z. lab 1: intubation & vaccines

intubation: placement of a _____, _____ tube into the _____ to maintain an _____ _____ or to serve as a conduit through which to administer certain _____

1. flexible

2. plastic

3. trachea

4. open airway

5. drugs

what are the benefits to intubating a patient?

1. maintaining an open airway

2. prevention of aspirating saliva

3. prevention of gastric regurgitation

4. seals the respiratory system & breathing circuit

what equipment is used for intubation?

1. 3-12 mL syringe

   • inflate the cuff

2. endotracheal tubes

   • varying sizes

3. gauze squares

   • to hold tongue

4. laryngoscope

   • to move epiglottis & expose tracheal opening

5. oxygen

6. sterile lubricant

7. supplies to secure endotracheal tube

what types of material are used for endotracheal tubes?

1. silicone

2. red rubber

3. polyvinyl chloride (PVC)

what types of endotracheal tubes are there?

1. plain/uncuffed

2. cuffed

plain: cole tube

• best for _____ species, _____ animals, or _____ pets

• excellent _____-_____; provides less resistance

1. avian

2. pediatric

3. exotic

4. pressure-flow

what should plain tubes be used for avian species & NOT cuffed?

birds have a complete trachea (rings are closed) & using a cuffed tube will cause pressure necrosis if inflated too much since the trachea has no elastic ligament to accommodate the expansion

what feature of the avian species allow for an airtight seal at the entrance of the larynx?

shoulders

cuffed tube

• used in _____ _____

• serves two purposes

  • prevent _____ _____ around the tube

  • reduces risk of _____ of _____ or _____ secretions

• there are two types:

  • _____ pressure, _____ volume (1)

  • _____ pressure, _____ volume (2) - less _____ to the tracheal _____

1. all species

2. gas leaks

3. aspiration

4. gastric

5. oral

6. high

7. low

8. low

9. high

10. damage

11. mucosa

what is the different between a murphy cuffed tube & a magill cuffed tube?

1. murphy - most common & has a murphy eye

   • an emergency opening if the distal end of the lumen of the tube becomes clogged

2. magill - does not have the murphy eye, otherwise very similar

what things should be kept in mind when selecting an endotracheal tube?

1. rapid intubation

2. minimize trauma

3. ensure proper airway protection

4. too large - trauma

5. too small - leaks; protection compromised

6. always choose 3 tubes

what are the 4 ways to measuring the correct endotracheal tube size?

1. correlating BW to tube size in brachycephalic breeds

2. evaluating the width of the nasal septum

3. palpation of the width of the thoracic trachea just above the thoracic inlet

4. proximal end should not pass incisor teeth & distal end should not pass shoulders

what are stylets used for?

1. for small or very flexible tubes, they provide extra support for intubation

2. for cats with laryngospasm

** ensure tip does not protrude beyond tip of endotracheal tube

what are the two types of laryngoscopes?

1. macintosh - curves

2. miller - straight

sternal recumbency

• on stomach

• access to face & back

lateral recumbency

• on side

• access to teeth

dorsal recumbency

• on back

• access to abdomen

intubation procedure for dogs

1. sedate/anesthetize

2. pull out tongue

3. examine epiglottis & soft palate

4. apply lubricant

5. locate tracheal opening with a laryngoscope

6. intubate

7. inflate cuff with syringe

intubation procedure for cats

• same as dogs

• laryngospasm: arytenoids remain closed

  • can use one drop of lidocaine to prevent

  • can be toxic if more than 0.5 mL used

ways to confirm proper intubation

1. visual - tube passes through arytenoids

2. cough - tube has advanced into trachea

3. condensation - tube clear on inhalation, cloudy on exhalation

4. palpation - ventral cervical regional should reveal one rigid structure

ways to monitor anesthesia

1. circulation

   • electrocardiography (ECG)

   • oscillometric blood pressure measurement - low BP = low blood flow = low O2 to organs

2. ventilation

   • capnography: measurement of CO2 in exhaled breath

3. oxygenation

   • pulse oximetry

4. body temperature

   • thermometer - lower BT when anesthetized

5. depth of anesthesia

   • gas analyzer

when should extubation occur?

after confirmation that the pharyngeal reflex is reestablished (swallowing)

what should occur before extubation?

1. check for excessive secretions (saliva)

2. fully deflate cuff

what should occur after extubation?

1. monitored

2. head is kept elevated to avoid aspiration

3. flow-by O2 administered

4. respiration & oxygenation monitored until animal is fully awake

administration by injection is referred to as the _____ route

parenteral

injection: the act of putting a _____, especially a _____, into a muscle or other organs using a _____ & _____

1. liquid

2. drug

3. needle

4. syringe

what are the different types of injections?

1. intramuscular - muscle

2. subcutaneous - tissue under skin

3. intravenous - veins

4. intradermal - skin

5. intraperitoneal - abdominal cavity

6. intrapleural - thoracic cavity

7. intraosseous - bone

what are the 3 most commonly used injections?

1. subcutaneous

2. intramuscular

3. intravenous