Emergency Tracheostomy: Indications And Procedure

Emergency Tracheostomy: Indications And Procedure

Discuss emergency tracheostomy.

Answer. Emergency tracheostomy is performed within 2 to 3 minutes in an emergency situation when patient is anoxic and requires immediate oxygenation and verifiation to avoid cerebral hypoxia.

Emergency tracheostomy Procedure

• Step I and II: Preparation of skin and local anesthesia is not performed in emergency tracheostomy.
• Step III: Skin of the neck over second tracheal ring is identified and an incision is placed horizontally along natural cervical skin crease.
• Step IV: Sharp dissection following the skin incision is done to cut across platysma muscle.
• Step V: Blunt dissection is given parallel to long axis of trachea for separating submuscular tissues until isthmus is identified.
• Step VI: A cricoids hook engages the space between cricoids and fist tracheal ring pull trachea upward.
  Blunt dissection is continued longitudinally through pretracheal fascia.
• Step VII: Entrance in trachea
  • A linear incision is made through inter-space between second and third tracheal rings.
  • Mid-portion ofthird or fourth tracheal ring is removed for creating tracheal window.
  • An inferiorly placed U-shaped flap also known as Bjork flap incorporates the ring below the tracheal incision is raised and sutured to the skin at inferior margin.
• Step VIII: Tube is placed and is secured to neck.
  Tube is inserted vertically downward into the trachea avoiding damage to the tracheal mucosa of posterior wall.
  The tube is secured by suturing the flnges to the neck skin.
  This is followed by tying the flnges oftube with thread encircling the neck taking care to avoid strangulation.