tracheostomy

Assalamualaikum to all my friends n anyone who read this post.i hope all of u are in excellent conditions physically n spiritually as well.i would like to seek an apology from all u guys bcoz this week post for ENT is a little bit late..for this entry I want to bring up to you some important surgical knowledge we should know at least as a 4^th year under graduate student n most importantly as a future doctors insyaAllah..it is the TRACHEOSTOMY.This surgery have NO CONTRAINDICATION.

Tracheostomy is a live saving technique and the most important approach in any obstruction of the airways.this technique is applied for almost all cases OF airways obstruction.

Definition: artificial opening of i cervical trachea.

Indication: 1.Lower airway obstruction

2.Upper airway obstruction

A. LOWER AIRWAY OBSTRUCTION.this patient facing one of these problem:

Aspiration

a.bilateral adductor paralysis

b.absent of cough reflex(protective function of the larynx).the patient cant expel the secretion.the secretion will flow back to I lung. Ie; the patient drowning in his own secretion.

Notes:larynx will protect the airway by closure of ventricle fold n vocal fold.this is the main mechanism of I larynx to protect the lower airways.

Patient with absent of cough reflex 1) comatous

2)paralysis of respiratory muscles

3)multiple ribs fracture

B.UPPER AIRWAY OBSTRUCTION ( trachea,larynx,supralaryngeal)

Tracheal obstruction; in the neck:enlarged goiter,malignant goiter

In the chest:retrosternal goiter,enlarged mediastinal glands

Laryngeal obstruction-congenital,traumatic,inflammation,neoplastic,etc..

Supralaryngeal-haryngeal carcinoma,very big nasopharyngeal fibroma.glossitis

*I just mention some examples

This is the least you must know about tracheostomy to perform the operation: Surgical anatomy

- The trachea is situated exactly a tthe midline,but maybe displaced to one side by an enlarged lobe of the thyroid or by cervical gland.

- Trachea more superficial at the upper end.it pass downward n backward.so at the manubrium it is deep.

- About 7-8 cartilaginous rings

- In child mote the following’; neck is shorter,larynx is higher,trachea is more superficial, the thyroid isthmus usually cover 3^rd n 4^th rings

Types of tracheostomy:

1.HIGH: in emergency n malignancy

2.Low: tracheal stenosis/tumor/multiple papillomatosis in children.

3.MID:mostly tracheostomy done in mid position.

Every doctor should know how to do tracheostomy.We maybe found in a situation desperately calling for it.for instance a patient in severe stridor n about to suffocate..you can read further in the text book from page 244 till 249.I think it is not neccesarry for me to write all the contents..what important is, I just want to highlight ” how important it is”.

This is a true story from my own collection. last week I go to the OT n dr HAZEM EMANN( the one who teach us tracheostomy) ask about it,I answer nothing except silentness..3 others doctors are there n just looking at me. Then dr said, “ I feel very sad bcoz I learn u nothing,you can leave everything on this chapter except tracheostomy.” .At that time I fell like the whole world is falling on me. OH HO HO HO HO..terrible,terrible,terrible..

B4 I finish this entry..i want to share something ..something that make us wiser person if we understand..something that make the world really a heaven..something that cheer up our heart..something that every muslims should understand..

4 hal yg membuat hidup menjadi sulit,perasaan menjadi tertekan dan dada terasa sempit:

1.Tidak menerima qadha’ dan qadar

2.membuat maksiat tanpa disertai dgn taubat

3.irihati dan hasad dengki

4.berpaling dari Allah.Naudzubillah..

KULLU ‘AM WA ANTUM BI KHOIR

Selamat berpuasa & menyambut AidilAdha :)