Airways Flashcards
1
Q
Tracheostomy vs Laryngectomy
A
- Tracheostomy
- Hole in trachea created through incision in the neck
- Mainly used to treat airway obstruction
- Speech through speaking valve - normal sounding
- Can ventilate through nose and mouth
- Changes usually temporary
- Laryngectomy
- Complete removal of the larync with redirection of the trachea
- Used to treat cancer of the larynx (person now breathes through a stoma)
- Speech never ‘normal’ again - possible through tracheo-oesophageal puncture (TEP) or electrolarynx
- Can only ventilate through stoma
- Changes are permanent and irreversible
2
Q
Indications for tracheostomy
A
- Mechanical obstruction
- Protection of trachebronchial tree
- Respiratory failure
- Retention of bronchial secretions
- Elective (part of major surgery)
3
Q
Advantages and disadvantages of tracheostomy
A
- Advantages
- Relief of obstruction when ET tube cannot be passed
- Decreases dead space by 150mls (50%)
- Better tolerated than ET
- Eventual swallowing and speaking
- Disadvantages
- Loss of humidification and warming (increased mucous and plugging)
- Neck wound/scar
- Tracheocuteneous fistula
- Possible discharge from hospital delay
4
Q
Technique
A
- Between 2nd and 3rd tracheal rings
- Can be percutaneous (square), Bjork flap (square flap) and slit type
- Care involves:
- Humidification
- Suctioning
- Cleaning
- Changing
5
Q
Immediate management of airway obstruction
A
- Oxygen
- Could patient obstruct?
- Call senior
- Anaesthetics
- ENT
- Airway manoeuvres
- Head tilt chin lift
- Jaw thrust
- Airway adjuncts
- Guedel
- Nasopharyngeal airway
- Nebilised adrenaline 1:1000 in 5mls NaCl
- IV steroids
- Heliox
- NBM
- Needle cricothyroidotomy - through cricothyroid membrane
6
Q
Causes of airway obstruction
A
- Vascular
- Infective
- Traumatic
- Autoimmune
- Metabolic
- Inflammatory
- Neurological
- Degenerative
- Environmental
- Neoplastic
- Idiopathic/Iatrogenic
7
Q
Angioedema
A
- 50% idiopathic
- Allergic - Type 1 response
- Non-allergic - Type 3 response (autoimmune)
