Foreign bodies are frequently aspired into the pharynx, the larynx or the trachea, especially in children.
They cause symptoms in two ways; by obstructing the air passages they cause difficulty in breathing that may lead to asphysia; they may be drawn further down later on, entering the bronchi or one of their branches causing symptoms of irritation, such as a croupy cough, bloody or mucous expectoration and paroxysms of dyspnea.
If the foreign body has been lodged in the pharynx, it may be dislodged by inserting the finger.
If the obstruction is in the larynx or the trachea, a tracheotomy is immediately necessary.
A tracheotomy is an operation in which an opening is made into the trachea through which the patient may breathe.
It may be performed for any one of several reasons: an inadequate upper airway, which may be caused by tumors, foreign bodies, edema, nerve or vocal paralysis; a need for effective removal of excessive tracheobronchial secretions; shallow respirations resulting from unconsciousness or respiratory paresis; problems resulting from poor gas transport across alveolar capillary membrane as may occur in severe pulmonary edema or prolonged cardiac or lung surgery; and the need to reduce dead space when tidal volume is impaired as in severe emphysema.
If the opening is permanent, then it is called a tracheostomy.
For the surgical procedure the patient is placed in supine position with the head in midline and the neck extended with the chin pointing to the ceiling.
Local or general anesthesia may be infiltrated.
A bronchoscope or endotracheal tube may be in place fro oxygen and anesthesia.
A vertical or horizontal incision of approximately three centimeters is made about two centimeters above the suprasternal notch.
The sternohyoid and sternothyroid muscles are separated midline.
The front part along the trachea is dissected to allow insertion of small curved retractors that help to immobilize the trachea.
A vertical incision is usually made through the second and third tracheal cartilages.
Forceps or a tracheal dilator is used to spread the incision and the proper tube with obturator is slipped into the trachea, this is held in place by tapes which are fastened around the patient's neck.
A square piece of sterile gauze is placed between the tube and the patient's skin before the tape is fastened.
The tubes are usually made of sterling silver, although plastic is available.
Each tube consists of three pieces: an outer cannula, to which the retaining tapes are fastened; an obturator, an olive shaped, curved silver rod used to guide the cannula into the opening in the trachea; and an inner cannula, which is inserted into the outer cannula after the obturator is withdrawn.
The standard procedure for fitting of the tube is as follows: the outer tube plate is flush with the skin of the neck, without any pressure; aspirating catheter can easily pass through the tube; and the patient can breathe easily through the tube.
When emergencies arise in which a tracheotomy must be done, the life of the patient is at risk, and strict observance of aseptic technique and the psychological preparation of the patient is important.
However, there are instances where there is time to explain the purpose of the surgery to the patient, with the result that he will adjust much better to his situation.
He should realize that he will lose his voice temporarily, and will breathe through a tube in his trachea.
The patient with a tracheotomy needs to be humidified, since the nose and the pharynx usually moisten the inspired air and filter out the dust; this is no longer possible for the patient.
Therefore, it is necessary to have continuous moist air for the first two to three days.
After the operation many surgeons usually cover the opening of the tube with a few layers of gauze moistened in warm saline solution.
This tends to moisten the inspired air and filter out the dust.
Heavily saturated mist can be provided in a tent, by ultrasonic fog, or inhalation of nebulized water, saline or mucolytic agents.
An adequate intake of fluids also helps in the humidification process.
Fluids may be given to the patient during the day of the operation.
Careful attention is given to the mouth before and after meals and whenever necessary.
The patient may be placed in a sitting position.
Paper and pencil or a marker should be kept near the patient as a means of communication.
A tap bell or electric cord signal should be within the patient's reach, as he needs reassurance, especially during the first night, as he may fear that he will suffocate.
Blood-tinged mucous is usually the first signs of secretion to come through the tracheotomy tube.
As time goes by, the amount of blood that passes through should diminish and disappear.
All secretions should be carefully and quickly wiped away before they are aspirated by the patient.
The secretions are aspirated by a sterile rubber or polyethylene catheter connected to a suction machine.
The catheter should be cut diagonally at the tip and have two or three holes along the side.
To avoid irritation of the lining of the trachea, the suction is turned off while the catheter is inserted.
The suction is adjusted to the type of secretion to be removed.
Suction should be applied intermittently for periods no longer than five seconds.
Prolonged aspiration may produce a drop in the arterial oxygen concentration.
Insufficient suctioning irritates the mucosa of the trachea.
It is recommended that sterile gloves be worn by the individual performing the suctioning to prevent contamination of the suction tube.
The tube can be exchanged for a sterile tube with each suctioning.
They cause symptoms in two ways; by obstructing the air passages they cause difficulty in breathing that may lead to asphysia; they may be drawn further down later on, entering the bronchi or one of their branches causing symptoms of irritation, such as a croupy cough, bloody or mucous expectoration and paroxysms of dyspnea.
If the foreign body has been lodged in the pharynx, it may be dislodged by inserting the finger.
If the obstruction is in the larynx or the trachea, a tracheotomy is immediately necessary.
A tracheotomy is an operation in which an opening is made into the trachea through which the patient may breathe.
It may be performed for any one of several reasons: an inadequate upper airway, which may be caused by tumors, foreign bodies, edema, nerve or vocal paralysis; a need for effective removal of excessive tracheobronchial secretions; shallow respirations resulting from unconsciousness or respiratory paresis; problems resulting from poor gas transport across alveolar capillary membrane as may occur in severe pulmonary edema or prolonged cardiac or lung surgery; and the need to reduce dead space when tidal volume is impaired as in severe emphysema.
If the opening is permanent, then it is called a tracheostomy.
For the surgical procedure the patient is placed in supine position with the head in midline and the neck extended with the chin pointing to the ceiling.
Local or general anesthesia may be infiltrated.
A bronchoscope or endotracheal tube may be in place fro oxygen and anesthesia.
A vertical or horizontal incision of approximately three centimeters is made about two centimeters above the suprasternal notch.
The sternohyoid and sternothyroid muscles are separated midline.
The front part along the trachea is dissected to allow insertion of small curved retractors that help to immobilize the trachea.
A vertical incision is usually made through the second and third tracheal cartilages.
Forceps or a tracheal dilator is used to spread the incision and the proper tube with obturator is slipped into the trachea, this is held in place by tapes which are fastened around the patient's neck.
A square piece of sterile gauze is placed between the tube and the patient's skin before the tape is fastened.
The tubes are usually made of sterling silver, although plastic is available.
Each tube consists of three pieces: an outer cannula, to which the retaining tapes are fastened; an obturator, an olive shaped, curved silver rod used to guide the cannula into the opening in the trachea; and an inner cannula, which is inserted into the outer cannula after the obturator is withdrawn.
The standard procedure for fitting of the tube is as follows: the outer tube plate is flush with the skin of the neck, without any pressure; aspirating catheter can easily pass through the tube; and the patient can breathe easily through the tube.
When emergencies arise in which a tracheotomy must be done, the life of the patient is at risk, and strict observance of aseptic technique and the psychological preparation of the patient is important.
However, there are instances where there is time to explain the purpose of the surgery to the patient, with the result that he will adjust much better to his situation.
He should realize that he will lose his voice temporarily, and will breathe through a tube in his trachea.
The patient with a tracheotomy needs to be humidified, since the nose and the pharynx usually moisten the inspired air and filter out the dust; this is no longer possible for the patient.
Therefore, it is necessary to have continuous moist air for the first two to three days.
After the operation many surgeons usually cover the opening of the tube with a few layers of gauze moistened in warm saline solution.
This tends to moisten the inspired air and filter out the dust.
Heavily saturated mist can be provided in a tent, by ultrasonic fog, or inhalation of nebulized water, saline or mucolytic agents.
An adequate intake of fluids also helps in the humidification process.
Fluids may be given to the patient during the day of the operation.
Careful attention is given to the mouth before and after meals and whenever necessary.
The patient may be placed in a sitting position.
Paper and pencil or a marker should be kept near the patient as a means of communication.
A tap bell or electric cord signal should be within the patient's reach, as he needs reassurance, especially during the first night, as he may fear that he will suffocate.
Blood-tinged mucous is usually the first signs of secretion to come through the tracheotomy tube.
As time goes by, the amount of blood that passes through should diminish and disappear.
All secretions should be carefully and quickly wiped away before they are aspirated by the patient.
The secretions are aspirated by a sterile rubber or polyethylene catheter connected to a suction machine.
The catheter should be cut diagonally at the tip and have two or three holes along the side.
To avoid irritation of the lining of the trachea, the suction is turned off while the catheter is inserted.
The suction is adjusted to the type of secretion to be removed.
Suction should be applied intermittently for periods no longer than five seconds.
Prolonged aspiration may produce a drop in the arterial oxygen concentration.
Insufficient suctioning irritates the mucosa of the trachea.
It is recommended that sterile gloves be worn by the individual performing the suctioning to prevent contamination of the suction tube.
The tube can be exchanged for a sterile tube with each suctioning.