Tracheostomy for acute laryngeal obstruction

Tracheotomy is an emergency surgery that was originally used only to relieve dyspnea caused by a laryngeal obstruction. With an in-depth understanding of the pathophysiological function of the respiratory tract, tracheotomy has become an important adjunct to some diseases. For a long time, coma patients caused by various reasons, lower respiratory secretions, affecting lung ventilation function, after tracheotomy, lower respiratory secretions can be sucked from the tracheotomy opening, and can be thinned through the trachea. Drugs and antibiotics with thick secretions to prevent or treat the lungs. After the tracheotomy, the air enters directly from the incision, reducing the resistance of the airway and the dead space. In the same respiratory tidal volume, it can increase the effective gas exchange volume, reduce the oxygen consumption and improve the respiratory function. In addition, when respiratory muscle paralysis or other causes of respiratory arrest, tracheotomy, positive pressure artificial respiration, etc. Therefore, all clinicians should be familiar with the indications of tracheotomy for timely application, correct treatment, and saving patients' lives. Treatment of diseases: laryngeal foreign body throat obstruction Indication Acute laryngeal obstruction tracheotomy is applicable to: 1. Laryngeal obstruction, acute laryngitis, laryngeal edema, laryngeal or hypopharyngeal tumor, laryngeal diphtheria, laryngeal foreign body, bilateral vocal cord abduction numbness, laryngotracheal scar stenosis, and adjacent organ disease or involving the throat and trachea causing difficulty in breathing . 2, various causes of lower respiratory secretions obstruction of craniocerebral trauma, barbiturate poisoning and other causes of coma; Guillain-Barre (Green-Barry) syndrome, tetanus, poliomyelitis and other nerves, Muscle disorders; chest and abdomen trauma or obstruction of lower respiratory secretions after surgery. 3, some oral, nasopharynx, pharynx, throat surgery to maintain airway patency, intubation anesthesia, to prevent blood from flowing into the lower respiratory tract, can be first tracheotomy. 4, various reasons caused by respiratory dysfunction such as chronic bronchitis, pulmonary heart disease, pulmonary heart disease, chronic emphysema, etc., tracheotomy can increase the amount of ventilation, suction the lower respiratory secretions, and can directly send drugs Into the lower respiratory tract, to play a complementary treatment. 5. When the breathing stops, the tracheotomy is performed by positive pressure artificial respiration. 6. When the foreign body of the lower respiratory tract is critical or the condition is limited, the foreign body can be removed by tracheotomy. Preoperative preparation 1. Learn more about the condition and neck palpation, and understand the position of the laryngotracheal tube and whether there is a mass in the neck before it affects the tracheotomy, such as thyroid enlargement. 2. If necessary, take a positive and lateral X-ray of the neck to understand the position and pathology of the trachea. 3, children or severe airway obstruction, can be inserted into the anesthesia cannula or bronchoscope. 4. Selection of tracheal tube: According to the diameter of the casing, it is divided into 8th. When using, the corresponding casing should be selected according to the age of the patient. Surgical procedure General tracheotomy (1) Incision: divided into straight and transverse incisions. Conventional straight incision: in the middle of the neck from the lower edge of the cartilage, down to the upper sternum notch, cut the skin and subcutaneous tissue. Pull the skin to the sides with a hook, and see the white line of the median neck of the neck; transverse incision: 3 cm from the lower edge of the cartilage, and a transverse incision about 3 to 4 cm along the front of the neck. Cut the skin and subcutaneous tissue, separate the skin up and down, and see the white line of the anterior cervical muscle. (2) Separate the muscles under the hyoid bone: make a small incision at the muscle white line, insert with a vascular clamp or a straight scissors, and bluntly separate the band muscles on both sides until the anterior fascia of the trachea. It can be separated vertically from the anterior wall of the trachea, and should not be separated to the sides to avoid damage to important blood vessels on both sides. The force on the hooks on both sides should be equal to avoid pulling the air tube. Touch the position of the trachea with your finger at any time to keep the trachea in the middle position. (3) Exposure of the trachea: After separating the banded muscles on both sides, the thyroid isthmus can be seen covering the anterior wall of the 3 to 4 tracheal ring. If the thyroid isthmus is not large, the fascia around it can be slightly separated, and then the isthmus is pulled up with a hook to fully expose the anterior wall of the trachea. (4) Incision of trachea: After exposure of the anterior wall of the trachea, in non-emergency cases, adult patients can be injected into the tracheal cavity with 0.5 ml of 1% tetracaine to avoid coughing. After a while, cut the trachea again. Children are hanged. The incision site is usually between 2 and 4 tracheal rings. The left finger is fixed to the trachea, and the right hand is holding a sickle knife or a sharp knife. The blade edge is upward, and the knife tip is inserted between the tracheal rings, and the 3, 4 tracheal ring or 2, 3 tracheal ring is picked up from the bottom. (5) Insert the tracheal cannula: Immediately after the tracheotomy, put the tracheal dilator or curved vascular clamp to open the trachea. Insert the prepared tracheal tube with the ferrule into the trachea along the dilator and immediately remove the wick. At this time, secretions were coughed from the mouth of the tube, which proved that the tracheal cannula was inserted into the trachea. Aspirate the secretions with an aspirator. If there is no secretion, the cotton yarn is slightly observed at the nozzle to see if it flutters with the respiratory airflow. If there is no fluttering, the sleeve may not be inserted into the trachea, and the sleeve should be pulled out and reinserted. After the tracheal tube is unobstructed, it is placed in the cannula. The tracheal cannula is wrapped around the neck and knotted to prevent the tracheal cannula from falling out. (6) Incision treatment: Carefully check the incision. If there is blood vessel bleeding, it should be ligated to stop bleeding. If the incision is too long, a needle can be sutured with a thread above the cannula, but it should not be too tight. Finally, an open gauze pad is placed around the tracheal cannula to cover the incision.