Tracheostomy

Tracheostomy

Q. 1

A double lumen tracheostomy tube all are true EXCEPT:

 A

Easy to remove inner cannula

 B

Easy to clean inner cannula

 C

Easy to replace inner cannula

 D

No inner cannula

Q. 1

A double lumen tracheostomy tube all are true EXCEPT:

 A

Easy to remove inner cannula

 B

Easy to clean inner cannula

 C

Easy to replace inner cannula

 D

No inner cannula

Ans. D

Explanation:

Q. 2

In emergency tracheostomy the following structures are damaged except?

 A

Isthmus of the thyroid

 B

Inferior thyroid artery

 C

Thyroid ima

 D

Inferior thyroid vein

Q. 2

In emergency tracheostomy the following structures are damaged except?

 A

Isthmus of the thyroid

 B

Inferior thyroid artery

 C

Thyroid ima

 D

Inferior thyroid vein

Ans. B

Explanation:

Isthmus, thyroid ima artery and inferior thyroid veins are midline structures and thus can be injured during tracheostomy, more so during emergency tracheostomy. Inferior thyroid artery, a branch of the thyrocervical trunk of the subclavian artery lies laterally away from midline, thus can escape injury.

In emergency tracheostomy following structures can be damaged:

– Isthmus

–  Inferior thyroid veins

– Thyroid ima artery

–  Left brachio-cephalic vein, jugular venous arch

–  Pleura (especially infants)

– Thymus

–  Esophagus (the trachea is small, mobile, and soft in infants damage the esophagus)


Q. 3

High tracheostomy is indicated in:

 A

Carcinoma

 B

TB

 C

Diphtheria

 D

All of the above

Q. 3

High tracheostomy is indicated in:

 A

Carcinoma

 B

TB

 C

Diphtheria

 D

All of the above

Ans. A

Explanation:

Q. 4

Indication for tracheostomy are all, EXCEPT:

 A

Flail chest

 B

Head injury

 C

Cardiac Tamponade

 D

Foreign body

Q. 4

Indication for tracheostomy are all, EXCEPT:

 A

Flail chest

 B

Head injury

 C

Cardiac Tamponade

 D

Foreign body

Ans. C

Explanation:

Indications for tracheostomy are Flail chest, Head injury, Foreign body, Tetanus etc.

Cardiac tamponade is not an indication for tracheostomy.


Q. 5

Mid tracheostomy is done over which of the following anatomical landmarks?

 A

1st and 2nd tracheal rings

 B

3rd and 4th tracheal rings

 C

5th and 6th tracheal rings

 D

7th and 8th tracheal rings

Q. 5

Mid tracheostomy is done over which of the following anatomical landmarks?

 A

1st and 2nd tracheal rings

 B

3rd and 4th tracheal rings

 C

5th and 6th tracheal rings

 D

7th and 8th tracheal rings

Ans. B

Explanation:

Tracheostomy has also been divided into:

A) High tracheostomy: Done above level of thyroid isthmus. Indication is ca larynx.

B) Mid tracheostomy: It is the preferred one and done through II and III rings, division of isthmus.

C) Low tracheostomy: Done below level of isthmus. Trachea is deep at this level and close to several large vessels.

 
A mid tracheostomy is done through the II or III rings and would entail division of the thyroid isthmus (isthmus lies against II, III and IV tracheal rings) or its retraction upwards or downwards to expose this part of trachea.

Q. 6

Which of the following could be the indication for a middle aged man posted for a high tracheostomy?

 A

Carcinoma

 B

TB

 C

Tetanus

 D

Diphtheria

Q. 6

Which of the following could be the indication for a middle aged man posted for a high tracheostomy?

 A

Carcinoma

 B

TB

 C

Tetanus

 D

Diphtheria

Ans. A

Explanation:

A high tracheostomy is done above the level of thyroid isthmus. It violates the 1st ring of trachea.
Tracheostomy at this site can cause perichondritis of the cricoid cartilage and subglottic stenosis and is always avoided.
Only indication for high tracheostomy is carcinoma of larynx because in such cases, total larynx would ultimately be removed and a fresh tracheostome made in a clean area lower down.
 

Q. 7

In emergency tracheostomy all of the following structures are damaged, EXCEPT?

 A

Isthmus of the thyroid

 B

Inferior thyroid artery

 C

Thyroid ima artery

 D

Inferior thyroid vein

Q. 7

In emergency tracheostomy all of the following structures are damaged, EXCEPT?

 A

Isthmus of the thyroid

 B

Inferior thyroid artery

 C

Thyroid ima artery

 D

Inferior thyroid vein

Ans. B

Explanation:

Bleeding can occur immediately after a tracheostomy and in the late postoperative period. Sources of hemorrhage include granulation tissue in the stoma or trachea, and erosion of thyroid vessels or the thyroid itself, the tracheal wall (frequently from suction trauma), or the innominate artery. Inferior thyroid artery, a branch of the thyrocervical trunk of the subclavian artery lies laterally away from midline, thus can escape injury.

Q. 8

True about pediatric tracheostomy –

 A

Most common early complication is subcutaneous emphysema

 B

3rd & 4th tracheal rings are incised

 C

Easy to remove the tracheostomy tube

 D

a and b

Q. 8

True about pediatric tracheostomy –

 A

Most common early complication is subcutaneous emphysema

 B

3rd & 4th tracheal rings are incised

 C

Easy to remove the tracheostomy tube

 D

a and b

Ans. D

Explanation:

Ans. is ‘a’ i.e., Most common early complication is subcutaneous emphysema; b i.e., 3rd & 4th tracheal ring are incised

o In most of the cases tracheostomy is performed with general anaesthesia and the patient intubated and paralyzed. o Neck is extended.

o A horizontal incision is made halfway between the cricoid cartilage and the sternal notch.

  • Subcutaneous fat and tissues are reflected, and deep cervical facia, is cut to expose thyroid isthmus.
  • A vertical cut is given in 2-3 or 3-4 rings in midline and no part of the tracheal wall is removed.
  • The endotracheal tube is withdrawn and a suitable size tracheostomy tube is simultaneously inserted.
  • Post-operatively neck & chest radiograph are obtained to evaluate the position of the tube and to identify the subcutaneous emphysema & pneumothorax that could have developed as complication.

o Tube must be cleaned at frequent intervals.

o Patient should be nursed in and atmosphere of moist air.


Q. 9

Indications of tracheostomy are

 A

Flail chest

 B

Head injury

 C

Tetanus

 D

All

Q. 9

Indications of tracheostomy are

 A

Flail chest

 B

Head injury

 C

Tetanus

 D

All

Ans. D

Explanation:

A i.e. Flail chest; B i.e. Head injury; C i.e. Tetanus


Q. 10

A new born with a goiter large enough to cause dyspnoea is best treated with –

 A

Sulfonamieds

 B

Tracheostomy

 C

T3

 D

Iodides

Q. 10

A new born with a goiter large enough to cause dyspnoea is best treated with –

 A

Sulfonamieds

 B

Tracheostomy

 C

T3

 D

Iodides

Ans. B

Explanation:

Ans. is ‘b’ i.e. Tracheostomy 

Partial thyroidectomy is preferred over tracheostomy.


Q. 11

Interstitial Emphysema may be found in the following conditions –

 A

Chest injury

 B

Tracheostomy

 C

Surgical wound

 D

All

Q. 11

Interstitial Emphysema may be found in the following conditions –

 A

Chest injury

 B

Tracheostomy

 C

Surgical wound

 D

All

Ans. D

Explanation:

Ans. is ‘d’ i.e., All 


Q. 12

A cricoid hook is used particularly –

 A

In thyroidectomy

 B

In block dissection of the neck

 C

For retracting the superior laryngeal nerve

 D

In tracheostomyMiscellaneous / 817

Q. 12

A cricoid hook is used particularly –

 A

In thyroidectomy

 B

In block dissection of the neck

 C

For retracting the superior laryngeal nerve

 D

In tracheostomyMiscellaneous / 817

Ans. D

Explanation:

Ans. is ‘d’ i.e., In tracheostomy 


Q. 13

A patient of carcinoma larynx with stridor presents in casualty, immediate management is:

 A

Planned tracheostomy

 B

Immediate tracheostomy

 C

High dose steroid

 D

Intubate, give bronchodilator and wait for 12 hours, if no response, proceed to tracheostomy

Q. 13

A patient of carcinoma larynx with stridor presents in casualty, immediate management is:

 A

Planned tracheostomy

 B

Immediate tracheostomy

 C

High dose steroid

 D

Intubate, give bronchodilator and wait for 12 hours, if no response, proceed to tracheostomy

Ans. B

Explanation:

 

Carcinoma larynx presenting with stridor means it is subglottic laryngeal carcinoma .Ideally in such cases emergency laryngectomy should be performed.

 

But not done in cases if

  • Intubation can not be done as growth is seen in subglottic area, therefore tube can not be put.
  • Planned tracheostomy can not be done as patient is suffering from stridor, which is an emergency. Therefore we will have to do emergency tracheostomy. With the precaution that the area of cancer should be removed within 72 hours.



Q. 14

Maintenance of airway during laryngectomy in a patient with carcinoma of larynx is best done by

 A

Tracheostomy

 B

Laryngeal mask airway

 C

Laryngeal tube

 D

Combi tube

Q. 14

Maintenance of airway during laryngectomy in a patient with carcinoma of larynx is best done by

 A

Tracheostomy

 B

Laryngeal mask airway

 C

Laryngeal tube

 D

Combi tube

Ans. A

Explanation:

Q. 15

Tracheostomy is indicated in all except:

 A

Tracheal stenosis

 B

Bilateral vocal cord palsy

 C

Foreign body larynx

 D

Uncomplicated bronchial asthma

Q. 15

Tracheostomy is indicated in all except:

 A

Tracheal stenosis

 B

Bilateral vocal cord palsy

 C

Foreign body larynx

 D

Uncomplicated bronchial asthma

Ans. D

Explanation:

Q. 16

The most common indication for tracheostomy is: 

 A

Laryngeal diphtheria

 B

Foreign body aspiration

 C

Carcinoma

 D

Asthma

Q. 16

The most common indication for tracheostomy is: 

 A

Laryngeal diphtheria

 B

Foreign body aspiration

 C

Carcinoma

 D

Asthma

Ans. B

Explanation:

Historically, the main indication for a tracheostomy was to bypass upper airway obstruction caused by a foreign body or infection, particularly diphtheria.

Nowadays upper airway obstruction is the least common indicator for tracheostomy. Almost two thirds of tracheostomies are currently performed on intubated intensive care patients, mainly to aid removal of secretions from the distal tracheobronchial tree and to facilitate weaning from distal tracheobronchial tree in acute respiratory failure and prolonged ventilation

 


Q. 17

Tracheostomy is not indicated in: 

 A

Emphysema

 B

Bronchiectosis

 C

Atelectasis

 D

Pneumothorax

Q. 17

Tracheostomy is not indicated in: 

 A

Emphysema

 B

Bronchiectosis

 C

Atelectasis

 D

Pneumothorax

Ans. D

Explanation:

 

 



Q. 18

A high tracheostomy may be indicated in:

 A

Scleroma of the larynx

 B

Multiple papilliomatosis of larynx

 C

Bilateral vocal cord paralysis

 D

Carcinoma of larynx

Q. 18

A high tracheostomy may be indicated in:

 A

Scleroma of the larynx

 B

Multiple papilliomatosis of larynx

 C

Bilateral vocal cord paralysis

 D

Carcinoma of larynx

Ans. D

Explanation:

 

 It is important (in tracheostomy) to refrain from causing any damage in the region of cricoid cartilage.

An exception to this rule is when a patient has laryngeal malignancy and under these circumstances tracheostomy should be placed high so as to allow resection of tracheostomy site at the time of laryngectomy – Scott Brown 7th/ed vol 2 pg. 2295

The high tracheostomy is generally avoided because of the postoperative risk of peri-chondritis of the cricoid cartilage and subglottic stenosis. In cases of carcinoma larynx with stridor when total laryngectomy would be done, high tracheostomy is indicated.



Q. 19

True about tracheostomy tube are all except:

 A

Double tube

 B

Made of titanium silver alloy

 C

Cuffed tube for IPPV

 D

Has to be changed ideally in every 2 to 3 days

Q. 19

True about tracheostomy tube are all except:

 A

Double tube

 B

Made of titanium silver alloy

 C

Cuffed tube for IPPV

 D

Has to be changed ideally in every 2 to 3 days

Ans. D

Explanation:

Q. 20

All are true about tracheostomy tube except: 

 A

Jackson’s tube has 2 lumens

 B

Removal of metallic tube in every 2-3 days

 C

Cuffed tube is used to prevent aspiration of pharyngeal secretion

 D

Made up of titanium-silver alloy

Q. 20

All are true about tracheostomy tube except: 

 A

Jackson’s tube has 2 lumens

 B

Removal of metallic tube in every 2-3 days

 C

Cuffed tube is used to prevent aspiration of pharyngeal secretion

 D

Made up of titanium-silver alloy

Ans. B

Explanation:

 

A tracheostomy tube may be metallic or nonmetallic

  • Metallic Tracheostomy Tube

Metallic tubes are formed from the alloy of silver, copper and phosphorus

Has an inner and an outer tube.The inner tube is longer than the outer one so that secretions and crusts formed in it can be removed and the tube reinserted after cleaning without difficulty. However, they do not have a cuff and cannot produce an airtight seal.

  • Nonmetallic Tracheostomy Tube

Can be of cuffed or noncuffed variety, e.g. rubber and PVC tubes. 

Cuffed Tracheostomy Tubes

  • A cuff is a balloon-like device around the distal end of the tracheostomy tube. Most cuffed tubes now available have low pressure cuffs with a high volume. This significantly reduces the possibility of pressure necrosis and potential stenosis formation. Pediatric tubes do not have a cufr. Cuffed tubes are used in situation where positive pressure ventilation is required, or when the airway is at risk from aspiration. (In unconscious patient or when patient is on respiration).

The cuff should be deflated every 2 hours for 5 mins to present pressure damage to the trachea.

Uncuffed Tracheostomy Tubes

This tube does not have a cuff that can be inflated inside the trachea.

It is suitable for a patient who has returned to the ward from a prolonged stay in intensive care and requires physiotherapy and suction via trachea.

This type of tube is not suitable for patients who are unable to swallow due to incompetent laryngeal reflexes, and aspiration of oral or gastric con­tents is likely to occur.

An uncuffed tube is advantageous in that it allows the patient to breathe around it in the event of the tube becoming blocked. Patients can also speak with an uncuffed tube.

 


Q. 21

In emergency tracheostomy following structures are damaged except:

 A

Isthmus of thyroid

 B

Inferior thyoid vein

 C

Inferior thyroid artery

 D

Thyroid ima

Q. 21

In emergency tracheostomy following structures are damaged except:

 A

Isthmus of thyroid

 B

Inferior thyoid vein

 C

Inferior thyroid artery

 D

Thyroid ima

Ans. C

Explanation:

 

Structures which lie below the midline viz. isthmus of thyroid and thyroid ima artery can be damaged in emergency tracheostomy.

Inferior thyroid veins emerge at the lower border of the isthmus form a plexus in front of the trachea and drains into brachioce­phalic vein can be damaged during tracheostomy but inferior thyroid artery, a branch of thyrocervical trunk of subclavian artery lies laterally away from midline and can thus escape injury.


Q. 22

Most common complication of tracheostomy is: 

 A

Tracheoesophageal fistula

 B

Tracheocutaenous fistula

 C

Surgical emphysema

 D

All

Q. 22

Most common complication of tracheostomy is: 

 A

Tracheoesophageal fistula

 B

Tracheocutaenous fistula

 C

Surgical emphysema

 D

All

Ans. D

Explanation:

 

 Complications of Tracheostomy

IMMEDIATE

Most common complication of tracheostomy is hemorrhage. The commonest cause of bleeding during tracheostomy is Anterior jugular vein.

Other Immediate Complication of tracheostomy

  • Air embolism                                                                    • Apnea (due to sudden release of retained CO2)
  • Cardiac arrest                                                                   • Local damage to structures
  • Pneumothorax (d/t injury to apical pleura)

INTERMEDIATE

During first few hours or days

  • Dislodgement/Displacement of the tube
  • Surgical emphysema :May occur as the air may leak into the cervical tissues.

This is occasionally found in the immediate postoperative period.

Presents as a swollen area around the root of the neck and upper chest, which displays crepitus on palpation. It is due to overtight suturing of the wound and is not dangerous unless it leads to mediastinal emyphysema and cardiac tamponade.

  • Pneumothorax/pneumomediastinum
  • Tubal obstruction by Scabs/crusts
  • Infection (tracheitis and tracheobronchitis, local wound infection).
  • Dysphagia :

– This is fairly common in the first few days after tracheostomy.

– In normal swallowing a positive subglottic pressure is created by the closing of the vocal cords – which is why one cannot speak during swallowing.This is not possible with a tracheostomy tube in place, and thus swallowing is incoordinate. – Another reason for dysphagia is that if an inflatable cuff is blown up it will press on and obstruct the oesophagus.

  • Tracheal necrosis
  • Tracheo arterial (Tracheal innominate artery fistula) /Tracheoeshophageal fistula
  • Recurrent laryngeal nerve injury.

LATE

  • Hemorrhage due to erosion of major vessels
  • Stenosis of the trachea (at the level of stoma)
  • Laryngeal stenosis due to perichondritis of cricoid cartilage.
  • Difficulty with decannulation
  • Tracheocutaneous fistula/scars.

According to Scott-Brown’s 7th vol 2 p. 2301 – Tracheoarterial fistula / Tracheoesophageal fistula are intermediate complications and not late complications like tracheocutaneous fistula.


Q. 23

“Gold standard” surgical procedure for prevention of aspiration is:

 A

Thyroplasty

 B

Tracheostomy

 C

Tracheal division and permanent tracheostome

 D

Feeding gastrostomy/jejunostomy

Q. 23

“Gold standard” surgical procedure for prevention of aspiration is:

 A

Thyroplasty

 B

Tracheostomy

 C

Tracheal division and permanent tracheostome

 D

Feeding gastrostomy/jejunostomy

Ans. C

Explanation:

 

Aspiration is the passage of foreign material beyond the vocal cords:

  • The larynx has 3 distinct functions – respiration, phonation and airway protection. Dysfunction of larynx can lead to aspiration.
  • The primary goal of treatment of aspiration is to separate the upper digestive tract from the upper respiratory tract for a short period of time or in some cases, permanently.
  • There are 3 broad categories of treatment.

Temporary/Adjunct Treatments

  • Medical Therapy – in the form of antibiotics is important to prevent aspiration pneumonia.
  • It is important to make the patient NPO, to avoid further aspiration and to find an alternate feeding route to maintain the patients nutritional status. A nasogastric tube (feeding gastostomy/jejunostomy) is commonly placed, but this may actually increase the aspiration reflux by making the lower esophageal and upper esophageal sphincters incompetent.

  

Vocal cord medialization (by injecting Gel foam) is useful in unilateral paralysis.This is helpful but is rarely curative, if there is a serious aspiration problem.

Tracheostomy will often make aspiration worse by preventing laryngeal elevation on swallowing. It does however, allow easy access to the chest for suctioning. Even a cuffed tube doesn’t prevent aspiration as secretions pool above the cuff and the seal is never perfect”- Scotts Brown 7th/ed vol 1 pg. 1278

Definite – Reversible Procedures

  • Endolaryngeal stents: They function like a cork in the bottle. There job is to seal the glottis and therefore thay need to be used in conjunction with a tracheostomy tube. But they are not often used as they are effective only as a short term solution, plus there is risk of glottic stenosis.
  • Laryngotracheal separation: The procedure involves transecting the cervical trachea and bringing out the lower end as a permanent end stoma
  • But it has disadvantage of sacrificing voice.
  • Alternative procedure is Tracheoesophageal diversion but has higher complication rates.

Definite – Irreversible Procedure

It includes: Narrow field laryngectomy: it was considered as a gold standard prior to 1970s, when the irreversible procedures like laryngo tracheal separation were not done.

Also Know

  • Investigation of choice for diagnosing aspiration = Fibreoptic endoscopic evaluation of swallow (FESS)
  • Videofluoroscopic modified Barium swallow (often called as ideofluoroscopy)



Q. 24

All are true statement about tracheostomy and larynx in children except:

 A

Omega shaped epiglottis

 B

Laryngeal cartilages are soft and collapsable

 C

Larynx is high in children

 D

Trachea can be easily palpated

Q. 24

All are true statement about tracheostomy and larynx in children except:

 A

Omega shaped epiglottis

 B

Laryngeal cartilages are soft and collapsable

 C

Larynx is high in children

 D

Trachea can be easily palpated

Ans. D

Explanation:

 

Infant’s larynx differs from adult in:

  • It is situated high up (C2 – C4).Q (in adults = C3 – C6)
  • Of equal size in both sixes (in adults it is larger in males)
  • Larynx is funnel shaped
  • The narrowest part of the infantile larynx is the junction of subglottic larynx with trachea and this is because cricoid cartilage is very small
  • Epiglottis is omega shaped, soft, large and patulous.
  • Laryngeal cartilages are soft and collapse easily
  • Short trachea and short neck.
  • Vocal cords are angled and lie at level of C4
  • Trachea bifurcates at level of T2
  • Thyroid cartilage is flat. The cricothyroid and thyrohyoid spaces are narrow.

Tracheostomy in Infants and Children                                                                                                              

Trachea of infants and children is soft and compressible and its identification may become difficult and the surgeon may easily displace it and go deep or lateral to it injuring recurrent laryngeal nerve or even the carotid.

During positioning, do not extend too much as this pulls structures from chest into the neck and thus injury may occur to pleura, innominate vessels and thymus or the tracheostomy opening may be made twoo low near suprasternal notch

Tracheostomy in Infants and Children                                                                                               

The incision is a short transverse one, midway between lower border of thyroid cartilage and the suprasternal notch. The neck must be well extended.

A incision is made through two tracheal rings, preferably the third or fourth.



Q. 25

Complication commonly occurring in tracheostomy in children is:       

March 2004

 A

Stenosis

 B

Difficult decanulation

 C

Difficult weaning

 D

Infection

Q. 25

Complication commonly occurring in tracheostomy in children is:       

March 2004

 A

Stenosis

 B

Difficult decanulation

 C

Difficult weaning

 D

Infection

Ans. B

Explanation:

Ans. B i.e. Difficult decanulation


Q. 26

All of the following are true regarding tracheostomy tube except:               

September 2008

 A

Double lumen tube

 B

Made of titanium silver alloy

 C

Cuffed tube prevents aspiration of pharyngeal secretions

 D

Ideally should be changed every 3rd day

Q. 26

All of the following are true regarding tracheostomy tube except:               

September 2008

 A

Double lumen tube

 B

Made of titanium silver alloy

 C

Cuffed tube prevents aspiration of pharyngeal secretions

 D

Ideally should be changed every 3rd day

Ans. D

Explanation:

Ans. D: Ideally should be changed every 3rd day

Care of the tracheostomy tube:

Inner cannula should be removed and cleaned as and when indicated for the first 3 days. Outer tube, unless blocked or displaced, should not be removed for 3-4 days to allow a track to be formed when tube placement will be easy.


Q. 27

One of the most important complication of tracheostomy is:              

September 2008

 A

Surgical emphysema

 B

Hemorrhage

 C

Recurrent laryngeal nerve palsy

 D

Displacement of tube

Q. 27

One of the most important complication of tracheostomy is:              

September 2008

 A

Surgical emphysema

 B

Hemorrhage

 C

Recurrent laryngeal nerve palsy

 D

Displacement of tube

Ans. B

Explanation:

Ans. B: Hemorrhage

Indications for tracheostomy

To relieve upper airway obstruction

  • Foreign body
  • Trauma
  • Acute infection – acute epiglottitis, diphtheria
  • Glottic oedema
  • Bilateral abductor paralysis of the vocal cords
  • Tumours of the larynx
  • Congenital web or atresia

– To improve respiratory function

  • Fulminating bronchopneumonia
  • Chronic bronchitis and emphysema
  • Chest injury and flail chest
  • Respiratory paralysis
  • Unconscious head injury
  • Bulbar poliomyelitis
  • Tetanus
  • Advantages of tracheostomy over endotracheal intubation
  • Reduces patient discomfort
  • Reduces need for sedation
  • Improves ability to maintain oral and bronchial hygiene
  • Reduces risk of glottic trauma
  • Reduces dead space and reduces work of breathing
  • Augments process of weaning from ventilatory support
  • Complications of tracheostomy

– Immediate

  • Haemorrhage
  • Surgical trauma – oesophagus, recurrent laryngeal nerve
  • Pneumothorax

– Intermediate

  • Tracheal erosion
  • Tube displacement
  • Tube obstruction
  • Subcutaneous emphysema
  • Aspiration and lung abscess Late
  • Persistent tracheo-cutaneous fistula
  • Laryngeal and tracheal stenosis
  • Tracheomalacia
  • Tracheo-oesophageal fistula
  • Post-operative tracheostomy care
  • Maintain patent airway
  • Frequent atraumatic suction
  • Humidification of inspired air and oxygen
  • Mucolytic agents
  • Coughing and physiotherapy
  • Occasional bronchial lavage
  • Prevent infection and complications
  • Aseptic tube suction, handling and tube changing
  • Prophylactic antibiotics
  • Deflate cuff for 5 minutes every hours
  • Avoid tube impinging on posterior tracheal wall
  • Percutaneous tracheostomy
  • Indicated in patients likely to require ventilatory support for more than 2 weeks
  • Usually performed at the bedside in an ITU
  • Has significant cost benefits compared to open procedure

Q. 28

Method to establish a safer airway in a patient with neck trauma, cricoid fracture with possibility of a difficult airway:                                     

March 2011

 A

Orotracheal intubation

 B

Cricothyroidotomy

 C

Emergency tracheostomy

 D

None of the above

Q. 28

Method to establish a safer airway in a patient with neck trauma, cricoid fracture with possibility of a difficult airway:                                     

March 2011

 A

Orotracheal intubation

 B

Cricothyroidotomy

 C

Emergency tracheostomy

 D

None of the above

Ans. C

Explanation:

Ans. C: Emergency tracheostomy

Tracheostomy is an alternative when intubation is not possible

Tracheostomy:

  • Double tube
  • Made of titanium silver alloy
  • In emergency trachesostomy, structure which can be injured are:

–        Inferior thyroid vein

–        Isthmus of thyroid

–        Thyroid imam artery

  • Common complication is tracheal stenosis
  • Mitomycin is used for tracheal stenosis

Q. 29

Mini tracheostomy is performed through ‑

 A

Cricothyroid membrane

 B

2nd and 3rd tracheal rings

 C

Any of the above

 D

None of the above

Q. 29

Mini tracheostomy is performed through ‑

 A

Cricothyroid membrane

 B

2nd and 3rd tracheal rings

 C

Any of the above

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Cricothyroid membrane

Cricothyrotomy or Laryngtomy or Minitracheostomy

  • It is the procedure to open the airway through the cricothyroid membrane.
  • Patient’s head and neck are extended, lower border of throid cartilage and cricoid ring is identified. Skin in this area is incised vertically and then cricothyroid membrane is opened with a transverse incision.
  • It is an emergency procedure to buy time for the patient to be shifted to the operation theatre.


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