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Tracheostomy - Coggle Diagram
Tracheostomy
SLP's role
Re-establish comm: cuff is inflated, X phonate, X speak, facilitate alternate or laryngeal comm
Swallowing-because of how clinically unwell they are, also want to prevent aspiration
Decannulation: contributing to medical decision wrt safety, suitability for trache to be removed
Can only do oral suctioning. Nasopharyngeal, pharyngeal, tracheal suctioning is BEYOND scope of prac. Need training!
Steps SLP is involved in
Admission-ventilated via endotracheal tube
Changed to trache, ventilated via trache
Commenced weaning from ventilation
Majority of trache mgt
Note: mgt of trache pt who is weaned from ventilation, can tolerate partial cuff deflation, often at this stage, have been transferred out of ICU, moved to ward
Weaned from ventilation (from this onwards then voicing with cuff deflated)
Commence cuff deflation trials: resume normal anat for full speaking, swallowing, few more days then decannulated
Steps when working w dysphagic trache pt
What is causing the aspiration: medical condition: neurological invl
Nature of aspiration: physiology of swallow that's disrupted, causing aspiration pre, during, post swallow
Commence mgt accordingly
Artificial airway
Why need?
To enable, improve respiratory fn eg. significant cortical damage, brain control for respiration has been disrupted
In presence of impaired respiratory fn or complete respiratory paralysis
To enable respiration to continue in presence of any upper airway obstruction: upper airway oedema, laryngeal cancerous growth tumour in pharynx, larynx causes reduction in airway opening, restricts capacity to breathe
For surgical pts (H&N, upper spinal), trauma pts (spinal cord injury), ICU patients, neurological conditions (stroke, TBI), degenerative disorders (MND), respiratory disorders (COPD)
Types
Short term tubes: to make sure tongue X fall back (oral, nasopharyngeal airways): few hours only
(NO SLP)
Endotracheal tubes: days, up to 2 weeks and in b/w VFs.
(SLP invl may be required for speech, swallow post extubation)
.
Trache tubes: long term intubation
(SLP invl for speech, swallow during, after intubation staff rehab in ICU)
Defns
Tomy:
surgical procedure to provide artificial airway. Incision 1cm above sternal notch, stoma created b/w 3-4 tracheal rings below level of larynx, vertical skin incision for easier insertion, removal and for more normal laryngeal excursion
Stomy:
is the opening created during tomy procedure, stomy tube is placed into incision to create an open, artificial airway. Opening aka stoma is temporary