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Cummings > Chapter 7: Tracheotomy > Flashcards

Chapter 7: Tracheotomy Flashcards

1
Q

Earliest accounts of a procedure resembling tracheotomy are found in Egyptian tablets 

A

3600 BCE

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2
Q

A sacred Hindu text allude to cutting the neck to access the airway

A

Rig Veda (2000 to 1000 BCE)

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3
Q

Allude to cutting the neck to access the airway

A

Ebers Papyrus of Egypt (c. 1550 BCE)

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4
Q

Vehemently opposed to the procedure, citing potential risk to the carotid artery

A

Hippocrates

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5
Q

A poet who regaled the court with stories of Alexander the Great, who saved a fellow warrior choking on a bone by opening the soldier’s airway with his sword

A

Homerus of Byzantium 

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6
Q

A Greek physician who performed an elective tracheotomy around 100 BCE, but it was not until 340 CE that a firsthand account of the surgery was recorded

A

Asclepiades

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7
Q

A physician who described making an incision at tracheal rings three and four and pulling the cartilage apart with hooks to allow a patient to breathe more easily

A

Antyllus of Rome 

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8
Q

Best known for his work De Humani Corporis Fabrica, placed a reed into the trachea of a pig and demonstrated lung ventilation by blowing into it I ntermittently

A

Andreas Vesalius (1543)

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9
Q

He was credited with providing the first documented successful tracheotomy

A

Antonio Musa Brassavola

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10
Q

He performed the procedure on a patient in 1546 to relieve airway obstruction resulting from a peritonsillar abscess

A

Antonio Musa Brassavola 

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11
Q

One of the first attempts involved in maintaining the opening into the airway by using a short, straight cannula designed by _____.
This tube sat against the common wall between the trachea and esophagus and was prone to create fistulae

A

Sanctorius (1590)

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12
Q

Curved metal tube was introduced by____

A

Julius Casserius 

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13
Q

Who awoke one morning in 1799 with a severe sore throat. His airway obstructed, and he died shortly thereafter from anemia of acute blood loss 

A

George Washington

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14
Q

Doctors who involved in the treatment of George Washington

A

James Craik
Gustavus Brown
Elisha Dick

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15
Q

Attitudes toward tracheotomy began to change when outbreaks of diphtheria in Europe resulted in numerous deaths as a result of airway obstruction

A

Mid-nineteenth century

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16
Q

French surgeons who advocated for a more aggressive use of tracheotomy for airway management

A

Pierre Bretonneau

Armand Trousseau

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17
Q

A French surgeon who published his experience in 1869, noting that he had “performed the operation in more than 200 cases of diphtheria, and…had the satisfaction of knowing one-fourth of these operations were successful.”

A

Armand Trousseau 

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18
Q

He presented a paper in 1871, in which he described using tracheotomy to provide general anesthesia

A

Friedrich Trendelenburg 

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19
Q

He helped to standardize techniques for performing tracheotomy and establish protocols for the care of these patients (surgical patients)

A

Chevalier Jackson

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20
Q

He warned against the potential pitfalls of the “high tracheotomy” (cricothyrotomy) and the associated risk of laryngotracheal stenosis

A

Chevalier Jackson

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21
Q

He also designed a double-lumen metal tube of an anatomically appropriate length and curvature, even going so far as to create tubes with longer shafts that allowed tracheal obstructions to be bypassed

A

Chevalier Jackson

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22
Q

They published their work on endotracheal intubation based on their experience with patients who sustained facial injuries during  World War I

A

Rowbotham and Magill

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23
Q

Indications for tracheostomy

A
  1. Prolonged mechanical ventilator
  2. Pulmonary toilet
  3. Surgical access
  4. Airway obstruction
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24
Q

Potential advantage of tracheotomy in patient who requires long-term ventilation

A

Decreased need for sedation

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25
Q

Other advantages of tracheotomy include:

A

Potential for early return to oral nutrition and communication

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26
Q

According to American College of Chest Physicians translaryngeal intubation was recommended if

A

Fewer than 10 days of ventilation were anticipated

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27
Q

Tracheotomy was recommended if

A

The need for mechanical ventilation was expected to exceed 21 days

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28
Q

Creation of an opening in the anterior tracheal wall

A

Tracheotomy

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29
Q

Formalization of a permanent stoma by suturing the edges of the trachea to the skin

A

Tracheostomy

30
Q

Vertical incision is marked from the 

A

Inferior aspect of the cricoid and extends 2 to 3 cm inferiorly

31
Q

Horizontal incision is marked from the

A

At the approximate level of tracheal ring two, 1 cm below the cricoid 

32
Q

Tracheotomy should be created between the 

A

Second and third or the third and fourth ring

33
Q

Inferiorly based tracheal flap between rings two and three 

A

Bjork flap

34
Q

What is the use of Bjork flap?

A

Help prevent false passage when replacing a dislodged tube

35
Q

Bjork flap results in

A

Semipermanent tracheostomas that may require surgical closure after decannulation

36
Q

First described percutaneous tracheotomy using the Seldinger technique in 1969

A

Toye and Weinstein

37
Q

Introduced the dilational percutaneous technique in 1985 that  the procedure began to become more commonplace in the ICU

A

Ciaglia 

38
Q

Percutaneous dilational tracheostomy is contraindicated in children because of the

A

Collapsible, mobile trachea of the pediatric airway is difficult to localize and stabilize for safe performance

39
Q

Open tracheotomy is preferred in

A
  1. Coagulation abnormalities
  2. High level of respiratory support
  3. Cervical spine injuries 
40
Q

Tube configurations are defined by the

A
  1. Inner diameter (ID)
  2. Outer diameter
  3. Length
  4. Curvature of the appliance
41
Q

In dual-cannula systems, the ID refers to the

A

Diameter of the inner cannula

42
Q

The ID in single-cannula tube systems is determined by the

A

ID of the tube itself

43
Q

ID of the tube determines

A

Airflow

44
Q

If the ID is too small, resistance through the tube increases and has an impact on the

A

Work of breathing

45
Q

Estimated resistances through size 4, 6, 8, and 10 Shiley tubes are 

A

11.4, 3.96, 1.75, and 0.69 cm H2O/L/s, respectively

46
Q

Tubes with extra proximal length (horizontal) are designed for

A

Obese neck or neck masses that displace the trachea posteriorly

47
Q

Tubes with extra distal length can be used to

A

Bypass areas of stenosis or malacia distal to the stoma

48
Q

Are ideal for patients who do not require mechanical ventilation

A

Uncuffed tubes

49
Q

These tubes can bypass upper airway obstruction, allow for pulmonary toilet, and accommodate speech

A

Uncuffed tubes

50
Q

Are designed to facilitate positive-pressure ventilation

A

Cuffed tubes

51
Q

Tracheal mucosa capillary perfusion pressure

A

Approximately 25 to 30 mm Hg

52
Q

Cuff pressures above that can result in 

A

Ischemic necrosis, which leads to stenosis

53
Q

Ideal for patients who need only intermittent positive pressure; the low profile of the cuff, once deflated, allows for easier speech

A

Tight-to-shaft TTS] tubes

54
Q

Complications of tracheotomy can be classified as

A

Early (<7 days) or late (7 )days

55
Q

Initiation and propagation of fire requires three things:

A
  1. a fuel source
  2. an energy source 
  3. an oxidizing source
56
Q

Most common cause of bleeding intraoperatively

A
  1. Anterior jugular vein injury

2. Bleeding edge of the thyroid

57
Q

Potential mechanisms of pneumothorax and pneumomediastinum include

A
  1. direct injury to the pleura
  2. dissection of air along the trachea
  3. rupture of an alveolar bleb
58
Q

Early complications

A
  1. Infection
  2. Tube Obstruction
  3. Accidental Decannulation
59
Q

True or False
Tracheotomy bypasses the natural warming and humidification provided by the nasal passages. The result is desiccation of the tracheal mucosa with decreased mucociliary function

A

True

60
Q

Late complications

A
  1. Tracheal Stenosis
  2. Tracheo-innominate Fistula
  3. Tracheoesophageal Fistula
  4. Tracheocutaneous Fistula
61
Q

True or False
When cuff pressure exceeds capillary perfusion pressure, the result is ischemic necrosis and chondritis of the underlying tracheal cartilages

A

True

62
Q

Stenoses from PDT 

A

Corkscrew pattern

63
Q

Tracheo-innominate fistula occurs in about

A

0.7% of patients in both acute (<2 weeks) and chronic (>2  weeks)

64
Q

Risk factors for tracheo-innominate fistula 

A
  1. low placement of the tracheostomy
  2. malnutrition
  3. radiation
  4. steroid usage
  5. hyperextension of the head
65
Q

Definitive treatment for tracheo-innominate Fistula

A

Median sternotomy with ligation of the innominate artery

66
Q

Tracheoesophageal fistula occurs in 

A

1%

67
Q

Risk of fistula formation through the party wall is increased when 

A

A large-bore nasogastric tube is also in place

68
Q

Tracheoesophageal fistula is best managed by 

A

Interposition of viable tissue between the membranous trachea and the esophagus

69
Q

Increases the risk of a persistent tract after decannulation

A
  1. history of radiation exposure

2. use of a Bjork flap

70
Q

Fistulae should be closed because of the risk of

A
  1. aspiration pneumonia
  2. skin irritation
  3. difficulties with voicing

Cummings (6 decks)

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