Podcast
Questions and Answers
Which airway device is most appropriate for providing a patent airway in an unconscious patient who lacks a gag reflex?
Which airway device is most appropriate for providing a patent airway in an unconscious patient who lacks a gag reflex?
What is the key factor to consider when selecting the size of a nasopharyngeal airway (NPA)?
What is the key factor to consider when selecting the size of a nasopharyngeal airway (NPA)?
Which airway management technique is typically indicated for patients who may require long-term ventilation?
Which airway management technique is typically indicated for patients who may require long-term ventilation?
What is a potential complication associated with the use of an endotracheal tube?
What is a potential complication associated with the use of an endotracheal tube?
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Which of the following is a crucial step in the documentation of airway management procedures?
Which of the following is a crucial step in the documentation of airway management procedures?
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What is the primary method used to confirm successful endotracheal intubation after tube placement?
What is the primary method used to confirm successful endotracheal intubation after tube placement?
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Which of the following is NOT a potential complication of tracheostomy?
Which of the following is NOT a potential complication of tracheostomy?
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In nasotracheal intubation, which of the following is primarily important to ensure during the procedure?
In nasotracheal intubation, which of the following is primarily important to ensure during the procedure?
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What is the key step in the assessment process prior to intubation?
What is the key step in the assessment process prior to intubation?
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What is a vital professional responsibility for healthcare providers during airway management?
What is a vital professional responsibility for healthcare providers during airway management?
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What is a key goal in the care of a tracheostomy patient?
What is a key goal in the care of a tracheostomy patient?
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Which complication is a tracheostomy patient at high risk for?
Which complication is a tracheostomy patient at high risk for?
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When documenting tracheostomy care, which information is essential?
When documenting tracheostomy care, which information is essential?
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Which sign indicates a potential airway obstruction in a tracheostomy patient?
Which sign indicates a potential airway obstruction in a tracheostomy patient?
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What should be prioritized in nursing assessments for tracheostomy patients?
What should be prioritized in nursing assessments for tracheostomy patients?
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Study Notes
Introduction to Respiratory Care
- Respiratory care is a vital profession focusing on optimizing cardiopulmonary function and health.
- Breathing is essential for life, making respiratory care a crucial medical specialty.
Airway Management
- Airway management involves devices to maintain open, patent airways.
- These devices aim to either displace the tongue or directly insert into the trachea, bypassing obstructions.
- Common airway management devices used in the discussion are:
- Oropharyngeal airway (OPA)
- Nasopharyngeal airway (NPA)
- Laryngeal mask airway (LMA)
- Endotracheal tube (ETT)
- Tracheostomy
Oropharyngeal Airway (OPA)
- A rigid tube inserted through the mouth to the pharynx.
- Used in unconscious patients to prevent airway obstruction by the tongue, and for potential seizure situations.
- Different sizes exist for varying patient needs (4.0mm ID - 120mm).
- Indications include unresponsive patients without a gag reflex, unconscious patients with difficult bag/mask seal, and patients experiencing a seizure.
Oropharyngeal Airway (OPA): Contraindications
- Conscious patients
- Patients with a gag reflex
Oropharyngeal Airway (OPA): Complications
- Gagging/vomiting, aspiration, laryngospasm (especially in alert or semi-conscious patients with a gag reflex)
- Damage to teeth and oral mucosa, bleeding
- Airway obstruction (if too long) or failure of airflow
- Tongue displacement (if too short)
Nasopharyngeal Airway (NPA)
- A soft rubber or silicone tube inserted through the nose into the pharynx.
- Used to prevent airway obstruction caused by the tongue or soft palate falling against the posterior wall of the pharynx.
- It can also be used as a dilator for the nose.
Nasopharyngeal Airway (NPA): Indications
- Patients who will not tolerate an oropharyngeal airway.
- Patients without a history of a fractured nasal bone.
- Facilitating spontaneous breathing and bag-valve-mask ventilation for patients needing head-tilt/chin-lift or jaw-thrust maneuvers.
Nasopharyngeal Airway (NPA): Contraindications
- Nasal bleeding or bleeding disturbance
- Suspected or existing basilar skull fractures (CSF discharge from nose)
- Nasal trauma (facial trauma)
- Resistance to insertion
Nasopharyngeal Airway (NPA): Complications
- Epistaxis
- Deterioration requiring intubation (in semi-conscious patients)
- Potential deterioration and intubation in semi-conscious patients
Laryngeal Mask Airway (LMA)
- A device with a tube and a triangular distal end that fits over the laryngeal inlet.
- Oxygen can be delivered directly into the trachea.
Laryngeal Mask Airway (LMA): Advantages
- Easy and fast insertion
- Avoids laryngeal and tracheal trauma
- Intubation possible without removing the LMA
Laryngeal Mask Airway (LMA): Disadvantages
- Short-term use only
- Unable to provide high ventilation pressures
- Potential for esophageal injury
- Aspiration still possible, though risk is decreased
Laryngeal Mask Airway (LMA): Placement
- Lubricate the posterior surface of the mask
- Fully deflate the cuff
- Use the index finger to guide insertion along the palate and into the oropharynx
- Inflate the cuff to a maximum of 60 cmH₂O
Endotracheal Tubes (ETT)
- Hollow, flexible airways typically made of PVC.
- Inserted through the mouth or nose, larynx, and into the trachea.
- Proper position is 2 cm above the carina, verified by chest radiograph.
- Used to bypass soft tissue obstructions.
Endotracheal Tube (ETT): Indications for Intubation
- Maintain airway patency
- Prevent aspiration
- Cardiopulmonary arrest
- Establish or maintain mechanical ventilation
- Bronchial hygiene
Endotracheal Tube (ETT): Contraindications for Intubation
- Patients with an intact gag reflex.
- Patients likely to react with laryngospasm during intubation attempts (e.g., children with epiglottitis).
- Basilar skull fracture—avoid nose-tracheal intubation.
Endotracheal Tube (ETT): Advantages of Intubation
- Protects the airway from aspiration
- Provides access to the tracheobronchial tree for suctioning secretions.
- Prevents gastric distention and regurgitation.
- Maintains a patent airway, avoiding further obstruction.
- Enables aerosolized medication delivery
Endotracheal Tube (ETT): Complications Associated with Intubation
- Damage to turbinates, causing epistaxis, and potential nasopharyngeal mucosa perforation
- Hypertension and tachycardia from intubation stimulation (especially in CAD patients)
- Transient cardiac arrhythmias due to vagal and sympathetic nerve traffic
- Cuff damage, resulting in a cuff leak and poor seal
Endotracheal Tube (ETT): Additional Intubation Complications
- Esophageal intubation, resulting in gastric distention and regurgitation during ventilation attempts.
- Barotrauma due to over-ventilation without a pressure release valve (pneumothorax).
- Complete airway obstruction due to laryngospasm from larynx overstimulation
- Unilateral intubation (right bronchus) from inserting the tube too deeply.
- Airway obstruction due to foreign material, dried respiratory secretions, and/or blood
Endotracheal Tube (ETT): Tube Marking/Identification
- I.T.: Implant tested
- I.D.: Inner diameter
- O.D.: Outer diameter
- Z-79: Meets standards for non-toxicity
- Radiopaque line: Determines position after placement
- Centimeter markings: Indicate depth of placement
Endotracheal Tube (ETT): Sizes
- Adult male: 7.5-8 mm
- Adult female: 7-7.5 mm
- Pediatric: (16+ Age)/4
Tracheostomy
- An incision made below the cricoid cartilage through the 2nd-4th tracheal rings.
- Creates an opening (stoma) to insert a tracheostomy tube.
Tracheostomy: Indications
- Maintain patent airway (temporarily or permanently impaired)
- Bypass an obstructed airway
- Facilitate removal of secretions
- Permit long-term ventilation / prevent aspiration with prolonged comas.
- Decrease work of breathing in severe COPD
Tracheostomy: Procedures
- Various methods exist (transtracheal jet ventilation, cricothyrotomy/laryngotomy).
Tracheostomy: Equipment
- Flange
- Outer cannula
- Inner cannula
- Obturator
- Cuff
Tracheostomy: Types
- Cuffed or un-cuffed
- Fenestrated or non-fenestrated
- Disposable or non-disposable inner cannulas ('Shiley' tubes)
- Mini tracheostomy
- Talking tracheostomy tube (to facilitate speaking)
Tracheostomy: Complications
- Hemorrhage
- Pneumothorax
- Subcutaneous emphysema
- Dislodged tube
- Airway obstructions
- Infection (Aspiration, Tracheal damage)
- Obstruction (Clinical Presentation: Skin color, respirations, BP, O2 sat.)
Tracheostomy: Prevention & Documentation
- Skilled and timely nursing assessment and care are key to prevention.
- Thorough respiratory assessments are needed, especially in patients with tracheostomies (at least Q4 hrs regardless of the shift).
Intubation
- Procedures to insert an endotracheal tube (ETT) into the trachea.
- Procedures to verify proper placement include observing breath sounds, end-tidal CO2 checks, and physical assessments.
Intubation: Equipment
- Laryngoscopes (Macintosh, Miller)
- Suction equipment
- Forceps
- Stylets
- End-tidal CO2 detectors
- Equipment for cuff inflation (syringes, etc)
Intubation: Nasal Intubation
- Inserting an endotracheal tube through the nasal passages.
Intubation: Technique
- Detailed steps are detailed in slide 62.
Specialized Endotracheal Tubes
- Covers various tubes suited to different patients, abnormalities, and procedures. (These are listed and described in the slides)
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Description
Test your knowledge on airway management techniques and equipment with this quiz. It covers essential questions regarding intubation, airway devices, and potential complications. Perfect for healthcare professionals seeking to enhance their expertise in managing airway emergencies.
