Useful Tips

Emergency Tracheotomy

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It will be practically difficult for an experienced surgeon to perform it. In an ambulance, such a set of tools is present, but there are few who can boast of the ability to perform it. It is necessary, at least once, to see from the side, in what place and how, to fulfill it. Or in the atlas on topographic anatomy to see how this operation is performed. With a fool, you can also dissect the cricoid cartilage, get dangerous bleeding and aggravate asphyxiation with blood entering the trachea, you can cross the isthmus of the thyroid gland. In short, instead of helping, finish off a person.

A tracheostomy is performed from the midline incision, up to 3 cm long, just above the bright cut of the sternum. After dissection of the tracheal ring, technical difficulty again lies in wait. The mucous membrane of the trachea can exfoliate from the tracheal ring and its lumen, you will not see. Only after seeing the lumen of the trachea can you insert a suitable tube. So, it’s difficult to act with one penknife, but it’s possible for a trained person. A tracheostomy, far from artificial respiration and not a direct cardiac massage, which are available to everyone.

How to do emergency tracheotomy

One of the most common causes of death due to accidents is asphyxiation. In hopeless, critical situations, when the reception of Heimlich has already been carried out, but breathing has not been restored, a tracheotomy can be performed to save a person's life. The procedure for tracheotomy at home or in the field is quite an operation, especially it is difficult for an unprepared person and dangerous, the procedure should only be performed by a medical professional, and only as a last resort, but the ambulance most likely will not be able to arrive, the bill goes in a few minutes, delay is inevitable death the victim. So choose you, give the victim a chance to survive, or just watch him suffocate.

Technique and procedure for performing emergency tracheotomy

- Call an ambulance.

- Note the time or ask another person to start counting the time. Choking for more than three minutes leads to irreversible damage to the brain.

- Locate the cricothyroid membrane at the victim. This is a soft space under the larynx where you make an incision. Find Adam's apple or Adam's apple. Put your finger on the Adam's apple and slide down until you feel another bulge, this is a cricoid cartilage. The deepening between the Adam's apple and cricoid cartilage is the cricoid membrane - here you will make an incision.

- Make an incision 1.5 cm long and 1.5 cm deep. Cut the skin and you will see a cricoid membrane. Make an incision in the membrane. The depth of incision should be sufficient to gain access to the airways. To facilitate breathing, place a tube from improvised means in the trachea, the most suitable case is the ballpoint pen case. Hope for the victim’s self-restoration of breathing. Otherwise, you will need to do artificial respiration through this tube.

Tracheotomy is the last thing you can resort to in the absence of other possible techniques and medical personnel.
Use a clean pipe if possible. The infection you bring into the trachea can be a serious complication of tracheotomy.
This is an extremely dangerous procedure. With the wrong technique, it is possible to cause harm to the victim’s health and even death.
Remember also the legal consequences of failure. You may be charged with a person’s death.

Buy paracord bracelet with portable emergency stock

Requirements for the room where the patient with a tracheostomy is located

  • Daily wet cleaning. The room should not accumulate dust and bacteria.

Do not use strong smelling cleaning agents. Clean carpets and books.

  • Non-allergenic environment. Do not use sprays (deodorants) in the room.
  • «Right "air. Ventilate the room at least 2 times a day for 10-15 minutes.

Consult a doctor about using special humidifiers!

Oral hygiene

Caring for the patient's oral cavity is important to avoid dryness, pain, the development of infections and inflammatory processes.

Need to:

  • Brush your teeth and mouth twice a day.
  • If necessary, moisten lips with a damp cotton swab.
  • Use hygienic lipstick to moisturize your lips.
  • Rinse your mouth with water or let the patient suck a small piece of ice.

Always warn the patient about all actions and get his consent to the procedure. Arrange with the patient, as in case of discomfort, he may give you an alarm.

Life with a tracheostomy

  • It is not recommended to walk in very cold weather.
  • You can take a shower, but make sure that water does not get into the tube, so during the shower cover it with your hand or use a special protection for the shower - a heat and moisture exchanger. You can’t dive.
  • If it’s difficult for the patient to talk, put a notebook and pen in each room. Ask simple questions that can be answered yes or no.
  • If there are no contraindications for the voice valve, discuss with the doctor the possibility of its use. The first experience of talking through the valve is best done in the presence of a doctor.
  • Make a note with data on the disease and medicines that the patient is taking. Let him always carry it with him - in a crisis situation this can save his life.
  • Assemble the emergency kit: interchangeable tracheostomy, vacuum suction, catheters, gloves, syringes, saline, clamps to secure the tracheostomy tube, wipes for putting under the tube.

Hygiene

Observe hygiene, especially in everything related to the electric suction:

  • at least 1 time per day, thoroughly wash the container and hose of the aspirator with disinfectants,
  • when handling suction, use gloves, wash your hands before and after the procedure, or treat your hands with antiseptic agents.

To avoid accidents, it is helpful to have:

  • spare tracheostomy tube of the right size,
  • a smaller tracheostomy tube (if you can’t get the right size, use the smaller one for a while, and later the doctor will help you),
  • mechanical aspirator (if there are frequent blackouts in your home).

Make sure you always have in stock:

  1. Vacuum aspirator - for aspiration of sputum from a tracheostomy tube (1 pc.).
  2. Aspiration catheters for sputum suction from a tracheostomy tube (150-300 pcs./month).
  3. Fixing tapes for fastening the tube (1 pc. / Month) or a specially folded bandage
  4. Replaceable tracheostomy tubes (1 pc. / Month).
  5. Compresses or napkins for laying under the tube (30-50 pcs. / Month).
  6. Gauze swabs or sterile wipes for treating the skin around the tracheostomy (30 pack / month).
  7. Saline solution (sodium chloride 0.9% sterile) for sanitation (individually).
  8. An aqueous antiseptic for treating the skin around the tracheostomy (500 ml / month).
  9. Humidifier (as recommended by a doctor) (1 pc.).
  10. Heat and moisture exchanger as protection against moisture (30-50 pcs. / Month).
  11. Cap for tracheostomy.
  12. Antiseptic for the treatment of hands.

The pdf memo can be downloaded here.

In the creation of the material involved: V.N. Brusnitsyna, GBUZ "Center for Palliative Care DZM", T.V. Zadorozhnaya, Children's hospice "House with a lighthouse", A.N. Ibrahimov, GBUZ "Center for Palliative Care DZM", GBU "NIIOZMM DZM".

The material was prepared with the participation of “Workshop Care”, a project of the Vera hospice charity foundation, using a grant from the President of the Russian Federation for the development of civil society provided by the Presidential Grants Fund.

Tracheotomy

This term refers to surgery that is performed in the neck. To ensure proper breathing, a tube is placed in the hole obtained.

With the help of manipulation, it is possible to bypass obstacles that disrupt breathing.

The hole obtained as a result of the procedure is called a stoma or tracheostomy. It may be present temporarily or be permanent.

With the help of the procedure, the doctor opens the airways. It is carried out to normalize breathing in such situations:

  1. Airway blockage at or above the larynx. The provoking factors of this violation include traumatic neck injuries and tumor lesions of the upper respiratory organs.
  2. Respiratory failure, which needs continued support. Pneumonia or traumatic damage to the spinal cord in the neck can be a provoking factor.
  3. Congenital malformations of the larynx or trachea.
  4. Damage to the respiratory tract due to inhalation of smoke or harmful chemical elements.
  5. Complex forms of night apnea.
  6. Ingestion of foreign objects that lead to blockage of the trachea or larynx.

Technique

To perform the procedure, the surgical field is processed in accordance with general surgical rules. Manipulation is carried out under local anesthesia, which involves the use of a 0.5% solution of novocaine with the addition of adrenaline.

In severe hypercapnia in children, anesthesia may not be used, since in such situations the sensitivity decreases sharply, and the surgeon has very little time.

During the procedure, the nose and mouth must not be closed. This will help the patient to breathe better, and the doctor to control the progress of the operation. An incision is made in the neck area and a specific fragment is removed in the trachea. A tracheostomy tube is placed in the hole obtained. It will become a replacement for the respiratory tract. The skin around this device is covered with braces or stitches.

As long as the tube remains in the throat, breathing takes place through it. To improve ventilation, a special apparatus for artificial respiration is used.

TTracheotomy technique in our video:

Recommendations

Any variant of tracheotomy is a rather complicated intervention, the implementation of which requires appropriate skills and a special set of tools. Compliance with sterile conditions and anesthesia is of no small importance. Therefore, at home, this operation is not performed.

For this purpose, you can use any improvised device. Often use a thick needle or a kitchen knife. In the resulting hole, you need to put some kind of tube - for example, the body of a ballpoint pen. These manipulations can save the life of the victim.

Rehabilitation

To avoid complications, special attention should be paid to the recovery period. At the rehabilitation stage, such manipulations may be required:

  1. Maintain a clean stoma. It must be cleaned every day with hydrogen peroxide or water with a mild soap. The dressing should be constantly changed.
  2. Ask a specialist when it is possible to carry out water procedures.
  3. Familiarize yourself with the rules for caring for a tracheostomy tube. It must be cleaned, systematically purged to eliminate secretions, moisten the air. When going out, the pipe should be covered with a scarf so that foreign objects do not get into it.
  4. On the recommendation of a doctor, consult a speech therapist.
  5. If necessary, take antibiotics.
  6. Avoid serious stress for 1.5 months after the intervention.
  7. Follow your doctor’s recommendations.

How to clean the tracheotomy tube. look in our video:

Provided that the operation is performed correctly and all medical recommendations are followed, the prognosis is favorable. However, in some cases, tracheotomy provokes unpleasant complications. These include the following:

  • damage to the vocal cords, nerve fibers or esophagus,
  • infection
  • bleeding,
  • violation of swallowing function,
  • lung tissue damage,
  • cicatricial changes in the neck, which can lead to closure of the tracheostomy,
  • pressure reduction
  • displacement and damage to the tube in the stoma.

The following factors increase the likelihood of complications:

  • children and old age
  • excess weight,
  • malnutrition
  • recent pathologies, especially damage to the upper respiratory system,
  • the use of certain medications
  • smoking,
  • alcoholism.

Tracheotomy is a serious operation, which in some cases can save a person’s life. To achieve the desired results and avoid complications, it is necessary to consult a qualified surgeon and clearly adhere to medical recommendations during the rehabilitation period.

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