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.
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.
This is a seminar presentation conducted by 4th year medical students under supervision of a lecturer. Reference were not attached here, but all information are from google, few textbooks and also from previous ENT posting's seminar.
This is a seminar presentation conducted by 4th year medical students under supervision of a lecturer. Reference were not attached here, but all information are from google, few textbooks and also from previous ENT posting's seminar.
Tracheostomy /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Tracheostomy tube displacement can be a life threatening event. Novice users tend to overreact and pursue ventilation strategies that incur harm. Using more force to ventilate a malpositioned tracheostomy tube can cause pneumomediastinum and pneumothorax, and continues the hypoxemia given absence of ventilation. In this talk we review this issue and offer emergency strategies to manage this crisis event.
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
TRACHEOSTOMY is a surgical procedure to maintain a patent airway to the person who is in airway distress or electively in certain surgical procedures like oncological resections to maintain an adequate oxygenation to the patient by creating a stoma on the trachea
A tracheostomy (also called a tracheotomy) is an opening surgically created through the neck into the trachea (windpipe) to allow air to fill the lungs. After creating the tracheostomy opening in the neck, surgeons insert a tube through it to provide an airway and to remove secretions from the lungs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. DEFINATION :-
Tracheotomy : Surgical opening of the trachea.
Tracheostomy : Creation of a stoma at the skin surface
which leads into the trachea.
It is a surgically created airway fashioned by making a
hole in the anterior wall of the trachea.
4. HISTORY :-
Tracheostomy is one of the oldest surgical procedures.
The first successful tracheostomy was performed by
Brasovala in the 15th century.
Sheldon : Percutaneous tracheostomy in 1957.
In 1909, Chevalier Jackson : Guidelines for safe
tracheostomy.
5. TEMPORARY TRACHEOSTOMY
Temporary tracheostomy may be either elective or
emergency.
An elective temporary tracheostomy may be part of a
planned procedure, such as a major head and neck
operation.
An emergency temporary tracheostomy is a rare
procedure and is indicative in some certain conditions.
6. PERMANENT TRACHEOSTOMY
Permanent tracheostomy is an elective procedure
carried out as part of an operation involving larynx or
trachea.
The trachea is permanently disconnected from the
pharynx and the proximal end of the trachea is sutured
to the skin.
In a permanent tracheostomy the only access to the
lower airway is via the tracheostome.
7. EFFECTS AND FUNCTIONS :-
Alternative pathway for breathing.
Laryngeal bypass - All of the normal laryngeal
functions are lost, the patient is unable to cough or
phonate.
Improves alveolar ventilation.
Protects the airways - By using cuffed tube.
8. EFFECTS AND FUNCTIONS :-
The filtration of particulate matter and humidification
of inspired air by the nasal mucosa is lost.
An increased risk of infection.
Permits removal of tracheobronchial secretions.
To administer anesthesia and IPPR.
9. INDICATIONS :-
Upper Airway obstruction secondary to –
trauma, burns
corrosive poisoning,
laryngeal dysfunction, foreign body,
infections, inflammatory conditions, Neoplasms,
Postoperatively , obstructive sleep apnea
Access for pulmonary toilet
Prolonged ventilatory support
Airway protection in head injured or comatose patient
and in postoperative neurosurgical patients
10. ANATOMY
The trachea is a fibro muscular tube supported by 20 hyaline
cartilages.
The soft tissue posterior wall is in contact with the oesophagus.
Trachea lies in midline of the neck extending from cricoid
cartilage (C6) superiorly to the tracheal bifurcation at the level of
sternal angle (T5).
11. ANATOMY :-
Adults - 12-16 cms long and
16-20 mm wide.
Blood supply -
bracheocephalic artery and
through the inferior thyroid
and bronchial arteries.
Parasympathetic supply to
the trachea is by the
recurrent laryngeal nerve
12. TECHNIQUES
Cricothyroidotomy
For Urgent Procedures
PercutaneousTracheostomy
Can be done in the ICU at the bedside
SurgicalTracheostomy
13. CRICOTHYROIDOTOMY / MINITRACHEOSTOMY
The patient lies supine with the neck extended over a pillow.
Ascertain the correct anatomical landmarks by palpation.
The thyroid cartilage is gripped between the thumb and middle finger
of the left hand; in this position the index finger can be used to palpate
the cricothyroid membrane.
Airway is entered using a needle and cannula attached to a 10 ml
syringe half full of saline.
The needle is angled in a caudal direction and the cannula is passed
over the needle into the trachea.
14. CRICOTHYROIDOTOMY / MINITRACHEOSTOMY
Connect the cannula to an ambu bag using a syringe with a 7-mm
endotracheal tube adaptor.
CO2 is not cleared effectively.
15. PERCUTANEOUS TRACHEOSTOMY
1955, Shelden et al - cutting trocar into the trachea.
Ciaglia, in 1986 -wire-guided technique.
1990, Griggs et al - the guide wire dilating forceps.
Others -
using a single tapered dilator (BlueRhino)
passing the dilator from inside the trachea to the
outside (Fantoni’s technique).
using a screw like device to open the trachea wall
(PercTwist).
20. PERC TWIST TECHNIQUE
PercTwist , a screw action dilator
that was designed to allow dilation
with twisting while lifting the
trachea rather than pushing down.
21. SURGICAL TRACHEOSTOMY
Surgical tracheostomy (ST) is usually performed in the
operating room on a patient under general anesthesia,
but it may be performed at the bedside in the intensive
care unit.
The patient’s shoulders are elevated with head extension
(unless cervical disease or injury is present), elevating the
larynx and exposing more of the upper trachea.
Local anesthesia with a vasoconstrictor is usually
infiltrated into the skin and deeper tissues
22. SURGICAL TRACHEOSTOMY
The skin of the neck over the 2nd
tracheal ring is identified, and a
vertical
incision about 2–3 cm in length
is created.
Sharp dissection following the
skin incision is used to cut across
the platysma muscle, and
bleeding controlled by
hemostats and ties or
electocautery.
23. SURGICAL TRACHEOSTOMY
Blunt dissection parallel to
the long axis of the trachea is
then used to spread the
submuscular tissues until the
thyroid isthmus is identified
If the gland lies superior to
the 3rd tracheal ring, it can
be bluntly undermined and
retracted superiorly to gain
access to the trachea
24. SURGICAL TRACHEOSTOMY
There are 2 basic approaches to
tracheal entry.
the 2nd tracheal ring is divided
laterally and the anterior portion
removed.
Lateral sutures are used to provide
counter traction during
tracheostomy-tube insertion.
These are left uncut to provide
assistance if the tube is
accidentally dislodged later.
25. TRACHEOSTOMY TUBES
Tracheostomy tubes are available in a variety of sizes and
styles, from several manufacturers.
Dimensions of tracheostomy tubes are given by their inner
diameter (ID), outer diameter (OD), length, and curvature.
Cuffs on tracheostomy tubes include high-volume low-pressure
cuffs, tight-to shaft cuffs, and foam cuffs.
27. METAL VS PLASTIC TRACHEOSTOMY
TUBES
Tracheostomy tubes can be of either metal or plastic.
Metal tubes are constructed of silver or stainless steel.
Metal tubes are not used commonly because they are
→ rigid construction
→ uncuffed
→lack a 15 mm connector for attachment to a ventillator
28. METAL VS PLASTIC
TRACHEOSTOMY TUBES
Plastic tubes are most commonly used and are made
from polyvinyl chloride or silicone.
Polyvinyl chloride softens at body temperature
(thermolabile), adjustable to patient’s tracheal
anatomy and centering the distal tip in the trachea.
29. TRACHEOSTOMY TUBES :
If the ID is too small, it will
→increase the resistance through the tube,
→make airway clearance difficult,
→ increase the cuff pressure required to create a
seal
If the OD is too large,
→ Difficulty in speech
→difficult to pass through the stoma.
→may not conform to the shape of the trachea,
→compression of the membranous trachea,
30. CUFFED TRACHEOSTOMY TUBE
Cuffed tracheostomy tubes
→allow airway clearance,
→protection from aspiration
→ positive pressure ventilation
It is recommended that cuff pressure be maintained at 20–
25 mmHg (25–35 cm H2O) to
minimize the risks for both
tracheal wall injury and aspiration.
32. FENESTRATED TRACHEOSTOMY
TUBES
The fenestrated tracheostomy tube is similar in construction to
standard tracheostomy tubes, with the addition of an opening
in the posterior portion of the tube above the cuff.
With the inner cannula removed, the cuff deflated, and the
tracheostomy air passage occluded, the patient can inhale and
exhale through the fenestration and around the tube.
34. FENESTRATED TRACHEOSTOMY
TUBES
This allows for assessment of the patient’s ability to
breathe through the normal oral/nasal route
→ preparing the patient for decannulation
→ allowing phonation
Supplemental oxygen administration to the upper airway
(eg, nasal cannula) may be necessary if the tube is capped.
38. TRACHEOSTOMY CARE :-
Humidification
Tube position -To prevent decubitus of trachea.
Suctioning and Inner tube care - Daily to remove and clean
crusts
Skin care - To prevent irritation and secondary
inflammation due to discharge
39.
40. TRACHEOSTOMY AND
WEANING
Advantages of early tracheostomy
reduced dead space
decreased airway resistance,
decreased work of breathing,
better secretion clearance by suctioning,
reduced requirements of sedatives and MR
better glottic function with
reduced risk of aspiration, atelectasis,pneumonia
shortened ICU stay.
41. DECANNULATION
Decannulation should be approached in a stepwise fashion.
if the initial cuffed tube has been changed there should be
enough airflow around the tube to allow the patient to breath
easily with the tube lumen occluded.
Block the tube during the daytime initially, and then for a full
24 hours, followed by decannulation.
42. DECANNULATION
Once the tube has been removed the stoma must be occluded with
an airtight dressing.
Change the dressing whenever an air leak becomes apparent to avoid
a persistent tracheocutaneous fistula.
Psychologically dependent patients require longer duration for
decannulation.
43. SPEECH WITH TRACHEOSTOMY
Spontaneous breathers
Tolerate cuffless mech.
ventilation
Conscious patient
For mechanically dependent
patients that may tolerate cuff
deflation
For unable to close the tube
outlet with finger (quadriplegia)
44. SPEECH WITHTRACHEOSTOMY
A tracheostomy speaking valve is
a one-way valve, allows air in, but
not out.
This forces air around the
tracheostomy tube, through the
vocal cords and the mouth upon
expiration, enabling the patient
to vocalize .