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Questions and Answers
What is the primary cause of respiratory distress in children with tracheostomy?
What is the primary cause of respiratory distress in children with tracheostomy?
Which of the following is a type of humidification for the trachea?
Which of the following is a type of humidification for the trachea?
What is a common symptom indicating a mucus plug in a patient with tracheostomy?
What is a common symptom indicating a mucus plug in a patient with tracheostomy?
Which of the following is NOT considered an early complication of tracheostomy?
Which of the following is NOT considered an early complication of tracheostomy?
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What is a potential cause of tracheostomy tube dislodgement?
What is a potential cause of tracheostomy tube dislodgement?
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Which emergency action should be taken if a tracheostomy tube is displaced?
Which emergency action should be taken if a tracheostomy tube is displaced?
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What is the primary purpose of endotracheal intubation?
What is the primary purpose of endotracheal intubation?
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Which late complication is characterized by abnormal narrowing of the trachea?
Which late complication is characterized by abnormal narrowing of the trachea?
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What should be done if a patient with a tracheostomy shows sudden voice change?
What should be done if a patient with a tracheostomy shows sudden voice change?
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Which condition is NOT a contraindication for endotracheal intubation?
Which condition is NOT a contraindication for endotracheal intubation?
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What is the effect of an esophageal intubation during the intubation process?
What is the effect of an esophageal intubation during the intubation process?
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How is the endotracheal tube (ETT) diameter estimated for a patient older than 1 year?
How is the endotracheal tube (ETT) diameter estimated for a patient older than 1 year?
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What is a common complication that can arise from endotracheal intubation?
What is a common complication that can arise from endotracheal intubation?
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What is the recommended maximum time for an intubation attempt?
What is the recommended maximum time for an intubation attempt?
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What should be the length of an endotracheal tube for a 1-year-old patient?
What should be the length of an endotracheal tube for a 1-year-old patient?
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Which of the following is an appropriate ETT diameter for adult women?
Which of the following is an appropriate ETT diameter for adult women?
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What is the primary purpose of a tracheostomy?
What is the primary purpose of a tracheostomy?
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Which type of tracheostomy tube is designed with an inner cannula for removal and cleaning?
Which type of tracheostomy tube is designed with an inner cannula for removal and cleaning?
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What is one contraindication for performing a tracheostomy?
What is one contraindication for performing a tracheostomy?
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Which type of tracheostomy tube is primarily used in newborns and most pediatric patients?
Which type of tracheostomy tube is primarily used in newborns and most pediatric patients?
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Which of the following is NOT an indication for a tracheostomy?
Which of the following is NOT an indication for a tracheostomy?
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In patients with a tracheostomy tube, which tube type allows for speech and breathing through the upper airway?
In patients with a tracheostomy tube, which tube type allows for speech and breathing through the upper airway?
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What is the use of suctioning equipment in relation to tracheostomy care?
What is the use of suctioning equipment in relation to tracheostomy care?
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Which tool is essential for checking the placement of an endotracheal tube post-insertion?
Which tool is essential for checking the placement of an endotracheal tube post-insertion?
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What is the primary advantage of using uncuffed trach tubes?
What is the primary advantage of using uncuffed trach tubes?
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Why should the trach tube be changed before feeding or two hours after feeding?
Why should the trach tube be changed before feeding or two hours after feeding?
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What is the appropriate procedure for changing trach ties?
What is the appropriate procedure for changing trach ties?
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What is an essential step in routine wound care for tracheostomy?
What is an essential step in routine wound care for tracheostomy?
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When is it necessary to change trach ties?
When is it necessary to change trach ties?
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What should be used to clean the dressing under the tracheostomy tube?
What should be used to clean the dressing under the tracheostomy tube?
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What is the main reason humidification is necessary for tracheostomy patients?
What is the main reason humidification is necessary for tracheostomy patients?
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Who is allowed to change the trach tube?
Who is allowed to change the trach tube?
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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.
