The "life channel" at the critical moment! Unveiling the mystery of "tracheotomy" for you

Introduction:

In medical treatment, tracheotomy is an important emergency rescue technique, especially when the patient's airway is blocked or unable to breathe independently, it can quickly establish a "life channel" and buy precious rescue time for the patient.

Today, Yongzhou City Lingling District Traditional Chinese Medicine Hospital will talk to us about this "life-saving technology" - tracheotomy .

Health Science

1. What is a tracheotomy?

Tracheotomy is a surgical procedure that creates an artificial airway by making a small incision in the trachea of ​​the neck and inserting a tracheal tube. It is mainly used to solve problems such as upper airway obstruction, long-term mechanical ventilation or clearing respiratory secretions .

2. In what cases is a tracheotomy necessary?

Upper airway obstruction: such as laryngeal tumors, severe laryngeal edema, trauma, etc. leading to breathing difficulties.

Long-term mechanical ventilation: When critically ill patients need long-term ventilator support, tracheotomy can reduce the risk of airway injury and infection.

Clear respiratory secretions: For patients who are unconscious or unable to cough up sputum, tracheotomy can help suction sputum and keep the airway open.

First aid: In emergency situations (such as suffocation, severe trauma), tracheotomy can quickly restore ventilation function.

3. How is a tracheotomy performed?

1. Preoperative preparation

Your doctor will assess your condition, determine if surgery is necessary, and administer local or general anesthesia.

2. Surgical procedures

A small incision is made in the middle of the neck, the tissue is separated to expose the trachea, and then a small hole is cut in the tracheal wall to insert a tracheal tube.

Detailed steps of the surgery:

The standard position is supine, with a pillow under the shoulders, the head stretched straight, and a sandbag placed on the side of the head to fix the head position. If the patient has severe breathing difficulties, the surgery can also be performed in a semi-sitting position, with the neck extended, the head kept in the middle position, and the shoulders padded, but the head position must not be tilted , so that the cervical trachea remains on the midline of the neck.

Anesthesia: Local 1% lidocaine infiltration anesthesia or general anesthesia.

Pay attention to palpation before making the incision to determine whether there is an obvious high-positioned innominate artery. A median longitudinal skin incision can be made from the lower edge of the cricoid cartilage to the jugular notch, or a horizontal skin incision can be made from the horizontal finger below the cricoid cartilage to cut open the skin, subcutaneous tissue and superficial cervical fascia.

Expose the isthmus of the thyroid gland and keep the incision in the middle position to ensure safety and avoid damaging the large blood vessels in the neck. Use a retractor to pull the skin and subcutaneous tissue to both sides. In the middle, you can see the white line connecting the two strap muscles. Cut it with a knife, use blunt-headed scissors or straight vascular forceps to separate it up and down along the white line, pull up the strap muscles on both sides to expose the isthmus of the thyroid gland.

The isthmus of the thyroid gland can usually be handled by pulling the isthmus upward with a retractor to expose the anterior tracheal wall.

After exposing the trachea and processing the isthmus of the thyroid gland, the anterior tracheal fascia and the faintly visible tracheal cartilage rings below it can be seen. If the exposure is not clear, the surgeon can palpate with the index finger to feel the position of the trachea. Use a vascular clamp to slightly separate the anterior tracheal fascia and expose the tracheal rings.

Tracheotomy: After the trachea is confirmed, use a sharp blade to pick open the two tracheal rings from bottom to top, generally at the 2nd to 4th tracheal rings. Do not insert the tip of the blade too deeply to avoid puncturing the posterior wall of the trachea and the anterior wall of the esophagus, causing tracheoesophageal fistula.

Once the trachea is incised, secretions will be coughed up immediately and should be suctioned out promptly. A core tube should be inserted into the outer tube of the tracheal cannula as a guide and then inserted into the trachea. After the core tube is removed, the inner tube should be inserted.

Tie the strap on the cannula holder around the neck to secure the cannula in place to prevent it from falling out. Suture the skin incision with 1-2 stitches as appropriate and pad the area with gauze.

3. Postoperative care

After surgery, the tracheal tube needs to be cleaned regularly, the airway needs to be kept moist, and complications such as infection need to be closely monitored.

4. Risks and complications of tracheotomy

Although tracheotomy is a mature technology, it still has the following risks:

Infection: Infection may occur at the incision site and requires strict disinfection and care.

Bleeding: Minor bleeding may occur at the surgical site and usually stops on its own.

Tracheal stenosis: Long-term use of a tracheal tube may cause damage to or narrowing of the tracheal wall.

The cannula is detached or blocked: The cannula position needs to be checked regularly to ensure it is unobstructed.

5. Postoperative care precautions

Keep the airways moist: use a humidifier or regularly drip saline solution to prevent sputum from becoming thick.

Clean the cannula regularly: Disinfect the cannula and surrounding skin daily to prevent infection.

Observe breathing: If breathing difficulties, cannula detachment or abnormal bleeding are found, seek medical attention immediately.

Psychological support: Patients may experience anxiety or discomfort due to tracheotomy, and family members should provide adequate care and support.

6. The “life meaning” of tracheotomy

Tracheotomy is not only a manifestation of medical technology, but also opens a "life channel" for patients. In critical moments, it can buy more rescue time for patients and create opportunities for subsequent treatment.

Hunan Medical Chat Special Author: Jiang Tingfang, Yongzhou Lingling District Traditional Chinese Medicine Hospital

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(Edited by Wx)