Tracheostomy / ENT Lectures . скачать в хорошем качестве

Tracheostomy / ENT Lectures .

⸻ 🔷 Tracheostomy 🔹 সংজ্ঞা (Definition) Tracheostomy হলো একটি surgical procedure যেখানে 👉 neck দিয়ে trachea-তে একটি স্থায়ী বা অস্থায়ী opening (stoma) তৈরি করা হয় যাতে airway maintain করা যায়। ⸻ 🔹 Indications (সবচেয়ে গুরুত্বপূর্ণ) 🚨 Emergency indications • Acute upper airway obstruction (Laryngeal edema, foreign body, trauma) • Bilateral vocal cord paralysis • Laryngeal carcinoma • Severe facial / neck trauma • Failed intubation 🕒 Elective indications • Prolonged mechanical ventilation • Neuromuscular diseases • Head & neck malignancy • Tracheal toilet (excessive secretions) • Obstructive sleep apnea (rare) ⸻ 🔹 Types of Tracheostomy 1️⃣ According to urgency • Emergency tracheostomy • Elective tracheostomy 2️⃣ According to level • High tracheostomy (dangerous ⚠️) • Mid tracheostomy ✅ (most common) • Low tracheostomy 3️⃣ According to duration • Temporary • Permanent 4️⃣ Percutaneous tracheostomy • Done in ICU • Less tissue trauma ⸻ 🔹 Anatomy (Viva favourite) • Usually done between 2nd–4th tracheal rings • Avoid: • Cricoid cartilage • Thyroid isthmus (retracted or divided) ⸻ 🔹 Procedure (Brief steps – exam style) 1. Patient in supine position, neck extended 2. Skin incision (vertical / horizontal) 3. Separate strap muscles 4. Expose trachea 5. Incise tracheal rings 6. Insert tracheostomy tube 7. Secure tube ⸻ 🔹 Types of Tracheostomy Tubes • Metal tube (Jackson) • Plastic tube • Cuffed / uncuffed • Fenestrated tube ⸻ 🔹 Post-tracheostomy Care (Very important) • Humidified oxygen • Regular suction • Tube patency check • Stoma care • Prevent tube blockage ⸻ 🔹 Complications ⚠️ Immediate • Hemorrhage • Apnea • Pneumothorax • Subcutaneous emphysema • Tube blockage ⚠️ Early • Infection • Tube displacement • Surgical emphysema ⚠️ Late • Tracheal stenosis • Tracheoesophageal fistula • Persistent tracheocutaneous fistula • Difficulty in decannulation ⸻ 🔹 Decannulation (Tube removal) Criteria • Airway obstruction resolved • Patient breathing normally • Good cough reflex • No excessive secretions ⸻