Exam 2 Review

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School

Pima Medical Institute, Mesa *

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Course

211

Subject

Health Science

Date

Feb 20, 2024

Type

docx

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Uploaded by BarristerRhinoceros4025

RES211 Critical Care Techniques Exam 2 Review ● Patient flows vs Equipment flows VT/I time * 60 = PIF Ratio added * flow = equipment flow ● Action when patient is in distress / intolerant with any procedure s top and reassess ● Cricothyrotomy - What is it / What are the purpose, benefits, risks emergency trac without risk of puncturing esophagus ● Fiberoptic Bronchoscopy - What is it / What are the purpose, benefits, risks flexible cable used to diagnose, therapeutic reasons, ett placement, and ett switch to tracheostomy ● Intubation Proper placement of ETT MLT vs MOV MLT- intentionally inflate the cuff and release just enough to hear slight air passing at peak inspiration MOV- filling the cuff during intubation (don't worry till stabilized) THEN auscultate neck deflate and then inflate until the point no air is heard. Cuff Pressure – how to determine appropriate for patient: use MOV!! Range by the book: 20-30 cm H2O ETT complications → ↑ Peak inspiratory pressure could be caused by: -secretion -bronchospasm -coughing -fighting the tube -ANY obstruction ● Tracheostomy Indications: airway is needed, with more time than allotted for cricothyrotomy (in ED setting) patient with ETT has been vented for 7-21 days FOR NON EMERGENCY and they still need to be vented for an extended period of time (trach is indicated) Time range to perform if not emergency: 7-21 days What is a stoma: hole left after decannulation Stoma – techniques to minimize infection -check drain sponge and clean around and through the trach tube -after this replace drain sponge and tie Obturator - What it is / What does it do How do you use it

device that comes with each new trach tube takes the place of inner cannula during insertion and decannulation minimizes risk of trauma. sits out the end of the trach tube. Purpose of inner cannula should always have replacement in room Considerations for change from ETT Percutaneous Tracheostomy - What is it / How is it done Tracheoinnominate Artery Fistula – What is it / What are the risks with tracheostomy Tracheostomy troubleshooting Tracheostomy humidity deficit complications just humidify the gas dude (HME or active humidity set up) Fenestrated – function – what it can and cannot do This is primarily used to facilitate speech, but can at times be used to help wean Tracheostomy – performing bedside / keeping replacement at bedside Speaking valve – function, alternate name, application PMV, allows intake of air through trach but no exhale to facilitate air movement through the chords and helps speech Speaking Valve / PMV assessment -can the patient speak? -can they cough? -can they take an adequate breath? ● Suction Indications indicated via patient assessment Goals improve flow by eliminating secretions, reduce airway resistance Frequency PRN Time limit 10-15 Hypoxemia prevention hyperoxygenate Sizing suction catheter & points of internal space ETT * 2 and choose the next size down

Troubleshooting -correct vacuum pressure -appropriate size catheter Adverse reactions ● Extubation Indications Considerations Cuff leak test NIF / MIP - What is it / What does it indicate / What is acceptable Equipment planning Actual ETT removal Post extubation monitoring Post extubation actions with retained secretions Minimizing potential laryngeal edema post extubation Hazards/risks – inflated cuff during extubation Indications for re-intubation Determination of re-intubation ● Stridor What is stridor / what causes it / how to treat Stridor treatment – options / order of application What is indicated with racemic epinephrine does not resolve stridor

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