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Tracheostomy
 

Tracheostomy

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    Tracheostomy Tracheostomy Presentation Transcript

    • TRACHEOSTOMY DR. A. NAVEED FRCS (Ed) ENT Department Tawam Hospital Al-Ain, Abu Dhabi U.A.E.
      • Tracheotomy
      • operative procedure that creates an artificial opening in the trachea.
      • Tracheostomy
      • c reation of permanent or semi permanent opening in trachea.
      • Anatomy
      • Trachea lies in midline of the neck extending from cricoid cartilage (C6) superiorly to the tracheal bifurcation at the level of sternal angle (T5).
      • Comprises 16-20 C shaped cartilage rings.
      • Length 10-12cm.
      • Diameter 15-20mm.
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        • Indications
        • Upper Airway Obstruction.
        • Pulmonary Ventilation.
        • 3. Pulmonary Toilet.
        • 4. Elective Procedure
      • Upper Airway Obstruction
      • Trauma
      • Foreign body
      • Infections
      • Malignant lesions
      • Pulmonary Ventilation
      • Tracheostomy should be performed in a patient still requiring ventilation through an endotracheal tube for more than a one week.
      • Pulmonary Toilet
      • Those who cannot cough and clear their chest.
      • Prevent aspiration by low pressure high volume cuff tracheostomy tube.
      • Elective Procedures
      • For major head and neck operations.
    • Elective Tracheostomy Anaesthesia : G A Position: Supine with sand bag under the shoulder Incision :horizontal incision b/w cricoid cartilage and suprasternal notch. Division /retraction of thyroid isthmus Opening of Trachea and insertion of tube
        • Emergency Tracheostomy
        • Within 2-4 mints with vertical incision
        • Cricothyrotomy/mini tracheostomy
        • Transverse incision over the cricothyroid membrane. Keep only for 3-5 days
    • Pediatric Tracheostom
      • Vertical incision in trachea b/w 2 nd and 3 rd ring.
      • No excision of ant. Wall of trachea
      • Secure the tube with neck by two sutures
    • Percutaneus Dilational Tracheostomy
      • ICU Bed SideTracheostomy
      • Use of guide wire and Dilators
      • Under the vision of Bronchoscope through endotracheal tube
      • Less time ,Less Expensive
      • Not suitable for thick neck and in emergency
    • Complications of Tracheostomy
      • Intraopertaive Complications.
      • Bleeding and injury to big vessels
      • Injury to tracheoesophageal wall
      • Pneumothorex
      • Early Complications
      • Bleeding
      • Tracheostomy tube obstruction
      • Tracheostomy tube displacement
      • Infection
      • Late Complications
      • Tracheal Stenosis
      • Granulation tissue
      • Tracheocutaneus fistula
      • Tracheo - inominate fistula
    • PROBLEMS DURING TRACHEOSTOMY CARE
      • Dislocation of tracheostomy tube.
      • Bleeding from stoma or during suction.
      • Blockage of tracheostomy tube.
      • Aspiration and swallowing problems.
      • Speaking problems.
    • HOME CARE PLAN
      • Education and training of the attendant.
      • Supply of dressing, suction catheters and suction machine.
      • When to come to the hospital.
      • Visit by community nurse.