tracheostomy
DESCRIPTION
tracheostomyTRANSCRIPT
It is a life saving procedure by creating a surgical opening into the trachea bypassing an upper respiratory obstruction. It can be done as an emergency or electively.(stomy = stoma = opening).
Trachea & larynx
A) Upper airway obstruction: 1- Congenital : laryngeal web, laryngeal stenosis, haemangioma,
laryngomalacia… 2- Trauma : ETT injuries, cut throat, gun shot, steam
inhalation, corrosives, DXT, flail chest… 3- Infection: Ac. Epiglottitis, L.T.B. , Diphtheria, Ludwick’s
angina. 4- Malignant Tumours: Ca tongue Base, ca larynx & upper
trachea, ca thyroid. 5- Preoperative procedture of laryngeal or oral surgery. 6- Bilat. Vocal Cord paralysis: - post- thyroidectomy, bulber
palsy. 7- Hair-dye Poisoning: angioneurotic oedema.
B) Protection of tracheobronchial tree:
(Reduction of secretions):
1- Myathenia Gravis, Polyneuritis.
2- Brainstem Stroke.
3- Multiple rib fractures.
C) Respiratory Failure (Reduction of dead space):
1- Chronic obstructive airway disease.
2- Severe bronchial asthma.
3- Gillian Barry syndrome.
4- Abnormal thoracic cage (thoracic kyphosis).
D) Assisted ventilation (Prolonged intubation)
1- Prolonged coma for any cause
2- Extensive faciomaxillary surgery.
3- Any condition needing IPPR , artificial or
mechanical respiration.
Types of tracheostomy : - High - Mid- Low
Procedure :-
- G.A. , local , no anaethesia.- Position of the patient: supine, neck extended. - Incision : emergency: Transverse, longitudinal:elective.- Layers: skin , superficial cervical fascia , platysma, strap muscles, pretracheal fascia, thyroid isthmus , stoma in 2nd , 3rd & 4th rings. Insert tube :metal or portex. - Close wound & dressing.
Post-operative Care:
• - Position: semi-sitting.• - Humidification.• - Suctioning . • - Observe breathing & bleeding.• - Feeding.• - Antibiotics & analgesics.• - Tube care.• - Decannulation.
Complications:• - Hemorrhage. • - Surgical emphysema .• - Pneumothorax.• - Respiratory obstruction (tube slipping or obstruction).• - Injuries to blood vessels, nerves, • esophagus…etc.• - Wound infection: perichondritis, stenosis,
septicaemia. • - Difficult extubation .• - Tracheo-esophageal fistula. • - Speech problems.