surgicalAirway - The Surgical Airway Joseph B Carter MD MS...

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The Surgical Airway Joseph B. Carter MD, MS, FACS Department of Otolaryngology - Head and Neck Surgery
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Goals and Objectives I will discuss: Brief history General principles Complications, acute and delayed Indications Routine management Basic technique Hopefully you will gain: Understanding of basic principles, procedures, risks, and possible complications Appreciation of indications and limitations of various techniques
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Tracheotomy in Popular Culture M*A*S*H (TV) - Father Mulcahy performs a tracheotomy on a patient whose swollen tongue prevents him from breathing House M.D. Several episodes (including the pilot) include tracheotomies - often in great detail Scrubs episode (“My Drive-By”), Dr. Turk used a knife from a nearby taco stand to perform a trach on a man choking on a burrito Jerico (pilot episode), Jake Green performs emergency trach on a young girl who sustained a neck injury
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Tracheotomy or Tracheostomy? Used interchangeably (incorrectly?) to designate an opening in the anterior neck into the trachea Tracheo tomy: The incision made into the trachea Tracheos tomy: Surgical creation of a stoma through which air may pass to the lungs, bypassing the upper airway (implies suturing skin edges to trachea)
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History of Tracheostomy Long, and until recently maligned Earliest buried in legend Pictured on Egyptian tablets circa 3600 B.C. Sacred Hindu book Rig Veda, written between 2000 and 1000 B.C. “The bountiful one who can cause the windpipe to reunite when the cervical cartilages are cut across.” Asclepiades (b 124 BC) generally considered first to carry out the procedure Galen and Aretaeus, 2 nd and 3 rd centuries A.D. - first detailed reports Originally used for emergency management of upper airway obstruction (limited success)
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History of Tracheostomy “Arteria aspera” or “rough artery” - “Cartilage does not heal” - Hippocrates Known as the “Scandal of surgery” and “A semi-slaughter” throughout the middle ages No surgeon’s account until Brasavola (1500 - 1570) described his successful surgical management of Ludwig’s Angina in 1546. Surgical attempts feared - only 28 successful tracheotomies were reported from 1546 - 1833.
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* C. Jackson, Laryngoscope 1909 History of Tracheostomy 1718 Lorenz Heister coined the term tracheotomy Did not become respectable until Bretonneau and Trousseau popularized for diptheria in the early 19th century, 25% success rate was excellent at that time Chevalier Jackson, modern incarnation in early 20th century, standardized technique, reduced operative mortality from 25% to 2%, proscription against incising cricoid, 1 st ring, or below 5 th ring*
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C. Jackson, Laryngoscope, 1909, 1921
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C. Jackson, Laryngoscope, 1909, 1921 “The profession hesitates longer to advise tracheotomy than it did 50 years ago.” “The percentage of mortality is almost as high as of stab
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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surgicalAirway - The Surgical Airway Joseph B Carter MD MS...

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