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29 Cards in this Set
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Assignment 7 |
Egan chapter 36 page 768 to 788 |
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Airway trauma assocciate with tracheal tubes |
Tracheal lesions :granulomas :tracheomalacia :tracheal stenosis :tracheosophageal fistula :tracheo inominate artery erosion |
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Airway trauma associated with tracheal tubes |
Treatment :depends on severity, especially length and circumference of damage :Laser therapy may be useful for small lesions :Resection and end to end anastomosis(tying to tubes together) may be indicated when damage involves less than three tracheal rings :Staged repair and stents may be required for more involved damages Prevention :Tube movement is primary cause of injury :sedation can help avoid self extubation :nasotracheal tubes are easier to stabilize :swivel adapter can reduce tube traction :Selection of correct airway size is important :Maintain pressure of 25 to 36 cm H2O to reduce tracheal wall injury |
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Airway trauma associated with tracheal tubes |
Alternative cuff designs :Lans tub incorporates external pressure regulating valve and control reservoir ::Designed to limit cuff pressure between 16 and 18 mm Hg :Foam cuff designed to seal trachea with atmospheric pressure in cuff ::Not commonly used except in patients who have already developed tracheal injury
Alternative cuff designs continued :Tight to shaft cuff ::Low volume, high pressure cuff design ::That maximizes airflow around cuff when deflated ::Can only be inflated with sterile water not air since it is made of porous silicone material |
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Speaking valve |
cuff must be deflated so you can get air in around the tube :one way valve that fit over trach and allows inspiration through trach but not expiration :Air is directed up through vocal cords enabling patient to speak. Cuff must be deflated ::Often referred to as a passy muir valve :Air is directed up through vocal cors enabling patient to speak. Cuff must be deflated |
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Tracheostomy tubes |
RT responsibilities :maintenance of patent airway :provide humidification and hydration :Suction PRN :infection prevention :Maintain tube in correct alignment :regular trach care (RN or RT) per hospital policy |
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Tracheostomy care |
Equipment: :Trach dressing kit with sterile gloves :2 pair clean gloves :Suction kit with catheter and sterile gloves :10 ml syringe :Oxygen source and suction source :Manual resuscitator |
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Troubleshooting airway emergencies |
Tube obstruction :kinking or biting tube ::Obstruction is reversed by moving patients head and neck or respositioning tube :Herniation of cuff over tip ::Deflate cuff ::If deflating cuff failrs to overcome obstruction, try to pass suction catheter through tube |
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Troubleshooting airway emergencie |
Obstruction of tube orifice against tracheal walll :Mucus plugging ::Suction tube if instillation of sterile normal saline is not necessary Cuff Leads :primarily problem for patients receiving mechanical ventilation :will cause reduced delivery of tidal volume :If pilot valve is leaking, tube needs to be changed as soon as possible ::Pilot valve repair kit offers safe and effective alternative by permitting insertion of replacement valve into pilot tubing Cuff Leaks :Ruptured cuff requires extubation and reintubation or using endotracheal tube exhanger ::ETT tube exchanger is a semi rigid guide like a bousgie, over which damaged tube can be removed and new tube inserted |
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Troubleshooting airway emergencies |
Spare trach :Same sized taped above the bed in case the tube gets obstructed, pulled out etc :Manual resuscitator with ped mask is good if available |
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Troubleshooting airway emergencies |
Accidental extubation :partial displacement of airway out of trachea can be detected by: ::decreased breath sounds ::Decreased airflow through tube ::Decreased ability to pass catheter past end of tube |
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Troubleshooting airway emergencies |
Accidental extubation :With positive pressure ventilation, airflow through mouth and nose or into stomach may be heard ::Completely remove tube and provide ventilatory support by manual resuscitator and mask as needed ::Until patient can be reintubated or trachesotomy tube reinserted |
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Decannulation |
Removal of tracheostomy tube Weaning process :Fenestrated tube ::Double cannulated tube that has opening in posterior wall of outer cannula ablove cuff :Progressively smaller tubes :Tracheotomy buttons |
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Alternative airway devices |
Laryngeal mask airway (LMA) :consists of short tube and small mask that is inserted deep into oropharynx :Open surface of mask faces laryngeal opening :Ventilation is directed to lungs Artificial airways (EOA) Esophageal obturator airway :Designed to faciliate blind intubation quickly and effectively EOA : is positioned into the esophagus, the distal cuff is inflated with the syringe :esophagus is sealed, air cannot enter the stomach. it is diverted into the trachea Includes mask, syringe and airway tube with check valve |
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Indications for various EOA type devices |
Emergency responders not trained in endotracheal intubation Attempted endotracheal intubation has not been successful Patient is apneic, without reflexes and unconscious |
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Contraindications |
Endotracheal intubation can be performed Patient is responsive with gag reflex EOA would be in place less than 1 to 2 hours until they are intubated Patient is known to have: :Esophageal trauma :pathology :Ingested corrosive substance
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Alternative airway devices |
Laryngeal mask airway (MLA) :LMAs range in sizes from size 5 for aduluts to size 1 for infants :DIsadvantages ::Cannot be used in conscious or semi comatose patients due to stimulation of gag reflex ::If ventilation pressure greater than 20 cm H2O is needed, gastric distention may occur |
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Artifiicial airways LMA
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LMA laryngeal mask airway used by anesthesiologist :Cuff seals the larynx when inflated, does not absolutely protect against aspiration :usually used for simple surgery :Or can not intubate patient
Double lumen airway :also called combitute :Inserted blindly through oropharynx into R mainstem bronchus :Has two external openings, two 15 mm adapters, two lumens and 2 cuffs :One cuff seals the oropharynx and second seals the right mainstem bronchus :Combitube ::A double lumen tube ::Patient can be ventilated via esophagus or trachea |
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Artificial airways combitube |
Advantages :all of the same as tracheal airway :for independent lung ventilation |
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Bronchoscopy |
Insertion of visualization instrument endoscope into bronchi Purpose :Inspect airways :Collect samples :Remove foreign objects :place devices into airway There is diagnostic (75% of them) or therapeutic Two different bronchoscopic techniques :Rigid tube bronchoscopy :Flexible bronchoscopy |
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Rigid tube bronchoscopy |
Open metal tube with distal light source Port for attaching oxygen or ventilating equipment Used most often by otorhinolaryngologist and thoracic surgeons Disadvantages :very uncomfortable for conscious patients :Usually requires assistance of anesthesiologist and use of operating room :cannot assess smaller airways |
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Bronchoscopy |
Flexible fiberoptic bronchoscopy :gained popularity because it allows access to small airways :typical scope has three Channels ::light transmission channel ::visualization channel ::multipurpose open channel :::Used to give O2 take tissue samples and suction |
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Bronchoscopy |
Premedication :Sedatives reduce anxiety :Anticholinergic agent dry patients airway :narcotic analgesics may also be given to reduce pain Equipment preparation :RTs are often responsible for preparing equipment :thoroughly checking for function, tight connections and integrity |
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Bronchoscopy |
Airway preparation :Goal is to prevent bleeding, coughing, gagging, pain :Topical vasoconstrictors ::racemic epi or ::lidocaine may be used to prevent bleeding :Airway anesthesia (lidocaine) is achieved by topical anesthetics or nerve block |
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Bronchoscopy |
Monitoring :RTs have active role in monitoring ::SpO2, EKG, vital signs Complications :hypoxemia ::Minimized by providing oxygen before and after procedure :Hemodynamic changes, ::Heart rate, BP, and cardiac output vary depending on technique and medications used |
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Complications |
Bronchoscopy complications :Bronchospasm ::Premediccate with bronchodilators ::Fentanyl are better for asthma patients :RT should be present during procedure ::Adjust ventilator ::monitor SpO2 ::exhaled volumes |
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Tracheostomy |
Artifiial airway position in trachea More complicated then ETT intubation! Percutaneous tracheostomy insertion |
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Trachesotomy |
Insertion of a trach tube in place of a ETT, 2nd, 3rd, 4th cartilage below cricoid Advantages :pt has ability to talk :less gag reflex :easy to SX :easy oral care |
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Cricothyrodomy kit |
Its an emergency procedure, into the cricothyroid cartilage for ventilation |