Kettering-Equipment (2) (copy)
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- What is the size of an oral airway?
- Length should be equal to distance from angle of jaw to tip of chin OR angle of jaw to just past corner of mouth
- What is the size of a nasal airway?
- Outside diameter of airway should be equal to inside diameter of patients external nares. Length is from tip of earlobe to center of nostrils
- How should you insert an oral airway
- insert opposite its anatomical shape to back of throat and then twist into correct position
- How should you insert a nasal airway
- Insert the way it is anatomically shaped with water soluble lubricant
- **What is a curved/Macintosh**
- **Fits into vallecula indirectly raises epiglottis**
- **What is a straight/Miller blade?
-
**Fits directly under the epiglottis**
**Preferred for infant intubatin** -
What are the intubation blade sizes for
adult
pediatric
term infant
Pre-term infant -
adult: size 3
pediatric: size 2
term infant: size 1
Pre-term infant: Size 00 - **When do you use a stylet?**
-
**ONLY to aid in oral intubation**
**End is to recessed 1 cm above tip of the endotracheal tube** - **When do you use Magill forceps**
-
**Only in nasal intubation*
-Inserted in mouth to lift tube -
What are the ET tube sizes for
Pre-term infant
**Full term infant**
adult -
Pre-term infant: 2
**Full term infant**: 3
adult: wt in kg/10 - Where should tube marking be of normal and nasal ET tubes
-
-0rally at the lips should be at 21-25 cm mark
-Nasal should be at 26-29 mark - **What should the cuff pressure be on an ET tube?**
- **Cuff pressure should not exceed 20 mm Hg in order to allow circulation to the tracheal mucosa**
- How should you monitor cuff pressure
-
1. Minimal occluding volume
**2. Minimal leak technique** - **What is the minimal leak technique**?
- **slowly inject air into cuff during positive pressure inspiration until leak stops; a small amoung of air is removed to allow a slight lead during peak inspiration**
- **What should you remember when checking cuff pressure with a maonometer**?
- **If cuff pressure registers 0, check to make sure connections are tight between manometer and pilot balloon**
- *What is a double-lumen ET tube (DLT)/Endobronchial?
-
- A tube with two lumen of different lenghts. THe long one is inserted into left or right mainstem and short into trachea
**Each lumen can ventilate each lung separately of they can be connected via a wye and share a ventilation source. - **what are the indications for *What is a double-lumen ET tube (DLT)/Endobronchial?
- **used in surgery during pneumonectomy, lobectomy, esopheageal resection and aortic aneurysm repair**
- How do you plug a trach tube?
- When plugging the tube, be sure to deflate cuff, remove the inner cannula and then plug the trach tube
-
What size vacuum regulator should you use for an
adult
child
infant -
**adult: 100-120 mm Hg
child: 80-100
Infant: 60-80 - What is a Coude tip catheter used for
- It is angled to help suction the LEFT main stem bronchus
- What is a closed system suction catheter used for?
- To permit suctioning through an ET or Trach tube with patients who have a critical ventilation or sxygenation status often requiring PEEP
- What is appropriate size of a catheter
-
-20-22 inches
**The external diameter of the suction catheter should be ideally no greater than 1/2 the inside diameter of the ET of trach tube - What is an oral suction device
-
**Yankauer, Tonsil suction device
*Used to suction the mouth and throat, suing aseptic technique (flush to clear)
*use saline for cytology - How do you test for leaks of a self inflating resuscitation bag?
- *test for leaks by occluding bag and turn off pressure pop off
- **How do you troubleshoot a a self inflating resuscitation bag?**
-
*If bag fill rapidly and collapses easily on minimum pressure, check for absent inlet valve or if stuck open
*If bag is difficult to compress and compliance is normal,Patient valve may be stuck open or closed.
*Do not try and fix bag, use another form of ventilation
*used for short term, emergency, transport or back up ventilation - What is specific about a mouth to valve ventilator
- A one way valve between the mask and the practioners mouth eliminates the exposure to exhaled air
- Bird mark 7 - flow rate contol
- Turning the control to a higher number causes a greater flow into the breathing circuit and nebulizer (decreases I-time)
- How do you adjust volume of a Bird mark 7
- Volume is changed by adjustig the pressure limit
- What is the main difference between a bird mark 7 and bennett PR 11
- Terminial flow - it compensates for leaks
- What control changes will change the volume?
-
-Increasing the pressure will increase the colume
- Increasing the flow will increase turbulence and decrease volume - Bennett MA 1 ventilator
-
Volume cycled ventilator
- If you increase peep, you much increase sensitivity - What must you do when you change ventilator circuits?
- Manual ventilation with a resuscitation bag
- How do you read a barometer?
- If mercury, you read from the top of the meniscus. If contains water, read from the bottom
- What is the most appropriate noninvasive techniquee to measure oxygen saturation
- Oximetry
- What is wrong if there is a sudden fall in oximetry readings without a change in the patients condition
- There is a malfunction of the probe. Change or reattach the probe
- What is oximetry recommended for?
- Monitoring sleep apnea, and for resting and exercise desaturation
- What can affect a pulse ox reading
-
-perfusion (shock and hypotension)
- light transmission (polish, bright lights. - When will finger pulse ox's read a higher saturation?
- If carbon monoxide is present
-
What are the values of COhb in
normal people
smokers
heavy smokers -
normal: 1-3%
smokers: 5-10%
heavy smokers: 10-15% - What is the best way to evaluate oxygenation in a CO poisoning patient
-
co-oximeter
It more accurately measures COhb, O2Hb, and MetHb - How is co-oximetry measured
- It is invasive and non-continuous measurement
- What should we do if a patient has CO poisoning
- Patient should be started on oxygen therapy at 100% via a non-rebreather mask
- What is capnogography
- Measures carbon disxide using infrared absorption
- Which is normally lower, the PetCO2 or the arterial PCO2
- PetCO2 reads lower
- Where should the capnography sensor be placed?
- proximal to the patients airway connection (at the endotracheal tube)
- What does an increase in the capnograph (PECO2 or PETCO2) indicate
- a decrease in ventilation (ventilatory failure)
- What does a decrease in the capnograph (PECO2 or PETCO2) indicate
- An increase inventilation or a decreased perfusion (deadspace disease: pulmonary embolism, hypovolemia).
- What should you do if you get a reading of "zero" or "low"
- Reconnect patient to ventilator
- What would a low PETCO2 reading indicate immediatley following intubation
- The ET tube is in the esophagus
- What happens to PETCO2 during CPR
- Increases
- What can exhaled CO2 detetion devices detect?
-
-esophageal intubation Purple =poor and yellow =normal
- Can get false readings in patients who have been down without CPR for a while
- Moisture and secreation can cause false readings and obstruct tube - What is a MIP/MEP device
- manometer
- What is MIP used for
- Monitor and assess the readiness to wean in vent patients. Assesses the degree of resp muscle impairment in Guillain and Myasthenia
- What is MEP used for
- Useful in evaluating a patient's ability to maintain an airway and clear secretions (ability to cough)
- What is normal peak flow?
- 40-60 L/min
- What is pasteurization?
- disinfection process using moderate temperatures to kill vegetative organisms
- What is ethylene oxide sterilization (ETO)
-
-Sterilizes equip by alkylation of enzymes
Sterilizes Bird Mark, Electric IS and non-disposable bag removed from HIV patients room - Items that have been gamma radiated should not be re-sterilized with ethylene oxide
- Note
- How should you disinfect a bronchoscope?
- Alkaline glutaraldehyde (Cidex)