Gas Exchange/Vents/Trach

Gas Exchange

Tracheostomy
Emergencies

Miranda Smith, Ed.D., AGACNP-BC

Adapted from Dr. Joseph Chamness

Objectives

• Identify Tracheostomy Emergencies

• Discuss the steps to improve

oxygenation during a tracheostomy
emergency

At Bedside

Identify Trach Emergency

Dislodgment
Obstruction
Pneumothorax
Equipment
Stacked Breaths

Dislodgement
Obstruction
Pneumothorax
Equipment
Stacked breaths

Dislodged

Old Trach then Replace

How do you replace?

Do not Force in

Fresh Trach

Less than 7 days old

CALL FOR HELP!

Do not replace

Why do we not replace?

Should have been sutured

Obstruction

Vigorous coughing

Suction

Change inner cannula

If old replace entire trach

RT may lavage

Oxygenation

Trach collar over stoma

BVM face or stoma

Cover stoma when using BVM

Be prepared to orally intubate

Is air getting past the balloon if using BVM?

BVM Straight to Stoma

Laryngeal mask around stoma to oxygenate

Trach Hemorrhage

Suction isn’t helping

Stop the bleed

Orally intubate

Steps to take

1

2

3

4

Call For
Help

Give
Oxygen

Remove
Inner
Cannula

Suction

Steps to take

5

6

7

8

Remove
Trach

Ventilate
Stoma

Intubate
Orally

Intubate
Stoma

Questions?

Multiple Choice

The nurse is caring for a client in the ICU who had a tracheostomy placed 14 days ago. The client has a forceful cough and the tracheostomy comes out. What should the nurse do immediately?

• Call for help and wait for assistance.
• Reinsert the tracheostomy tube using the obturator

• Administer oxygen and monitor vital signs.
• Perform chest compressions immediately.

Multiple Choice

Which CXR would you expect with a client who has ARDS?

Multiple Choice

The nurse is providing care to a client who is being treated for aspiration pneumonia. Which finding below is the HALLMARK sign for the client who is developing ARDS?

• PaO2 45

• RR 8

• BP 180/96

• Restless and confusion

Multiple Choice

Which statement correctly explains ARDS?

• This condition develpos because the exocrine glands start to work incorrectly which leads to thick mucous.

• It is a pulmonary disease that gradually cause obstruction of airflow in the lungs

• It occurs due to the collapsing of the lung because air has accumulated in the pleural space

• It develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs

Multiple Choice

The nurse is caring for a client who is on mechanical ventilation with high levels of PEEP for ARDS. Which finding would indicate the patient is developing a complication related to their treatment?

• HCO3 26

• BP 70/45

• PaO2 80

• PaCO2 38

Multiple Select

Which treatments would be appropriate for a client who is being treated for ARDS?

• Low Tidal Volume

• High PEEP

• Low FiO2

• High RR

Multiple Select

Vent Settings: PRVC TV 500 FiO2 60% RR 24 PEEP 10

ABG: pH 7.48 PaCO2 32 HCO3 24 PaO2 180

Which ventilator changes would be appropriate?

• Decreaese FiO2

• Decrease RR

• Decrease PEEP

• Increase tidal volume

Multiple Choice

Vent Settings: PRVC TV 400 FiO2 60% RR 18 PEEP 14

ABG: pH 7.38 PaCO2 12 HCO3 15 PaO2 80

Which ventilator changes would be appropriate?

• Increase TV and decrease RR
• Maintain current settings without changes
• Increase PEEP and decrease FiO2
• Decrease TV and increase RR

Multiple Choice

A high pressure alarm is sounding on the ventilator. The nurse goes to assist the client and the vital signs are: HR 113, BP 174/98 (123), SpO2 78% PIP 55 RASS score +1. Which intervention would be most appropriate?

• Increase PEEP

• Increase tidal volume

• Increase sedative

• Administer labetalol

Multiple Choice

A client is brought into the ED with respiratory distress. ABG results pH 7.44, HCO3 22, pCO2 28, PaO2 54.

Which type of respitory failure is this client experiencing and what is the treatment?

• Chronic respiratory failure; treatment is bronchodilators.
• Acute respiratory distress syndrome; treatment is corticosteroids.
• Acute respiratory failure type I; treatment is supplemental oxygen.

• Acute respiratory failure type II; treatment is mechanical ventilation.

Multiple Choice

Which would be a cause of hypercapnic respiratory distress?

• Pneumonia

• Myasthenia gravis

• ARDS

• Pulmonary embolism

Multiple Choice

A client presents to the ED with a severe asthma exacerbation. Which treatment would be priority?

• Prescribe a long-acting beta-agonist (LABA) like salmeterol.
• Administer oral corticosteroids immediately.
• Obtain a chest x-ray

• Administer a short-acting beta-agonist (SABA) like albuterol.

ICU Delirium

Categorize

Options (15)

Slow to answer

Low energy

Reduced responsiveness

Decreased motor activity

Quiet demeanor

Restlessness

Increased talkativeness

Impulsivity

Rapid speech

Difficulty sitting still

Haloperidol

Benzodiazepines

Precedex

Flat, withdrawn

Agitation

Match the symptoms with the correct type of delirum

Hypoactive

Hyperactive

Treatment for delirium w/o withdrawal

Tx for delirium with withdrawal