31603 Tracheostomy, emergency procedure; transtracheal

Name of the Procedure:

Tracheostomy, emergency procedure; transtracheal

Summary

A tracheostomy is an emergency medical procedure where a hole is made through the neck into the trachea (windpipe) to allow air to flow directly into the lungs. This provides an alternate airway when normal breathing is obstructed.

Purpose

This procedure is performed to address severe breathing difficulties when the normal airway is blocked or impaired. The goal is to ensure the patient can breathe adequately and receive sufficient oxygen.

Indications

• Severe airway obstruction due to trauma, swelling, or foreign objects
• Acute upper airway blockage from infections like epiglottitis
• Situations where intubation is not possible or has failed
• Severe allergic reactions causing airway swelling
• Life-threatening respiratory conditions requiring an immediate airway

Preparation

• Patients are usually in critical condition, so there is little time for preparation.
• If feasible, a quick assessment of the airway and vital signs is performed.
• No specific pre-procedure fasting or medication adjustments due to emergency nature.
• Emergency diagnostics like chest X-ray may be ordered if there's time.

Procedure Description

1. Patient is positioned with the neck extended to expose the trachea.
2. Local anesthesia is administered if the patient is conscious.
3. A horizontal incision is made in the neck.
4. The trachea is identified and opened.
5. A tracheostomy tube is inserted through this opening into the trachea.
6. The tube is secured and connected to a ventilator if necessary.
7. The incision site is dressed and monitored for complications.

Duration

Typically takes 10-15 minutes in emergency situations.

Setting

Performed in emergency settings such as ER, ICU, or field situations (e.g., ambulance).

Personnel

• Emergency physician or surgeon
• Nurse or medical assistant
• Anesthesiologist if available (considering the emergency context)
• Respiratory therapist

Risks and Complications

• Infection at the tracheostomy site
• Bleeding
• Tracheal damage or perforation
• Tube displacement or blockage
• Long-term voice changes or swallowing difficulties
• Scar formation

Benefits

• Immediate restoration of airway patency
• Rapid improvement in oxygen levels
• Potentially lifesaving in obstructive airway emergencies

Recovery

• Intensive monitoring in a hospital setting initially
• Post-procedure care includes regular cleaning and dressing of the site
• Gradual adjustment to breathing through the tracheostomy tube
• Follow-up appointments for evaluation and potential tube removal once the underlying issue is resolved

Alternatives

• Endotracheal intubation: inserting a tube through the mouth into the trachea
  • Pros: Non-surgical, can be done quickly
  • Cons: May fail in case of severe obstructions or anatomical difficulties
• Cricothyrotomy: emergency incision through the cricothyroid membrane
  • Pros: Faster and simpler in extreme emergencies
  • Cons: Higher risk of suboptimal airway control and complications

Patient Experience

• Immediate relief of severe breathing difficulty
• Possible discomfort during the procedure, managed with anesthesia
• Post-procedure, patients may feel soreness and need time to adapt to the tracheostomy tube
• Pain management includes analgesics and proper site care for comfort