Equine Trachea Flashcards
When are tracheotomies performed on horses?
- emergencies where there is a complete airway obstruction
- planned upper airway/oral surgery where obstructions are expected
What are 5 clinical signs that indicate a horse may need an immediate tracheotomy?
- cyanotic MM
- weakness
- labored breathing, usually loud noise associated
- reduced airflow at both nostrils
- agitation due to reduced airflow
DON’T HESITATE - do the trach before diagnostics
What area is prepared for performing a tracheotomy? What preparation are preferred?
junction of the cranial and middle third of the neck
- clip, rough prep, final prep (skipped if horse can’t breath)
- local anesthetic
What position is preferred for performing a tracheotomy on horses? What landmark is used?
dorsal
create a ventral, vertical midline skin incision and locate the sternothyrohyoideus muscle and blunt dissect between muscle bellies to uncover the trachea
- easier in larger horses, like TB, to palpate tracheal rings
How is the incision into the trachea for a tracheostomy done? How big is it able to be?
create a horizontal incision through the annular ligament between rings
- place scalpel in the center
- cut in one direction
- reverse w/o removing scalpel and cut in the other direction
- place a Kelly forcep in incision to save spot while placing the trach tube
1/3 - 1/2 of circumference —> beyond = losing stability, leading to collapse and stenosis
What are the 3 major types of tracheotomy tubes?
- self-retaining - remains in position without stabilization due to 2 pieces and clip
- J-tube - requires stabilization, commonly with gauze
- larger tubes able to be hooked up to ventilators - not recommended for long-term placement
Why is the length of the skin incision so important when placing a tracheotomy tube? What area is avoided?
want the incision to be long enough so that is can heal and allow discharge to run out
down into the mediastinum
What 2 things should be avoided when performing a tracheotomy?
- cutting the tracheal rings
- cutting > 1/2 the circumference - decreased stability, can affect carotid arteries and vagal nerve trunk
What are 4 options in emergencies when there are no tracheal tubes available?
- segment of stomach tube
- garden hose
- large syringe case
- plastic jug handle
What maintenance is required for tracheostomy tubes? What can be applied to avoid serum scald?
clean area twice daily
apply Vaseline distally
How are the incisions treated when taking out a tracheostomy tube?
heal by second intention —> close quickly and only leave a small scar
What is a permanent tracheotomy indicated? 3 examples?
upper airway obstruction is unable to resolve
- cicatrix
- arytenoid chondropathy
- laryngeal hemiplegia
What are 3 differences in performing a permanent tracheostomy?
- slightly more proximal incisions
- remove tracheal rings
- suture tracheal mucosa to the skin
What clinical signs are associated with tracheal perforations/ruptures? What sequela is commonly seen?
- external wounds
- subcutaneous emphysema
- harsh tracheal sounds
air leaks into the mediastinum and leads to pneumothorax
How are small and large tracheal perforations treated?
SMALL = conservative
LARGE = refer for surgical management including suture tear and tracheal resection and anastomosis
What are the 3 most common etiologies of tracheal collapse?
- cartilage trauma
- cartilage malformation
- peritracheal mass - external compression, internal neoplasia or abscess
What clinical signs are associated with tracheal collapse?
- respiratory distress
- exercise intolerance
- stridor, wheezing, honking
How is tracheal collapse treated?
extra/intraluminal prosthetics —> similar to dogs, issues with accessibility
What is a common etiology of tracheal stenosis in horses?
too large tracheostomy (>50% lumen) = loss of stability
- clinical signs/treatment similar to tracheal collapse
