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UPPER AIRWAY OBSTRUCTION & TRACHEOTOMY

UPPER AIRWAY OBSTRUCTION & TRACHEOTOMY. Babak S aedi MD OTOLARYNGOLOGIST TEHRAN UNIVERSITY OF MEDICAL SCIENSES. Common symptoms of acute airway obstruction. Voice change Dyspnea Local pain Cough. Common findings of acute airway obstruction. Stridor Hoarseness Retraction

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UPPER AIRWAY OBSTRUCTION & TRACHEOTOMY

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  1. UPPER AIRWAY OBSTRUCTION&TRACHEOTOMY BabakSaediMD OTOLARYNGOLOGIST TEHRAN UNIVERSITY OF MEDICAL SCIENSES

  2. Common symptoms of acute airway obstruction • Voice change • Dyspnea • Local pain • Cough

  3. Common findings of acute airway obstruction • Stridor • Hoarseness • Retraction (intercostal- suprasternal-supraclavicular) • Drooling - bleeding - emphysema

  4. Management of impaired airway • Simplest adequate form of control should be selected • Lower level • Other medical problems

  5. Throat Anatomy

  6. Indications for tracheostomy • Prolonged intubation • Ventilation support • Manage bronchopulmonary secretion • Upper airway obstruction • Obstructive sleep apnea • Bilateral vocal cord paralysis • Inability to intubate • Major head & neck surgery or trauma

  7. Tracheostomy Advantages • lower risk of laryngotracheal injury • improved comfort/mobility • improve airway stabilization • allows for oral nutrition • improved secretion clearance

  8. Surgical anatomy • Sternal notch • Thyroid cartilage • Cricoid cartilage - cricothyroid membrane - innominate artery - thyroid gland (isthmus) - recurrent laryngeal nerve

  9. Anatomy

  10. Anatomy • Venous supply • Superior and middle thyroid v. drain into the IJ • Inferior thyroid v. drains into the brachiocephalic trunk

  11. Anatomy • Anatomy variant: thyroid ima artery, in 1.5% to 12%, in front of the trachea.

  12. Anatomy of Upper Airway

  13. Tracheotomy timing • Emergent (slash trach) • Urgent (awake) • Elective

  14. Surgical technique • Optimally under general anesthesia • Incision between sternal notch and cricoid • Dissection in a vertical plane • Thyroid isthmus (third and fourth ring) • Entrance into trachea • Tracheotomy tube insertion

  15. Site of Incision

  16. Anatomical Position of Trach Tube

  17. Immediate complications • Hemorrhage • False route • Electrocautery fire • Injury to adjacent structures

  18. Intermediate complications • Hemorrhage [most common ] • Infection • Subcutaneous emphysema • Pneumomediastinum • Pneumothorax [most common in infant ] • Obstruction of tacheotomy tube • Displacement of tube

  19. Late complications • Hemorrhage • Tracheoesophageal fistula • Tracheal stenosis • Tracheocutaneous fistula

  20. Questions?

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