What is the primary indication for tracheal suctioning
retention of secretions
What is the most common complication of suctioning?
hypoxemia
Complications of tracheal suctioning include all of the following except:
hyperinflation
How often should patients be suctioned?
when physical findings support the need
What is the normal range of negative pressure to use when suctioning an adult patient?
100 to 120 mm Hg
What is the normal range of negative pressure to use when suctioning children?
80 to 100 mm Hg
You are about to suction a 10
year old patient who has a 6 mm (internal diameter) endotracheal tube in place. What is the maximum size of catheter that you would use in this case
10 Fr
You are about to suction a female patient who has an 8 mm (internal diameter) endotracheal
tube in place. What is the maximum size of catheter you would use in this case?
14 Fr
to prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following?
Preoxygenate the patient with 100% oxygen
To maintain positive end-expiratory pressure (PEEP) and high FIO2 when suctioning a mechanically ventilated patient, what would you recommend?
Use a closed-system multiuse suction catheter.
Total application time for endotracheal suction in adults should not exceed which of the following?
10 to 15 seconds
While suctioning a patient, you observe an abrupt change in the electrocardiogram wave form being displayed on the cardiac monitor. Which of the following actions would be most appropriate?
Stop suctioning and immediately administer oxygen.
Which of the following methods can help to reduce the likelihood of atelectasis due to tracheal suctioning?
1. Limit the amount of negative pressure used.
2. Hyperinflate the patient before and after the procedure.
3. Suction for as short a period of time as possible.
Which of the following can help to minimize the likelihood of mucosal trauma during suctioning?
Rotate the catheter while withdrawing.
Limit the amount of negative pressure.
Absolute contraindication for nasotracheal suctioning includes which of the following?
epiglottitis
croup
Which of the following equipment is NOT needed to perform nasotracheal suctioning?
laryngoscope
After repeated nasotracheal suctioning over 2 days, a patient with retained secretions develops minor bleeding through the nose. Which of the following actions would you recommend?
Stop the bleeding and use a nasopharyngeal airway for access.
Before the suctioning of a patient, auscultation reveals coarse breath sounds during both inspiration and expiration. After suctioning, the coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem?
The patient has hyperactive airways and has developed bronchospasm.
What general condition requires airway management?
1. airway compromise
2. respiratory failure
3. need to protect the airway
Which of the following conditions require emergency tracheal intubation?
1. upper airway or laryngeal edema
2. loss of protective reflexes
3. cardiopulmonary arrest
4. traumatic upper airway obstruction
Which of the following autonomic or protective neural responses represent potential hazards of emergency airway management?
1. hypotension
2. bradycardia
3. cardiac arrhythmias
4. laryngospasm
All of the following indicate an inability to adequately protect the airway except:
wheezing
Which of the following types of artificial airways are inserted through the larynx?
nasotracheal tubes
orotracheal tubes
Compared with the nasal route, the advantages of oral intubation include all of the following except:
less retching and gagging
Compared with the oral route, the advantages of nasal intubation include all of the following except:
reduced risk of kinking
Compared with translaryngeal intubation, the advantages of tracheostomy include all of the following except:
decreased frequency of aspiration
What is the standard size for endotracheal or tracheostomy tube adapters?
15 mm external diameter
What is the purpose of the additional side port (Murphy eye) on most modern endotracheal tubes?
ensure gas flow if the main port is blocked
What is the purpose of a cuff on an artificial tracheal airway?
to seal off and protect the lower airway
What is the purpose of the pilot balloon on an endotracheal or a tracheostomy tube?
to monitor cuff status and pressure
Which of the following features incorporated into most modern endotracheal tubes assist in verifying proper tube placement?
1. length markings on the curved body of the tube
2. imbedded radiopaque indicator near the tube tip
3. additional side port (Murph
a. 1 and 2
The removable inner cannula commonly incorporated into modern tracheostomy tubes serves which of the following purposes?
aid in routine tube cleaning and tracheostomy care
provide a patent airway should it become obstructed
What is the purpose of a tracheostomy tube obturator?
to minimize trauma to the tracheal mucosal during insertion
In the absence of neck or facial injuries, what is the procedure of choice to establish a patent tracheal airway in an emergency?
orotracheal intubation
While checking a crash cart for intubation equipment, you find the following: suction equipment, oxygen apparatus, two laryngoscopes and assorted blades, five tubes, Magill forceps, tape, lubricating gel, and local anesthetic. What is missing?
syringe(s)
resuscitator bag or mask
tube stylet
Before beginning an intubation procedure, the practitioner should check and confirm the operation of which of the following?
1. laryngoscope light source
2. endotracheal tube cuff
3. suction equipment
While checking a Miller and a MacIntosh blade on an intubation tray during an emergency intubation, you find that the Miller blade "lights" but the MacIntosh blade does not. What should you do now?
Check and replace the bulb in the MacIntosh blade.
What size endotracheal tube would you select to intubate a 3-year-old child?
b. 4.5 to 5.0 mm
What size endotracheal tube would you select to intubate a 1500-g newborn infant?
3.0 mm
What size endotracheal tube would you select to intubate an adult female?
8 mm
What is the purpose of an endotracheal tube stylet?
it adds rigidity and shape to ease insertion.
To make oral intubation easier, how should the patient's head and neck be positioned?
neck flexed, with head supported by towel and tilted back
What should be the maximum time devoted to any intubation attempt?
30 seconds
Which of the following statements are FALSE about methods used to displace the epiglottis during oral intubation?
Levering the laryngoscope against the teeth can aid displacement.
During oral intubation of an adult, the endotracheal tube should be advanced into the trachea about how far?
until its cuff has passed the cords
Immediately after insertion of an oral endotracheal tube on an adult, what should you do?
1. Stabilize it with your right hand.
2. Inflate the tube cuff.
3. Provide ventilation or oxygenation.
Ideally, the distal tip of a properly positioned endotracheal tube (in an adult man) should be positioned about how far above the carina?
3 to 6 cm
Which of the following bedside methods can absolutely confirm proper endotracheal tube position in the trachea?
fiberoptic laryngoscopy
After an intubation attempt, an expired capnogram indicates a CO2 level near zero. What does this finding probably indicate?
placement of the endotracheal tube in the esophagus
After intubation of a cardiac arrest victim, you observe a slow but steady rise in the expired CO2 levels as measured by a bedside capnometer. Which of the following best explains this observation?
return of spontaneous circulation
Serious complications of oral intubation include which of the following?
1. cardiac arrest
2. acute hypoxemia
3. bradycardia