Resume Of Tracheotomy


Categories: TRACHEOTOMY
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Instruments.

Headlight

Sandbag

Scalpel

Hemostats

Small retractors

Tenaculum

Tracheotomic cannulae (proper kind)

Long.

Half area cross-section trachea.

Proper curve: Radius too short will press ant. tracheal wall; too

long, post. wall.

Sterling Silver

Tracheobronchial aspirator.

Probe.

Tapes for cannulae

Trousseau dilator

Sponges

Infiltration syringe and solution

Oxygen tank.



Indications: Laryngeal dyspnea.

(Indrawing guttural and clavicular fossae and at epigastrium.

Pallor. Restlessness. Drowning in his own secretions.)



Do it early. Don't wait for cyanosis.

[294] Never use general anesthesia on dyspneic patient.

Forget about high and low distinctions until trachea is exposed.

Memorize Jackson's tracheotomic triangle.

Patient recumbent, sand bag under shoulders or neck. Nose to zenith.

Infiltration, Intradermatic.

Incise from Adam's apple to guttural fossa.

Hemostasis.

Keep in middle line.

Feel for trachea.

Expose isthmus of thyroid gland.

Draw it upward or downward or cut it.

Ligature, torsion, etc. before incising trachea.

Hold trachea with tenaculum.

Incise trachea below first ring.

Avoid cutting cricoid or first ring. Cut 3 rings vertically. Don't

hack. Don't cut posterior wall which almost touches the anterior wall

during cough. Spread carefully, with Trousseau dilator.

Insert cannula; see it enter tracheal lumen; remove pilot; tie

tapes.

Don't suture wound. Dress with large squares.

Don't give morphine.

Decannulation by corking partially, after changing to smaller

cannula.

Do not remove cannula permanently until patient sleeps without

indrawing with corked cannula.





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