Trauma - Surgical airways Flashcards
(12 cards)
What are the indications for cricothyroidotomy?
Indications
Can’t intubate, can’t ventilate Scenario
have the most experienced person there. A.k.a. Anaesthetic support
What are the contraindications for cricothyroiotomy?
Contra-indications
Airway trauma unableable to access cricothryoid membrane
Laryngeal fracture, tracheal transection
What equipment is needed for an emergency airway?
Size 6 ETT ((6mm)
Bougie
10 blade
How do you position the patient for an emergency airway?
supine, neck extended
Surgeon to the patients right
What are the five steps of emergency cricothyroidotomy?
Steps - stabilised, scalpel, bougie, tube or “scalpel, finger, bougie”
- Preperation
Oxygentate the patient with 100% via mask
Extend the neck, with bulster under shoulders. - Immobilised trachea
Feel for thyroid lamina-crichocartilage and criothyroid membrane in between
Hold paients thyroid cartilage in non-dominate hand. - Access
Make verticle incison through skin
Then horizontal stab incision – in cricothyroid membrane.
Keep blade in a turn by 10 blade - ET insert
Pass bougie
6mm ET tube, pass cuff pass level of cords
Inflate cuff 10ml - Check position and ventilation
Signs of breathing, asultations, CO2
What are the complications of emergency cricothyroidotomy?
Failure
Hypoxia/death
Bleeding, ant jagular, thryoid isthmus
Infection
Cricoid fracture
What are the principles of elective tracheostomy?
I perform an elective tracheostomy through a skin crease incision, placing the stoma between the 2nd and 3rd tracheal rings.
What are the indications for elective tracheostomy?
Upper airway obstruction
Respsory failure and ventilatory dependence
What equipment do your need for an elective tracheostomy?
Size 7, 8 tube
if available use Trachostomy tube
Tracheal spreader
What positioning do you use for an elective tracheostomy?
supine, neck extended
Surgeon to the patients right
Describe the procedure for elective tracheostomy, including :
Incision
Exposure
Dissection/Resection
Closure
Incision
Identify landmarks: thyroid lamina, cricoidcartilage, sternal notch
Horizontal skin crease incision halfway between cricoid and suprasternal notch
Exposure
Dissection through subcut and platysma.
Identify midline raphe, may need to control anterior jugular veins
Separate the strap muscles and retract laterally, exposing
the pretracheal fascia and the thyroid isthmus
For further exposure, divide the isthum with diathermy, ligate inferior thyroid veins
Dissection/resection
Tracheostomy
1-2cm tranverse incision between 2nd and 3rd tracheal ring
Hold stoma open with tracheal spreader
Bjork flap optional (not done routinely anymore)
Transition
Key is communication with Anaesthesia
Retract the ET Tube under direct vision, not completely though
Insert Tracheostomy tube, inflate cuff
Confirmation of Placement and Secure
Check for chest raise, misting and CO2 trace
Closure
Suture tracheostomy tube + collar strap
What are the complications of elective tracheostomy?
Accidental extubation
Avoid!
Can insert strong stitch through cut tracheal edge leaving ends long so as can be used to draw trachea forwards and open incision
Subglottic stenosis in cricothyroidotomy patients <12 years old
Tracheobrachiocephalic artery fistula
Especially if below 4th ring
Tube tilts forward eroding into innominate arterial trunk
Manage with finger in stoma and inflated endotracheal balloon (and tube)
