Airway Management and Intubation Quiz
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Questions and Answers

What is the primary cause of respiratory distress in children with tracheostomy?

  • Bleeding
  • Mucus plugs (correct)
  • Tracheal stenosis
  • Infection
  • Which of the following is a type of humidification for the trachea?

  • Tracheal mask (correct)
  • Saline solution
  • Cough assist device
  • Trach ring
  • What is a common symptom indicating a mucus plug in a patient with tracheostomy?

  • Fever
  • Resistance during suctioning (correct)
  • Coughing
  • Rapid breathing
  • Which of the following is NOT considered an early complication of tracheostomy?

    <p>Tracheal stenosis (C)</p> Signup and view all the answers

    What is a potential cause of tracheostomy tube dislodgement?

    <p>Coughing (D)</p> Signup and view all the answers

    Which emergency action should be taken if a tracheostomy tube is displaced?

    <p>Ventilate using a bag mask (C)</p> Signup and view all the answers

    What is the primary purpose of endotracheal intubation?

    <p>To maintain an open airway in patients who cannot breathe independently (C)</p> Signup and view all the answers

    Which late complication is characterized by abnormal narrowing of the trachea?

    <p>Tracheal stenosis (C)</p> Signup and view all the answers

    What should be done if a patient with a tracheostomy shows sudden voice change?

    <p>Assess for upper airway obstruction (C)</p> Signup and view all the answers

    Which condition is NOT a contraindication for endotracheal intubation?

    <p>Respiratory arrest (B)</p> Signup and view all the answers

    What is the effect of an esophageal intubation during the intubation process?

    <p>Hypoxia due to lack of ventilation (C)</p> Signup and view all the answers

    How is the endotracheal tube (ETT) diameter estimated for a patient older than 1 year?

    <p>By adding 16 to age in years and dividing by 4 (A)</p> Signup and view all the answers

    What is a common complication that can arise from endotracheal intubation?

    <p>Trauma to the lips, tongue, and teeth (D)</p> Signup and view all the answers

    What is the recommended maximum time for an intubation attempt?

    <p>15 to 20 seconds (C)</p> Signup and view all the answers

    What should be the length of an endotracheal tube for a 1-year-old patient?

    <p>12 cm (D)</p> Signup and view all the answers

    Which of the following is an appropriate ETT diameter for adult women?

    <p>7.5 – 9.0 mm (D)</p> Signup and view all the answers

    What is the primary purpose of a tracheostomy?

    <p>To create a surgical opening through the neck for airway ventilation (D)</p> Signup and view all the answers

    Which type of tracheostomy tube is designed with an inner cannula for removal and cleaning?

    <p>Double cannula tracheostomy tube (D)</p> Signup and view all the answers

    What is one contraindication for performing a tracheostomy?

    <p>Laryngeal carcinoma (B)</p> Signup and view all the answers

    Which type of tracheostomy tube is primarily used in newborns and most pediatric patients?

    <p>Single cannula tracheostomy tube (D)</p> Signup and view all the answers

    Which of the following is NOT an indication for a tracheostomy?

    <p>Requirement for short-term respiratory support (A)</p> Signup and view all the answers

    In patients with a tracheostomy tube, which tube type allows for speech and breathing through the upper airway?

    <p>Fenestrated tracheostomy tube (C)</p> Signup and view all the answers

    What is the use of suctioning equipment in relation to tracheostomy care?

    <p>To remove excessive secretions and maintain airflow (C)</p> Signup and view all the answers

    Which tool is essential for checking the placement of an endotracheal tube post-insertion?

    <p>Stethoscope (C)</p> Signup and view all the answers

    What is the primary advantage of using uncuffed trach tubes?

    <p>They decrease the risk of aspiration. (A)</p> Signup and view all the answers

    Why should the trach tube be changed before feeding or two hours after feeding?

    <p>To avoid aspiration during feeding. (A)</p> Signup and view all the answers

    What is the appropriate procedure for changing trach ties?

    <p>Change the position of the knot slightly with each change. (D)</p> Signup and view all the answers

    What is an essential step in routine wound care for tracheostomy?

    <p>Washing hands before starting the procedure. (C)</p> Signup and view all the answers

    When is it necessary to change trach ties?

    <p>When they become soiled, wet, or loose. (A)</p> Signup and view all the answers

    What should be used to clean the dressing under the tracheostomy tube?

    <p>Sterile hydrogen peroxide. (B)</p> Signup and view all the answers

    What is the main reason humidification is necessary for tracheostomy patients?

    <p>It compensates for the bypassed upper airway that moistens the air. (C)</p> Signup and view all the answers

    Who is allowed to change the trach tube?

    <p>Only an expert. (D)</p> Signup and view all the answers

    Flashcards

    Endotracheal Intubation

    Insertion of a tube into the trachea to maintain a clear airway in patients who cannot breathe on their own or are unconscious.

    Indications for Intubation

    Situations where endotracheal intubation is necessary.

    Contraindications for Intubation

    Conditions or factors that prevent endotracheal intubation from being appropriate for a particular patient.

    Complications of Intubation

    Potential risks or adverse effects that can occur during or after endotracheal intubation.

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    ETT Internal Diameter

    The size of the endotracheal tube (ETT) is determined based on the patient's age and weight. You calculate the appropriate diameter by using specific formulas or charts.

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    ETT Length

    The ideal length of an endotracheal tube is determined by the patient's age and size, ensuring it is placed correctly in the trachea.

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    Intubation Equipment

    A collection of equipment used during the endotracheal intubation process.

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    Carina

    A critical parameter in ETT placement, the carina is the point in the airway where the trachea branches into the left and right main bronchi. Correct positioning ensures the tube is not inserted too far.

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    Tracheostomy

    A surgical procedure that creates an opening in the neck, connecting to the trachea, allowing for insertion of a tube to maintain an airway.

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    Tracheostomy Tube

    A specialized tube inserted into the trachea through the tracheostomy opening, used to maintain an open airway.

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    Single Cannula Tracheostomy Tube

    A type of tracheostomy tube with a single opening, used for both air flow and suctioning, often used on newborns and pediatric patients.

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    Double Cannula Tracheostomy Tube

    A tracheostomy tube with a removable inner cannula that fits inside an outer cannula, providing separate pathways for airflow and cleaning.

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    Fenestrated Tracheostomy Tube

    A type of tracheostomy tube with a small opening or 'window' in the tube, allowing air to pass through the natural airway.

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    Cuffed Tracheostomy Tube

    A tracheostomy tube with an inflatable cuff, providing an airtight seal around the trachea to prevent air leakage and ensure effective ventilation.

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    Un-cuffed Tracheostomy Tube

    A tracheostomy tube without an inflatable cuff, suitable for patients who can breathe on their own and don't require mechanical ventilation.

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    Indications and Contraindications of Tracheostomy

    A procedure with specific indications and contraindications, performed to bypass the upper airway and maintain ventilation.

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    Tracheostomy Humidification

    Humidification systems for tracheostomy patients help maintain the right moisture levels in the airways, preventing dryness and thick mucus.

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    Tracheal Mask Humidification

    A tracheal mask delivers humidified air directly to the trachea through a mask worn over the nose and mouth.

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    HME (Heat Moisture Exchange) Humidification

    Heat and Moisture Exchangers (HMEs) are devices that warm and humidify air before it enters the trachea through a tracheostomy tube.

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    Tracheal Ring

    A tracheal ring is a device worn around the tracheostomy tube to provide support and help prevent dislodgement.

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    Mucus Plugs

    Mucus plugs are common complications of tracheostomies, especially in children.

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    Tracheal Stenosis

    Tracheal stenosis is a narrowing of the trachea that can occur after a tracheostomy, potentially leading to breathing difficulties.

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    Tracheoesophageal Fistula

    A tracheoesophageal fistula is an abnormal connection between the trachea and esophagus.

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    Tracheo-innominate Fistula

    A tracheo-innominate fistula is a rare complication of tracheostomy involving a connection between the trachea and the innominate vein.

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    Changing the Tracheostomy Tube

    The process of changing the tracheostomy tube, requiring two people and typically done every 1-4 weeks. Never perform this unless you're trained and experienced.

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    Tracheostomy Ties

    Tracheostomy ties used to secure the tube in place. They should be snug but not too tight, allowing for one finger to fit underneath. Changing their position with each change helps prevent skin pressure.

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    Tracheostomy Wound Care

    Cleaning the area around the tracheostomy tube to reduce the risk of infection. Includes daily examination of the stoma and applying a clean dressing.

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    Tracheal Humidification

    The process of providing moisture to the air entering the lungs through the tracheostomy, necessary because the upper airway is bypassed which naturally humidifies the air.

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    Tracheostomy Tube Change (Procedure)

    A sterile procedure, requiring two people, to prevent the tracheostomy tube from becoming dislodged.

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    Assembly of Materials for Tracheostomy Wound Care

    The process of providing sterile water, hydrogen peroxide, cotton applicators, gauze pads, gloves, and scissors for cleaning the tracheostomy site.

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    Study Notes

    Airway Management

    • Airway management involves maintaining an open airway in unconscious or non-breathing patients.
    • Endotracheal intubation is the insertion of a tube into the trachea to maintain an open airway.

    Indications for Endotracheal Intubation

    • Respiratory arrest/failure
    • Preventing aspiration
    • Airway obstruction
    • Prolonged ventilatory support
    • Facilitating suction

    Contraindications for Endotracheal Intubation

    • Inability to extend the head
    • Severe trauma to the cervical spine
    • Epiglottitis
    • Mandibular fracture
    • Uncontrolled oropharyngeal hemorrhage
    • Awake patient

    Complications of Endotracheal Intubation

    • Trauma to lips, tongue, and teeth
    • Hypertension, tachycardia, or arrhythmia
    • Laryngospasm and laryngeal edema
    • Increased intracranial pressure
    • Spinal cord trauma (in cervical spine injury)
    • Esophageal intubation
    • Right lung intubation

    ETT Internal Diameter

    • For patients over 1 year old, ETT diameter (mm) = (Age (years) + 16) / 4 or Height (cm) / 20
    • 6 to 12 months = 4.0 mm
    • Newborns:
      • < 1,000 g = 2.5 mm
      • 1,000 to 2,000 g = 3.0 mm
      • 2,000 to 3,000 g = 3.5 mm
      • 3,000 g = 4.0 mm

    • Adults:
      • Women = 7.5 - 9.0 mm
      • Men = 8.0 - 9.5 mm

    ETT Length

    • Pediatrics:
      • Newborn = 9.5 cm
      • 6-month-old = 11.5 cm
      • 1-year-old = 12 cm
      • Older pediatrics: ETT length = age(years) / 2 + 12
    • Adults:
      • Women = 21 cm
      • Men = 23 cm
      • Approximately 23-25 cm mark at teeth.
      • Tube end should be 2-5 cm above the carina (on radiographs, seen at the 4th rib or 4th thoracic vertebra).
      • Never exceed 15-20 seconds for intubation attempts (preoxygenate the patient).

    Intubation Equipment

    • Resuscitation bag (proper size, functional, with 100% O2, flow meter, and O2 tubing)
    • Oropharyngeal or nasopharyngeal airway (proper size)
    • Resuscitation mask (proper size)
    • Laryngoscope with proper blades ("Mac or Miller," double check bulb)
    • Stylet (different sizes)
    • ETT (proper size, check cuff)
    • Lubricant (water-based, e.g., Xylocaine)
    • Suctioning equipment
    • Megyle forceps (for nasotracheal intubation)
    • Stethoscope (for ETT placement check)
    • Tapes and ties (for securing ETT)

    Tracheostomy

    • Tracheostomy is a surgical opening in the neck into the trachea.
    • A tube is inserted to maintain effective airway ventilation.

    Tracheostomy Indications

    • Prolonged mechanical ventilation
    • Difficult to manage oral or nasotracheal tubes
    • Upper airway obstruction
    • Difficulty weaning from ventilatory support
    • Reducing laryngeal injury from prolonged intubation, improving oral hygiene, accessing and removing secretions.

    Tracheostomy Contraindications

    • Laryngeal carcinoma (no other absolute contraindications)

    Types of Tracheostomy Tubes

    • Single cannula
    • Double cannula
    • Fenestrated
    • Cuffed
    • Un-cuffed

    Tracheostomy Tube: Single Cannula

    • Used for newborns and most pediatric patients
    • One passage for both airflow and suctioning

    Tracheostomy Tube: Double Cannula

    • Removable inner and outer cannulas
    • Inner cannula used for ventilation
    • Outer cannula keeps stoma open for cleaning.

    Tracheostomy Tube: Fenestrated

    • Patient practices breathing through upper airway.
    • Speech possible.
    • Less airway resistance

    Tracheostomy Tube: Cuffed

    • Initial choice for mechanical ventilation.
    • Reduces aspiration risk.
    • Cuff may be foam or balloon.
    • Used for adults and older children

    Tracheostomy Tube: Un-cuffed

    • Used when mechanical ventilation is not needed.
    • Less airway resistance compared to the cuffed tube.
    • Used for pediatrics.

    Changing Tracheostomy Tubes

    • Typically changed every 1-4 weeks.
    • Done with two people; except in emergencies
    • Done before feeding or 2 hours after feeding.
    • Change procedure involves securing new ties, using a square knot, tying snugly but not tightly, and shifting the knot slightly with each change.
    • Avoid skin irritation by placing a gauze under the ties.

    Tracheostomy Wound Care

    • Requires two people for safety
    • Routine care to reduce infection risks
    • Daily examination of the stoma
    • Clean insertion of dressings under the tracheostomy tube.
    • Precut wound dressings are used to reduce fiber entry into the stoma.
    • Care procedures involve hand-washing and assembling sterile materials (H20/Hydrogen Peroxide/cotton applicators/gauze pads/gloves/scissors) for wound care. Making a T-shape gauze is also part of care.

    Tracheal Humidification

    • Humidification maintains proper secretion viscosity due to bypassing of upper airway moistening components.

    Tracheal Humidification Types

    • HME (Heat Moisture Exchange)
    • Tracheal Mask (attached to humidifier)
    • Tracheal Ring
    • Saline Solution

    Tracheostomy Emergencies

    • Tube obstruction
    • Tube displacement

    Troubleshooting Dislodgement

    • Causes: Ties loose, cough, cuff deflated, tube too short/wrong size.
    • Clinical signs: difficulty ventilating, increased airway pressure, suction catheter obstructed, poor cough, sudden voice change, stridor/shortness of breath (SOB).

    What to Do: Dislodgement

    • Extend neck, remove inner cannula, use an obturator, pull out trach tube if needed, ventilate with mask/intubate, use flex bronchoscope.

    Tracheostomy Complications: Early

    • Bleeding
    • Obstruction
    • Displacement
    • Infection

    Tracheostomy Complications: Late

    • Tracheal Stenosis
    • Granulation tissue
    • Tracheocutaneous Fistula
    • Tracheo-innominate Fistula

    Tracheostomy Complications: Other

    • Infection (Tracheitis)
    • Tracheoesophageal Fistula
    • Granuloma
    • Pressure Necrosis

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    Description

    Test your knowledge on airway management techniques and the indications, contraindications, and complications of endotracheal intubation. This quiz covers essential concepts for maintaining an open airway in various patient scenarios. Challenge yourself and enhance your understanding of critical care practices.

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