Chapter 33 Airway Management When you cant breathe nothingWord格式.docx

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