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Surgery

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Thyroid & Adrenal

Question
33 out of 99
 

All of the following statements are true of tracheostomy, except:



A It reduce dead space

B It is as commonly practiced today as in the past

C It is necessary when prolonged artificial ventilation is needed

D It makes tracheobronchial toileting easy

Ans. B It is as commonly practiced today as in the past (REF. ACS SURGERY 5TH EDITION PG 312)

Tracheostomy is an operative procedure that creates a surgical airway in the cervical trachea.

A tracheostomy is most commonly performed in patients who have had difficulty weaning off a ventilator, followed by those who have suffered trauma or some catastrophic neurologic insult. Infectious and neoplastic processes are less common in diseases that require a surgical airway.

The advent of the antibiotic era coupled with great advances in anesthesia have made tracheotomy or tracheostomy a commonly performed elective procedure.

a. To bypass obstruction

i. Congenital anomaly (eg, laryngeal hypoplasia, vascular web)

ii. Foreign body that cannot be dislodged with Heimlich and basic cardiac life support (BCLS) maneuvers

iii. Supraglottic or glottic pathologic condition (eg, infection, neoplasm, bilateral vocal cord paralysis)

b. Neck trauma that results in severe injury to the thyroid or cricoid cartilages, hyoid bone, or great vessels.

c. Subcutaneous emphysema

i. Appears in face, neck, or chest

ii. Readily dissecting air, especially through inflamed or traumatized tissue planes, leading to massive soft tissue edema

d. Facial fractures that may lead to upper airway obstruction (eg, comminuted fractures of the midface and mandible)

e. Edema

i. Trauma

ii. Burns

iii. Infection

iv. Anaphylaxis

f. To provide a long-term route for mechanical ventilation in cases of respiratory failure

g. To provide pulmonary toilet

a. Inadequate cough due to chronic pain or weakness

b. Aspiration and the inability to handle secretions (The cuffed tube allows the trachea to be sealed off from the esophagus and its refluxing contents. Thus, this intervention can prevent aspiration and provide for the removal of any aspirated substances. However, some would argue that the risk of aspiration is not actually lessened, as secretions can leak around the cuffed tube and reach the lower airway.)

h. Prophylaxis (as in preparation for extensive head and neck procedures and the convalescent period)

i. Severe sleep apnea not amendable to continuous positive airway pressure (CPAP) devices or other, less invasive surgery

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