Tracheostomy Examination

Head and mouth ( upper air way obstruction ကိုexclude လုပ္ ခ်င္လို ့ )
neck ( tracheostomy ကို စမ္း ပါ ။ )
Throx
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(1) INSPECTION : Well conscious , no dyspnoeic , no accessory muscle working ,

Head : head inury
facial oedema,injury , burn
eyes - pupils are equil
ear - discharge
nose - discharge

Mouth : Lips - crack ,ulcer
Teeth & gum - helathy or not
Tongue -
Tonsil
Posterior pharyngeal wall - inflammation
Uvula , soft plate & surrounding structures - healthy or not
Mandible - fracture or severe double fracture

(2) Neck : Swelling ( # lewis angina has massive swelling )
Trachea trauma
Cutthroat injury ( # sucidal ( -) /homicidal ( vessels inury +)
Throid surgery scar
Burn injury
Radiation mark
Trocheostomy tube : site -midline , lower part of neck
type - metal ( aspiration risk + ) / non-metal ( Platic with cuff, no need string, 100% no aspiration )
Parts - outer tube and inner tube ( ျဖဳတ္ျပ ႏုိင္ )
tracheostomy wind (2) ( ေတာင္ ပံ ၂ ခု )
tracheostomy soulder (rare) ( စကားေျပာရ လြယ္ေအာင္ လုပ္ထား ရ တယ္။ ဒါမပါဘဲစကားေျပာလို ့ရ ရင္ non functional tube ပဲ)
tracheostomy tape ( string ) ( ၾကိဳး )
ၾကိဳး နဲ ့ လည္ပင္း ၂ ခု ၾကား လက္ညိုွ း ထည့္ၾကည့္
There can insert one index finger (oedema မရ ေအာင္ ေခ်ာင္ေအာင္လုပ္ထားတာ ။)
Nod of tape - R / L side of neck( ဘယ္ညာ မညီပဲ တဘက္မွာပဲ ရွိ ရ မယ္ ။)
Tie - by securely
လက္ကိုအေပါက္ေရွ့ထား ၿပီး ေခ်ာင္းဆိုးၾကည့္ပါ ။ အသက္ ျပင္း ျပင္းရွုၾကည့္ပါ။
tube is funstioning
Dressing က ိုျဖဳတ္ၾကည့္ရင္ - scar ( longitudinal = elective or vertical = emergency )
stitch ( not equal pattern for afraid of surgical emphysema)

(3) chest - intercostal resection
surgical emphysema
trauma ( flail chest ) ဒီ ၃ ခု ကို သိ ခ်င္ ။
Inspection
Palpation - rib ေတြ ဖိၾကည့္--emphysema (+)< 10 days is normal ( from under the jaw to inguinal ligamant)
Percussion
Auscultatioin စမ္းပါ ။
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Others : Tracheostomy Tray ( Night Patient မွာ ပဲ ရွိ မယ္ ။ )
၃ ခု ပါ ရ မယ္ ။ ၁ -- Tray - tracheostomy tube ( အပို ၁ ခု)
Cissors ျဖဳတ္ ဖို ့
Tracheostomy dilator
Suction mechine & suction tap
Water
oxygen ( ready )
၂ -- Book and pen
၃ -- Bell ( for emergency call by patient )


ဘယ္ေတာ့ ျဖဳတ္မလဲ ? indication မ ရွိ ရ င္ ျဖဳတ္ မယ္ ။( temporary tube )
Ca lung and Ca Larynx မွာဆိုရင္ ( permanent ထား ရ မယ္။ )
Tracheostomy weaning ၃ ရ က္လုပ္ရမယ္။ ပထမရက္ - ခဏ ေလး ခဏ ေလး
ဒုတိယရက္ - ၁ နာရီ စီ က်င့္ေပး ။
တတိရရက္ - ၁ ညလံုး
ညအိပ္လို ့ရရင္ ေနာက္ေန ့ န ံ နက္ ဆရာႀကီးေတြ စံုခ်ိန္မွာ ျဖဳတ္လို ့ ရ ၿပီ ။
အေပါက္ပိတ္ ဖို ့ မ လို ပါ ၊ သူ ့ ဘာသာ ျပန္ ပိတ္ မယ္ ။
ျပဳတ္သြားရင္ ဘာလုပ္ မလဲ ? < 24 hours ဆို ရ င္ OT ျပန္ပို ့ ။
မနက္ ထည့္ ည ျဖဳတ္ မ လုပ္ ရ ။ 24 hours ထား ရ မယ္ ။
Fistula well formed ျဖစ္ မွ ျဖဳတ္ ရ မယ္ ။


Indication : To relief upper airway obstruction
To redue dead space
Artificial respiration
As a part of surgery in Ca larynx ( parment tube )
Complication : Immediate - haemmorage
injury
Early - surgical emphysema
tube obstruction
dislodgement
infection
pronation difficulty
feedinf difficlty
Late : stenosis
dependence