Tracheostomy

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Tracheostomy?
A tracheotomy or a tracheostomy is an opening surgically created through the neck into the trachea (windpipe) to allow direct access to the breathing tube and is commonly done in an operating room under general anesthesia. A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. Breathing is done through the tracheostomy tube rather than through the nose and mouth.

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Great job Taylor Swift! She visited a sick boy today at Hasbro Children’s Hospital in Providence. A loving father sent this photo. 

“Taylor Swift visited my boys today at Hasbro Children’s Hospital in Providence. My son has been here for 5 months since he was born. This is such a special moment. Brayden Garcia was diagnosed with down syndrome and other medical complication that led to him having a tracheostomy.Our other son is Benjamin Garcia jr and he’s five years old.” - Benjamin Garcia of Darmouth, MA (x)

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Demonstration of how to suction a patient’s tracheostomy- by Hawknurse on youtube.

Watch on mylifewithlupus.tumblr.com

Jasey, 1 month before her last surgery! which was september 21st 2011. the following month miss.Jasey will be having a sleep study conducted in order to determine whether or not she’s okay to have the trach removed. So far, things look promising!

The Denna Laing Team: I’m a firm believer that accessories can make or break an outfit, whether it be a fun accent necklace or a pop of color in your heels. On the other hand, hospital accessories are ones I could live without. So I’m excited to say that in addition to not having to wear my fashionable hospital gown anymore, I’ve lost most of my new accessories this week including my neck brace and my tracheostomy tube. Now that I’ve lost my extra hardware, I’m capable of turning my head to see the clock hanging on the wall. I am also able to move around in my wheelchair without a hospital chaperone, and can move floor to floor without having any monitors attached to my fingers. 18 days stronger.

I love the kids I tutor so much, but...

it seems like all they can focus on when they’re with me is the “breathing thing” on my neck. I mean, I don’t mind questions or anything like that - I’ve had to deal with it all my life. And I know they’re just curious and want to learn more about it since they’re not familiar with this type of “contraption,” as some individuals call it. 

It just gets uncomfortable when the kids start staring and staring… nonstop…and they can’t focus on their schoolwork. One little boy even said, “Ew, that’s nasty…I don’t like that breathing noise. It’s irritating.”

Will my own child think that I am weird and gross? Will she ask me why everybody else’s moms have a normal nose, while I have two? Will she be embarrassed of me? 

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Demonstration of how to perform tracheostomy care for a patient. -This video is [one of many] by my favorite nurse channel on youtube, called Hawknurse.

I'm having my tracheostomy tube taken out

….A Specialist Nurse comes over and has a chat with me, she goes on to tell me that I can finally have my tracheostomy tube taken out in the next few days. I’m over the moon by this news :-).

The day I have my tube taken out finally arrives and the removal goes so much quicker than I expected, I have to keep a dressing sealed up over the hole for a few days while it heals and closes up.

I’m now breathing through my mouth without any hole in my throat at last, it heals up quickly and I’m told that it looks very neat….

Cervical Spinal Cord Injury: Who Needs A Tracheostomy?

The sad truth is that patients with cervical spine injury may need a tracheostomy. In very high lesions (C1-2) the need may be permanent. Lower injuries (C3-5) frequently need a trach for a limited period of time while they develop enough reserve to compensate for the lost of chest wall muscle power.

It’s not always easy to tell which patient is likely to need intubation upon arrival in the ED. I’ve seen occasional patients fail while getting their CT scans, which is poor planning. Is there a way to predict who might fail, thus benefiting from early intubation and an early plan for tracheostomy?

The trauma group at LAC + USC Medical Center undertook a National Trauma Databank review to try to answer this question. They identified 5256 patients with cervical spinal cord injuries without a severe traumatic brain injury that would otherwise require intubation. About 21% received tracheostomies, and the common predictors were:

  • Intubation at the scene by EMS (they’ve done the job of deciding for us!)
  • Intubation in the ED
  • Complete cord injury at any level
  • Facial fractures
  • Chest trauma
  • Injury Severity Score >=16

Patients who received a tracheostomy generally spent more days on the vent, in the ICU and in the hospital than those who did not. However, their mortality was lower.

It’s generally recognized that patients with complete injuries from C1-C5 routinely require tracheostomy. The surprising thing about this study was that complete injuries at C6 or C7 did as well.

Bottom line: If you have a patient with a spinal cord injury who meets any of the criteria above, stand ready to intubate. I tell my trainees that, if at any time they see something that makes them think about intubating, they should have already done it. Likewise, the surgical ICU team should have a low threshold to performing an early tracheostomy on these patients.

Reference: Incidence of clinical predictors for tracheostomy after cervical spinal cord injury: a National Trauma Databank review. J Trauma 70(1): 111-115, 2011.

Picture: crossbow bolt through the mouth and cervical spinal cord.

Haley has started trach mask! This means she no longer has to be on the vent 24/7! Currently she is off for half an hour twice a day and adding 15min twice a week!! In about a month she will have had the trach and vent for a year. This is such a huge accomplishment!! My baby is so strong and continues to amaze us and all of her doctors!! #yay!! #baby #love #beautiful #trach #tracheostomy #trachmask #nose #freedom #ventilator #cutie #omphalocele #oneyear #biggirl #daughter #always #happy #smile #laugh #so #strong

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