VTI Anesthesia – Endotracheal Intubation – Flashcards
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a flexible tube placed inside the trachea of an anesthetized patient used to transfer gases directly from the anesthetic machine into the lungs
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Endotracheal Tube (ET tube)
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what does an ET tube bypass
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the nasal passages, oral cavity pharynx, and larynx
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what are 4 reasons to intubate
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maintain airway decrease anatomic dead space allow precise delivery of inhalant and O2 prevent aspiration
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what does intubation improve, prevent and allow for
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improves: oxygenation prevents: atelectasis (allowing ventilation) allows for: medication delivery IT in emergency situations
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what is PPV
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positive pressure ventilation
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this tube has a beveled end and a Murphy eye and may or may not have a cuff
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Murphy Tube
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this tube has no cuff or side hole, but decrease in diameter at the patient end (used in birds and reptiles)
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Cole tube
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this tube is cuffed or uncuffed with no hole at the tip
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Magill tube
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creates a seal between the tube and the trachea
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cuff
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the tube lumen is commonly expressed in what
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mm (ID)
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what tube length is commonly expressed in what
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cm
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a device used to increase visibility of the larynx when placing an ET tube
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laryngoscope
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the patient end of the ET tube is what
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cuffed
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the machine end of the ET tube is what
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attaches to breathing circuit
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what does the pilot balloon indicate
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that the cuff has been inflated
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what does a Macintosh blade look like
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a curved blade
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what does a Miller blade look like
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a straight blade
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when is endotracheal intubation performed
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after induction for the maintenance of inhalant anesthesia and to maintain airway or used for patients in respiratory or cardiac arrest for manual ventilation
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what should an ET tube be placed
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during stage III plane I
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what equipment is needed to perform an endotracheal intubation
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appropriately sized ET tube (bring 3 different sizes) 2 foot length of IV tubing or rolled gauze gauze sponge 12 ml syringe laryngoscope stylette lidocaine
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what are cats predisposed to
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laryngospasm
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what is a stylette used for
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to facilitate intubation when smaller tubes are used to help prevent bending of the tube; should never extend beyond the patient end of the tube
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when selecting a tube, what should you look for
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it must be small enough to allow placement but large enough to produce a seal when the cuff is inflated, must be sufficient length to reach the thoracic inlet
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what tubes are typically used on cats
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3-4.5 mm
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what tubes are typically used on dogs
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20 kg = 9.5-10 mm then increase or decrease 1 mm for each 5 kg of weight
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the length of the tube should extend from the tip of the nose to the what
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thoracic inlet
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what should you do to the cuff of the tube
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lubricate the cuff with a small amount of sterile water-soluble saline
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how does the restrainer hold the patient to be intubated
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hold muzzle behind the canines, extend the head and neck towards the person intubating; animal may be in sternal or lateral recumbency
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what animal is blind intubation performed on
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horses
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how should horses be positioned for endotracheal intubation
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lateral with head, neck and back extended
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jaw tone is assessed by who
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the restrainer prior to intubation
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how do you insert the tube past the vocal cords
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using a gentle rotating motion
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what is the procedure after successful insertion of endotracheal intubation
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transfer animal to lateral recumbency (if not already there), check that the tube is inserted into the trachea and not the esophagus, secure tube, turn on O2, connect to breathing circuit, inflate the cuff, check for leaks, turn on the vaporizer
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where are the 3 places you can secure the ET tube to
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around the maxilla, mandible or behind the ears
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what type of ET tube can you watch to see it fog up to make sure it is in the right place
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vinyl types
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what are the 6 ways to ensure you have the ET tube in the proper position
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visualize with a laryngoscope, watch reservoir bag for movement, feel air movement from tube, watch for fogging of ET etube, unidirectional flutter valve movement, and palpation of neck
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how many rigid tubes should be felt when palpating the neck after placing an ET tube
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1
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what does it mean if you palpate 2 rigid tubes in the neck after placing an ET tube
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the ET tube is in the esophagus and not the trachea
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ET tube is advanced too far, breath sounds will be absent on one side, possible cyanosis
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One-lung intubation
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will animals vocalize with proper placement
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no
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what type of knot is used to secure the ET tube
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lark's head knot
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respiratory distress is usually seen with what type of intubation
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bronchial
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what does cuffing prevent
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aspiration, waste gas, and problems maintaining anesthetic depth at normal concentrations
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what size syringe should be attached with air to the valve port
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12 ml
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when you inflate the cuff, what should you do to the pop-off valve
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close it
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while slowly inflating the cuff ...........
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compress reserve bag and listen for leakage around cuff
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what does it mean if you have to use more than 5 ml of air to inflate the cuff
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the ET tube could probably be switched to a larger tube
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what is a problem with overinflation
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tracheal trauma
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what is a problem with underinflation
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inadequate depth, contamination of room with inhalant
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what is more common in cats and can be treated/prevented by applying no more than 0.1ml of 2% Lidocaine directly to the glottis prior to tube placement
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Laryngospasm
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what drug is commonly used to treat/prevent laryngospasms
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Lidocaine
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how is Lidocaine applied to the glottis
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place a drop of Lidocaine on a swab and "paint" the vocal folds, wait a short time, then intubate
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List some complications with endotracheal intubation
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tracheal rupture, pneumothorax, pneumomediastinum, vagal nerve stimulation, trauma to soft tissue, pressure necrosis, obstructed ET tubes, chewing of tube, infection
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what should be expected to happen for 1-2 days after extubation
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the patient should have some minor irritation and coughing
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what is the most common complication with endotracheal intubation
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placement of the tube into the esophagus
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what drugs are given to prevent vagal nerve stimulation
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anticholinergics (atropine or glycopyrrolate)
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what must be present before extubation
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the swallowing reflex
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what should you do when extubating brachycephalic breeds
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wait until they are fully conscious before extubating
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once the patient is extubated, what should you do with them
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place them in sternal recumbency with the neck extended
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what are the vinyl tubes made out of
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PVC polyvinyl chloride
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what does the cuff require on the vinyl tube
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manual deflation
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why is the vinyl tube considered trachea friendly
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higher volume of air injected creates a nice gentle low pressure cuff against trachea
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what is a problem with using the red rubber tube
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it is prone to kinks and collapsing
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what is an advantage to using the red rubber tube
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the cuff automatically deflates with cap release
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what type of tube is similar to vinyl
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silicone
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what is considered the best tracheal tube to use
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the silicone tube
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what does the cuff on the silicone tube require
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manual deflation
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specialized rubber tubes that contain a coil of metal or nylon embedded into the rubber designed to resist kinking or collapse
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spiral or anode tubes
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performed in an emergency situation to establish an airway when endotracheal intubation is contraindicated or impossible
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tracheostomy
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a method of oxygen delivery
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ambu bag
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how should an ET tube be cared for
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use safe disinfectant, hang to dry, cover from dust, and check for obstruction
