Airway Management
What is the primary reason the pilot balloon is palpated during assessment?
To verify cuff inflation
What does “tidal volume” measure?
Amount of air delivered each breath (mL). Based on height & weight.
What does a high-pressure alarm usually indicate?
Airflow resistance (e.g., secretions, kink, water in tubing, bronchospasm)
How can you tell if a trach tube is cuffed or uncuffed?
Presence of a pilot balloon = cuffed
What daily nursing intervention tests readiness to wean?
Sedation vacation with spontaneous breathing trial (SBT)
After oral intubation, the tube is secured at 22 cm at the lip. Later it’s at 19 cm. What does this mean?
Tube migrated outward; airway is compromised. Reassess breath sounds and notify RT/provider.
In Assist-Control (AC) mode, what happens when the patient initiates extra breaths?
Ventilator delivers the full preset tidal volume each time → risk for respiratory alkalosis.
What does a low-pressure alarm usually indicate?
Loss of system pressure (disconnection or cuff leak)
Why must trach-collar oxygen be humidified?
Bypasses nose/mouth → no natural moisture → prevents thick secretions and mucus plugs
Which finding after extubation demands immediate action?
Stridor → call rapid response for airway obstruction (laryngeal edema)
Why can’t an orally intubated patient speak?
The ET tube passes between the vocal cords, preventing vibration
Which mode allows spontaneous breaths between mandatory breaths and is used for weaning?
SIMV (Synchronized Intermittent Mandatory Ventilation)
Sequence for troubleshooting any vent alarm?
1. Assess patient
2. Check connections
3. Fix obvious cause
4. Manually bag if oxygenation fails
What is the first action if the trach accidentally dislodges?
Insert the spare trach tube immediately to re-establish airway
Vagal stimulation during suctioning causes what?
Bradycardia & hypoxia → stop suction and oxygenate
Name two nursing actions to prevent facial skin breakdown from the ET holder.
Rotate oral tube L–C–R each shift and inspect mouth/lips q2h.
What does a PEEP of 15 cm H₂O risk causing?
Hypotension & barotrauma from increased intrathoracic pressure → ↓ venous return.
High-pressure alarm + absent right-sided breath sounds = ?
Right-sided pneumothorax; manually ventilate & call for help
“Rice-Krispie” sensation under skin near trach site =
Subcutaneous emphysema → notify provider immediately
Why are PPIs or H₂ blockers given to vented patients?
Prevent stress ulcers and GI bleeding from increased acid production
What early sign suggests a right-mainstem intubation?
Absent left-sided breath sounds + unequal chest rise → withdraw slightly and re-verify placement.
A patient on volume-cycled ventilation develops crepitus and high PIP. What complication occurred?
Barotrauma → alveolar rupture (pneumothorax or subcutaneous emphysema)
Low-pressure alarm + soft pilot balloon + hissing = ?
Cuff leak → reinflate via pilot balloon and reassess SpO₂
Why use sterile gloves when inserting the inner cannula?
To maintain sterility and prevent tracheal infection or sepsis
What long-term complication occurs from prolonged mechanical ventilation and immobility?
Ventilator dependence with muscle deconditioning → early mobilization/PT prevents it