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Cricothyrotomy
A cricothyrotomy (also called cricothyroidotomy or laryngotomy) is a medical procedure where an opening is created through the cricothyroid membrane to establish a patent airway during emergency airway management. Cricothyrotomy is primarily performed as the last step in airway management algorithms in cases where an airway cannot be established by other means of nasal or oral tracheal intubation. These situations, often referred to as "cannot intubate, cannot ventilate" (CICV) or "cannot intubate, cannot oxygenate" (CICO), are commonly seen as a result of airway obstruction, angioedema, trauma, burns, or abnormal anatomy. Multiple types of cricothyrotomy may be considered for emergency surgical airway management, including surgical cricothyrotomy and needle cricothyrotomy. Surgical cricothyrotomy is performed by inserting a large-bore tube through an opening in the cricothyroid membrane created via incision or using the Seldinger technique. Needle cricothyrotomy is performed by ...
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Tracheal Intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic catheter, tube into the vertebrate trachea, trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill, or anesthetized patients to facilitate Ventilation (physiology), ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction. The most widely used route is orotracheal, in which an tracheal tube, endotracheal tube is passed through the mouth and larynx, vocal apparatus into the trachea. In a nasotracheal procedure, an endotracheal tube is passed through the nose and vocal apparatus into the trachea. Other methods of intubation involve surgery and include the cricothyrotomy (used almost exclusively in emergency circumstances) and the tracheotomy, used primarily in situations where a prolonged need for air ...
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Surgical Airway Management
Surgical airway management (bronchotomy) is the medical procedure ensuring an open Respiratory tract, airway between a patient’s lungs and the outside world. Surgical methods for airway management rely on making a surgical incision below the glottis in order to achieve direct access to the lower respiratory tract, bypassing the upper respiratory tract. Surgical airway management is often performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Surgical airway management is also used when a person will need a mechanical ventilator for a longer period. The surgical creation of a permanent opening in the larynx is referred to as laryngostomy. Surgical airway management is a primary consideration in anaesthesia, emergency medicine and intensive care medicine. Surgical methods for airway management include cricothyrotomy and tracheostomy History Asclepiades of Bithynia is credited with being the first person who proposed bro ...
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Airway Management
Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve an airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the Obtundation, obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (Pulmonary aspiration, aspiration). Airway management is commonly divided into two categories: Basic airway management, basic and Advanced airway management, advanced. Basic techniques are generally non-invasive and do not require specialized medical equipment or advanced training. Techniques might include head and neck maneuvers to optimize ventilation, abdominal thrusts, and back blows. Advanced techniques require specialized ...
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Cricothyroid Membrane
The cricothyroid ligament (also known as the cricothyroid membrane or cricovocal membrane) is a ligament in the neck. It connects the cricoid cartilage to the thyroid cartilage. It prevents these cartilages from moving too far apart. It is cut during an emergency cricothyrotomy to treat upper airway obstruction. Structure The cricothyroid ligament is composed of two parts: * the median cricothyroid ligament along the midline (a thickening of the cricothyroid membrane). It is a flat band of white connective tissue that connects the front parts of the contiguous margins of the cricoid and thyroid cartilages. It is a thick and strong ligament, narrow above and broad below. Each lateral ligament is known as the conus elasticus. * the lateral cricothyroid ligaments on each side (these are also called conus elasticus). Each is overlapped on either side by laryngeal muscles. The conus elasticus (which means elastic cone in Latin) is the lateral portion of the cricothyroid ligam ...
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Tracheostomy
Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision on the front of the neck to open a direct airway to the trachea. The resulting stoma (hole) can serve independently as an airway or as a site for a tracheal tube (or tracheostomy tube) to be inserted; this tube allows a person to breathe without the use of the nose or mouth. Etymology and terminology The etymology of the word ''tracheotomy'' comes from two Greek words: the root ''tom-'' (from Greek τομή ''tomḗ'') meaning "to cut", and the word ''trachea'' (from Greek τραχεία ''tracheía''). The word ''tracheostomy'', including the root ''stom-'' (from Greek στόμα ''stóma'') meaning "mouth", refers to the making of a semi-permanent or permanent opening and to the opening itself. Some sources offer different definitions of the above terms. Part of the ambiguity is due to the uncertainty of the intended permanence of the stoma (hole) at the time it ...
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Cricothyroid Ligament
The cricothyroid ligament (also known as the cricothyroid membrane or cricovocal membrane) is a ligament in the neck. It connects the cricoid cartilage to the thyroid cartilage. It prevents these cartilages from moving too far apart. It is cut during an emergency cricothyrotomy to treat upper airway obstruction. Structure The cricothyroid ligament is composed of two parts: * the median cricothyroid ligament along the midline (a thickening of the cricothyroid membrane). It is a flat band of white connective tissue that connects the front parts of the contiguous margins of the cricoid and thyroid cartilages. It is a thick and strong ligament, narrow above and broad below. Each lateral ligament is known as the conus elasticus. * the lateral cricothyroid ligaments on each side (these are also called conus elasticus). Each is overlapped on either side by laryngeal muscles. The conus elasticus (which means elastic cone in Latin) is the lateral portion of the cricothyroid ligamen ...
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Trachea
The trachea (: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from the larynx and branches into the two primary bronchi. At the top of the trachea, the cricoid cartilage attaches it to the larynx. The trachea is formed by a number of horseshoe-shaped rings, joined together vertically by overlying annular ligaments of trachea, ligaments, and by the trachealis muscle at their ends. The epiglottis closes the opening to the larynx during swallowing. The trachea begins to form in the second month of embryo development, becoming longer and more fixed in its position over time. Its epithelium is lined with columnar epithelium, column-shaped cells that have hair-like extensions called cilia, with scattered goblet cells that produce protective mucins. The trachea can be affected by inflammation or infection, usua ...
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Tracheotomy
Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision on the front of the neck to open a direct airway to the trachea. The resulting stoma (hole) can serve independently as an airway or as a site for a tracheal tube (or tracheostomy tube) to be inserted; this tube allows a person to breathe without the use of the nose or mouth. Etymology and terminology The etymology of the word ''tracheotomy'' comes from two Greek words: the root ''tom-'' (from Greek τομή ''tomḗ'') meaning "to cut", and the word ''trachea'' (from Greek τραχεία ''tracheía''). The word ''tracheostomy'', including the root ''stom-'' (from Greek στόμα ''stóma'') meaning "mouth", refers to the making of a semi-permanent or permanent opening and to the opening itself. Some sources offer different definitions of the above terms. Part of the ambiguity is due to the uncertainty of the intended permanence of the stoma (hole) at the time i ...
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Transtracheal Jet Ventilation
Transtracheal jet ventilation refers to a type of high-frequency ventilation, low tidal volume ventilation provided via a laryngeal catheter by specialized ventilators that are usually only available in the operating room or intensive care unit. This procedure is occasionally employed in the operating room when a difficult airway is anticipated, such as Treacher Collins syndrome, Robin sequence, head and neck surgery with supraglottic or glottic obstruction. It is NOT recommended in emergencies if a person cannot be intubated Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Most commonly, intubation refers to tracheal intubation, a procedure during which an endotracheal tube is inserted into the trachea to supp ... or ventilated by other means.{{cite journal, last1=Duggan, first1=LV, last2=Ballantyne Scott, first2=B, last3=Law, first3=JA, last4=Morris, first4=IR, last5=Murphy, first5=MF, last6=Griesdale, first6=DE, title=T ...
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Airway Obstruction
Airway obstruction is a blockage of respiration in the airway that hinders the free flow of air. Airway obstructions can occur either in the upper airway or lower airway. The upper airway consists of the nose, throat, and larynx. The lower airway comprises the trachea, bronchi, and bronchioles. Airway obstruction is a life-threatening condition and requires urgent attention. Upper airway obstruction Causes The causes of upper airway obstructions can be acute or chronic. Acute causes of upper airway obstruction include foreign body aspiration, blunt trauma to the neck, infection, and swelling due to allergies or other inflammatory conditions. In children, viral infections such as croup or epiglottitis are frequent causes. Adults are more likely to experience obstruction from enlargement of the tonsils or vocal cord paralysis. Obstructive sleep apnea is the most common chronic cause of upper airway obstruction. Symptoms Stridor is a high-pitched sound which occurs d ...
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Seldinger Technique
The Seldinger technique, also known as Seldinger wire technique, is a medical procedure to obtain safe access to blood vessels and other hollow organ (anatomy), organs. It is eponym, named after Sven Ivar Seldinger (1921–1998), a Sweden, Swedish radiology, radiologist who introduced the procedure in 1953. Uses The Seldinger technique is used for angiography, insertion of chest drains and central venous catheters, insertion of percutaneous endoscopic gastrostomy, PEG tubes using the push technique, insertion of the leads for an artificial pacemaker or implantable cardioverter-defibrillator, and numerous other interventional medical procedures. Complications The initial puncture is with a sharp instrument, and this may lead to hemorrhage or perforation of the organ in question. Infection is a possible complication, and hence asepsis is practiced during most Seldinger procedures. Loss of the guidewire into the cavity or blood vessel is a significant and generally preventable com ...
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