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Emergencies in Otolaryngology (Tracheotomy (Indications (Trauma, Edema …
Emergencies in Otolaryngology
Laryngeal dyspnea
Types
Acute dyspnea- occurs
suddenly
with a dramatical follow
Chronic dyspnea-
progressive
closure of the upper respiratory tract lumen. Frequently associated with adaptation
Common symptoms:
Laryngeal
stridor
(„noisy breathing”=wheeezing)
~ difficulty in inspiration
dysphonia
or
aphonia
Anxiety
Stridor
INSPIRATORY STRIDOR
supraglottic or glottic stridor
BIPHASIC STRIDOR
subglottic
EXPIRATORY STRIDOR
lower tracheobronchial tree
Diagnosis
laryngoscopy
Videolaryngoscopy
3.Oral cavity and pharynx examination
Causes
region of pharynx
Peritonsillar abscess (especially posterior)
Retropharyngeal abscess
Quincke edema
Lingual abscess
Phlegmone of the floor of the mouth (Ludwig’s angina)
Malignant neoplasms:
a. oropharynx, hypopharynx
b. Lymph nodes metastases causes press the pharynx or larynx displacement
Contagious diseases
a. infectious mononucleosis
b. Croup (diphtheria)
region of larynx
neoplasms
Laryngeal edema
Epiglottitis
Vocal folds paresis
Neck traumas
Foreign body
Laryngeal scars
in children (region of larynx)
Subglottic laryngitis
Laryngeal webs
Laryngomalacia
Foreign body
Subglottic hemangioma
Congenital subglottic stenosis
region of trachea
Tracheal stenosis
Tracheal injury
Foreign body
Inflammation (severe)
Benign and malignant neoplasms
Tracheomalacia
Complications after tracheotomy
Foreign body of the upper respiratory tract
Life-threatening
emergency state
Treatment:
conicotomy
(cricothyrotomy)
tracheotomy
steroids therapy (i.v.)
direct laryngoscopy
tracheoscopy
Cricothyrotomy
emergency incision through the skin and cricothyroid membrane to secure a patient’s airway during serious, life-threatening situations
only in pre-hospital care
Indications
in acute upper airway obstruction
when intubation is not possible (emergency= before hospital): risk of not intubating is > than surgical airway risk
Contradictions
~ inability to identify cricothyroid membrane
~ anatomical abnormality
~ tracheal trauma (rupture)
~ phlegmon, abscess
~ small children (under 10 yrs old)
Complications
~ bleeding and hematoma
~ blood aspiration
~ dammage of laryngeal cartilages
~ incorrect tube placement
~ esophageal laceration
~ tracheal wall perforation
~ emphysema
~ vocal cords paralysis and hoarseness
~ subglottic stenosis
Tracheotomy
incision commonly between II and III or III and IV tracheal ring in order to insert a tube
EMERGENCY: obstruction in the upper airway tract
NON-EMERGENCY: otolaryngological and/or anesthesiological indications
Indications
Trauma, Edema
Intubation failure
Foreign body obstruction
Subglottic or tracheal stenosis
Bilateral Vocal Cord Paralysis
Tumors, Infections
Congenital abnormalities (Pierre Robin, Trecher Collins syndromes)
OSAS
before laryngectomy, pharyngotomy, operations in the floor of the mouth region
Cervical spinal cord injuries with respiratory muscles paralysis
Prolonged intubation (> 1 week)
Complications
Apnea due to loss of hypoxic respiratory drive
Bleeding
Pneumothorax or pneumomediastinum
Damage to the vocal cords (direct)
Injury to adjacent structures
Hypotension
Arrhythmia
Early Complications:
Early bleeding
Tracheitis
Cellulitis
Tube displacement
emphysema
Atelectasis
Late Complications:
Bleeding - tracheoinnominate fistula
Tracheo- and laryngomalacia
Stenosis
Tracheoesophageal fistula
Tracheocutaneous fistula
Granulation
Scarring
Failure to decannulate
Matar