Thursday, 12 January 2017

Trachy

There are a few potential problems for trachys - bleeding, obstructing and needing to insert one. All of these could present to the emergency department.

Tracheotomy is an incision in the trachea and comes from two Greek words: the root tom- meaning 'to cut', and the word trachea.

Tracheostomy, including the root stom- meaning 'mouth' - refers to the making of a semi-permanent or permanent opening, and to the opening itself.

Laryngectomy is the surgical removal of the larynx, usually completely and permanently. The remnants of the trachea are stitched to the anterior neck. There is no connection from the nose or mouth to the lungs, so traditional airway manipulation will not work.

If a trachy has been inserted, the upper airway anatomical dead space can be reduced by up to 50%, The natural warming, humidification and filtering of air that usually takes place in the upper airway is lost.

Bleeding Trachy
- Hyperinflate cuff
- Silver nitrate if local bleeding
- Pressure over sternal notch

Respiratory Distress - "DOPES"
Displacement
Obstruction
Patient - bronchospasm, pneumothorax
Equipment - is cuff OK?
Stacked - are breaths being stacked?

Following the emergency guidelines can be very helpful.




References
http://foamcast.org/2015/10/07/episode-35-the-trachea/
http://www.tracheostomy.org.uk/
http://portal.e-lfh.org.uk/myElearning/Index?HierarchyId=0_132_132&programmeId=132
http://emcrit.org/podcasts/surgical-airway/



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