eMentorSurgery

Dear students, This is only for your revision and NOT A FULL TEXT.

Tracheostomy

Def : An operation to relieve Air Way Obstruction or ImproveRespiratory function

Here a direct entrance is made to the trachea from theskin

Before Tracheostomy, Try Intubation

Rapid Sequence Intubation

•        Prepare

•        Pre-Oxygenate

•        Pre-treat

•        Paralyze

•        Pressure - Cricoids

•        Pass the tube

•        Post-Intubation Assessment

Indications

1. Acute Upper Airway Obstruction

            ForeignBody

            Tumours(Laryngeal Carcinoma)

            LaryngealDiphtheria

            Laryngotracheo-Bronchitis

            LaryngealOedema

            Bil.Vocal Cord Palsy

            CutThroat Injuries

2. Improve Respiratory Function

            Bronchpneumonia

            ChestInjuries

            Maxillo-FacialInjuries

            HeadInjuries

Reduces Anatomical Dead Space

Helps in Tracheal aspiration

3. For Positive Pressure Ventilation

            BulbarPoliomyelitis

            BarbituratePoisoning

            Tetanus

4. As a part of another operation

            Laryngectomy

            Head& Neck Cancer Surgery         

Steps

Position : Supine with NECK            EXTENDED

            PillowUnder the Shoulders ß

Anaesthesia

            Local  / General Anaesthesia

Incision :         Verticalin Emergency

            Otherwise Horizontal

Incision centered over 2, 3 & 4         Tracheal cartilages

Incise Skin, Platysma, Deep Fascia

Retract the Strap Muscles

Retract or Divide Thyroid Isthmus

Identify Trachea

            TrachealRings

            Aspirateand get Air

Inject Local Anaesthetic - Larynx

Incise the trachea

Use a Tracheal Dilator

Insert Tracheostomy Tube

Suture the Skin loosely

Tie Tracheostomy tube in place

Maintainance

Humidify the Inspired Air

Suction of Secretions

Clean the Inner Tube (Metal)

Frequently Deflate Cuff

Complications

Bleeding

Infection

Tracheal Stenosis

Tracheo-Oesophageal Fistula

Pneumothorax

Surgical emphysema