Tracheostomy

Tracheostomy is a surgical opening of trachea while tracheostomy creation of stoma at the skin surface which leads to the trachea.
it may be used as temporary or permanent, according to the conditions of the patients.

Indication.

Upper airway obstruction.
Swelling resulting from burns.
Prolonged ventilation.
To provide broncho pulmonary toileting and to protect the airway.
Conversion of cricothyroidotomy
An alternate pathway of breathing bypass
the upper airway obstruction.
improve the alveolar ventilation.

By Congenital
Laryngomalacia(congenital disease ).
Vocal cord paralysis
inflammatory
acute epiglottis, acute Laryngo-bronchitis, diphtheria.
Traumatic injury
Malignant conditions
Bilateral abductor paralysis
Foreign bodies
Bronchial asthma
Strider

Types of according to the uses

1.Elective
2.Permanent
3.Emergency

Effect of a tracheostomy.

The larynx is bypassed.
There is the risk of respiratory tract infection.
Foreign body reaction can occur causing local inflammation.

Principle

Consent
Before getting consent from the patients and patients guardians, you must have explained about the precaution, procedure, risk, and complication clearly.
Before the procedure confirms with the ultrasound, whether there is a presence or absence of large blood vessels

Nasogastric feeding should be stopped at least two hours, that may reduce any chance of aspiration of gastric content to the lungs.
Sedation, analgesia drugs, muscle relaxant, and vasoconstriction drugs kept ready before the procedures.
oxygen supply with the appropriate device for delivery with a connector.
keep the suction ready.

Bronchoscope for visualization of the bronchus and carina if needed.

Procedure tracheostomy

It is done under local anesthesia

Positions

Patient in the supine position with neck extended and a wedge keeps a roll under the shoulder.

Before incision of the injection of the 1% lidocaine with 1:20000 epinephrine.
lubricate the tracheostomy tube 2% lignocaine jelly.

A transverse skin incision overlying the upper trachea, that separating the strap muscle of the neck in the midline by retractors

Often thyroid isthmus may displace or divided to allow for adequate exposure of an anterior surface of the trachea.
The tracheostomy tube placed through the second or the third tracheal ring.
keep the suction ready and oxygen by the side.
After incision inserts the tracheotomy tube with the guide wire or an obturator is take out and suction is done when there is a secretion.
Inflate the cuff and check for the position of the tracheostomy tube with an assessment of chest movement, auscultation after confirmation sees the capnography for the confirmation chest, x-ray must be taken when there is extended pneumothorax.

Complication

Tracheal stenosis

Tracheoesophageal fistulas

Patient discomfort

Tracheal trauma (bleeding)

Tracheo-innominate artery damage

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