5. TYPES OF TRACHEOSTOMY
Emergency tracheostomy
Elective tracheostomy
Percutaneous dilatational tracheostomy
Mini tracheostomy
6. TECHNIQUE
Position
Supine position with pillow under shoulder
Anaesthesia
No anaesthesia in unconciouss or emergency patient
1-2%lignocaine with epinephrine
GA
7. STEPS OF OPERATION
A vertical incision is made in the midline of neck,extending
from cricoid cartilage to just above the sternal notch
After incision tissues are dissected in midline.
dilated veins are either ligated or displaced
Strap muscles are seperated in midline and retracted
laterally
Thyroid isthmus is displaced upward or divided between the
clamps and suture ligated
A few drops of 4% lignocaine are injected into the trachea to
suppress the cough when trachea is incised
Trachea is fixed with a hook and opened with a vertical
incision in the region of 3rd and 4th or 3rd and 2nd ring. this is
then converted into circular opening
8. CONTD..
Tracheostomy tube is inserted and secured by tapes
Skin incision should not sutured or packed
Gauze dressing is placed between skin and flange of the
tube around the stoma
10. COMPLICATION
Immidiate
Haemorrhage
Apnoea
Pneumothorax due to injury to apical pleura
Injury to recurrent laryngeal nerve
Aspiration of blood
Injury to esophagus
Intermitant
Bleeding,reactionary or secondary
Displacement of tube
Blocking of stube
Subcutaneous emphysema
Local wound infection and granulation
11. CONTD..
Late
Haemorrhage due to erosion of major vessel
Laryngeal stenosis
Tracheal stenosis
Tracheo-oesophageal fistula
Problem of tracheostomy scar
12. CRICOTHYROIDOTOMY
emergency procedure performed on patients with severe
respiratory distress in whom attempts at orotracheal or
nasotracheal intubation either have failed or were deemed
to have an unacceptable level of risk
13. INDICATION
Inability to intubate
Inability to ventilate
Severe facial or nasal injuries (that do not allow oral or nasal
tracheal intubation)
Massive midfacial trauma
Possible cervical spine trauma preventing adequate
ventilation
Anaphylaxis
14. PROCEDURE
Using IV cannula
14 gauge iv cannula introduced into the lumen of trachea with patent
neck in extended position
Cannula is then directed and advanced aaudally and the needle
removed
Using a scalpel
Thyroid is steadied with thumb and middle finger of the left hand and
cricothyroid space identified with index finger of right hand
Scalpel is used to cut the skin, subcutaneous tissue, and cricothyroid
membrane horizontally to enter the subglottic area and then turned
vertically to admit a thin endotracheal tube
15. CONTD..
Using a cricothyrotome or mini-tracheostomy set
mini-tracheostomy set is used
16. CONTRINDICATION
Inability to identify landmarks (cricothyroid membrane)
Underlying anatomical abnormality (tumor)
Tracheal transection
Acute laryngeal disease due to infection or trauma
Small children under 10 years old (a 12–14 gauge catheter
over the needle may be safer)
17. COMPLICATION
esophageal perforation occurs when the blade penetrates
too deeply
subcutaneous emphysema may occur if the horizontal
incision is too wide, allowing air to become trapped in the
subcutaneous tissue
hemorrhage may occur if a vessel is ruptured
18. POSTOPERATIVE CARE
chest x-ray film to confirm placement of the tracheostomy
tube
respiratory therapy so the patient can be mechanically
ventilated
Tracheostomy tube placed during an emergency
cricothyroidotomy can be left in place for up to 72 hours.