The Intern At Work: Internal Medicine 238. Catch a Breath - Tracheostomy 101
May 26, 2024
Explore the ins and outs of tracheostomies, from what they are to their ideal placement. Discover the reasons for performing them, along with absolute contraindications. Learn about the anatomy of tracheostomy tubes and the differences between single and double cannula options. The podcast dives into procedural techniques, including surgical versus percutaneous methods, and emergency cricothyroidotomy. Complications, both early and late, are also discussed, alongside insights from the TRACMAN trial on tracheostomy timing.
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Procedure Vs. Opening And Optimal Position
- Tracheostomy denotes the physical stoma while tracheotomy names the procedure to create it.
- The ideal tracheostomy sits between the second and third tracheal rings to minimize serious vascular and subglottic risks.
When To Consider A Tracheostomy
- Perform emergent tracheostomy when intubation fails and anatomy prevents secure airway placement.
- Consider elective tracheostomy for prolonged ventilation, impaired swallowing, weak cough, or to improve comfort and oral intake.
Absolute Contraindications And Laryngectomy Caution
- Avoid tracheostomy with anterior neck infection, uncorrectable coagulopathy, or prior cervical tracheal resection.
- Recognize laryngectomy patients have isolated airways and cannot be orally intubated or ventilated.