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Airway obstruction

Airway obstruction. Trauma foreign bodies inflammation hematomas CNS disease secretions Drug overdose Infections glottitis Obstructive sleep apnea. Airway Protection. May be impaired for similar reasons May decompensate with addition of varied bolus sizes and consistencies.

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Airway obstruction

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  1. Airway obstruction • Trauma • foreign bodies • inflammation • hematomas • CNS disease • secretions • Drug overdose • Infections • glottitis • Obstructive sleep apnea

  2. Airway Protection • May be impaired for similar reasons • May decompensate with addition of varied bolus sizes and consistencies

  3. Artificial Airways • Rationale • upper airway obstruction • loss or impairment of airway protective reflexes • inability to maintain clear airway (secretions) • ventilator support

  4. Maintaining a Patent Airway • Maintaining a clear airway • secretions • inability can have drastic effects • lung collapse • hypoxemia • laborious breathing

  5. Skills needed for effective clearing mechanism (cough) • deep breath • competent glottis • generate increased pressure • vital capacity of 15 cc/kg

  6. Ventilator • Inability to maintain pulmonary function • Apnea • Acute ventilator failure • increased CO2 decreased pH • Hyperventilation • tracheostomy tube is required for ventilator function

  7. Disadvantages • Airway contamination • Diminished cough • Inability to vocalize • Loss of control • Increased difficulty swallowing

  8. Types of Artificial Airways • Endotracheal tube • emergency • surgical • ICU • Cricothyroidotomy • emergency

  9. Nasotracheal • nonpreferred method • oral cavity surgeries • Tracheostomy • long term intubation • greater than 10 - 21 days

  10. Tracheostomy Advantages • lower risk of laryngotracheal injury • improved comfort/mobility • improve airway stabilization • allows for oral nutrition • improved secretion clearance

  11. Potential problems (24 hours) • pneumothorax • hemorrhage • subcutaneous emphysema • infection • tube displacement

  12. Problems (long term) • aspiration • swallow dysfunction • increased incidence of RTI and pneumonia • tracheal stenosis a/o malacia • TE fistula • granulomas • obstruction

  13. Tracheostomy tubes • Inner cannula • Outer cannula • Phalange • Obturator • Pilot balloon • Cuffs • high volume, low pressure • low volume, high pressure

  14. Changing trach tube • malfunction • infection • more flexible • weaning

  15. SuctioningComplications • hypoxemia • hypotension • slow heart rate • prolonged coughing which slows rate • arrhythmia • lung collapse • mucosal damage

  16. Trach tube types • Cuffed • Cuffless • Fenestrated • Communication tubes • Tracheal buttons

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