Tracheostomy

8. iv. Traumatic:
Blows, cut throat injuries,
corrosives ingestion,
foreign bodies,
inhaling irritatant fumes&gases
v. Infections:
Diptheria, Ludwig’s angina.
Laryngo-tracheal-bronchitis.
Acute retropharungeal and
Parapharyngeal abscess
Acute epiglottitis
vi. Misc:
Angioneuritic edema
1. Relief from upper airway obstruction:

11. Infants below 1year (mostly congenital lesions)
 Subglottic hemangioma
 Subglottic stenosis
 Laryngeal cyst
 Glottic web
 B/l vocal cord paraysis
Children (inflammatory/traumatic)
 Epiglottitis
 Acute laryngo-trachea-bronchitis
 Diphtheria
 Laryngeal oedema
 External laryngeal trauma
 Proonged intubation
 Juvenile laryngeal papillomatosis

14. Shoulders elevated , neck extended
Local infiltration in the Jackson's triangle

15. STEPS IN ADULT TRACHEOSTOMY

16. Incision- Elective: Transverse incision in the midline of neck(extending from cricoid cartilage to sternal notch
Emergency: Vertical incision 5cm long * 2fingers breadth above sternal notch.
Tissues are dissected in midline. Dilated veins are displaced or ligated
Strap muscles are separated in midline and retracted laterally
Thyroid isthumus is displaced upwards or divided between the clamps, suture-ligated
4% lignocaine is injected into trachea to suppress cough
Trachea is fixed with a hook and opened with vertical incision in 3rd & 4th or 3rd & 2nd rings
Appropriate sized tracheostomy tube is inserted and secured by tapes
Skin incision should not be sutured or packed tightly(risk of subcutaneous empysema)
Gauze dressing is placed b/w skin and flange of the tube around stoma

18. Thyroid isthmus elevated;
Pretracheal veins separated;
Window excised in trachea

20. TRACHEOSTOMY TUBE INSERTED AND TIED IN PLACE
WITH UMBILICAL TAPE,
CUFF INFLATED AFTER INTRODUCTION

29. NEGUS TRACHEOSTOMY TUBE
JACKSON’S METALLIC
TRACHEOSTOMY TUBE
FULLER’S BIFLANGED
TRACHEOSTOMY TUBE
EDINBURGH PATTERN
TRACHEOSTOMY TUBE

34. Anatomical positioning of a tracheostomy tube

36. COMPLICATIONS

46. Other Methods Of
Tracheostomy
For Airway Management

47. ANATOMY

52. STEPS IN PDT

53. Guidewire introduction,
with removal of sheath

54. Guidewire and catheter are
advanced together into the trachea
as far as the skin positioning marks
on the guide catheter to the skin
Guidewire, guide catheter, and
dilator unit are advanced together
into the trachea to the skin
positioning mark

55. The tracheotomy tube is loaded onto a dilator and advanced into the trachea
over the guidewire and catheter. The guidewire and catheter are removed,
leaving only the tracheostomy tube in the trachea

56. THANK YOU