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Resume Of Tracheotomy

Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Small retractors
Tracheotomic cannulae (proper kind)
Half area cross-section trachea.
Proper curve: Radius too short will press ant. tracheal wall; too
long, post. wall.
Sterling Silver
Tracheobronchial aspirator.
Tapes for cannulae
Trousseau dilator
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.
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
Don't suture wound. Dress with large squares.
Don't give morphine.
Decannulation by corking partially, after changing to smaller
Do not remove cannula permanently until patient sleeps without
indrawing with corked cannula.

Next: Resume Of Emergency Tracheotomy

Previous: Decannulation

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