Lectures on Respiratory Therapy and Intubation

Patient Condition and Timing

  • Patient mentions ongoing physical symptoms:

    • "I'm still big and I've got stuff" indicating possible respiratory issues.

    • Duration of symptoms: "Seven days. Seven to ten days."

Tracheostomy Procedures

  • Type of Tracheostomy: Bedside Procedure

    • Definition: A tracheostomy performed at the bedside is known as a Percutaneous tracheostomy.

    • Purpose of the Inner Cannula:

    • Function: Prevent obstruction by allowing easy removal in case of blockage.

    • Safety Factor: Ensures a patent airway remains if obstruction occurs.

Mechanics of Breathing with Tracheostomy

  • Fenestrated Trach Tube:

    • Purpose for Speaking: A one-way fenestration (air hole) allows air through the trach tube and up to the vocal cords, aiding verbal communication.

Emergency Protocols with Displacement

  • If tracheostomy tube is displaced and no spare is available:

    • Immediate Action: Ventilate the patient by occluding the stoma and bagging through the mouth.

    • Equipment Use: An ambu bag/manual resuscitation device is necessary.

Indications for Endotracheal Intubation

  1. Aspiration Risks: Protecting the airway to prevent aspiration.

  2. Respiratory Failure: Including impending respiratory failure and surgical preparations requiring general anesthesia.

Complications of Endotracheal Intubation

  • Two Main Complications:

    1. Trachial Tissue Damage: Scarring in the trachea due to unnecessary trauma.

    2. Aspiration: Risk during intubation and incorrect intubation can lead to bronchial intubation or broken teeth.

Reducing Ventilator-Associated Pneumonia Risks

  • Methods to Decrease Risks:

    1. Oral Suctioning: Regular suctioning of secretions.

    2. Using Sterile Equipment: Minimizes infection and contamination risks.

Screening for Readiness

  • Two Screening Tests:

    • Determination of readiness for extubation is crucial.

Patient Symptoms of Self-Extubation

  • Symptoms: High-pitched inspiratory stridor indicating possible airway obstruction.

  • Recommended Treatment: Administer airways medication (e.g., Racemic epinephrine).

Academic Insights and Examinations

  • Student Engagement: Discussion around clinical experiences (e.g., cardiac arrests).

  • Preparation for Practicals: Familiarity with equipment and intubation procedures is necessary.

  • Future of Respiratory Education:

    • Movement towards higher educational requirements (transitioning to a four-year degree).

    • The evolving role of respiratory therapists in clinical settings.

Job Market Insights for Graduates

  • Salary expectations range significantly with varying experience levels:

    • Starting salaries around $30/hour for new graduates, with possible peaks at $37/hour in certain areas.

Educational Pathways

  • Master's and Bachelor's Degree Implications: Discussion on the value of pursuing higher education to elevate professional status (BS in Cardiopulmonary Sciences).

Intubation Procedure Overview

  • Pre-Intubation Steps:

    1. Place patient in sniffing position to achieve line of sight to the vocal cords.

    2. Preoxygenation: Use a tight-fitting mask for 100% oxygen delivery, pre-oxygenate for a minimum of three minutes.

  • Pharmacological Preparation:

    • Administer analgesics and hypnotics to facilitate the intubation process.

  • Technique:

    1. Opening Airway: Use a chin lift or jaw-thrust maneuver as necessary.

    2. Ventilation Confirmation: Observe chest rise and end-tidal CO₂ monitor post-intubation to confirm placement.

    3. Securing Tube: After successful placement, secure with tape and initiate mechanical ventilation.

Laryngoscopy Techniques

  • Precise techniques for laryngoscope handling:

    • Holding the laryngoscope with three or four fingers for precision and control.

    • Technique to ensure exposure of vocal cords without unnecessary violence.

  • Tube Placement: Guide the endotracheal tube through the vocal cords; cuff inflation should be done after confirming tracheal placement.

Monitoring During Intubation

  • Essential Signs: Use of end-tidal CO₂ waves as a primary confirmation of correct tube placement.

Conclusion and Recap

  • Intubation training is integrated into routine practice.

  • Continuous emphasis on developing crucial skills and knowledge in emergency situations.