This is an automatically translated article.
The article is expertly consulted by Master, Doctor Nguyen Tung Hoanh - Interventional Cardiologist - Department of Resuscitation - Emergency - Vinmec Nha Trang International General Hospital.Tracheostomy is a necessary procedure in emergency or critically ill patients who are unable to breathe on their own through the nose or mouth, and an oxygen mask cannot provide adequate oxygen.
1. Tracheostomy and the purpose of tracheostomy
A tracheostomy is a procedure in which the skin and muscles of the neck are opened, the trachea is made, and a catheter is inserted into the trachea to maintain the patient's airway. The purpose of tracheostomy is to create a shorter airway than usual to reduce physiological dead space for the patient.2. What are the types of tracheostomy?
There are two basic types of tracheostomy: high tracheostomy and low tracheostomy.High tracheostomy: A technique to approach the trachea above the thyroid isthmus at the rings of tracheal cartilage 1 and 2.. Low tracheostomy: A technique to open the trachea at the cartilage rings below the thyroid isthmus, (at rounds 4-6). For emergency cases, severe patients often apply the high tracheostomy technique, which is relatively quick to perform. In contrast, low tracheostomy is often applied to patients with only mild dyspnea, not to the point of asphyxiation, this technique requires skilled operators and is more time consuming.
Mở khí quản được áp dụng đối với bệnh nhân từ khó thở nhẹ đến mức đe dọa ngạt
3. Indications and contraindications for emergency tracheostomy
3.1 Designation
3.1.1 Indications for tracheostomy in case the patient has problems with the ear, nose and throat
Patients with benign or malignant tumors (cancer of the larynx in adults, laryngeal papilloma in children). The patient had trauma to the pharynx and larynx. After inflammation or trauma, patients experience sequelae of laryngeal stricture scarring. Certain birth defects of the pharynx or larynx. Acute progressive forms of inflammation in the larynx such as laryngeal tuberculosis are common in adults or laryngeal diphtheria are common in children. The patient has a foreign body obstructing the airway. Common forms of paralysis in the larynx such as: open muscle paralysis, regression paralysis, ..
Bệnh nhân lao thanh quản được chỉ định mở khí quản
3.1.2 Indications for tracheostomy within the scope of respiratory resuscitation
Tracheostomy for patients with CNS disease with respiratory manifestations (respiratory failure due to central brain lesions, bulbar morphology encountered in childhood polio,...). Tracheostomy for patients with sputum stagnation and secretions in the trachea due to prolonged coma due to various causes glottis ligation. Patients with myasthenia gravis with respiratory manifestations also require tracheostomy. Emergency tracheostomy in case of severe or chronic respiratory failure. Tracheostomy for patients requiring surgery such as thoracic surgery, open heart surgery, neurosurgery (in some diseases of the posterior fossa and spinal cord). In emergency cases of serious patients such as: Trauma to the chest, skull, or severe maxillofacial injuries, severe burns... then tracheostomy is considered necessary because it helps to facilitate resuscitation and extend the time it takes to move the patient to an emergency medical facility.
Mở khí quản thuộc phạm vi hồi sức hô hấp được chỉ định đối với bệnh nhân uốn ván
3.2 Contraindications
In the emergency, especially the emergency of a serious patient, tracheostomy has no contraindications.
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