intubation Objectives

Question 1

name 3 techniques used to confirm ETT position

Answer 1

• CXR
• Position level of ETT in cm to teeth
• monitoring ETCO2, SpO2 and ventilation compliance

Question 2

what is the carina

Answer 2

the bottom of the trachea is the carina.

It is the tracheal burification, it is a ridge shaped structure at the level of the 6 or 7th thoracic vertebrae

Question 3

which bronchi is an ETT more likely to migrate to and why?

Answer 3

The right main bronchus is often the area the ETT has migrated due to its more vertical orientated than the left.

• check the position of the ETT and review previous records
• observe etCO2, RR and spO2 sats
• listen and look at pt chest.

Question 4

what are the indications for a nasopharyngeal intubation

Answer 4

• dental surgery

- maxillary facial surgery

Question 5

Discuss the reasons to intubate under the following heading and give one clinical reason for each. airway Airway protection

Answer 5

• airway management
• -paralysis
• sedation operation

Question 6

Discuss the reasons to intubate under the following heading and give one clinical reason for each. Respiratory failure

Answer 6

• management of type one or two respiratory failure

- management of muscle fatigue/reduce WOB

Question 7

Discuss the reasons to intubate under the following heading and give one clinical reason for each. Minimise oxygen consumption and improve delivery

Answer 7

• -prevent/reversal of alveolar trauma

- pneumothorax

Question 8

Discuss the reasons to intubate under the following heading and give one clinical reason for each. Neurological compromise or protection

Answer 8

• minimising associated complications and reducing mortality

- reducing ICP

Question 9

Discuss the reasons to intubate under the following heading and give one clinical reason for each. Temperature control

Question 10

What is Rocuronium? its duration and dose.

Answer 10

Rocuronium is a non depolarising neuromuscular blocking agent.

• It has a fast onset
• it made up into 100mg/10ml syringe : 1mg/kg IV bolus

Question 11

what is Vecuronium and its duration and dose.

Answer 11

• Vecoronium is a non depolarising neuromuscular (skeletal muscle relaxant)
• It take 2.5 to 3 minutes to take effect and can last 20 to 40minutes
• 0.1mg/kg with 0.02 to 0.04mg/kg incremental doses

Question 12

How can the following complications be minimised during intubation: Oesophageal intubation

Answer 12

• EtCo2 capnography = confirm placement of ETT

- CXR

Question 13

How can the following complications be minimised during intubation:Right main bronchus intubation

Answer 13

• listent to lungs
• EtCO2 monitoring
• O2 saturation
• CXR

Question 14

How can the following complications be minimised during intubation: Aspiration

Answer 14

• suctioning
• check feeding regime and ensure 45* elevate
• ensure cuff is properly inflated

Question 15

How can the following complications be minimised during intubation:Hypoxia

Answer 15

• may require suctioning
• ensure cuff inflated correctly
• ensure ETT correctly positioned

Question 16

How can the following complications be minimised during intubation: hypotension

Answer 16

• sedatives may be too much

- may require IVT

Question 17

How can the following complications be minimised during intubation: Infection

Answer 17

• maintain sterility when suctioning

- ensure pt sat at least 40* with feeds

Question 18

How often should the ETT be repositioned with and without the anchorfast?

Answer 18

• Every 2 hours assessing skin and mucosal breakdown

- 8 hourly/daily if not anchorfast

Question 19

How often should the anchorfast be changed?

Answer 19

-an anchorfast device should be changed at a minimum of every 5 days

Question 20

How often should tapes be changed?

Answer 20

Tape should be changed at least once daily or when visibly soiled

Question 21

How many nurses must complete an anchorfast procedure

Answer 21

Securing the ETT is a 2 person procedure