1- Inject 1% novocain and adrenaline along anterior border of both sternomastoid muscles and along the upper border of thyroid cartilage. 2- No anesthesia in urgent cases.
3- The patient should be supine with extended neck.
4- Midline longitudinal incision from upper border of cricoid cartilage to suprasternal notch including “skin – subcutaneous tissue – platysma and fascia”.
5- Separate between sternohyoid and sternothyroid in the midline.
6- Retract thyroid isthmus upward.
7- Dissect pretracheal fascia from anterior tracheal wall.
8- Open trachea and avoid blood aspiration or cough reflex.
9- Remove circular portion of 3, 4 tracheal rings.
10- Insert tube to be of same diameter of the opening.
5 comments:
make sure to get a proper concent and explain to the patient and relatives the procedure, benifits and all.
-Have an ansthesiologist or someone knouledgeable in emergency medicine in the room along with the head nurse of the dpartment present in the room at all times. You dont want to loose airway and shit your pants when you are unable to intubate properly.
-Put a rolled sheet under tha patients' shoulders for better neck extention.
-Palpate the thyroid cartilage, the cricoid and orientate in the space between the 1-2 tracheal rings or 2-3.
-anesthetise, make in cision, widen incision, paltate again for the perfect space.
* ask the anasthesiologist to slowly move the tubus out, and feel when your finger falls down; that is into a tubus free space.
- Place a syringe with sailine in the opening, inject some of the fluid and aspirate to make sure u are in the trachea.
-Widen the hole and proceed as usual, not forgeting to check the traceostomy baloon is not punctures, lubricate and insert.
-Have fun stiching and tieing the final knot around the neck.
Dana.
lacing a percutaneous tracheostomy is not a new idea. Surgical tracheostomy is usually performed in the operating room to a patient under general anesthesia.
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