TRACHEOSTOMY

• Dr. Manorama Mittal

• Dr. Namita Arora

55yr.old man with Ca. larynx

Q1: What comes to our mind first?

Q2: What are the relevant points in the history?

Q3: What do you see on examination?

Tracheostomy for Ca Lx Q1: What are the advantages of a pre-op. traecheostomy?

Q2: What are the disadvantages of pre-op.traecheostomy?

Q3: Traecheostomy done in ward & patient suddenly dies. What is the likely cause? How can we prevent it?

Q4: What are the problems with post-op. traecheostomy?

Q5:For how long is humidification required in these patients?

Heat & Moisture Exchanger (artificial nose)

Q1: What is HME?

Q2: How does it work?

Tracheostomy in a patient of chronic bronchitis with CO2 narcosis.

Q1: Take a hypothetical case of chronic bronchitis with CO2 narcosis with traecheostomy.He was put on ventilator following which he became conscious & then suddenly died.Why?

Tracheostomy vs Prolonged intubation in paediatric patient

Q1: What are theproblems of traecheostomy in children?

Q2:What should be method of suctioning & the interval in between the two suctions?

Q3:What are the methods of humidification?

Q4:What are the problems with humidification?

Weaning in paediatric patient with tracheostomy

Q1: Why is weaning difficult?

Q2: What is ward decannulation?

Patient on ventilator

Q1: What are the different types of cuffs?

Indications of Tracheostomy

Q1: What are the indications of preoperative Tracheostomy?

Q2: What are the indications of post-op Tracheostomy?

Q3: What are the other indications of elective Tracheostomy?

Q4: What are the indications of emergency Tracheostomy?

Cricothyroidotomy

Q1: What are the indications of cricothyroidotomy?

Q2: What are the advantages of cricothyroidotomy? Q3: What are the disadvantages of cricothyroidotomy?

Q4: What is an absolute contra-indication to jet ventilation through needle cricothyroidotomy?

Percutaneus Dialational Tracheostomy (PDT)

Q1: Enumerate the steps of PDT?

Q2: What are the advantages of PDT?

Q3: What are the disadvantages of PDT?

Q4:Complications of PDT?

Complications of Tracheostomy

Q1:What is the cause of massive hemorrhage following Tracheostomy?

Q2: What is the cause of mediastinal

emphysema?

Q3: What is a persistant stoma?

Q4: Usually how long does a stoma take to close?