Tracheostomy
airway trauma closed loop communication shared airway tracheostomy ventilation Jun 20, 2024
🌟 What and why? 🌟
A tracheostomy involves creating a passage through the front of the neck into the trachea to allow placement of an endotracheal tube. Common reasons for tracheostomy include upper airway obstruction, prolonged mechanical ventilation, trauma, and major neck surgery. A tracheostomy may be temporary or permanent.
🔍 Intraoperative considerations: 🔍
📍 Position: Supine, head ring +/- pad under shoulders.
⏱️ Duration: 30 mins
🌬️ Airway plan: Requires good communication when transitioning from an oral ETT. A short, cuffed tube is used to secure the airway. Ensure the circuit can reach the front of the neck. Consider a sterile tube extension for the surgical team to handle. Surgeon will require oral ETT cuff deflate and tube withdrawal to place the tracheostomy tube.
💡 Expert tips:
Preoxygenate with 100% O2 and paralyse the patient. Use closed-loop communication! Have a bronchoscope ready to check position or troubleshoot.
🌟 Postoperative considerations: 🌟
💥 Pain: Minimal pain. Coughing can be an issue if sedation is reduced.
❗ Airway risks: Bleeding can occur from thyroid vessels. A dislodged tracheostomy is a true airway emergency and requires immediate attendance by an anaesthetist and surgical team.
🔄 Other:
Retraction sutures are usually placed to identify the tracheal opening in an emergency.
✅ Build knowledge
✅ Improve safety
Ref: Turner, Grant, 'Ear, nose and throat surgery', in Rachel Freedman, and others (eds), Oxford Handbook of Anaesthesia, 5 edn, Oxford Medical Handbooks (Oxford, 2022; online edn, Oxford Academic, 1 Nov. 2021), accessed 13 June 2024.
Stay connected with news and updates!
Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.
We hate SPAM. We will never sell your information, for any reason.
Unlock Exclusive Free Content
Join the mailing list. We give too much great content away for free, see what all the fuss is about.
Categories
All Categories abg acid base acorn adrenaline adrenaline dosing adrenaline in anaphylaxis adverse reaction aed ahpra ahpra audit airway airway adjuncts airway assessment airway emergency airway filter airway management airway mass airway rescue airway trauma airwaylifeline airwayoptimisation algorithm allergy als als aftercare alsmedications amiodarone anaesthesia anaesthetic anaesthetic machine anaesthetics analgesia anaphylactoid anaphylaxis anaphylaxis aftercare anaphylaxis diagnosis anaphylaxis differential diagnosis anaphylaxis management anaphylaxis triggers anatomy antibiotics antiemetic anzaag anzcor apnoea arrest arterial blood gas arterial line arterial line complications arterial line errors arterial lines arterialcannulation arteriallines asa article asl aspiration aspiration risk assessing pain assessment awareness bag mask ventilation behaviours of concern beta blockers bis bispectral index blade bleeding bleeding airway block blocks blood blood pressure blood pressure monitoring blood products blood safety bluey boundaries breathing circuit bronchoscopy bronchospasm burns cannula technique cannulation capnography cardiac arrest cardiac output cardiac surgery cardiovascular causesofcardiacarrest cell saver central venous catheter centralvenouscatheter cerebral oximetry checklist checklists chlorhexidine cico circadian cycle circuit climate climate change closed loop communication co2 coagulation cognitive aid colonoscopy communication complications compression rates compressions contaminant coolinginmh core body temperature cpd cpr cricoid pressure cricothyrotomy crisis resource management critical incident cross matching cvc cvc complications dantrolene debriefing defibrillation dental surgery depth of anaesthesia diabetes diagnostics difficult airway documentation drug errors drug safety drugs ecg education educator emergence delirium emergency emergency management emotional intelligence end tidal carbon dioxide endoscopy endotracheal tubes ent entropy environment epidural anaesthesia equipment ercp error ett exchange catheter exercise fasting feedback ffp fluid balance fluid resuscitation fluid therapy fona formal diagnosis fracture fixation principles fracture patterns frailty ga gas gas analysis gastroscopy general anaesthetic gloves glp-1 ra glp-1 receptor agonists glp-1ras haemodynamic haemoglobin haemorrhage haemostasis handle handover hazard health heart rate hemodynamics hereditarydisorder high flow high risk hot debrief human factors hypnosis hypotension hypoxia icu immune response incomplete reversal induction infection infection control inotrope inotropes intravenous intravenous cannulation intubation invasive blood pressure monitoring invasive device invasivebloodpressuremonitoring iv induction ketamine laryngeal mask laryngectomy laryngoscope laryngospasm leadership learning lifelines lma local anaesthetic long term venous access major surgery malignanthyperthermia mallampati mask ventilation massive transfusion massive transfusion protocol mast cells mean arterial pressure medications mh mhtesting mls monitoring movement muscle relaxants neck surgery nerve blocks nerve monitoring neuraxial neuromuscular blockade neuromuscular junction nmt non-invasive blood pressure non-shockable rhythms nurse burnout nurse education nurse wellbeing nursing nutrition obstetric obstetrics anaesthesia obstruction opioid opioids orthopaedic biology orthopaedic nursing ot oxygen oxygenation ozempic pacu paediatric paediatric anaesthesia paediatric t piece paediatrics pain pain management patient safety perianaesthesia nurse educator perioperative perioperative orthopaedics perioperativenursing pipeline ponv positioning post operative preoperative preoperative care preoxygenation preparedness primary survey professional development protocol psychological safety publications pulmonary radiation rapid sequence induction recognition recovery recovery issues recovery room emeregencies refractory anaphyalxis refractory hypotension regionalanaesthesia renal resilience resources respiratory resuscitation reversal rotem safe apnoea time safety scalpel scalpel technique scrub scout nursing sedation seldinger shared airway shockable rhythms signs of anaphylaxis simulation skin prick testing sleep spinal spinal anaesthetic sterile procedures stress reduction surgery surgical considerations surgical safety checklist tachycardia teaching styles team time-out teamwork teg temperature testing tonsillectomy tracheostomy training transfusion transfusion reaction trauma treatment tryptase ultrasound ultrasoundprobes vascular surgery vasopressor ventilation vf videolaryngoscope volatileagents vortex approach vt waste wellbeing workshop