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    Tracheostomy

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    nahidanila439
    The document discusses tracheostomy, including its definition, indications, procedure, postoperative care, complications, and provides an example case of a patient presenting with stridor and hoarseness requiring diagnosis and management.

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    Tracheostomy

    Uploaded by

    nahidanila439
    9 views27 pages
    The document discusses tracheostomy, including its definition, indications, procedure, postoperative care, complications, and provides an example case of a patient presenting with stridor and hoarseness requiring diagnosis and management.

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    tracheostomy

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    The document discusses tracheostomy, including its definition, indications, procedure, postoperative care, complications, and provides an example case of a patient presenting with stridor and hoarseness requiring diagnosis and management.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    9 views27 pages

    Tracheostomy

    Uploaded by

    nahidanila439
    The document discusses tracheostomy, including its definition, indications, procedure, postoperative care, complications, and provides an example case of a patient presenting with stridor and hoarseness requiring diagnosis and management.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
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    Tracheostomy

    Definition:
    It is a surgical procedure
    where in a stoma (window)
    is created connecting
    anterior wall of trachea to
    exterior.
    1. Jaw thrust.
    2. Airway tube.
    3. Endotracheal Intubation.
    4. Cricothyroidotomy.
    5. Transtracheal Needle
    ventilation.
    6. Tracheostomy.
     To reduce anatomical dead space.
     To releife upper airway
    obstruction
     To facilitate Tracheo-bronchial
    toileting.
     To use mechanically assisted
    ventilation.
     To protect lower respiratory tract
     Emergency tracheostomy : usually done
    under local anaesthesia ( ca. larynx is the
    commonest cause )
     Elective tracheotostomy : a planned

    procedure may be done under L.A or G.A .


     Permanent tracheostomy : following total

    laryngectomy
     A 55 year old smoker male is presented to
    you with stridor, on query he gives history of
    progressive hoarsness for last 3 month.
     A) what is your diagnosis?
     B) What is the immidiate management of the

    patient?
     C) what should be the further plan of

    management of the patient?


     Anaesthesia : L.A or G.A

     Position : supine, head down, neck is
    extended by placing sand bag underneath
    shoulder blades.
     Incision : Emergency tracheostomy – A
    vertical incision is made in the midline of
    neck extending from cricoid cartilage to just
    above sternal notch.
     Elective tracheostomy – A
    transverse incision ( or collar ) is made about
    2 cm. below the level of cricoid cartilage.
    Procedure : 1. Skin , subcutaneous
    tissue , platysma are cut in the same
    line of incision .
    2. Strap muscles are
    separated in the midline and
    retracted laterally to expose
    pretracheal fascia and thyroid
    isthmus .
    3. Thyroid isthmus is either retracted upward or
    cut in between clamps.
    4. Trachea is fixed with a hook and
    opened with a vertical incision in the region of 3 rd
    & 4th / 2nd & 3rd rings. This is then conerted into a
    circular opening . The 1st tracheal ring is never
    divided as perichondrities of cricoid cartilage with
    stenosis can result .
    5. Tracheostomy tube of appropriate
    size is inserted.
    6. Skin is closed loosely .
    Post operative care/management

    A. Care of the patient

    Constant attention is essential for the first 24 h at


    least .
    Patient is kept sitting up right in bed / propped up
    position .
    Piece of paper , pen , calling bell are supplied as
    patient is unable to talk .
    Humidification is essential to prevent drying of the
    airway and crusting ; using humidifier or moistened
    gauze piece over the tube time to time.
    Patient is unable to cough and clear secretion , so
    periodic suction is needed by sterile catheter .
    I.V fluid and antibiotics.
    B Care of the tube

    Tube should be fixed comfortably not too loose


    not too tight .
    Inner tube is taken out and cleaned whenever
    necessary ( hourly at first ) .
    Outer tube is not removed until 5 days to form a
    stoma .
    The tube is removed when the patient is
    comfortable with it ‘ corked off . Gradual
    reduction in the size of tube , then sealing off and
    sometimes a small ‘ dummy help re-adaptation to
    using normal air passages .
    Care of the wound

    Regular dressing .
    Skin stitches are off on
    5-7 days .
    Complications of tracheostomy

    A. Immediate
    Haemorrhages
    thyroid vein
    Jugular veins
    arteries
    Air embolism
    Apnoea
    Cardiac arrest
    Local damage
    Cricoid/tracheal cartilage
    Recurrent laryngeal nerves
    B.Intermediate
    Dislodgement / displacement of

    the tube
    Surgical emphysema

    Pneumothorax/pneumomediastinum
    Scabs and crusts
    Infection
    Tracheal necrosis
    Tracheo-oesophageal fistula
    Dysphagia
    C. Late
    Stenosis of the trachea
    Difficulty with decanulation
    Tracheocutaneus fistula/Scars

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