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GENERAL OTOLARYNGOLOGY > CHAPTER 7: Tracheotomy > Flashcards

CHAPTER 7: Tracheotomy Flashcards

1
Q

The earliest accounts of a procedure resembling tracheotomy are found in Egyptian tablets dating back to

A

3600 BCE

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2
Q

Opposed the procedure, citing potential risk to the carotid

A

Hippocrates

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3
Q

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

Poet of Homerus of Byzantium

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4
Q

A firsthand account of the surgery was recorded

A

340 CE

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5
Q

Described making an incision at tracheal rings 3 to 4 and pulling the cartilage apart with hooks to allow a patient to breathe more easily

A

Antyllus of Rome

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6
Q

Placed a reed into the trachea of a pig and demonstrated lung ventilation by blowing into the cannula intermittently

A

Andreas Vesalius (1543), De Humani Corporis Fabrica

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7
Q

Is credited with providing the first documented successful tracheotomy. 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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8
Q

Physicians who attended George Washington, who awoke one morning in 1799 with a severe sore throat

A

James Craik, Gustavus Brown, Elisha Dick

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9
Q

The junior member ;of the group suggested that Washington should have a tracheotomy to relieve the obstruction

A

Elisha Dick

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10
Q

Advocated for a more aggressive use of tracheotomy for airway management

A

Pierre Bretonneau and Armand Trousseau

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11
Q

Published his experience in 1869, noting that he had “performed the operation in more than 200 cases of diphtheria

A

Armand Trousseau

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12
Q

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

A

Friedrich Trendelenburg

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13
Q

Helped to standardize techniques for performing tracheotomy and published protocols for the care of these patients

A

Chevalier Jackson

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14
Q

Published their work on endotracheal intubation based on their experience with patients who sustained facial injuries during WWI

A

Rowbotham and Magill

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15
Q

Indications for tracheostomy

A
  1. Prolonged mechanical ventilation
  2. Pulmonary toilet
  3. Surgical access
  4. Airway obstruction
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16
Q

TRUE or FALSE

Translaryngeal intubation was recommended if fewer than 10 days of ventilation were anticipated

A

TRUE

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17
Q

TRUE or FALSE

If the need for mechanical ventilation was expected to exceed 21 days, tracheotomy was recommended

A

TRUE

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18
Q

Creation of an opening in the anterior tracheal wall

A

Tracheotomy

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19
Q

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

A

Tracheostomy

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20
Q

Inferiorly based tracheal flap, help to prevent false passage when replacing a dislodged tube

A

Bjork flap

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21
Q

A curved metal tube was introduced by

A

Julius Casserius

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22
Q

Selection of the proper tube depends on

A
  1. Lung mechanics
  2. Patient anatomy
  3. Communication needs
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23
Q

Composed of silver or steel offer the benefit of a low profile but lack a 15-mm connector and cuff and therefore not suitable in patients who require mechanical ventilator

A

Metal tubes

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24
Q

Tube configurations are defined by

A
  1. Inner diameter
  2. Outer diameter
  3. Length
  4. Curvature of the appliance
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25
Q

Refers to the diameter of the inner cannula (dual-cannula systems)

A

Inner diameter

26
Q

Determined by the ID of the tube itself (single-cannula tube system)

A

Inner diameter

27
Q

TRUE or FALSE

If the ID is too small, resistance through the tube increases and impacts the work of breathing

28
Q

True or False
Tubes with extra proximal length (horizontal) are designed to accommodate the obese neck or neck masses that displace the trachea posteriorly

29
Q

True or False

Tubes with extra distal (vertical) length can be used to bypass areas of stenosis or malacia distal to the stoma

30
Q

Are ideal for patients who do not require mechanical ventilation

A

Uncuffed tubes

31
Q

True or False

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

32
Q

Designed to facilitate positive pressure ventilation

A

Cuffed tubes

33
Q

True or False

Most cuffs are designed to be high-volume/low-pressure cuffs to help mitigate the risk of tracheal stenosis

34
Q

Tracheal mucosa capillary perfusion pressure

35
Q

Cuff pressure greater than 25-30mmHg can result in

A

Ischemic necrosis—>stenosis

36
Q

Ideal for patients who need only intermittent postive pressure

A

Low -volume/high pressure (tight-to-shaft)

37
Q

Classifications of tracheotomy can be classified as

A
  1. Intraprocedural
  2. Early (<7 days)
  3. Late (>7 days)
38
Q

Intraprocedural complications:

A
  1. Airway fire
  2. Bleeding
  3. Pneumothorax/Pneumomediastinum
39
Q

The initiation and propagation of fire requires 3 things:

A
  1. Fuel source
  2. Energy source
  3. Oxidizing agent
40
Q

True or False

Intraoperatively, most bleeding is secondary to anterior vein injury or from the bleeding edge of the thyroid

41
Q

Potential mechanism (pneumothorax/pneumomediastinum)

A
  1. Direct injury to the pleura
  2. Dissection of air along the trachea
  3. Rupture of an alveolar bleb
42
Q

Early complications of tracheotomy

A
  1. Infection
  2. Tube obstruction
  3. Pressure ulcers
  4. Accidental decannulation
43
Q

True or False

Tracheotomy bypasses the natural warming and humidification provided by the nasal passages

44
Q

True or False

If the tube cannot be successfully placed through the tracheotomy, translaryngeal intubation should be attempted

45
Q

Late complications of tracheotomy

A
  1. Tracheal stenosis
  2. Tracheoinnominate fistula
  3. Tracheoesophageal fistula
  4. Tracheocutaneous fistula
46
Q

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

47
Q

True or False

High-volume, low-pressure cuffs have been designed to mitigate tracheal stenosis

48
Q

Characterized by a corkscrew pattern (disruption and fracture of the tracheal rings)

A

Stenoses from PDT

49
Q

True or false

Tracheoinnominate fistula occurs in approximately 0.7% of patients in both acute (<2 weeks) and chronic (>2 weeks)

50
Q

A sentinel bleeding event often, but not always, precedes massive hemorrhage

A

Tracheoinnominate fistula

51
Q

In 78% tracheoinnominate fistula, the event occurs between

A

3-4 weeks after tracheostomy

52
Q

Risk factors in treacheoinnominate fistula/bleeding

A
  1. Low placement of the tracheostomy
  2. Malnutrition
  3. Radiation
  4. Steroid usage
  5. Hyperextension of the head
53
Q

First priority in tracheoinnominate fistula/bleeding

A

Immediate attention to establishing an airway with an ETT that bypasses or tamponades the fistula

54
Q

Definitive treatment of tracheoinnominate fistula/bleeding

A

Median sternotomy with ligation of the innominate artery

55
Q

True or False

The risk of fistula formation through the “party wall” is increased when large-bore NGT is also in place

56
Q

Tracheoesophageal fistula is best managed by

A

Interposition of viable tissue between the membranous trachea and the esophagus

57
Q

True or False
Of patients who have a tracheotomy tube in place for more than 4 months, 70% will have a persistent tracheocutaneous fistula as a result of epithelialization of the tract

58
Q

True or False

A history of radiation exposure or the use of a Bjork flap increases the risk of a persistent tract after decannulation

59
Q

True or False
Patient who had had an open tracheostomy could have the first tracheostomy tube change by physicians between days 3 and 5

60
Q

True or False
Percutaneous tracheostomy appliances should not be removed or changed until day 10 because of the increased risk of false passage

61
Q

Candidates for decannulation should be assessed for

A
  1. Level of consciousness
  2. Respiratory status
  3. Ability to cough and swallow
62
Q

True or False

The length of the capping trial is patient dependent and can range from overnight to several weeks

GENERAL OTOLARYNGOLOGY (12 decks)

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