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急診病人氣切相關症狀需要問的基本問題 3-2-1 W's
3 What :
- 哪種氣切管與大小
- Cuff是否充氣
- 曾有什麼氣切相關併發症
2 When :
- 何時做氣切 (Stoma takes 7-10 days to mature)
- 如果滑脫 (decannulated), 何時發生
1 Why :
- 當初為何做氣切
常見 Complication : Obstruction, decannulation, bleeding, tracheal stenosis, infection
Obstruction
Decannulation
If the tracheostomy is < 7 days old, the tract will not be mature and manipulation may easily create a false passage within the soft tissue of the neck. If the situation is not emergent and the tracheostomy is < 7 days old, tracheostomy tubes should be changed by a surgeon familiar with the procedure.
Bleeding
最擔心形成 : tracheoinnominate fistula
If with massive bleeding, resuscitation and operative planning should begin immediately.
Hemorrhage control should first be attempted by hyperinflating the cuff.
If bleeding persists, slowly withdraw the tube while exerting pressure against the anterior trachea. If these initial maneuvers do not control the bleeding, then have an assistant remove the tracheostomy tube simultaneously while the patient is being orotracheally intubated.
The cuffed endotracheal should be placed distal to the source of bleeding.
Hemorrhage control is then attempted by placing a finger into the stoma, dissecting along the trachea, and then compressing the innominate artery against the posterior manubrium. This is known as the Utley maneuver.
- Cuffed : allow for positive pressure ventilation, minimizing aspiration
- Fenestrated : 用來發聲
Indications for a tracheostomy :
- Chronic ventilation
- Upper airway obstruction, typically a mass
- Post-operative total laryngectomy patients
- Failure to protect airway
* Inefficient swallowing
* Ineffective cough mechanism
https://emottawablog.com/2018/06/tricks-of-the-trach-approach-to-tracheostomy-patients-in-the-emergency-department/
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