Chotsekeka kapena Chotayika cha Tracheostomy Tube: Kuchotsa Mkati mwa Cannula, Kuyamwa, ndi Kutulutsa Mpweya wa Stoma¶

Tracheostomy kapena laryngectomy airway emergency imachitika pamene chubu chopumira chomwe chimayikidwa kutsogolo kwa khosi (** stoma ) chimalumikizidwa ndi chowuma, chowumitsidwa ** phula lamadzi ** kapena kutsekeka kwa magazi, kumatuluka mumphepo kupita ku ziwalo zofewa za khosi ( thirakiti labodza / kusamuka kwapang'onopang'ono * kuchotsedwa kwathunthu ), kuchotsedwa kwathunthu * , kusamuka pang'ono. Chifukwa ubongo umavutika ndi kuvulala kosasinthika kwa hypoxic mkati mwa ** 3 kwa mphindi 5 ** ya kutsekedwa kwathunthu kwa mpweya, wodwala kupuma, cyanotic neck-stoma sangathe kudikirira kuti ambulansi ifike: osamalira mabanja ndi oyankha oyambirira ayenera kutsatira ndondomeko yopulumutsira, 60-yachiwiri-pamanja yopulumutsira yopangidwa ndi National Project Tracheostomy Bungwe la National Tracheostomy Safety* Chofunika kwambiri, muyenera kusiyanitsa nthawi yomweyo pakati pa mitundu iwiri yosiyana ya odwala a khosi: (1) Wodwala Wokhazikika wa Tracheostomy (omwe akadali ndi larynx [bokosi la mawu] kulumikiza chitoliro chawo kukamwa ndi mphuno, kutanthauza kuti akhoza kutulutsa mpweya kudzera m'khosi kapena m'kamwa / mphuno ngati khosi la khosi ndi stomaient) ("Obligate Neck Breather")**, amene bokosi lake lonse la mawu linachotsedwa opaleshoni chifukwa cha khansa ya mmero ndipo mphuno yake yamphepo imasokedwa mpaka kalekale pakhungu la khosi ndi ziro kugwirizana pakamwa kapena mphuno (kutanthauza kupuma kwapakamwa ndi pakamwa kumapita 100 peresenti m'mimba ndipo sikumachitira kanthu mapapu). Ngati wina amene ali ndi chubu chopumira m'khosi kapena stoma akupuma mpweya, kukokera kolala yake, kumveketsa mluzu, kutembenuza milomo kukhala buluu, kapena osayankha, imbani foni kwanuko. manambala angozi nthawi yomweyo poyambitsa ndondomeko yamkati ya cannula ndi kuyamwa pansipa. Onaninso maupangiri okhudzana ndi ma airway pa kutsamwitsidwa ndi kutsekereza mpweya thandizo loyamba, epiglottitis, croup, stridor, ndi kutsekeka kwa mpweya,ndi hemoptysis ndi kutulutsa kwakukulu kwa mpweya.

Chifukwa ** 75 peresenti ya zopinga za tracheostomy zimathetsedwa mu masekondi 5 pongotulutsa cannula yamkati yochotsamo ** (yomwe imakoka pulagi yolimba ya ntchofu pomwe mukusiya chubu chakunja motetezedwa mumphepo yamkuntho), kusuntha kwanu koyamba ndi **musatulutsenso machubu onse a tracheostomy poyamba: nthawi zonse mumachotsa zotsekera zakunja.

Chitani izi tsopano¶

1. Imbani nambala yanu yadzidzidzi yakudera lanu pa sipikala nthawi yomweyo ndikuwonetsa wodwalayo khosi ndi pachifuwa chake ali opanda kanthu. Imbani 911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, 000 ku Australia, kapena onani mndandanda wathu wa manambala angozi. Nenani momveka bwino kuti: "Kuika moyo pachiswe kutsekeka kapena kutayika kwa tracheostomy / laryngectomy chubu: wodwala ali ndi vuto lalikulu la kupuma / cyanotic."
2. CHOCHITA 1 (Chotsani Zipewa + Kokani Cannula Yamkati Nthawi yomweyo):
3. Chotsani ** valavu yolankhula (Passy-Muir valve) **, ** decannulation cap **, kapena ** Heat and Moisture Exchanger (HME) fyuluta ** yolumikizidwa kumtunda wa chubu.
4. Gwirani khosi lathyathyathya (flange) la chubu lakunja la tracheostomy mosasunthika molunjika pakhosi ndi zala ziwiri za dzanja limodzi, ndi dzanja lanu lina **tsina kapena kupindika-tsegulani mphete yamkati (cannula yamkati) ndikuikoka molunjika mokhotakhota pansi **.
5. Yang'anani mkati mwa cannula yomwe yachotsedwa: ngati pulagi yokhuthala ya ntchofu zouma zachikasu/zobulauni kapena magazi ali mkati mwake, mwapulumutsa moyo wa wodwalayo. Siyani chubu chakunja pamalo ake, mulole wodwalayo apume (kapena ikani cannula yoyera yamkati), ndipo perekani mpweya wochuluka pachubu pakhosi.
6. CHOCHITA CHACHIWIRI (Ngati Chotsekeredwabe: Pitsani Catheter Yosinthika Pansi pa chubu kuti Muyese Kupirira):
7. Popanda kukakamiza, yesani kutsetsereka katheta woyamwa wosabala kupyola mu chubu chakunja cha tracheostomy (10 to 12 centimeters [4 to 5 inches]).
8. Ngati catheter idutsa mosavuta pamphepo: Yatsani kuyamwa (100 to 150 mmHg mwa akuluakulu, 80 to 100 mmHg kwa ana) ndikuyamwa ntchofu kwa osapitirira masekondi 10 potulutsa catheter (musalowetse madzi a saline pansi pa chubu, omwe amatsuka mapulagi a ntchofu ndikutsitsa mpweya).
9. Ngati catheter igunda khoma lolimba la 3 mpaka 5 centimita ndipo SINGAdutsa: Chubu chakunjacho chimalumikizidwa kunsonga yake OR chatuluka mumphepo kulowa m'khosi (ndime yabodza). Pitirizani pomwepo ku Gawo 3.
10. CHOCHITA CHACHITATU (Tetezani Khafi ya Tracheostomy Konse ndi Sirinji ya 10-mL):
11. Yang'anani pulasitiki yaing'ono yolendewera baluni yoyendetsa ndege yolumikizidwa m'mbali mwa chubu la tracheostomy. Ikani syringe yopanda kanthu 10-mL Luer-slip syringe ku valavu yoyendetsa ndi kokerani pa plunger mpaka baluni ya woyendetsayo ayamwidwe kwathunthu.
12. Kupukuta baluni yamkati kumatsegula malo * mozungulira * kunja kwa chubu chotsekeka kapena chosasunthika kotero kuti wodwala tracheostomy amatha kupuma nthawi yomweyo kudutsa chubu kudzera m'mawu ake, pakamwa, ndi mphuno.
13. CHOCHITA 4 (Ngati Wodwala Akadali Wotsekeredwabe Ndi Kuwonongeka Pambuyo Kuphwanyidwa Kwa Cuff: Chotsani Thupi Lonse la Tracheostomy Nthawi yomweyo):
14. Kachubu ka tracheostomy kotsekeka kapena kosiyidwa m'khosi kamakhala koopsa. Dulani kapena kumasula zomangira za khosi la Velcro, onetsetsani kuti khafuyo yatsekedwa (pavuto lalikulu ngati palibe syringe, dulani mzere wochepa wa inflation pamwamba pa baluni yoyendetsa ndegeyo ndi lumo kuti muchepetse khafu nthawi yomweyo), ndipo **kokani chubu lonse la tracheostomy mokhotakhota kutsogolo ndi pansi **.
15. Chubu chotchingacho chikatuluka, m'malo mwake ndi choyera spare tracheostomy chubu (kapena chichubu chaching'ono chaching'ono) chochokera m'kati mwa bedi pogwiritsa ntchito mafuta osungunuka m'madzi ndi obturator yopindika, kuchotsa obturator nthawi yomweyo chubu lilowa.
16. SITEPI 5 (Ngati Wodwala Sakupuma Kapena Sakutha Kutulutsidwanso: Phunzirani Pakhosi Pakhosi kapena Pakamwa):
17. Kwa Wodwala Wa Laryngectomy Wonse (Chizindikiro cha Green NTSP / "Neck Breather"): Ikani chigoba chakumaso cha ana (kapena chotchinga chozungulira cha laryngeal mask) molunjika pakhosi stoma yotseguka ndikufinya chikwama chotsitsimutsa (kapena perekani kupuma kwapakamwa ndi stoma). Osawombetsa mkamwa mwa munthu amene ali ndi vuto lochotsa khosi.
18. Kwa Wodwala Wokhazikika wa Tracheostomy (Chizindikiro cha NTSP cha Bedside Yellow/Blue NTSP): Mutha kutulutsa mpweya mwina mwachindunji pakhosi pa stoma ndi chigoba cha ana (pomwe wothandizira amatsina mphuno ndi kutseka pakamwa kuti mpweya usatuluke pamwamba) KOR kupyolera mkamwa ndi mphuno kwinaku mukukankhira chotchinga chapakhosi kuti muyimitse mpweya. kutulutsa khosi.

Mtengo wosankha: National Tracheostomy Safety Project (NTSP) algorithm yadzidzidzi¶

flowchart TD
    Start["Wodwala wa Neck Stoma (Tracheostomy kapena Total Laryngectomy) Ali ndi Kupsinjika Kwambiri Kwakupuma, Stridor, Cyanosis, Apnea, kapena Dislodged Tube"] --> CheckType{"Khwerero 1: Dziwani Anatomy ya Airway (Chongani Chizindikiro Chaku Bedi Kapena Funsani Banja): Kodi Iyi Ndi Tracheostomy Yokhazikika (Larynx Present) KAPENA Kuchotsa Thupi Lonse (Palibe Larynx, Kupuma Pakhosi Lokha)?"}

    CheckType -->|"Standard Tracheostomy OR Laryngectomy yokhala ndi Tube/Batani Pamalo"| RemoveInner["Khwerero 2: Chotsani Sefa Yolankhula Iliyonse, Kapu, kapena HME Nthawi yomweyo + Tulutsani INNER CANNULA (Fufuzani Pulagi ya Mucus)"]

    RemoveInner --> CheckCatheter{"Gawo 3: Kodi Airway Tsopano Yatsegulidwa? Yesani Podutsa Catheter Yosinthika Yoyamwa Pansi pa chubu"}

    CheckCatheter -->|"INDE: Catheter Yoyamwa Imadutsa Mosavuta Mu Trachea"| SuctionClean["Suction Mucus (Pansi pa Masekondi 10), Ikani Cannula Yoyera ya Spare Inner, Ikani Oxygen Wonyezimira Wapamwamba Pamwamba pa Mimba Ndi Pankhope Zonse, ndi Monitor"]

    CheckCatheter -->|"NO: Suction Catheter Igunda Resistance / Catheter Pass (Tube Yatsekedwa Pa Nsonga Kapena Imathamangitsidwa mu False Neck Tract)"| DeflateCuff["Khwerero 4: Tsitsani Khafi Konse Ndi Sirinji ya 10-mL (Imalola Wodwala Tracheostomy Kupumira Mozungulira Chubu Kudzera Mkamwa/Mphuno)"]

    DeflateCuff --> CheckImproved{"Khwerero 5: Kodi Kuchepetsa Cuff Kubwezeretsa Kupuma?"}

    CheckImproved -->|"INDE: Wodwala Kupuma mozungulira Tube"| O2Transport["Ikani Chigoba cha Oxygen Chothamanga Kwambiri Pamaso ndi Pakhosi Stoma; Yembekezerani Gulu la Emergency Airway kuti lisinthe Tube"]

    CheckImproved -->|"NO: Wodwala Akadali Wotsekeredwa, Cyanotic, kapena Osayankha"| PullTube["Khwerero 6: Chotsani Tchubu YONSE YA TRACHEOSTOMY MNTHAWI YOMWEYO (Bwezerani Maulalo a Pakhosi & Tulutsani ku Downward Arc)"]

    PullTube --> CheckStomaAge{"Khwerero 7: Yang'aniraninso Kupuma Kupyolera M'khosi Lotseguka Ndikuwona Ngati Stoma Yakhazikitsidwa (Kupitilira Masiku 7 mpaka 10) kapena Yatsopano (Pansi pa Masiku 7)"}

    CheckStomaAge -->|"Wosamalira Wophunzitsidwa Ali Ndi Sipachubu Chapa Bedi (Kukula Kofanana kapena 1 Kucheperako) & Stoma Kupitilira Masiku 7"| Reinsert["Mafuta a Spare Tube (Wokhala Ndi Obturator Mkati), Lowetsani Mofatsa Mu Stoma, Chotsani OBTURATOR MNTHAWI YOMWEYO, Tsimikizirani Kukwera kwa Chifuwa."]

    CheckStomaAge -->|"Stoma Yatsopano Yopangira Opaleshoni (Pansi pa Masiku 7) KAPENA Kubwezeretsa Kulephera / Odwala Apneic"| EmergencyVent["Khwerero 8: KUPULUKA KWA DZIWA ZOPHUNZITSA (OSATI KUKAKAMIKIZA CHIKOMBOLO M'TCHAKA LABWINO LA MASIKU 7): 1. NTCHITO YONSE YA LARYNGECTOMY: Ventilate Pokhapokha pa Neck Stoma (Chigoba cha Ana); 2. TRACHEOSTOMY: Ventilate Pakhosi Pakhosi (Tsekani Pakamwa/Mphuno) KAPENA Ventilateni Pakamwa-ku-ku-Mask Pamene Mukusindikiza Pakhosi Stoma Ndi Gauze"]

Kusiyana kwakukulu kwa anatomical: Standard Tracheostomy vs. Total Laryngectomy ("Neck Breather")¶

Musanakhudze wodwala aliyense yemwe ali ndi bowo kutsogolo kwa khosi lake, wosamalira aliyense, wothandizira opaleshoni, ndi namwino ayenera kudziwa kusiyana pakati pa tracheostomy ndi total laryngectomy:

Anatomy ya Tracheostomy Tube: Magawo 5 Omwe Muyenera Kudziwa Pavuto¶

Kuti mugwiritse ntchito njira yopulumutsira popanda mantha, dziwani zigawo zisanu za munthu wamkulu kapena mwana wa tracheostomy chubu (monga Shiley, Portex, kapena Bivona chubu):

1. The Outer Cannula ndi Neck Flange (Faceplate): Pulasitiki yayikulu yokhotakhota kapena chubu la silikoni lomwe limakhala mkati mwa trachea, lozikika lathyathyathya kutsogolo kwa khosi ndi zomangira zofewa za Velcro zopindika m'mapiko awiri a khosi flange. Kukula kwenikweni kwa chubu (mwachitsanzo, Size 8.0 kapena 7.0 mm mkati mwake) amasindikizidwa pa flange.
2. The Removable Inner Cannula (Machubu Awiri-Cannula): Kabokosi kakang'ono ka pulasitiki kamene kamasenda bwino mkati ka cannula akunja ndi kutsekera pakati ndi loko kota-turn twist lock kapena kanema wa zala ziwiri. Chifukwa chakuti mpweya wokoka mpweya umadutsa m'mphuno mwachibadwa kutentha ndi chinyezi, mamina amatuluka mkati mwake. Kutulutsa cannula mkati kumatenga masekondi a 2 ndikuchotsa 99 peresenti ya kutsekeka kwa lumen popanda kusokoneza thirakiti la stoma pakhosi. (Zindikirani: Machubu ambiri a ana a tracheostomy ndi machubu ena apadera otha kusintha okhala ndi lumini imodzi ndi machubu a cannula imodzi opanda kanula wamkati chifukwa chitoliro cha mwana n’chopapatiza kwambiri moti sichingagwirizane ndi makoma apulasitiki a pulasitiki; mu chubu cha ana, ngati katheta sangadutse, muyenera kusintha chubu chonsecho nthawi yomweyo).
3. The Inflatable Cuff and External Pilot Balloon: Machubu okhotakhota a tracheostomy ali ndi baluni yofewa yocheperako yomwe imakulungidwa kumapeto kwa cannula yakunja mkati mwa chitoliro champhepo (yokwiriridwa ndi mpweya kudzera pa chubu chopyapyala chakumbali chomwe chimathera mubuluu wakunja baluni woyendetsa). Khafu ikatenthedwa, ** 100 peresenti ya mpweya uyenera kudutsa pakati pa chubu chapulasitiki **; palibe mpweya umene ungadutse kunja kwa chubu kukafika ku zingwe za mawu kapena pakamwa.
4. ** Makapu, Mavavu Olankhula (Passy-Muir Valve), ndi Zosefera za HME:**
5. Kusinthanitsa Kutentha ndi Chinyezi (HME / "Swedish Nose"): Sefa yaing'ono ya siponji yotsekeredwa panja kuti igwire kutentha ndi chinyezi; ngati wodwala atsokomola phlegm yayikulu mu sefa ya HME, imamangika nthawi yomweyo ngati nsonga yonyowa.
6. Vavu Yolankhula Kunjira Imodzi (Vavu ya Passy-Muir, yomwe nthawi zambiri imakhala yofiirira kapena aqua): Imalola mpweya kulowa mu chubu pokoka mpweya, kenako imatseka potulutsa mpweya kukakamiza mpweya * kuzungulira* chubu kukwera kudzera m'mawu kuti wodwala athe kuyankhula. Vavu yoyankhulira kapena kapu yotsekera siyenera kuikidwa pa chubu pamene khafuyo yawonjezedwa: kutero imatchera mpweya wokokera m'mapapo ndi zero njira yotulutsira, zomwe zimayambitsa kupsinjika kwamphamvu kwa pneumothorax ndikuzimitsidwa mkati mwa masekondi 60.
7. The Obturator (Introducer): Ndodo yapulasitiki yosalala, yozungulira yokhala ndi chogwirira chomwe chimalowa mkati mwa chubu chilichonse chatsopano cha tracheostomy. Musanalowetse chubu cholowa m'khosi, mumalowetsa obturator mkati mwa chubu chakunja kotero kuti nsonga yake yosalala yooneka ngati chipolopolo itulukire pansi ndikulondolera chubucho pang'onopang'ono mu trachea popanda kukanda khoma lakumbuyo. **WOPHUNZITSIRA AMAtsekereza chubu ALI MKATI PAMODZI: microsecond chubu chatsopanocho chimalowa m'khosi, muyenera kutulutsa obturator molunjika kuti wodwalayo apume **, kenaka lowetsani cannula mkati mwake.

The "Fresh Stoma (<7 Days)" vs. "Mature Stoma (>Masiku 7 mpaka 10)" Lamulo Lochotsa Mwangozi¶

Pamene chubu cha tracheostomy chagwa mwangozi kuchokera m'khosi (**kuchotsedwa mwangozi ** panthawi ya chifuwa, kutembenuka pabedi, kapena wodwala wosokonezeka akukoka chubu), momwe mumayankhira zimadalira kwambiri **masiku angati apitawo opaleshoni ya tracheostomy inachitidwa **:

1. Wokhwima, Wokhazikitsidwa ndi Tracheostomy Tract (Kuposa Masiku 7 mpaka 10 Pambuyo pa Op)¶

Pambuyo pa masiku 7 mpaka 10, minofu ya granulation ndi khungu zachira kukhala mumsewu wosalala, wodziwika bwino wa ulusi womwe umalumikiza khungu la khosi polowera mu trachea. - Momwe Mungakhazikitsirenso Chubu Chotsalira Chaku Bedi Pakhomo: 1. Ikani wodwalayo pamsana pake ndi chopukutira pansi pa * mapewa ** (kuti atambasule khosi mofatsa ndikubweretsa trachea pafupi ndi khungu). 2. Tsegulani wosabala muchubu wocheperako wa tracheostomy (kapena ngati stoma wayamba kale kuchepa pakatha mphindi 15 mpaka 30, tsegulani chubu chaching'ono chaching'ono). 3. Tsimikizirani kuti obturator ili mkati mwa chubu chakunja, tsitsani khafu kwathunthu, ndipo valani kunsongako mopepuka ndi mafuta osungunuka osungunuka m'madzi (kapena saline wosabala). 4. Phatikizani m'mphepete mwa khungu la khosi stoma pang'onopang'ono ndi zala ziwiri, lowetsani nsonga ya chubu molunjika kukhosi poyamba, ndiyeno **pindani dzanja lanu pansi kupita pachifuwa mu arc yosalala ngati C ** pamene chubu chikulowa mumphepo yamkuntho. 5. ** Kokani obturator olimba kunja nthawi yomweyo ** ndi dzanja limodzi mutagwira khosi lopindika pakhungu ndi dzanja lina, ikani cannula yamkati, ndikuteteza zomangira za khosi la Velcro bwino (kulola ** chala chimodzi ** kuti chigwirizane pakati pa tayi ndi khosi). 6. Tsimikizirani Makhazikiko Owona a Tracheal: Imvani ndikumvetsera mpweya wofunda ukutuluka pakati pa chubu, yang'anani chifuwa chikukwera molingana, ndipo onetsetsani kuti catheter yoyamwa imadutsa bwino pansi pa chubu. 10 to 12 cm. Osakakamiza chubu ngati mukumva kukana.

2. Fresh Post-Operative Tracheostomy (<7 Masiku Akale, Makamaka Percutaneous Dilational Tracheostomy)¶

Masiku 7* oyamba atapangidwa tracheostomy m'chipinda chopangira opaleshoni kapena ICU, palibe njira yolumikizira ulusi. Zigawo zapakhungu, minofu yomangira, chithokomiro cha chithokomiro, ndi pre-tracheal fascia zimakhala ngati mapepala onyowa pamabowo amphepo; pamene chubu chikutuluka, minofu ndi mafuta zigawozo zimatsetsereka wina ndi mzake ngati chotsekera cha kamera, kubisa dzenje la mphepo yamkuntho kwathunthu. - Chifukwa Chake Kubwezeretsa Akhungu M'mimba Mwatsopano Kukhoza Kupha: Ngati woyankha wosaphunzitsidwa ayesa kukankhira chubu cha tracheostomy mwachimbulimbuli podula khosi (<7-day) mwatsopano (<7-day) khosi, *chubucho pafupifupi nthawi zonse chimaphonya dzenje la mphepo ndikubowola kutsogolo kwa trachea kulowa mu mediastinum) (kupanga zabodza). - Zoyenera Kuchita Zadzidzidzi Kwa Tracheostomy Watsopano (Masiku 7): Pokhapokha ngati katswiri wodziwa bwino za kayendedwe ka mpweya atagwiritsa ntchito fiberoptic bronchoscope kapena tracheal hook, MUSAJIKIZE mokakamiza chubu kukhala stoma yatsopano. M'malo mwake, kuphimba ndi kusindikiza khosi lopaka khosi mwamphamvu ndi chotchinga chosabala chopanda pake ndi dzanja lanu, tsegulani njira yapamwamba yopita kumtunda ndi kukweza mutu / chibwano, ndi kutulutsa mpwa wodwala kuchokera pamwamba pakamwa ndi mphuno pogwiritsa ntchito thumba-valve-mask ** pamene ntchito zadzidzidzi zikukonzekera oral endotracheal intubation. *(Kupatulapo: yang'anani mozama pakhosi pa stoma ya ulusi wa nayiloni wakuda kapena wabuluu wojambulidwa pakhungu la pachifuwa lolembedwa kuti "Stay Sutures"; popanga opaleshoni ya tracheostomies, madokotala ochita opaleshoni nthawi zina amasokerera zingwe ziwiri mumphete za tracheal kotero kuti kukokera pang'onopang'ono mmwamba ndi kunja kwa zingwe zonse zapakhungu zimakoka kumanja.

Chidziwitso Chadzidzidzi Chidziwitso: Kutuluka magazi kuchokera mu chubu la Tracheostomy (Tracheoinnominate Fistula "Herald Bleed")¶

Ngakhale timitsempha tating'onoting'ono tokhala ndi magazi a pinki titha kuchitika chifukwa cha mpweya wouma kapena kuyamwa mwamphamvu, magazi aliwonse ofiira owala kwambiri akutuluka kapena kutuluka mu chubu cha tracheostomy (ngakhale chifuwa chaching'ono cha mamililita 10 chamagazi ofiira owala chomwe chimaima chokha) ndi opaleshoni yadzidzidzi isanu yotchedwa **Tracheoinnominate.

Zomwe Ziyenera Kukhala Mkati mwa Bedi la Wodwala Aliyense & Kuyenda "Go-Bag" Tracheostomy Emergency Kit¶

Munthu aliyense amene akukhala pakhomo ndi tracheostomy kapena laryngectomy ayenera kusunga, odzipatulira, olembedwa bwino Airway Emergency Kit pamutu pabedi lake NDI kupachikika pa chikuku chawo kapena chikwama pamapewa nthawi zonse pochoka panyumba:

• Machubu awiri osabala a tracheostomy: Limodzi mwa kukula ndendende ndi mtundu lomwe lili pakhosi pano, KUWONJEZERA limodzi chubu chaching'ono chaching'ono (mwachitsanzo, ngati wodwala wavala Kukula 8.0, kunyamula zotsalira 8.0 ndi Kukula kochepa 7.0 kapena 6.0 ngati stoma ichepa panthawi yadzidzidzi).
• Sungani ma cannula oyera amkati ndi botolo la madzi osungunula mafuta odzola (kuphatikiza ma ampule a saline osabala).
• Makina oyamwa oyendetsedwa ndi batire okhala ndi batire yathunthu komanso wosabala ma catheter oyamwa osinthika (kukula moyenera: kukula kwa chubu kuchulukitsidwa ndi 1.5 ku 2 amapereka kukula kwa catheter ya ku France; mwachitsanzo, Kukula 8.0 chubu amagwiritsa a 12 Fr kapena 14 Fr kuyamwa catheter).
• 10-mL syringe yopanda kanthu ya Luer-slip (yokhayo yofewetsa/kukulitsa khafu) ndi malumo a bandeji* (podula zomangira khosi zolimba pakasekondi imodzi).
• Tracheostomy Velcro neck neck, tracheal dilator (Trousseau dilator) ngati itayikidwa, ndi Masefa a Heat and Moisture Exchanger (HME) kuteteza mpweya wouma kuti usatuluke mapulagi am'tsogolo.
• Laminated National Tracheostomy Safety Project (NTSP) Bedside / Wallet Card kufotokoza momveka bwino ngati wodwalayo ali ndi Tracheostomy (Green/Yellow) kapena Total Laryngectomy (Red/Obligate Neck Breather), tsiku limene stoma linapangidwira, chifukwa cha stoma, ndi kukula kwake kwa chubu.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

Zadzidzidzi zotsekedwa kapena zotayika za tracheostomy zimafuna kuyankha mwachangu kwa Advanced Life Support (ALS) ndi zoyendera zachipatala:

• United States ndi Canada: Imbani 911. Nenani momveka bwino ngati wodwalayo ndi tracheostomy kapena total laryngectomy ("kupumira khosi") wodwala. Imayendetsedwa pansi pa American Heart Association (AHA) BLS/ACLS Stoma Ventilation Guidelines ndi AAO-HNS Tracheostomy Consensus.
• United Kingdom: Imbani 999 kuti mupeze ambulansi ya Gulu 1. Ma ambulansi aku UK ndi zipatala amatsatira mtundu wa ** National Tracheostomy Safety Project (NTSP) Emergency Algorithms ** (yovomerezedwa ndi ** Resuscitation Council UK **, **DAS **, ** Intensive Care Society **, ndi ** ENT UK **).
• European Union: Imbani 112. Imayendetsedwa pansi pa European Resuscitation Council (ERC) ndi EAMS tracheostomy protocols.
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand (ANZICS ndi ANZCOR Guideline 4).
• India ndi Asia-Pacific: Imbani 112 (kapena 108 ku India), 995 ku Singapore, 119 ku Japan ndi South Korea, kapena 999 ku Malaysia ndi Hong Kong.

Mafunso omwe amafunsidwa pafupipafupi¶

Nchifukwa chiyani nthawi zonse muzitulutsa kanula wamkati kaye m'malo motulutsa chubu chonse cha tracheostomy pamene wina akupuma mpweya?¶

Mu chubu cha dual-cannula tracheostomy chubu, chubu chakunja chimatsegula stoma ya khosi mkati mwa chimphepo champhepo pomwe mawoko amkati ochotsamo (mkati mwa cannula) amagwira phlegm ndi ntchofu zouma zouma. Zoposa 75 peresenti ya kutsekeka kwadzidzidzi kwa tracheostomy kumachitika chifukwa cha pulagi yolimba ya mamina yomwe imamatira mkati mwake. Kupotoza kapena kumasula cannula yamkati ndikuyikoka molunjika kumatenga masekondi atatu okha, kumakoka pulagi yotsekereza kunja kwa thupi, ndipo nthawi yomweyo imabwezeretsa mpweya wabwino, wotseguka kwambiri kudzera mu chubu chakunja popanda chiopsezo chotaya thirakiti pakhosi.

Kodi pali kusiyana kotani pakati pa wodwala tracheostomy ndi laryngectomy kwathunthu ("khosi kupuma") wodwala pa CPR kapena kupulumutsa kupuma?¶

Wodwala wokhazikika wa tracheostomy akadali ndi bokosi la mawu (larynx) pamwamba pa chubu cha khosi, kotero kuti mphepo yawo yamphepo imagwirizanitsidwabe ndi pakamwa ndi mphuno; pamene khofu la tracheostomy lichotsedwa kapena chubu chichotsedwa, mukhoza kuwapumira kudzera pa khosi la stoma (potseka pakamwa pawo ndi mphuno) KAPENA kudzera pakamwa ndi mphuno (potseka khosi la stoma ndi gauze pad). Mosiyana ndi zimenezi, wodwala laryngectomy wathunthu wachitidwa opaleshoni ya opaleshoni ya khansa, ndipo mphuno yawo yamphepo imasokedwa mwachindunji pakhungu la m'munsi mwa khosi lawo ndi ZERO connection kukamwa kapena mphuno. Kuwomba mpweya m’kamwa kapena m’mphuno mwa wodwala laryngectomy kumatumiza 100 peresenti ya mpweya m’mimba mwawo; MUYENERA KUNGOpereka mpweya ndi kupulumutsa mpweya molunjika m'khosi mwawo pogwiritsa ntchito chigoba cha ana.

Chifukwa chiyani kuli kowopsa kuyika valavu yoyankhulira (Passy-Muir valavu) kapena kapu pa chubu cha tracheostomy pomwe khafuyo ili ndi mpweya?¶

Vavu yolankhulira njira imodzi imatseguka pamene wodwala akupuma kuti mpweya ulowe kudzera mu chubu, ndiyeno imatseka kotheratu pamene wodwalayo apuma kotero kuti mpweya wotuluka umakakamizika kuyenda kuzungulira kunja kwa chubu ndikukwera kudutsa mu zingwe za mawu. Ngati chibaluni chopumira chozungulira pansi pa chubu cha tracheostomy chakwera, malo ozungulira kunja kwa chubu amatsekedwa ndi 100 peresenti. Kuyika valavu yoyankhulira njira imodzi (kapena chipewa cholimba) pa chubu chokhala ndi chikhomo chofutukuka kumatanthauza kuti wodwalayo akhoza kuyamwa mpweya m'mapapo awo (kapena sangathe kupuma konse ndi kapu) ndipo ali ndi ZERO way to exhale, kuchititsa kusokonezeka ndi kuphulika kwa mapapo mkati mwa masekondi a 60. Nthawi zonse tsitsani khafu kwathunthu ndi syringe musanaphatikize valavu yoyankhulira kapena kapu.

Kodi ndimapuma bwanji pakhosi lotseguka la khosi ngati ndilibe cholumikizira chapadera cha tracheostomy?¶

Tembenuzani chigoba chaching'ono chokhazikika kapena chotsitsimutsa ana (kukula 0, 1, kapena 2) mozondoka kapena chammbali ndikukanikiza kansalu kofewa molimba ku khungu lakutsogolo kwa khosi pomwe pabowo la stoma lotseguka kuti mupange chisindikizo chopanda mpweya (chigoba cha Size 2 cha laryngeal chofikira mpweya wokhazikika pakhosi chimapangitsanso khosi). Ngati wodwalayo ali ndi tracheostomy yokhazikika (kutanthauza kuti njira yawo yakumtunda imalumikizanabe ndi pakamwa ndi mphuno) ndipo mpweya umatuluka mkamwa mwawo mukafinya thumba pakhosi, khalani ndi wothandizira wachiwiri kutsina mphuno yawo ndikutseka pakamwa pawo kuti mpweya wonse utsike m'mapapo.

Chifukwa chiyani simuyenera kukakamiza chubu la tracheostomy kubwerera ku stoma yatsopano yopangira opaleshoni yomwe ili yosakwana masiku 7?¶

Pamasiku 7 oyambirira atachitidwa opaleshoni ya tracheostomy, minofu yapakati pa khungu la khosi ndi mphepo yamkuntho sinachiritsidwebe kukhala mumsewu wolimba. Ngati chubu chatuluka mkati mwa sabata yoyambayo, minofu yotakasuka ndi minofu imatsetsereka pabowo la pamphepopo ngati katani. Kuyesera kukankhira chubu cholowa m'malo mwakhungu kubwerera ku stoma yatsopano pafupifupi nthawi zonse kumaphonya trachea ndikupanga "njira yabodza" muzofewa zofewa kutsogolo kwa chitoliro; ngati wina afinya thumba la Ambu mu chubu chosokonekeracho, mpweya wothamanga kwambiri umalowa m'khosi ndi pachifuwa, ndikuphwanya chiphuphu champhepo ndikupangitsa kuti pneumothorax iwonongeke. Mu stoma yatsopano yochepera masiku 7, tsekani bowo la khosi ndi yopyapyala ndikutulutsa mpweya kuchokera mmwamba kudzera pakamwa ndi mphuno mpaka akatswiri oyendetsa mpweya afika.

Nditani ngati magazi ofiira owala ayamba kutuluka muchubu cha tracheostomy?¶

Magazi ofiira owala omwe amatuluka mu chubu (ngakhale supuni 1 mpaka 2 yomwe imayima yokha) iyenera kuchitidwa ngati mlonda yemwe angathe kutuluka magazi kuchokera ku tracheoinnominate mtsempha wamagazi fistula, kumene chubu kapena chikhomo chakokoloka kupyola khoma lakutsogolo la mphepo yamkuntho kulowa mumtsempha wothamanga kwambiri. Imbani 911 nthawi yomweyo. Ngati magazi ofiira owala kwambiri ayamba, OSATI kukoka chubu cha tracheostomy; m'malo mwake, gwiritsani ntchito syringe kuti mulowetse chibaluni cha tracheostomy cuff ndi mpweya (mpaka 10 mpaka 50 mL) kukanikiza mtsempha wamagazi pafupa la pachifuwa, kuyamwa njira yodutsa mpweya kuti mapapu asamveke bwino, ndikukonzekera mayendedwe opangira opaleshoni mwadzidzidzi.

Magwero ndi malangizo ovomerezeka¶

• National Tracheostomy Safety Project (NTSP, United Kingdom / International): Malangizo Ambiri Othandizira Kuwongolera Matenda a Tracheostomy ndi Laryngectomy Airway Emergency (McGrath et al., Anaesthesia, universal Green Tracheostomy ndi Red Laryngectomy algorithms pambali ya bedi, kuyesa kwamkati kwa canula, kuchotsedwa kwa cannula, kutsekemera kwa dzuwa, kutsekemera kwa dzuwa, kutsekemera kwa dzuwa ndi kutentha kwa dzuwa. decannulation ya obstructed machubu).
• American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS, United States): Clinical Consensus Statement: Tracheostomy Care (Otolaryngology-Head and Neck Surgery, katundu wopita kwadzidzidzi, okhwima vs. <7-day kasamalidwe ka stoma tract, ndi tracheoinnominate mtsempha wamagazi fistula herald bleed protocol).
• American Heart Association (AHA) & European Resuscitation Council (ERC): Malangizo a Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Ventilation of Patients with Tracheostomies and Stomas.
• Difficult Airway Society (DAS), Intensive Care Society (ICS), Royal College of Anaesthetists, & ENT UK: Malangizo a Tracheostomy ndi Laryngectomy Care ndi Emergency Airway Management.
• Komiti ya Australian and New Zealand on Resuscitation (ANZCOR): ANZCOR Guideline 4: Airway Management (Rescue Breathing and Bag-Mask Ventilation through Neck Stoma).

Maupangiri ogwirizana¶

• Kutsamwitsidwa ndi kutsekereza njira yakunja yakunja thandizo loyamba
• Epiglottitis, croup, stridor, ndi kutsekeka kwapamwamba kwa mpweya
• Hemoptysis (kutsokomola magazi) ndi kukha mwazi kwakukulu kwa mpweya
• CPR wamkulu, kupuma kopulumutsa, ndi kugwiritsa ntchito AED
• CPR ya ana ndi makanda ndikutsamwitsa thandizo loyamba