Tracheostomy
Creation of surgical opening in the trachea and converting this opening into astoma on the skin surface.
Indications:
1-releife of upper airway obstruction
?Congenital
?Bilateral choanal atrasia
??Laryngomalacia
???Laryngeal web
????Subglottic stenosis
?Traumatic
?Either external trauma as in gun shot or stab wound (cut throat), or internal trauma as inhalation of irritating fumes, swallowing of corrosives, forign body.
? Infections
?Acute epiglottitis
??Acute laryngotracheobronchitis
???Diphtheria
????Ludwig s angina
? Tumours
Of the tongue,larynx,pharynx,thyroid:
?In advance stage
??If oedema from radiotherapy embarrasses respiration
???As adjuvant to surgery
? Bilateral recurrent nerve palsy
?After thyroidectomy
??Bulbar palsies
2, Protection of tracheobronchial tree, this achieved by:
? Provide good aspiration
?? Protect from inhalation of saliva, food or blood
??? Clear the airway from stagnation of bronchial secretion
These conditions include:
?Coma due to head injury, poisoning, cardiac arrest
??Burn of the face, neck
???Multiple fractures of the mandible
????Neurological diseases as myasthenia gravis, tetanus, cervical cord lesions or injury
3. Tretment of cases lead to respiratory insufficiency as in
? All above conditions
?? Pulmonary diseases as
?Chronic bronchitis and emphysema
?Post operative pneumonia
???Severe chest injury (flail chest)
????Neuromuscular in coordination
?????Need for intermittent positive pressure respiration IPPR
Aims of tracheostomy
?Relief upper airway obstruction(By-passing)
??Reduce the dead space (30-50%)
???Allowing easy toilet of bronchi
????Using of mechanically assisted ventilation PPV
Criteria for emergency tracheostomy:
?Recession of suprasternal notch and intercostals space
??Anxious, pale, sweating faces
???Cyanosis, indicate a late and grave stage
Types of tracheostomy
Elective or emergency,Temperary or permanent
Types of tracheostomy tube
?Metalic
??Non metallic
Criteria for emergency tracheostomy:
?Recession of suprasternal notch and intercostals space
??Anxious, pale, sweating faces
???Cyanosis, indicate a late and grave stage
Types of tracheostom*
Elective or emergency,Temperary or permanent
Types of tracheostomy tube*
?Metalic
??Non metallic
Technique of tracheostomy
?Anaesthesia either local or general
?Position extension of the head
?Incision either vertical or horizontal ,vertical always used in emergency midline from the level of cricoid cartilage to the suprasternal notch ,horizontal incision about 2 fingers breadth above the suprasternal notch
? Midline separation of strap muscle using blunt dissection scissor vertically with haemostasis of all bleeding points
? Thyroid isthmus either divided or separated
? Trachea exposed and opened ,tracheal incision is at 2nd,3rd and fourth tracheal rings
? Insertion of the tube
? Closure of the wound loosely and dressing
Post-operative care
?Nursing, constant attention for first 24 hours
??Position upright position in bed
???Humidification of inspired air
????Suction applied regularly
?????Fixation of the tube by silk suture to the skin and tape tied around the neck
??????Care of the wound by dressing and antibiotic
???????Change the tube at least after 36-48 hours and in children it should be done at least one week after surgery
Complication of Tracheostomy
?Immediate
?Haemorrhage from anterior jugular vein ,thyroid gland vessels
??Air embolism due to air sucked into large neck veins that may be opened
???Apnea due to sudden CO2 wash out
????Cardiac arrest either due adrenaline production of anxious patient,hyperkalaemia due to respiratory alkalosis or rapid rise in PH as aresult of rapid CO2 wash
?Intermediate complications
?Displacement or dislodgment of tube
??surgical emphysema
???Pneumothorax and pneumomediastinum
????Obstruction of tube by crusts
?????Infections of the wound
??????Tracheal necrosis due to over size of tube,improper curve of tube or pressure of the cuff on the trachea
???????Tracheoarterial fistula and tracheo-oesophageal fistula
????????Dysphagiadue to tethering of the larynx,pressure of inflated cuff on the oesophagusor due to original cause of tracheostomy
?Late complications
?Tracheal stenosis due to inflatable cuff, improper placed insicion, repetitive incision, tracheal resection or trauma, or tracheal infections
??Difficulty with decanulation especially in long standing tube due to suprastomal granulation and fibrous mass
????Tracheocutanous fistula and scars especially in long standing tracheostomy
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .