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A Tracheostomy is a medical procedure either temporary or permanent that involves creating an opening in the neck in order to place a tube into a person's windpipe.
A Tracheostomy is a medical procedure either temporary or permanent that involves creating an opening in the neck in order to place a tube into a person's windpipe.
TRACHEOSTOMY IN FULL DETAILS......
TRACHEOSTOMY, EMERGENCY TRACHEOSTOMY, SECURE AIRWAY, PERCUTANEOUS TRACHEOSTOMY, HISTORY OF TRACHEOSTOMY, PROCEDURES, GIGGS TECHNIQUE,VARIOUS TYPES OF TRACHEOSTOMY, TRACHEOSTOMA, DECANNULATION, INDICATIONS, CONTRAINDICATIONS, CRICOTHYROIDOTOMY, MINITRACHEOSTOMY, TRACHEOSTOMY TUBES, COMPLICATIONS OF TRACHEOSTOMY.
Tracheostomy decannulation is always challenging and this presentation address the various issues, indications, contra-indications, problems and solutions.
TRACHEOSTOMY IN FULL DETAILS......
TRACHEOSTOMY, EMERGENCY TRACHEOSTOMY, SECURE AIRWAY, PERCUTANEOUS TRACHEOSTOMY, HISTORY OF TRACHEOSTOMY, PROCEDURES, GIGGS TECHNIQUE,VARIOUS TYPES OF TRACHEOSTOMY, TRACHEOSTOMA, DECANNULATION, INDICATIONS, CONTRAINDICATIONS, CRICOTHYROIDOTOMY, MINITRACHEOSTOMY, TRACHEOSTOMY TUBES, COMPLICATIONS OF TRACHEOSTOMY.
Tracheostomy decannulation is always challenging and this presentation address the various issues, indications, contra-indications, problems and solutions.
detailed information about tracheostomy for the medical students , includes difinition, causes, indications, care provided, management, medical and nursing management of opening , complete care of the patient , patient teaching, family teaching and contained other detailled explanation of tracheostomy
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...NelTorrente
In this research, it concludes that while the readiness of teachers in Caloocan City to implement the MATATAG Curriculum is generally positive, targeted efforts in professional development, resource distribution, support networks, and comprehensive preparation can address the existing gaps and ensure successful curriculum implementation.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
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Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
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Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Delivering Micro-Credentials in Technical and Vocational Education and TrainingAG2 Design
Explore how micro-credentials are transforming Technical and Vocational Education and Training (TVET) with this comprehensive slide deck. Discover what micro-credentials are, their importance in TVET, the advantages they offer, and the insights from industry experts. Additionally, learn about the top software applications available for creating and managing micro-credentials. This presentation also includes valuable resources and a discussion on the future of these specialised certifications.
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3. Introduction
• Trachea is a passage between the upper airways and lungs.
Any blockage or pathology above this level can impede air
entry. At these times making an opening in the trachea is a
safe technique in restoring air entry.
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4. History
• 2000 BC :RigVeda
• 1000 BC : Ebers papyrus
• 400 BC: Hippocrates condemned tracheostomy, citing threat to carotid
arteries
• 1546 : first well-documented tracheostomy Antonius Musa Brasavola,
• 1921: Chevaliar Jackson – standardized the technique
- warned against high tracheostomy
• 1957: Shelden - Percutaneous tracheostomy
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5. • 124 BC : Asclepiades – first tracheostomy
• 1620 : Nicholos Habicot – 4 successful tracheostmies
• 1718 :Lorenz Heister -tracheotomy, Negus –tracheostomy
• 1730 : George Martin – inner cannula
• 1833 : Trousseau – 200 cases of - diphtheria
• 1969:Toy and Weinstein - the guidewire approach PT.
• 1985 : Ciaglia et al – Percutaneous Dilatation
Tracheostomy.
www.indiandentalacademy.com
7. History
• Vicq d' Azyr - first description of
cricothyrotomy.
• 1921: Chevalier Jackson “ It should never be
taught ,even in life threatening situatins”
• 1976: Brantigan and Grow – 655
cricothyroidotomies - complication rate 6.1%
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9. Indications
• Severe Maxillofacial trauma with upper airway obstruction.
• Oropharyngeal obstruction.
• Respiratory failure, sleep apnea syndrome
• Conditions in which tracheal intubation from above is either
contraindicated or unsuccessful.
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10. Contraindications
• Children < 11 yrs.
• Elderly patients
• Crush injury to the larynx
• Preexisting laryngeal or tracheal pathology.
• Laryngeal inflammation
• After prolonged intubation
www.indiandentalacademy.com
13. Cricothyrotomy vs tracheostomy
•
Faster, less than 2mins
•
Easier, with less instrumentation
•
Less dissection
•
Fewer surgical complications and less bleeding
•
Can be taught to those with little surgical training
Space narrow for tube
Perichondritis, laryngeal stenosis, voice changes
www.indiandentalacademy.com
15. NEEDLE CRICOTHYROTOMY
• first described by Sanders in 1967
• Spoerel et al (1971) and
Klain&Smith(1977) defined the
indications and technique.
AdvCan be very quickly performed with
fewer complications.
DisadvCan provide oxygen for short period, not
a definitive airway.
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17. Tracheostomy
• The surgical creation of an opening into the trachea to bypass
obstructions that are interfering with breathing,& insertion of a tube
into the opening to allow for normal breathing.
www.indiandentalacademy.com
18. Indications
- Head and Neck Surgery- Otolaryngology: Byron J. Bailey
1.To bypass upper airway obstruction
2. To assist respiration over prolonged periods
3. To assist with clearance of lower respiratory secretions
4. To prevent aspiration of oral and gastric secretions
www.indiandentalacademy.com
19. Rowe & Williams
Absolute indications for tracheostomy, for conditions other than impending
respiratory obstruction (IPPV):
•
When injuries are severe enough to cause hypercarbia and/or
hypoxaemia from the outset- flail chest, lung contusion or aspiration;
or developing later due to 'shock lung' (ARDS) or fat embolism.
•
Control of cerebral oedema (by controlling blood gases) in severe
head injuries
www.indiandentalacademy.com
20. Indications for tracheostomy in
maxillofacial trauma
• When prolonged artificial ventilation is necessary esp severe
associated head and chest injuries
• To facilitate anaesthesia for surgical repair in major injuries
• To ensure a safe postoperative recovery after extensive reparative
surgery
• Following obstruction of the airway from laryngeal oedema or
occasional direct injury to the base of the tongue and oropharynx
• Serious haemorrhage into the airway particularly when a further
secondary haemorrhage is a possibility
www.indiandentalacademy.com
- Synopsis of Otorhinolaryngology – Zakir Hussain
21. Timing of Tracheostomy
• The best time to do tracheostomy is the time when it is first felt
necessary, Tracheostomy has been recommended within 3 days of
intubation. (damage to the larynx & vocal cords is max b/w 3–7
days, if removed within this period, complete healing).
- RESPIRATORY CARE • APRIL 2005 VOL50 No 4 (483-487)
• The procedure is delayed long enough to allow extubation if
possible but is performed early enough to avoid complications of
long term intubation.
- Byron J. Bailey
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22. Advantages
•
Decreases the amount of dead space by 70-100 ml
•
Reduces resistance to airflow and increases compliance
•
Provides Protection against aspiration.
•
Enables pt to swallow without reflex apnea.
•
Provides access to trachea for removing the secretions.
•
Delivery of medication & humidification to the
tracheobroncheal tree.
www.indiandentalacademy.com
23. Adverse effects
•
Loss of heat & moisture exchange.
•
Desiccation of tracheal epithelium leading to loss or
metaplasia of ciliated cells
•
Increased mucus production
•
Increase in viscid mucin, formation of thick crusts,
blockage of the tube particularly in children.
www.indiandentalacademy.com
24. Types of Tracheostomy.
• Elective
Emergency
• High Tracheostomy
Mid Tracheostomy
Low Tracheostomy
• Temporary
Permanent
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43. Tracheostomy care
Guidelines
• Bedside equipment.
• Care of the inner cannula,stoma site & ties.
• Suctioning of the tube.
• Humidification of inspired gases.
• Care for cuffed tube
• Decannulation: removal of tracheostomy tube.
• Dealing with emergencies.
www.indiandentalacademy.com
44. Bedside equipment
• Spare tubes of Same / smaller size.
• Tracheal dilator.
• Suctioning equipment
-Ensure everyday equipment is assembled and working.
• Humidification unit
-Ensure everyday equipment is working properly.
• Container to hold speaking valve, occlusive cap/button or spare inner
cannula.
www.indiandentalacademy.com
45. Care of the inner cannula, stoma
site & ties.
AIM:
1. To maintain a patent airway
2. To maintain skin integrity.
3. To prevent infection.
4. To prevent tube displacement
www.indiandentalacademy.com
47. Humidification
Aims:
• To prevent drying of pulmonary secretions (tracheitis &
crust formation).
• To preserve muco-ciliary function.
Various methods of humidification
A) HEATED HUMIDIFIERS.
B) HEAT MOISTURE EXCHANGE FILTERS.
C) NEBULIZERS.
www.indiandentalacademy.com
48. CARE OF CUFFED TRACHEOSTOMY
TUBE
• When to inflate the cuff
• Immediately post-operatively - to prevent aspiration
of blood or serous fluid from the wound
• To seal the trachea during mechanical ventilation
• To prevent aspiration of leakage from tracheooesophageal fistula
• To prevent aspiration due to laryngeal incompetence
•Deflate:
• first suction the oropharynx.
• Cuff should be deflated atleast 5mins every hr.
www.indiandentalacademy.com
49. Tracheostomy decannulation
• Should be left in place no longer than necessary
• As soon as the patient's condition permits, reduced the size of tube to
avoid physiologic dependence on a large tube,
• Check for adequacy of the airway, ability to swallow and handle
secretions for 24 hrs and then plug the tube.
• Occlusion tolerated for 8-12 hrs, the tube is removed & the
tracheocutaneous fistula is taped shut.
• Bronchoscopy before decannulation in the pediatric patient,
• Immediately after decannulation, the patient must be closely observed,
www.indiandentalacademy.com
and means for reestablishing the airway must be at hand.
51. Immediate
1.Apnea- physiologic denervation of the peripheral chemoreceptors by the sudden
increase of p02; ventilatory assistance may be required.
2.Hemorrhage- raise in venous BP due to coughing associated with
insertion of the tube.
3.Pneumothorax
i. Respiratory obstruction - increased respiratory effort - air sucked
in mediastinum.
ii. secondary to laceration of the apex of pleural space (common in
children).
4.Injury of adjacent structures- dissection lateral & deep to the trachea.
www.indiandentalacademy.com
53. Intermediate
1.Tracheitis and tracheobronchitis- severe in infants
-necrotizing tracheo-bronchitis is frequent.
-Humidification, nebulization & instillation of fluid/mucolytics.
2. Improper tube –
Too long -partial tracheal obstruction & possible rupture of the innominate artery.
- extend in one bronchus, atelectasis of the opp lung
Too short- displacement of the tube out of the trachea,
3.Obstruction of the tube- mucus plug/ blood clot due to lack of care.
- suction no relief in obstructive symptoms, change the tube
www.indiandentalacademy.com
54. .
4.Subcutaneous emphysema- tight suturing or packing.
- Emphysema localized in the neck & upper chest but may
involve the whole body and progress to
pneumomediastinum and pneumothorax.
pneumothorax -chest drain with an underwater seal.
- Any constricting force around the tube b/w the skin& trachea
must be removed to prevent progression.
www.indiandentalacademy.com
55. Late
1.Stenosis- injury and perichondritis of the cricoid cartilage.
- can occur at
-Cuff level
-Tracheostomy level
-Subglottic level
www.indiandentalacademy.com
56. 2.Exuberant granulations
-anterior tracheal wall result of delayed epithelialization in case of large
defects ,causing obstruction and bleeding.
3.Localized tracheomalacia- immediately superior& posteriorly to the healed opening.
-Use of large & sharply angled tube,
-avoided by using a more flexible tube of Teflon or Silastic.
4. Scar -vertical skin incision.
-longer duration of tracheostomy
-Vertical contracture,hypertrophic scar require a Z plasty.
5.Tracheocutaneous fistula-wound must be revised and closed with careful approximation of tissue
layers.
www.indiandentalacademy.com
59. Percutaneous Tracheostomy
Shelden described a needle-guided trocar for access into the trachea.
Ciaglia et al described PDT based on the Seldinger technique, using
sequential dilators of increasing diameter.
INDICATIONS
Percutaneous tracheostomy has been proposed as an alternative to
open/surgical tech.
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60. Extended Indications for Percutaneous
Tracheostomy
• patients with short, fat neck;
• inability to perform neck extension;
• enlarged isthmus of thyroid;
• previous tracheostomy; or
• coagulopathy and anti-coagulation therapy.
www.indiandentalacademy.com
64. Complications of Percutaneous Tracheostomy
•
false passage of the tracheostomy tube,
•
pneumothorax,
•
delayed bleeding,
•
puncture of the posterior tracheal wall,
•
premature extubation during the procedure and loss of the
airway.
www.indiandentalacademy.com
65. Comparison of safety and cost of percutaneous versus
surgical tracheostomy
- Bowen, Whitney et all
- Division of Surgical Oncology, University of Virginia Medical Center
- Am Surg. 2001 Jan;67(1):54-60. Links
Percutaneous
Surgical
Cases
Complication
rate
74
6.76%
(4.1%)
139
2.2%
Cost
$1750
%2600
- PDT costs less and requires less time but carries more risk of
complications. Careful patient selection and adequate experience will
www.indiandentalacademy.com
reduce comlications
66. Endoscopic percutaneous dilatational tracheotomy: a
prospective evaluation of 500 consecutive cases
- Kost K.M.
-Department of Otolaryngology, McGill University, Canada
-Laryngoscope. 2005 Oct;115(10 Pt 2):1-30. Links
-Total complication rate was 9.2% (13.6% in the multiple dilator
group, and 6.5% in the single dilator group)
-
most common complications were oxygen desaturation (in 14 cases)
and bleeding (in 12 cases)
-
absence of serious complications such as pneumothorax and
pneumomediastinum were attributable to the use of bronchoscopy
-Endoscopic PDT is associated with a low complication rate and is at
least as safe as surgical www.indiandentalacademy.com
tracheotomy in the ICU setting
67. Percutaneous dilatational tracheostomy versus open
tracheostomy--a prospective, randomized, controlled
trial.
- Wu J.J., Huang et all
- Division of Trauma, Taipei Veterans General Hospital,
- J Chin Med Assoc. 2003 Aug;66(8):467-73
- 83 tracheostomies
- Procedure time was 22.0 +/- 12.1 minutes in PDT group, and
41.5 +/- 5.9 minutes in OT group,
- incidences of complications were not different between both
groups
- simple, safe and time-saving bedside procedure and can be
recommended when an elective tracheostomy is needed in a
critical patient.
www.indiandentalacademy.com
69. References
Rowe &William’s Maxillofacial injuries 2nd edition-vol I
Oral & maxillofacial trauma :Fonseca-3rd edition-vol I
Bailey & love’s short practice of surgery 23rd edition.
Schwartz principles of surgery -8th edition .
Lange’s current diagnosis&treatment in otolaryngeology-head&neck
surgery.
Clinical &operative methods in ENT, head & neck surgery-A systemic
approach: Hazarica Nayak.
An atlas of head & neck surgery-Lore’ 3rd edition.
www.indiandentalacademy.com
Operative otolaryngeo,head & neck surgery-Myers,vol I.