gastric tube airway it does not have a blunted end, so the NG tube can go down to relieve gastric distension
What is a combi-tube and what is its function pharyngotracheal lumen airway or PTL, a double lumen airway with an esophageal tracheal airway and an ett, an alternative airway device that is blindly inserted, vented depending on where in ends up
Combi-tube is in esophagus, how do you vent vent via long tube because esophagus is a long word
Combi-tube is in the trach, how do you vent vent via short tube because trach is a short word
Laryngeal mask airway short tube with a small mask on the end that covers the esophagus, mostly for surgery
Carlens tube double lumen double cuff, used for pts to stop air to one lung for surgery, or in ards pt to put pt on two vents
What are the two types of emergency surgical airways cricothyroidotomy and percutaneous dilatational tracheostomy
What is a cricothyroidotomy emergency opening of the airway placed through the space between the thyroid and cricoid cartilages
What is a percutaneous dilatational tracheostomy while ett tube is inserted, dr inserts needle and sheath beween cricoid and first trach ring or first and second trach ring, then adds larger dilators until opening (stoma) is large enough for trach tube.
SOAPME equipment for ETT, Sxn equipment, Oxygen, Airway equipment, Position the Pt, Monitors, Esophageal detectors
ETT procedure assumble and check equip, sxn equip, laryngoscope, largest ETT, test cuff, lubricate, insert stylet, position pt in sniffing, pre o2, insert laryngoscope, visualize glottis, insert tube, assess placement
What is a miller laryngoscope a straight blade scope that directly lifts the epiglottis
What is a macintosh laryngoscope a curved blade scope that indirectly lifts the epiglottis, by using a forward motion
How do we assess the tube placement of an ETT listen for breath sounds bilaterally over chest wall and over stomach, observe for chest wall or stomach movement, check tube length at teeth, esophageal detection device (bulb), light wand, capnometry, cxr
What is an esophageal detection device bulb and syringe with 15 mm adaptor, deflated bulb is attached to ett tube, if bulb does not re-expand ett is in esophagus, if it does reexpand, it is in trach
What is tube ave length at teeth for a male ETT 21-23 cm
What is tube ave length at teeth for a female ETT 19-21 cm
What is capnometry etco2 monitor, wave graph or digital monitor that checks exhaled co2 to assess tube placement
What is the percent of co2 in room inspired air .03-.04 percent
What is the percent of co2 in expired air 4-6 percent
What number does a ETCO2 give whole number that approximates PaCO2
What is colorimetry CO2 detector that uses litmus paper purple-bad yellow- good
What is the gold standard for ett placement cxr
When is a nasotracheal intubation done and why when oral rt is not available, because it is more difficult
What is the biggest hazard of nasotracheal intubation otitis media
What is otitis media ear infection caused by eustation tube being blocked by NT tube
What do we give pt for comfort during intubation of an NT tube spay of racemic epi .25 percent or lidocane 2 percent for vasoconstriction and succinylcholine as a sedation
What is a tracheotomy process of cutting the trachea to establish an airway
What is a tracheostomy the opening into the trachea for placement of the artificial airway
What is the primary indication for a tracheostomy continuing need for an artificial airway
What is the primary complication of tracheostomy procedure bleeding
What do we clean the inner canulla of trach with sterile h2o and peroxide
nasal trumpet is measured how from the tip of the nose to the meatus (middle of the ear opening)
Question Answer
Pressure from tracheal tubes can cause what ischemia and ulcerations
Friction like injuries to the trachea can be caused by what in a trached pt airway shifting as pt’s head or neck is moved, or by tube manipulation
Laryngeal dysfunction can be caused by what lack of stimulation, airflow, restricted movement secondary to equipment (trach tubes do not cause because they do not pass through)
What are the most common laryngeal lesions associated with endotracheal intubation glottis edema and vocal cord inflammation
What is glottis edema and vocal cord inflammation shows up after extubation-caused by pressure from ETT or trauma during intubation, swelling worsens over 24 hours symptoms are hoarsness and stridor
What is the main symptom of glottis edema hoarseness
What is the main symptom of vocal cord inflammation stridor, much more serious, indicates significant decrease in airway diameter, treated with racemic epi 2.25 solution aerosol, more common in children
What is the best way to treat pt’s who are be extubated that have been intubated for a long time or have failed prior extubation due to glottis edema IV steroids x 24 hours and watch carefully
Pt has hoarseness after extubation and the symptoms resolve spontaneously, what do you suspect laryngeal/vocal cord ulcerations
Several weeks or several months post extubation pt complains of difficulty swallowing, hoarseness and stridor, what do you suspect vocal cord polyps or granulomas (severe or persistent must remove surgically)
Vocal cord paralysis less common but more serious, usually in extubated pts with hoarseness and stridor that doesn’t resolve with Rx and time, if obstructive symptoms continue, pt will require trach
Laryngeal stenosis a less common but more serious problem of intubation, is scar tissue replaces normal tissue of the larynx causing stricture and decreased mobility, symptoms are hoarseness and or stridor may need surgery or permanent trach
What are the most common tracheal lesions granulomas, tracheomalacia and tracheal stenosis, they can occur separately or together along with other less common lesions
What are the signs and symptoms of tracheal granulomas difficultly swallowing, develop slowly and cause stridor/hoarseness
What is tracheomalacia aka floppy trach, softening of the cartilage rings causing collapse of the trachea during insp
Tracheal stenosis is narrowing of the lumen of the trachea due to fibrous scarring causing decrease diameter of tracheal lumen, in pts who have been ETT, occurs at cuff site, trach pt’s cuff, tube tip or stoma
What can cause tracheal stenosis in Pt’s with trach too large a stoma, infection of the stoma, movement of the tube, freq tube changes
Signs and symptoms of post extubation tracheal damage difficulty expectorating, dyspnea, stridor, often appear acutely, often appears over several months, symptoms may not appear until airy decreased by 50 percent
Anastomosis surgery to repair tracheal lesions where 3 rings are removed, sometimes when severe done as a staged repair-several surgeries to fix damage
Tracheoesophageal fistula TE-fistula, small rare complication of ETT or trach where a small opening between the trach and esophagus develops, my cause sepsis, malnutrition or trach erosion, Dx endoscope, rx surgery
Tracheoinnominate fistula trach tube causes erosion through the innominate artery causing massive hemorrhage and usually death, pulsing of trach tube may be only indicator, inflate cuff to slow bleed
What are the best ways to prevent airway trauma from ETT/Trach tubes limit tube movement, use largest tube size possible, don’t change unless necessary, discourage unnecessary coughing and talking, limit cuff press, always use sterile techniques
What are the best ways to limit ETT/Trach tube movement proper taping, sedation, swivel adaptors, O2-use trach mask instead of T
What are the most critical responsibilities in maintenance of artificial airways securing tube and maintaining proper placement, providing communication, ensure adequate humidification, minimize infections, aid secretion clearance, good cuff care, troubleshoot airway emergencies.
What is the best way to maintain proper placement of an ETT or NT tube tape, silk tape is ok short term, but cloth tape is best
What is the best way to secure a trach trach ties, threaded through the flange and tied on pts neck with one finger slack
When a pt has an ETT tube and flex’s his neck (flexion), what happens to the tube tube end moves down toward the carina
When a pt with an ETT tube extend his neck (extension) what happens to the tube end pulls tube up toward the larynx
What is a Passy-Muir valve and what does do one way valve that pt can breath in through so that air can then pass out over vocal cords, used for speech, good for spontaneous or vented pt, cuff must be deflated to work
What must be monitored following placement of a passey-muir valve HR, RR, SpO2
Our are trying out a Passy-Muir valve on a trach pt and when you remove it, a rush of air comes out, what do you suspect air trapping
What are the benefits to a Passy-Muir valve speech, better vocal cord function, better sense of smell, fewer secretion problems
How is humidity delivered to the airway of intubated or tached pts heated humidifier, LVN cool or heated aerosol, HME
What are the S and S of infection in a intubated or trached pt 1 changes in sputum; color, consistency, amount 2 BS wheezes, crackles, rhonchi 3 CXR, infiltrates/atelectasis 4 fever, increased HR, leukocytosis
What is the best way to minimize the possibility of infection to intubated/trached pts sterile techniques in sxn, clean and sterile resp equip, hand washing, prevent secretion retention, change inner canulla, prevent aspirations
What is the most common cause of airway obstruction in critically ill pts retained secretions
What are the 3 most common airway emergencies that can occur tube obstruction, cuff leak, accidental extubation
High press alarm goes off on a vented pt, what do suspect tube obstruction
Low press alarm goes off on a vented pt, what do you suspect cuff leak
What clinical signs often are seen in airway emergencies varying degrees of resp distress, decreased or changed BS, air movement through mouth, press changes in vent
Inability to pass a suction catheter down a pt tube suggests what airway obstruction
Ability to fully pass a catheter down a pt tube might suggest what full or partial extubation
Intubated pt can talk when you walk into the room might suggest what cuff is leaking
What extra equipment should always be kept at bedside of an intibated pt replacement airways, manual resuscitator with mask
What are the two biggest causes of tube obstructions biting tube and mucous plugging, others are kink, herniation of cuff, jamming tube against trach wall, toys
Clinical signs of a partial tube obstruction are increased HR, decreased BS, decreased airflow through tube, if on vent-increased airway press (VCV) and decreased volume (PCV)
Clinical signs of a complete tube obstruction are severe distress, no BS, no gas through tube
If you cannot clear an obstruction in an artificial airway what action should be taken remove the airway and oxygenate the pt
What is methylene blue used for put in pt food, if it shows up in secretions, pt is aspirating
What is a Hi-Lo Evac tube helps decrease chance of VAP by allowing for evacuation of the subglottic space (suctions the space just above the cuff where secretions can pool)
Pressure from tracheal tubes can cause what ischemia and ulcerations
Friction like injuries to the trachea can be caused by what in a trached pt airway shifting as pt’s head or neck is moved, or by tube manipulation
Laryngeal dysfunction can be caused by what lack of stimulation, airflow, restricted movement secondary to equipment (trach tubes do not cause because they do not pass through)
What are the most common laryngeal lesions associated with endotracheal intubation glottis edema and vocal cord inflammation
What is glottis edema and vocal cord inflammation shows up after extubation-caused by pressure from ETT or trauma during intubation, swelling worsens over 24 hours symptoms are hoarsness and stridor
What is the main symptom of glottis edema hoarseness
What is the main symptom of vocal cord inflammation stridor, much more serious, indicates significant decrease in airway diameter, treated with racemic epi 2.25 solution aerosol, more common in children
What is the best way to treat pt’s who are be extubated that have been intubated for a long time or have failed prior extubation due to glottis edema IV steroids x 24 hours and watch carefully
Pt has hoarseness after extubation and the symptoms resolve spontaneously, what do you suspect laryngeal/vocal cord ulcerations
Several weeks or several months post extubation pt complains of difficulty swallowing, hoarseness and stridor, what do you suspect vocal cord polyps or granulomas (severe or persistent must remove surgically)
Vocal cord paralysis less common but more serious, usually in extubated pts with hoarseness and stridor that doesn’t resolve with Rx and time, if obstructive symptoms continue, pt will require trach
Laryngeal stenosis a less common but more serious problem of intubation, is scar tissue replaces normal tissue of the larynx causing stricture and decreased mobility, symptoms are hoarseness and or stridor may need surgery or permanent trach
What are the most common tracheal lesions granulomas, tracheomalacia and tracheal stenosis, they can occur separately or together along with other less common lesions
What are the signs and symptoms of tracheal granulomas difficultly swallowing, develop slowly and cause stridor/hoarseness
What is tracheomalacia aka floppy trach, softening of the cartilage rings causing collapse of the trachea during insp
Tracheal stenosis is narrowing of the lumen of the trachea due to fibrous scarring causing decrease diameter of tracheal lumen, in pts who have been ETT, occurs at cuff site, trach pt’s cuff, tube tip or stoma
What can cause tracheal stenosis in Pt’s with trach too large a stoma, infection of the stoma, movement of the tube, freq tube changes
Signs and symptoms of post extubation tracheal damage difficulty expectorating, dyspnea, stridor, often appear acutely, often appears over several months, symptoms may not appear until airy decreased by 50 percent
Anastomosis surgery to repair tracheal lesions where 3 rings are removed, sometimes when severe done as a staged repair-several surgeries to fix damage
Tracheoesophageal fistula TE-fistula, small rare complication of ETT or trach where a small opening between the trach and esophagus develops, my cause sepsis, malnutrition or trach erosion, Dx endoscope, rx surgery
Tracheoinnominate fistula trach tube causes erosion through the innominate artery causing massive hemorrhage and usually death, pulsing of trach tube may be only indicator, inflate cuff to slow bleed
What are the best ways to prevent airway trauma from ETT/Trach tubes limit tube movement, use largest tube size possible, don’t change unless necessary, discourage unnecessary coughing and talking, limit cuff press, always use sterile techniques
What are the best ways to limit ETT/Trach tube movement proper taping, sedation, swivel adaptors, O2-use trach mask instead of T
What are the most critical responsibilities in maintenance of artificial airways securing tube and maintaining proper placement, providing communication, ensure adequate humidification, minimize infections, aid secretion clearance, good cuff care, troubleshoot airway emergencies.
What is the best way to maintain proper placement of an ETT or NT tube tape, silk tape is ok short term, but cloth tape is best
What is the best way to secure a trach trach ties, threaded through the flange and tied on pts neck with one finger slack
When a pt has an ETT tube and flex’s his neck (flexion), what happens to the tube tube end moves down toward the carina
When a pt with an ETT tube extend his neck (extension) what happens to the tube end pulls tube up toward the larynx
What is a Passy-Muir valve and what does do one way valve that pt can breath in through so that air can then pass out over vocal cords, used for speech, good for spontaneous or vented pt, cuff must be deflated to work
What must be monitored following placement of a passey-muir valve HR, RR, SpO2
Our are trying out a Passy-Muir valve on a trach pt and when you remove it, a rush of air comes out, what do you suspect air trapping
What are the benefits to a Passy-Muir valve speech, better vocal cord function, better sense of smell, fewer secretion problems
How is humidity delivered to the airway of intubated or tached pts heated humidifier, LVN cool or heated aerosol, HME
What are the S and S of infection in a intubated or trached pt 1 changes in sputum; color, consistency, amount 2 BS wheezes, crackles, rhonchi 3 CXR, infiltrates/atelectasis 4 fever, increased HR, leukocytosis
What is the best way to minimize the possibility of infection to intubated/trached pts sterile techniques in sxn, clean and sterile resp equip, hand washing, prevent secretion retention, change inner canulla, prevent aspirations
What is the most common cause of airway obstruction in critically ill pts retained secretions
What are the 3 most common airway emergencies that can occur tube obstruction, cuff leak, accidental extubation
High press alarm goes off on a vented pt, what do suspect tube obstruction
Low press alarm goes off on a vented pt, what do you suspect cuff leak
What clinical signs often are seen in airway emergencies varying degrees of resp distress, decreased or changed BS, air movement through mouth, press changes in vent
Inability to pass a suction catheter down a pt tube suggests what airway obstruction
Ability to fully pass a catheter down a pt tube might suggest what full or partial extubation
Intubated pt can talk when you walk into the room might suggest what cuff is leaking
What extra equipment should always be kept at bedside of an intibated pt replacement airways, manual resuscitator with mask
What are the two biggest causes of tube obstructions biting tube and mucous plugging, others are kink, herniation of cuff, jamming tube against trach wall, toys
Clinical signs of a partial tube obstruction are increased HR, decreased BS, decreased airflow through tube, if on vent-increased airway press (VCV) and decreased volume (PCV)
Clinical signs of a complete tube obstruction are severe distress, no BS, no gas through tube
If you cannot clear an obstruction in an artificial airway what action should be taken remove the airway and oxygenate the pt
What is methylene blue used for put in pt food, if it shows up in secretions, pt is aspirating
What is a Hi-Lo Evac tuve helps decrease chance of VAP by allowing for evacuation of the subglottic space (suctions the space just above the cuff where secretions can pool)
How can accident extubation be identified decreased BS and airflow through the tube, ability to pass catheter with hitting obstruction or getting cough, pt on vent, air through mouth, air into stomach, decreased VT and VCV, must be reintubated
How do we assess a pt for readiness for extubation does reason for artificial airway no longer exists? Can pt protect his airway-gag, caugh, can pt mange secretions
Does successful weaning mean a pt is ready to be extubated no, they have nothing to do with each other
How do we evaluate patency of the trachea perform a cuff leak test prior to extubation (test prior to extubation-not part of extubation), deflate the cuff, occlude the tube if breathing occurs test is positive, if no, suspect trach edema
What are the complete weaning parameters aka respiratory parameters pt must breath spontaneously off vent, parameters are RR, VT, VC, NIF(MIP), minute ventilation
RSBI tube removal parameters aka rapid shallow breathing index less than 105 take out, above 105 stays in. RR divided by VT in liters is RSBI
47 yr female with an upper GI bleed, becomes hypoxic post extubation and exhibits mild stridor, what do you suspect glottic edema, with partial airway obstruction. Treat with cool aerosol by mask with O2, Racemic epi .5 mls of 2.25% with in 3 mls NS
If post extubation glottic edema is severe, what can we do to oxygenate pt heliox 70/30 or 80/20
What are the common problems of extubation harseness and sore throat, airway obstruction, increased risk of aspiration, difficult secretion clearance and glottic edema
What is the major complication that is associated with extubation laryngospasm, usually transient, last a few seconds, high fio2 and positive press, if persists may have to reintubate
What is a self inflating bag bag with a one way valve on both ends and an elbow and reservoir, bag is resilient and returns to original shape after squeezed, O2 into bag at 10 lpm, fills bag then reservoir
What is fio2 of a self inflating bag a function of volume of the reservoir, gas flow and rate of return of the bag
Mapleson bag aka flow inflating bag an anesthesia type bag, O2 into bag inflates bag bag is manually compress and breath is delivered, 100% O2 most often with neonates, has valve so wont over inflate (17-20)
What is the prefeerd bag for neonatal resuscitation mapleson or flow inflating bag, operator can feel the patients compliance
What is the press that neonates are ventilated at on a bag mask 17-20
Inspired air contains how much CO2 .03-.04 %
Expired air contains how much CO2 4-6 %
What is transcutaneous monitoring aka TCM or T-COM non invasive way to indirectly measure ABG, electrode on skin surface,
What is a capnogram wave form look like square wave, bottom left of square is begin expiration, top right is end expiration
What is transcutaneous O2 monitoring aka PtcO2 heated clark electrode, best in neonates
What is transcutaneous CO2 monitoring aka PtcCO2 severinghous electrode
What are the advantages to transcutaneous monitoring non-invasive of blood gas values
What are the disadvantages of transcutaneous monitoring burns to skin at electrode site, not work well in adults, reposition 4-6 hours
What are the complications of suction hypoxemia, arrhythmias, hypotension, lung collapse, mucosal damage
What is the best way to prevent hypoxemia, arrhythmias and hypotension when sxn preoxygenation, intermittent O2 with high FIO2, limit sxn to 15 seconds, cardiac monitoring
Indications for nasotracheal sxn are retained secretions but no artificial airway
What extra equip is needed to nasotracheal sxn sterile water, jelly and nasal trumpet if needed
Nasotracheal sxn procedure lubricate catheter, gently insert through nostril toward septum, with out suction and twist, have pt assume sniffing position to align larynx with pharynx on inspiration pass catheter through cords into larynx advance to cough
Arterial lines are for what used for pts who require frequent blood draws and can also measure blood pressure
How do we read a tracing from an arterial blood pressure monitor highest point is systolic, lowest is diastolic, small bump is dicrotic notch and is when aortic valve flips closed
Where does the transducer have to be in order for an a-line to give an accurate blood pressure transducer has to be leveled so it sits at the 4th intercostals space at the mid axillary line
When placing a chest tube for a pheumothorax, what direction is the tube up
When placing a chest tube for a hemothorax, what direction is the tube tube down
When placing a chest tube and pt has both hemo and pneumo, which direction should the tube go in down, drain fluid first then deal with air
In a 3 bottle system, what do the bottles represent bottle 1 is collector, bottle 2 is the water seal and maintains the negative press in lungs and bottle 3 is the suction control bottle, a safety devise that keeps press down
What is a pleur-evac chest drainage system basically a 3 bottle system but in one disposable unit
What does bottle 3 do in a 3 bottle system the suction control bottle, a safety devise that keeps press down
what is the Heimlich chest drain valve flutter chest drain valve designed for field operations
the larynx is a passageway from what to what pharynx to trachea
the upper pair of folds are called the false vocal cords
cuff pressure should be 18-22
Question Answer
In low-perfusion patients, what site would be best for monitoring SpO2? Finger
Strategies for reducing the risk for colonization and VAP include all of the following except ____. saline instillation into the ET tube during suctioning.
Which of the following is NOT a cause of increased airway resistance? Suctioning
Although an SaO2 of 97% is considered to be normal, maintaining an oxyhemoglobin saturation of at least 90% is considered acceptable for adult patients. At a normal pH this represents a PaO2 of ____ mm Hg. 60
Capnometry describes the continuous display of carbon dioxide concentrations as a graphic waveform, whereas the term capnography suggests measurement of exhaled CO2 without a written record or waveform. False
Pulse oximeter saturations less than 80% should be confirmed with laboratory analysis of ABGs, including CO oximetry. True
____ occurs when an alveolus that is normally expanded is adjacent to one that is collapsed (atelectasis) and unstable. As airway pressure increases during inspiration, the normal alveolus inflates, but the collapsed unit does not. Shear stress
What is the average total work of breathing for healthy persons? 0.3 to 0.5 J/L
Mechanical ventilation is not benign and may cause lung injury. Treating patients with lung-protective strategies includes all of the following except ____. low FIO2
You patient has a P(A-a.O2 of 200 mm Hg while breathing 100% oxygen. What is the estimated percentage shunt? 10%
Hypoxemic events in mechanically ventilated patients are most often associated with all of the following except ____. increased peak pressures
Ventilator-associated pneumonia (VAP) refers specifically to a pneumonia acquired by a patient receiving mechanical ventilation 48 hours after intubation. True
Which of the following is NOT associated with a decreased end-tidal PCO2? Increase in lung perfusion
The term ____, in general, is used when referring to lung injury occurring in humans that has been identified as a consequence of mechanical ventilation. VALI
The easiest way to detect air trapping or auto-PEEP is to evaluate ____. the flow-time curve on the ventilator graphic
The correlation of PtcO2 and PaO2 (PtcO2/PaO2 index) has been shown to be good for both neonates and critically ill adult patients. False
Which of the following conditions is associated with an increased lung compliance measurement? Emphysema
In which of the following disorders would an increased VDS/VT ratio not be likely? Hypothalamus tumor
Prolonged alveolar over-distention from mechanical ventilation leads to the release of inflammatory mediators from the lungs that can cause failure of other organs of the body. This response has been termed ____. biotrauma
Transcutaneous oxygen electrodes are attached to the skin surface with a double-sided adhesive ring. The electrode is heated to ____. 42° to 45° C
What is the normal range for VDS/VT? 0.20 to 0.40
Both physiological and technical factors can influence the accuracy of pulse oximetry measurements. These include all of the following except ____. variations in patients’ pulse rate
It is generally considered important in mechanical ventilation of patients with ALI and/or ARDS to open alveoli with a recruitment maneuver and keep them open with an appropriate level of PEEP. True
Although it is generally used to trend oxygen saturations in neonates, pulse oximetry is not used to prescribe oxygen therapy in neonates because most neonatologists prefer to base oxygen therapy decisions on PaO2 rather than oxygen saturation. True
Which of the following parameters is NOT used in calculating the Murray lung injury score of a patient with acute lung injury? Cardiac output
More recent evidence demonstrates that the repeated opening and closing of lung units generates shear stress, with direct tissue injury at the alveolar and pulmonary capillary level as well as the loss of surfactant from these unstable lung units. atelectrauma
What is the normal range for P(A-a.O2 in a healthy 30-year-old person breathing room air? 5 to 15 mm Hg
What parameter is considered to be the most accurate and reliable measure of oxygenation efficiency? Qs/Qt
What is the upper limit for plateau airway pressure that is recommended during mechanical ventilation? Less than 30 cm H2O
Transcutaneous monitoring provides a noninvasive method of indirect measurement of the oxygen and carbon dioxide tensions at the skin surface. True
Which of the following breathing patterns suggests respiratory muscle decompensation? Rapid and shallow breaths
A vital capacity (Vc. value below what value indicates significant muscle weakness? 10 to 15 ml/kg
What is considered normal for the PaO2/FIO2 ratio? Greater than 400
Chemical mediators produced in the lung during ventilator mismanagement can leak into the blood vessels. The pulmonary circulation then carries these stimulating substances to areas the body sets up an inflammatory reaction to the kidneys, gut, and liver. True
A condition that can be accelerated by mechanical ventilation is ____. It can be detected by a hyperresonant percussion note and absence of breath sounds on the affected side of the thorax. pneumothorax