Flashcards in Endotracheal Intubation Deck (29)
Why do we intubate? (Name 3 reasons)
- Maintain airway (anaesthesia removes voluntary control of the airway )
- Anaesthesia abolishes protective airway reflexes e.g. coughing
- Prevent aspiration pneumonia
- Prevent laryngospasm
- Reduce environment pollution
- Allow IPPV
Why is mask airway not as good as ET? Name 3 reasons
- Mask increases pollution
- Never direct regardless of how hard you try
- Not particularly efficient
- Doesn't secure an airway
- may find sizes difficult?
What kind of animals is mask airway most commonly used on?
exotics, birds, small furries
Explain 2 ways to get the correct ET tube?
- Tip of incisor to spine of scapula compare to palpable width of trachea
- Palpate trachea to feel how wide it is
- Look at space between the nostrils
What equipment is required?(7 things)
1. Suitable sized ET tube
2. Tube tie
3. Mouth gag
4. Syringe to inflate cuff
7. Local anaesthetic spray
Name the 4 kinds of ET tubes
- Red rubber
- Murphy eye tubes
Name 3 benefits of using a PVC over a red rubber ET tube?
- Red rubber is not see through (PVC is transparent so can see for any obstructions)
- Red rubber has a low volume high pressure cuff which is more likely to cause damage to the trachea (PVC is high volume low pressure cuff)
- Even if you over inflate the cuff the PVC is less likely to cause tracheal damage than Red Rubber
- PVC lasts longer
What kind of ET tube is recommended in cats?
Why must you be careful when inflating an ET tube cuff?
- tracheal damage
- high mortality incidence with ET intubation
What checks should you do prior to use of an ET tube?
- ensure it is the correct size
- Make sure it is clean
- Make sure the cuff is operational
- Make sure it is not damaged / perished / is in date
For 'Gold standard' how long should you leave the cuff inflated for prior to use?
30 minutes then deflate
Generally what tube size is used for the following:
cat - 4.5-5
Dog 10kg - 8
Dog 20 kg - 10
Dog 30 kg - 12
Name the two types of laryngoscope:
Name 2 reasons why it is dangerous if the patinet is not adequately anaethetised prior to intubation?
- Could be bitten
- Could bite ET tube and section lodged in trachea
Explain the steps of intubating a patient
- Assistant holds animals head / restrains
- Ensure the anaesthetic depth is adequate
- Visualise glottis (with or without a laryngoscope)
- Insert tip of bevel then rotate to follow curve of trachea
- Use topical anaesthetic if required ( spray)
- Check placement and secure
- Inflate cuff if apt
How do you know if the patient is intubated correctly?
- Palpate within the trachea
- Ausculate both lung fields
- Observe movement in reservoir bag
- check for air movement
Name 4 disadvantages of intubation/
- Increased airway resistance if tube too narrow
- Kinking or occlusion of tube
- Iatrogenic trauma to larynx
- Irritation to mucosa if tube not rinsed
- Over inflation of cuff causing tracheal damage
- Endo-bronchial intubation
Give 2 reasons why a patient may be difficult to intubate:
- patient too light
- Anatomical problems e.g. brachycephalics
What should you do prior to intubating if you think a patient may be difficult to intubate?
Pre-oxygenate for at least 5 minutes
Name 3 potential ET tube problems?
- Tube in oesophagus
- Tube lodged in bronchus
- Laryngospasm in cats
- Tube blocked or kinked
- Tracheal rupture
What could a tube in the oesophagus cause?
- Patient doesn't stay asleep
What would tube lodged in bronchus cause?
- Patient wakes up
How do you tell if tube is lodged in oesophagus?
- patient wakes up
- Low spO2 on pulse oximeter
- Low/little movement of reservoir bag
How do you tell if tube is lodged in bronchus?
- spO2 is greatly reduced
- Unilateral breath sounds
- patient wakes up
How do you prevent laryngospasm in cats?
- Use 1 spray of local anaesthetic and wait
- Use laryngoscope
- If problems oxygenate and wait
How do you tell if there is a blocked or kinked ET tube?
- spO2 very low
- Little movement of reservoir bag
How do you tell if there is a tracheal rupture?
- Sub-cut emphysema
- Reduced breath sounds
How do you extubate your patient?
- Wait until pharyngeal reflexes have returned
- Make sure the oropharyngeal area is free of debris/blood
- Wait until patient coughs/chews if brachycephalic and monitor oxygen