Term
| What are the four types of artificial airways? |
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Definition
| Nasopharyngeal, Oropharyngeal, Endotracheal and Tracheostomy |
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Term
| What are the indications of Nasopharyngeal Tube use? (2) |
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Definition
| Relief of airway obstruction, and when head/neck trauma prevents oropharygeal tube use ie: when jaw is wired shut. |
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Term
| What are the benefits of a nasopharyngeal tube? (3) |
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Definition
| It's stable - once it's in it won't move. Provides access for suction. More comfortable than oropharyngeal. |
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Term
| What are the cons of a nasopharygeal tube? (5) |
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Definition
1. Difficult to use.
2. B/C it's wedged in so tightly, can cause pressure necrosis.
3. May block eustachian tube drainage -> sinusitis
4. Insertion difficulties w/ septal deviation.
5. Can't be used w/ mechanical ventilation. |
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Term
| What is the only indication for oropharyngeal tube use? |
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Definition
| To relieve airway obstruction. (It lifts the tongue out of the way) |
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Term
| What is the primary benefit to using an Oropharyngeal tube? |
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Definition
| provides access for suction. |
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Term
| What are the two major cons to use of oropharyng. tubes? |
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Definition
1. They're not comfortable
2. They are not a conduit for mechanical ventilation. |
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Term
| What are the four major indications for use of an artificial airway? |
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Definition
| 1. relief of airway obstruction. 2. prevention of aspiration. 3. facilitation of secretion removal. 4. support for mechanical ventilation (endotrach & tracheostomy) |
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Term
| Why can't a nasal or oral tube be used for mechanical ventilation? |
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Definition
| Nasal stops in the pharynx, so the air would go into the lungs AND stomach. Oral doesn't have the right attachment. |
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Term
| Why is "respirator" a poor term to use interchangeably with mechanical ventilator? |
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Definition
| Because respiration = gas exchange. Ventilators cannot change exchange problems - they can only improve FLOW to healthy parts of the lung. There is no such thing as a respirator. |
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Term
| What are the major predisposing factors that increase risk of needing to be ventilated? (3) |
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Definition
| 1. Pre-existing lung disease 2. neuromuscular disease 3. Multisystem organ failure. (This is the BIG one) |
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Term
| What are the indications for mechanical ventilation? (3) |
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Definition
1. Apnea (general anesthesia cuts CNS drive to breathe during and right after surgery)
2. Impending respiratory failure.
3. Acute ventilatory/pump failure (ie: stiff lungs or inability to exchange enough O2). |
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Term
| What are the complications of mechanical ventilation? |
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Definition
1. Infection
2. Impairment of cough effectiveness
3. Prevention of verbal communication
4. Loss of personal dignity. |
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Term
| Why is infection a concern w/ mechanical ventilation? |
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Definition
| Because the vent bypasses the normal airway defense mechanisms, so germs in the mouth go down with the tube and have access to lungs directly. |
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Term
| Why is impaired cough effectiveness a concern w/ mech. vent? |
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Definition
| Occurs particularly with endotrach. It becomes harder to cough voluntarily than it is to cough reflexively. |
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Term
| How does mech vent decrease personal dignity? |
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Definition
| They can't make their ideas understood easily and in a timely manner, due to lack of oral communication. |
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Term
| What are the complications specific to tracheostomy tubes? (3) |
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Definition
| Bleeding, pneumothorax, infection (around trach site b/c it's an incision) |
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Term
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Definition
| An endotrach or tracheostomy tube that has a small balloon on the end that inflates to prevent the lungs from pushing the air back out through the tube. |
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Term
| What are the complications of prolonged use of cuffed tubes? (8) |
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Definition
| 1. Tracheal-esophageal fistula 2. Vocal cord hematoma 3. Hemorrhage and infection 4. Airway obstruction 5. Laryngeal edema at extubation 6. Tracheal stenosis and tracheal malacia (scarring in trachea and erosion of tracheal rings - very rare) 7. Vocal cord paralysis 8. Vocal cord ulceration and polyp formation. |
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Term
| How can cuffed tubes cause tracheal-esophageal fistulas? |
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Definition
| Over time the pressure of the balloon can erode a hole from the trachea through to the esophagus. Ew. |
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Term
| How can cuffed tubes cause airway obstruction? |
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Definition
| The balloon can sometimes (rarely) slip over the end of the tube, inhibiting ventilation. |
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Term
| What is important to remember about extubation? |
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Definition
| Laryngeal edema. When the tube is removed, the cuff is deflated and the tube is pulled out quickly. If the larynx swells it obstructs the airway. Patients must be watched very carefully for about 6 hours after extubation. |
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Term
| How can cuffed tubes cause vocal cord complications? |
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Definition
| Endotracheal tubes go through the vocal cords, so they can cause complications in this area. (tracheostomies enter below, so they don't cause problems.) |
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Term
| What is the difference between volume and pressure-targeted ventilation? |
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Definition
Volume targeted: Delivers a fixed volume with each breath regardless of lung compliance or resistance to air flow.
Pressure Targeted: Delivers air until a certain pressure is reached regardless of volume in the lung. |
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Term
| What is the problem with volume-targeted ventilation? |
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Definition
| If resistance to airflow increases, or lung compliance decreases, they can give a pneumothorax from forcing the lung to comply with a set volume. |
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Term
| What is the problem with pressure-targeted ventilation? |
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Definition
| If lung resistance increases, not much air will get in and the patient will have inadequate tidal volumes. |
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Term
| What is the basic difference between CMV, ACV and SIMV? |
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Definition
| CMV:machine does everything, regardless of patient input. ACV:pt can start to have an influence over the breathing cycle. SIMV: pt can take quite substantial control over ventilation. |
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Term
| Controlled Mechanical Ventilation |
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Definition
| Has a preset number of fixed-volume breaths, and the patient can not change this (increase # breaths) no matter what they do. |
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Term
| Assist/Control Ventilation |
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Definition
| Preset number of fixed-volume breaths, but patient CAN trigger additional fixed-volume breaths. |
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Term
| Synchronized Intermittent Mandatory Ventilation |
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Definition
| Preset number of fixed-volume breaths, and patient can trigger additional breaths by breathing spontaneously through the ventilation circuit, as well as create variable-volume breaths. |
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Term
| A patient may be ready to wean if their: PO2>? on FiO2=? w/ pH>? and what other two criteria? |
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Definition
| PO2 > 60mmHg, FiO2 = .4 (40%O2), pH > 7.25, Hemodynamic stability, and the pt can initiate a spontaneous inspiratory effort. |
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Term
| Your IMV patient is showing signs of atelectasis. What is the first thing you should do for an exercise? |
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Definition
| Deep Breathing! Encourage them through hand placement on the chest, sitting them up, etc.. |
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Term
| Your patient on CMV has atelectasis. What do you do? |
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Definition
| There's nothing you can do, because the machine doesn't allow for patient effort - they can't do voluntary DB. |
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Term
| What is the cardinal sign of ARDS? |
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Definition
| Pt develops SOB and Decreased O2 sats, but the chest XR looks normal. Clinical signs appear before CXR signs. |
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