TRACHEOTOMY

(Redirected from Tracheostomy)

A tracheotomy is a procedure performed by paramedics, emergency physicians and surgeons in order to secure an airway. A 'tracheotomy' or 'tracheostomy' is a surgical procedure performed on the neck to open a direct airway through an incision in the trachea (the windpipe). (Technically, the former term, with the Greek root ''tom-'' meaning "to cut," refers to the procedure of cutting into the trachea, whereas the latter term, with the root ''stom-'' meaning "mouth," refers to the procedure of making a semipermanent or permanent opening. ''Tracheostomy'' can also refer to the result of the procedure, i.e. the opening itself.)

Contents

Uses for a tracheotomy

How a tracheotomy is performed

Complications

Problems

In Popular Culture

Celebrity Tracheotomies

See also

External links

Uses for a tracheotomy

The conditions in which a tracheotomy may be used are:

★ Acute setting - maxillofacial injuries, large tumors of the head and neck, congenital tumors, e.g. branchial cyst, acute inflammation of head and neck, and

★ Chronic / elective setting - when there is need for long term mechanical ventilation and tracheal toilet, e.g. comatose patients, surgery to the head and neck.
In emergency settings, in the context of failed endotracheal intubation or where intubation is contraindicated, cricothyroidotomy or mini-tracheostomy may be performed in preference to a tracheostomy.

How a tracheotomy is performed

# Curvilinear skin incision along relaxed skin tension lines (RSTL) between sternal notch and cricoid cartilage
# Midline vertical incision dividing strap muscles
# Division of thyroid isthmus between ligatures
# Elevation of cricoid with cricoid hook
# Placement of tracheal incision. An inferior based flap or Bjork flap (through second and third tracheal rings) is commonly used. The flap is then sutured to the inferior skin margin. Alternatives include a vertical tracheal incision (pediatric) or excision of an ellipse of anterior tracheal wall.
# Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures.
# Connect ventilator tubing
It is also possible to make a simple vertical incision between tracheal rings (typically 2nd and 3rd) for the incision. rear end flaps may produce more intratracheal granulation tissue at the site of the incisions, making it less favorable to some surgeons.

Complications

# Immediate - pneumothorax or pneumomediastinum, tracheoesophageal fistula, injury to great vessels or recurrent laryngeal nerves, bleeding, e.g. from divided thyroid isthmus
# Early - secretions and mucus plugging, dislodged tube, respiratory arrest and post obstructive pulmonary edema (when tracheostomy is performed in a patient with longstanding upper airway obstruction, and is dependent on hypoxic drive for respiration)
# Late - bleeding from tracheoinnominate fistula (can be torrential), tracheal stenosis (from ischemia induced by a cuffed tracheostomy tube), tracheoesophageal fistula, tracheocutaneous fistula and cosmetic deformity must be considered upon decannulation.

Problems

# Immune problems- air inhaled through a stoma is not filtered or moistened like it is when inhaled through the nose, or even the mouth.
# Drowning- as little as two teaspoons of water in the stoma can drown the person, therefore, they cannot take a shower, bathe, or swim.
# Suffocation- if the stoma is covered, the person will suffocate, as in some cases they cannot breathe through their nose or their mouth.

In Popular Culture

★ In an episode of ''M
★ A
★ S
★ H'', Father Mulcahy performs a tracheotomy on a patient whose swollen tongue prevents him from breathing.

★ In numerous episodes of House M.D., the doctors perform a tracheotomy in great detail every so often, for example in the pilot episode (season 1)

★ In a Scrubs episode entitled, "My Drive-By," surgeon Dr. Turk used a knife from a nearby taco stand to perform an emergency tracheotomy on a man choking on a burrito.

★ In the pilot episode of Jericho, Jake Green performs an emergency tracheotomy on a young girl who had sustained a neck injury and was unable to breathe.

★ In an episode of "Neighbours", Dr. Karl Kennedy's son Malcolm was performing builder activities while in Lou's bar when a large wooden plank fell onto his throat, crushing his windpipe and forcing his father to perform a tracheotomy.

Celebrity Tracheotomies

★ Actress Elizabeth Taylor once underwent a tracheotomy while hospitalized with pneumonia.

★ In 1985, the famous scientist Stephen Hawking also contracted pneumonia and had a tracheotomy. As a consequence, he lost his natural speech ability and has since used an electronic voice synthesizer to communicate.

★ Actress Catherine Zeta-Jones has a scar from a tracheotomy performed in childhood for breathing problems from a viral infection. [1] [2]

★ Film critic Roger Ebert underwent a tracheotomy in 2006 as part of treatment for complications from surgery to treat salivary cancer. This tracheotomy prevented participation in his television show Ebert & Roeper. [3]

★ At the 1994 San Marino Grand Prix, Brazilian Ayrton Senna had an emergency tracheotomy performed on track after his accident. Senna died later that afternoon.

★ At the 1995 Australian Grand Prix, Finnish Mika Häkkinen crashed out due to a tyre failure and had his life saved by an emergency tracheotomy performed on track. He would later go on to win two Formula One world championships.

See also

★ Cricothyroidotomy

★ Intubation

★ Mechanical ventilation

External links

★ Tracheotomy Info (A Community For Tracheotomy-wearers and the people who love them)

★ Aaron's tracheostomy page (Caring for a tracheostomy)

★ How to perform an emergency tracheotomy (For information purposes only.)

★ RT Corner (Educational Site for RT's and Nurses)

★ (Pictures with video clipping)