Chapter 33 Airway Management When you cant breathe nothingWord格式.docx
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Chapter 33 Airway Management When you cant breathe nothingWord格式.docx
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Cardiacarrhythmia
Hypoxia,vagalstimulation
Pre-andpost-oxygenationon100%
C.
Hypotension
Cough,vagalstimulation
Topicalanesthetic
D.
Atelectasis
Suction
Hyperinflationbeforeandafterprocedure
E.
Mucosaltrauma
Vacuum,technique
Useappropriatesuctionpressure,technique
F.
IncreasedICP
Cough
4.Reference:
pages696-698
A.nodisconnection,lowerriskofinfection,fewerproblemswithhypoxiaB.weight,airwayresistance,ventilatortriggering
5.Reference:
page695
Coudecatheterwithbenttip
6.Reference:
page698;
Figure33-4,page700
sniffingposition7.Reference:
page698
water-solublelubricant8.Reference:
page700
nasalairway,whichiscommonlycalledanasaltrumpet9.Reference:
sputumtrapisitscommonnamealsocalledaspecimencontainerWORDWIZARDendotracheal,polyvinyl,15,length,beveled,Murphy,cuff,positive,pilot,valve,radiopaquetracheostomy,silver,outer,cuff,flange,inner,15mm,obturator
ETTUBES
10.Reference:
pages703-704
Unilaterallungdiseasethatmaycallforindependentlungventilation(ILV),whereeachlungisventilatedseparately.
11.Reference:
page704
A.Onelineisforthehigh-pressureinjectionB.Theotherlinecanbeusedforhumidification,liquids,andpressuremonitoring.
12.Reference:
pages704-705
EvactubesareintendedtoreducetheincidenceofVAP.
INTUBATIONPROCEDURES13.Reference:
page706
oralroute
14.Reference:
A.anesthesiologist,emergencydepartmentdoctor,orpulmonaryspecialistB.respiratorytherapistC.paramedicD.RN(usuallynurseanesthetist)15.Reference:
toclearvomitorsecretionssoyoucanvisualizethevocalcords16Reference:
Tightenthebulb.Checkbatteries.Replacethebulb.17.Reference:
Table33-2,page707
Byweight;
wealsousebaby’slengthontheBraslowtape.
18.Reference:
Table33-2,page707
Similarlybysize,butfemalesusuallygetsmallertubesthanmales.No.8isthestandardsizeforadults.Smallfemalesmayget6.5-7.5,whereaslargermalesmaybeintubatedwithaNo.9.
19.Reference:
pages706-707
Checkthecuffforleaks.
20.Reference:
page707sniffingpositionandrolledtowelunderthehead
21.Reference:
page707
Ventilateandpreoxygenatethepatient.
22.Reference:
page707nomorethan30seconds;
otherwise,thepatientwillbecomehypoxic
23.Reference:
page708epiglottis,arytenoidcartilage,glottis
24.Reference:
page708TheMacIntoshbladefitsintothevallecula(atthebaseofthetongue)andliftstheepiglottisindirectly.TheMillerbladeslipsundertheepiglottisanddirectlyliftstheepiglottisoutofthewaytoallowvisualizationoftheglottis.TheMillerismorecommonlyusedinpediatricpatientsastheirepiglottisisnotasrigidasanadult’sandmustbeliftedoutoftheway.
25.Reference:
Box33-4,page709
PrimarySurvey:
A.Listenforequalandbilateralbreathsounds.
B.Listenforairintheepigastrium.C.Observethechestwallforequalandadequateexpansion.SecondarySurvey:
A.colorimetry
B.Checkthedepthofinsertionagainstthetubemarkings.Normaldepthinmalesis21to23cmfororalintubation,normaldepthinfemalesis19to21cm.C.UsetheEDDtocheckforesophagealintubation.D.Usealightwandtocheckfortrachealintubation.E.UseofcapnometrytodetectthepresenceofCO2.
TertiarySurvey:
Fiberopticlaryngoscopyorbronchoscopysetthegoldstandardasyouactuallyvisualizethetrachea,carina,etc.distaltotheendotrachealtube.
26.Reference:
page710
Cardiacarrestvictimshavepoorpulmonarybloodflowthusverylowlevelsofexpiredcarbondioxide.Thiscanrenderthesedevicesineffectiveintheassessmentofpropertubeplacement.
27.Reference:
page711chestradiograph
28.Reference:
page712
A.cervicalspineinjuriesB.maxillofacialinjuries
29.Reference:
pages712-713
A.Blind—Insertthetubethroughthenoseinanuprightpatient,listeningthroughthetubeforbreathsounds.Advancethetubeoninspirationastheairwayopeningwillbeatitswidest..B.Directvisualization—Visualizethelarynxwithalaryngoscope.AdvancethetubeintothelarynxwiththeuseofMagillforceps..
30.Reference:
Table33-1,page704
A.OB.NC.OD.OE.OF.NG.NH.OI.OJ.NK.NTracheotomy31.Reference:
page713
Theprimaryindicationistheneedforanartificialairwayforaprolongedperiodoftime.
32.Reference:
page713Preferredroutetoovercomeairwayobstructionortrauma,ortobestmanagetheairwayforlong-termcareofpatientswithneuromusculardisease.
33.Reference:
page713TheETtubeshouldremaininplaceuntiljustpriortoinsertingthetracheostomytube.Asyouinsertthetrach,thecuffoftheETisdeflatedanditisremovedmoreorlessatthesametimeasthetrachispushedintoplace.
PERCMEUP!
34.Reference:
page713Traditionalsurgicaltracheostomyplacesthetubeintheneckoverthesecondorthirdtrachealring.Percutaneoustrachtubesareplacedbetweenthecricoidcartilageandthefirstring,orbetweenthefirstandsecondtrachealrings.
35.Reference:
page714
A.rapidB.avoidstheneedfortransporttotheoperatingroomC.lowerincidenceofintraoperativeandpostoperativecomplications
AirwayTrauma
36.Reference:
pages715-716
INJURY
SYMPTOMS
TREATMENT
Glotticedema
Hoarseness,stridor
Racemicepinephrine,steroids
B.
Vocalcordinflammation
Hoarseness
Usuallyresolvesquickly
Laryngealulceration
Notreatment
Polyp/granuloma
Difficultyswallowing,hoarseness,stridor
Ifsymptomsdonotresolve,surgicalremovalisindicated.
Vocalcordparalysis
Tracheostomymaybeneeded.
F.
Laryngealstenosis
Stridor,hoarseness
Surgicalcorrectionoftracheostomy
37.Reference:
page716
A.granulomasB.tracheomalaciaC.trachealstenosis
38.Reference:
PATHOLOGY
Malacia
Softeningofrings
Collapseoftrachea
Resection
Stenosis
Narrowing
Fibrousscarring
Laserresection
39.Reference:
page717
Tracheoesophagealfistulaiscausedbytrachealerosionfromcuffs,esophagealerosionfromNGtubes,malnutrition,orpoorsurgicaltechnique.Aspirationmayoccur.Treatmentinvolvessurgicalclosureoftheopening.
40.Reference:
Apulsatingtracheostomytubemaybetheonlyclue.Oncehemorrhagebegins,hyperinflationofthecuffmayhelp,butsurgeryisneeded.Seventy-fivepercentofthesepatientswilldie.
CareandFeedingofYourNewARTIFICIALAirway
41.Reference:
ETtubesaresecuredwithtape.Tracheostomytubesaresecuredwithclothties.Commercialharnessesareavailableforbothtypesoftubes.
42.Reference:
page717;
Figure33-25,page718Extension(headup)movesthetubeup.Flexionmovesthetubedown.Thetubemaymoveasmuchas1.9cmineitherdirection.
Talktome
43.Reference:
page718
talkingtracheostomytubesandPassy-Muirvalves,writingboards
44.Reference:
Talkingtracheostomytubesallowaflowofoxygenorairtobedirectedabovethecuffandthroughthevocalcords,whichallowsthepatienttotalk.
45.Reference:
page718Thecuffisdeflatedandtheventilatorvolumeisincreased.
HUMIDIFICATION
46.Reference:
page719
completeobstructionofthetubeandasphyxiation
47.Reference:
page720
32°
to35º
48.Reference:
heat-moistureexchangers,sometimescalledanartificialnose
49.Reference:
A.bypassupperairwayfiltration
B.increaseaspirationfromthepharynx
C.contaminatedequipmentorsolutions
D.impairedmucociliaryclearanceintrachea
Alsomucosaldamagefromtubeorsuctioning;
ineffectivecough
50.Reference:
A.adheringtosteriletechniquewithsuctioningB.usingasepticorsterileequipmentC.handwashing
51.Reference:
retainedsecretions
CUFFCARE
52.Reference:
highresidualvolume,lowpressure
53.Reference:
Keepthecuffpressuresbelowthe20to25mmHg(orbelow25to30cmH2O)whichwillmaintaintrachealmucosalcapillarybloodflow.Ifcuffpressureexceedsthemucosalperfusionpressure,ischemia,ulceration,andnecrosismayresult.Ifcuffpressuresaretoolow,lunginfectionsaremorelikelysecondarytomaterialabovethecuffslidingpastthecuffandintothelungs.
54.Reference:
page755
A.Minimaloccludingvolume—Slowlyinflatethecuff.Stopimmediatelywhenyoucannolongerhearairescapingaroundthecuffduringapositivepressureinspiration.Adjustmentstocuffvolumemayberequiredwithchangesinpatientpositionorifpeakventilatingpressureschange.B.Minimumleak—Fillthecuffasnotedabove.Thenremoveasmallamountofairuntilaslightleakisheardattheveryendofapositivepressureinspiration.
55.Reference:
page722
Cuffpressureswillhavetobeelevated,maybeexcessivelyso,toachieveaseal.
56.Reference:
page723
Amethylenebluetestisperformedbyaddingmethylenebluetothepatient’stubefeedings,orbyaddingittosome
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