جابريون⁸ (جراحة عملي )

Tracheostomy : ♦️Indications of tracheostomy 🚑1-Upper airway obstruction below vocal cord 🚑2-Removal of secretions : -congestive cardiac failure -infection -pulmonary oedema -bulbar palsy 🚑3-Prolonged ventilation. 🚑 4-Part of another procedure

3️⃣cricothyrodotomy ♦️indication: 🚑intubation not possible(treacheal or laryngeal intubation) 🚑tracheotomy not possible (there is no landmark(kyphiscoilosis) , large mass of goiter ♦️contrainducation: 🚑laryngeal truma 🚑neck hematoma 🚑nenoate or children ♦️Advantage: 🚑easy, simple,safe 🚑because : 🔥no blood supply 🔥no nerver supply 🔥suprrfical layer ♦️Disadvantage: 🚑poor ventilation 🚑temporary method ♦️type of cricothyrodotomy: 🚑needle cricothyrodotomy 🚑convertional cricothyrodotomy

Needle cricothyrodotomy

زين يابه شفنه المريض عنده maior facial fractur و laryngeal obstruction لأي سبب كان هنا خو منخلي المريض يموت هنا يجي دور surgical method

Laryngeal mask supraglotic device

🧠Laryngeal mask supraglotic device: ♦️Indication: maintain airway when endotracheal intubation cannot be ♦️Contraindications : if there is laryngeal obstruction by any pathology (stenosis , tumor, adductor position of vc after thyroid surgery)

🧠Endotracheal intubation ( either from the mouth , Oro tracheal •or from the nose, nasotracheal intubation . •Nasopharyngeal tube (contraindicated in patients with severe head or  facial injuries where a skull base • fracture allows the possibility of •entering  the intracranial •compartment)  . •should not be performed in •Traumatic  patients.

1️⃣endotracheal intubation (non surgical method)

1️⃣endotracheal intubation (non surgical method) ♦️Indication : to maintain airway ♦️Absloute contrainduction : 🚑major facial fractures (disttored the anatomy with sever bleeding) 🚑sustained laryngotracheal truma or transection ♦️relative contrainducation 🚑short neck 🚑kyphoscoliosis 🚑obese pateint

1️⃣ NON_Surgical method ♦️endotracheal tube ♦️laryngeal mask 2️⃣Surgical Metheod ♦️cricothyriodectomy ♦️tracheostomy

شوفوا اجانه مريض للطوارئ و المجرى التنفسي مالته مسدود و انت روتيتر شنو تسوي حته تأمن المجرى التنفسي عدنه طريقين و كل طريق بي خيارين

🚨🚨🚨🚨مهمممم

🚨Signs of impending respiratory failure: 🚑Reduced level of consciousness or lethargy Quiet 🚑shallow breathing 🚑Decrease respiratory rate or Apnea. 🚑Bradycardia

♦️Stridor 🚑-high pitched musical sound -due to upper airway 🚑 obstructionstertor:-noise, as heard in snorers -due to oropharyngeal obstruction 🚑inspiratory stridor : supraglotic obstruction 🚑 expiratory stridor: infraglotic obstruction 🚑biphasic stridor: trachea ♦️sign 1.Hoaresness of voice . 2.use of accessory muscle . 3.Restlessness : (irritability because of hypoxia ) patient tire from the extreme respiratory effort, so become less restless,(quite shallow breathing ) its not mean improve ) which may precede complete respiratory failure. A patient showing signs of restlessness and suprasternal recession requires urgent respiratory support . 4.Subcutaneous emphysema in fractures of the laryngeal skeleton or trachea and implies a disruption of the aero digestive tract, with escape of air into the soft tissue In severe cases it is responsible for the airway obstruction rather than being an associated .

0️⃣2️⃣المحطة العشرون ENT