Trach Procedures

Absolutely! Here are detailed flashcard-style notes from your Tracheostomy and Emergency Airway Management presentation, organized by topic. These are great for active recall and spaced repetition.

🔹 Terminology

Q: What is a tracheotomy?
A: A procedure that creates access to the trachea via a neck incision.

Q: What is a tracheostomy?
A: The opening created by a tracheotomy procedure.

Q: What is a laryngectomy?
A: Surgical removal of the larynx, separating it from the mouth and nose.

Q: What is a cricothyrotomy?
A: An emergency incision through the cricothyroid membrane to establish a patent airway.

🔹 Indications for Tracheostomy

Q: When should a tracheostomy be considered instead of an ETT?
A:

  • Projected prolonged need for an artificial airway

  • Poor ETT tolerance

  • Patient condition (nutritional, cardiovascular, infection status)

  • Tolerance of the procedure

  • Risk comparison: ETT vs. trach

Q: Why is a tracheostomy preferred in some cases?
A:

  • Upper airway obstruction or trauma

  • Long-term ventilation

  • Neuromuscular disease (NMD) management

  • Reduce complications of ETT (e.g., vocal cord injury, infection)

  • Improved phonation

🔹 Surgical Tracheostomy

Q: What is the surgical tracheostomy technique?
A:

  • Done by ENT in OR

  • Tissue dissection to expose trachea

  • “Trap door” cut made in anterior trachea

  • Tissue may be sutured to incision border

Q: What is a false passage?
A: Misplacement of the trach tube outside the trachea.

Q: Risks of a false passage?
A:

  • Hypoxia / hypercapnia

  • Bleeding

  • Pneumothorax

  • Pneumomediastinum

  • Subcutaneous emphysema

  • Esophageal damage

  • Recurrent laryngeal nerve injury

🔹 Bedside Tracheostomy – Percutaneous Dilational Technique (PDT)

Q: What are the benefits of bedside trach procedures?
A:

  • Less invasive

  • No tissue dissection

  • Performed in ICU

  • Local anesthesia only

  • Cost-effective

  • Avoids transport risks

  • Smaller scar, less bleeding/infection

Q: Required equipment for PDT?
A:

  • Flexible bronchoscope

  • Percutaneous Dilatation Kit

  • Tracheostomy tubes

  • BVM, suction, intubation gear

Q: Patient prep before PDT?
A:

  • Off enteral feeds for 6+ hours

  • Check labs: INR, PTT, HCT, ABG, electrolytes, Hgb

  • Sedatives, analgesics, paralytics

  • Preoxygenate

  • Position with neck extended

  • Identify landmarks (thyroid, cricoid, sternal notch)

🔹 PDT Procedure (Step-by-Step)

Q: Describe the PDT placement steps.
A:

  1. Sedate patient and prep site (sterile)

  2. Preload trach tube on dilator

  3. RRT loosens ETT, suctions, deflates cuff

  4. Advance bronchoscope and ETT withdrawn to just below cords

  5. Needle + catheter inserted → wire passed (Seldinger technique)

  6. Confirm wire position with bronchoscope

  7. Dilate tract using pressure (monitor closely)

  8. Ventilation paused briefly

  9. Insert preloaded dilator + trach tube over wire

  10. Inflate cuff, confirm placement with scope

  11. Secure trach and remove ETT

🔹 Contraindications for PDT

Q: When is PDT contraindicated?
A:

  • Inability to extend neck (C-spine precautions, prior injury)

  • Neck abnormalities (tumor, edema, large thyroid)

  • Burns or infections at site

  • Coagulopathy

  • Pediatric patients (soft airways)

  • Hemodynamic instability

  • Not for emergency airway creation (ETT must already be in place)

🔹 Complications

Q: What are potential tracheostomy complications?
A:

  • Bleeding: Mild at stoma is common; internal bleeding → mucosal/tracheal tear

  • Accidental decannulation: Especially dangerous within 72 hours

  • Stomal infection: Treated with wound care and antibiotics

Q: What would you do if accidental decannulation occurs within 72 hours?
A: Treat as a medical emergency — immediate action required to secure the airway.

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