STABLE: Airway

8/12/2019 STABLE: Airway

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AIRWAY


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INTUBATION AND POSITIVE PRESSUREVENTILATION SHOULD BE STRONGLY ONSIDEREDWHEN THE FOLLOWING RESPIRATORY FAILUREWARNING SIGNS ARE PRESENT:

1) Labored respiratory effort, mod. to sev.retractions, grunting, nasal flaring.2) Not able to maintain acceptable O2 sat for

suspected disease process.NOTE: some forms of cyanotic congenital heartdse, O2 sat may remain


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7) Severe apnea and bradycardia.

8) Gasping: signifies extremely criticalstate and should be treated withbag/mask ventilation, then endotrachealintubation with assisted ventilation


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PRE-TRANSPORT/ TRANSFER MONITORING

EVALUATE Oxygen saturation (pulseoximetry)

Oxygen concentration (percent)being delivered

Skin perfusionStrength of the pulses in the arms

and legs

VITALSIGNS

TemperatureRespiratory rate and effortHeart rate and rhythmBlood pressure


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TESTS Chest x-ray (abdominal x-rayif problem is GI)

Blood sugarBlood gas (ABG)Blood cultureComplete blood count (CBC)


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BLOOD GAS EVALUATION- NORMAL VALUES

ARTERIAL CAPILLARY

pH 7.30-7.45 7.30-7.45

pCO2 35-45 mmHg 35-50 mmHg

pO2 (on room air) 50-80 mmHg 35-45 mmHg (notuseful for assesing

oxygenation)Bicarbonate (HCO3) 19-26 mEq/L 19-26 mEq/L

Base Excess -4 to +4 -4 to +4

Oxyhemoglobin

Saturation (pulseoximeter) on room air

90-95 %

NOTE: The p02 and saturation will vary with altitude. Warm heelfor 3-5 min before CBG obtained.


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ENDOTRACHEAL TUBE (ET TUBE) SIZE ANDINSERTION DEPTH

Tube size (IDmm)

Weight (gms) GestationalAge (weeks)

InsertionDepth (cm)*

2.5 Below 1000 Below 28 6.5-7 (at thelip)

3.0 1000-2000 28-34 7-83.5 2000-3000 34-38 8-9

3.5-4.0 Above 3000 Above 38 >9

*(centimeter marking on the tube when the inserted tube ismeasured at the LIP)


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INSERTION DEPTH USING LIP TO TIPMEASUREMENT: WEIGHT IN KILOGRAMS PLUS 6

1. For extremely low-birth weight infants, (lessthan 1000 grms), the ET tube insertion depth atthe lip is usually between 5.5 & 7 cm. Confirmlocation by exam & chest X-ray. Tip location willvary with head position, therefore, take each x-ray with the head in the same position.

2. A size 2 ET tube is too small that ventilation isimpaired & insertion of this size tube should beavoided. Consult with the tertiary centerneonatologist prior to inserting 2.0 mm ET tube.


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(THORACOCENTESIS)

NEEDLE ASPIRATIONPROCEDURE


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THORACOCENTESIS

is an invasive procedure toremove fluid or air from the pleural space fordiagnostic or therapeutic purposes.

A cannula, or hollow needle, is carefullyintroduced into the thorax, generally afteradministration of local anesthesia. Theprocedure was first described in 1852.Pneumothorax is one of the diseasecondition that this procedure is used.


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PNEUMOTHORAX

is an abnormal collection of air or gas inthe pleural space that separatesthe lung from the chest wall and which mayinterfere with normal breathing.


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NEEDLE ASPIRATION KIT

Angiocath gauge18, 20,223 way stopcock

T-connector30ml syringe

Antiseptic solution


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NEEDLE ASPIRATION PROCEDURE

Connect the T-connect to the male end of thestopcock and connect the 30 ml syringe tothe female of the stopcock.

After the catheter is inserted into the pleuralspace and the stylette is withdrawn, connectthe T-connector to the hub of the catheter.Open stopcock to patient.


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Aspirate air in the chest.When resistance is felt or plunger is pulled back to the30 ml mark, turn the stopcock off to the patient.

Push the air out of the syringe.Open the stopcock to the patient again and repeat theprocedure.

If air is continuously aspirated from the chest, a chesttube may need to be placed.Consult the tertiary center as needed for guidance.

CHEST TUBE SIZES: Small or premature infant Fr 8/Large or term infant Fr 10

STABLE: Airway

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