CWMP - Trachea Flashcards
Approximate length of trachea distal to subglottic space
10-13 cm
What is the 1st cartilaginous ring of the airway?
Cricoid cartilage
What is the narrowest part of the trachea?
subglottic space
Internal diameter of subglottic space
2cm
Origin of vocal cords
Arytenoid cartilages
To which part of the cricoid cartilage does the arytenoids articulate to?
Posterior plate of the cricoid cartilage
True of the trachea EXCEPT
a. distal trachea has 18-22 rings
b. distal trachea internal diameter is 2.3cm
c. C shaped hyaline cartilaginous structures that provide rigidity to the posterior and lateral tracheal walls
d. each arterial branch supplies 2-3cm of the trachea.
e. NOTA
D
most common cause of injury to the trachea
overinflation of the endotracheal cuff
Full thickness injury of the trachea during endotracheal intubation can fistulae between these two structures
innominate anteriorly and esophagus posteriorly
In circumstances of prolonged ventilatory support and high airway pressure, cuff pressure monitoring goal should be to maintain pressure at this level
<20mmHg
Intubation-related risk factors for tracheal stenosis
T - ransverse rather than vertical incision on the trachea
T - raumatic intubation
O- ver sized tracheostomy tube
P - rior tracheostomy or intubation
P - rolonged intubation
H - igh tracheostomy through the first tracheal ring or cricothyroid membrane
How do you minimize risk for prosttracheostomy stenosis
Rapid downsizing
Use of smallest tracheostomy tube possible
Vertical tracheal incision
Primary symptoms of tracheal stenosis
Stridor and dyspnea on exertion
The following statement/s is/are true
a. Stenosis caused by tracheostomy is most commonly due to weblike fibrous growth
b. Stenosis due to intubation is due to excess granulation tissue
c. both
d. neither
D.
Tracheostomy - granulation tissue
Intubation - weblike fibrous growth
What is the acute management of severe stenosis and respiratory compromise?
rigid bronchoscopy
Most common site of intubation injuries, and how is it accessed?
upper third of trachea, access through a collar incision
Two main cuases of tracheoinnominate artery fistula
low placement of a tracheostomy
hyperinflation of the tracheal cuff
Where should tracheostomy be placed?
3rd-4th tracheal rings
without reference to the location of the sternal notch
What to do initially with significant bleeding of tracheoinnominate artery fistulas ?
Hyperinflate the endoctracheal cuff to temporarily occlude arterial injury
In caes of bleeding tracheoinnominate artery fistulas, what should be done if hyperinflation of the endotracheal cuff to occlude artery does not work?
Tracheostomy incision should be immediately opened widely and a finger inserted to compress the artery against the manubrium.
What is the treatment of tracheoesophageal fistula from prolonged endotracheal mech. vent. support and concomittant indwelling nasogastric tube?
Remove esophageal tubes
Endotracheal cuff should be placed below the fistula
To minimize aspiration, gastrostomy tube should be placed
Jejunostomy tube for feeding
Most common primary tracheal neoplasm (2)
Squamous cell carcinomas
Adenoid Cystic carcinoma
Which tracheal neoplasm?
A type of salivary gland tumor, generally slow growing, spread submucosally and tend to infiltrate along nerve sheaths and within the tracheal wall
Adenoid Cystic carcinoma
Which tracheal neoplasm?
Often present with regional lymph node metastases and are frequently unresectable at presentation
Squamous cell carcinomas
True about Tracheal neoplasm evaluation and treatment
a. should include neck and chest computed tomography and rigid bronchoscopy
b. If the tumor is judged to be completely resectable, primary resection and anastomosis is the treatment of choice
c. both
d. neither
C
How much of the trachea can be resected with primary anastomosis?
50%
Tracheal adenoid cystic carcinomas and squamous cell carcinomas are sensitive to radiotherapy. What is the dose used?
50Gy or greater
