Tracheostomy (Open and Percutaneous)

Procedure Snapshot

• Indication: Prolonged ventilation or airway obstruction.
• Expected duration: ___
• Special instruments: Tracheostomy set, bronchoscope (for percutaneous).

Step Workflow — Open

1. Supine with neck extended.
2. Horizontal skin crease 2 cm above sternal notch.
3. Divide strap muscles midline; retract thyroid isthmus.
4. Enter trachea between 2nd–3rd rings; insert tube.

Step Workflow — Percutaneous

1. Bronchoscopic visualization; needle entry between 2nd–3rd rings.
2. Seldinger dilation; insert cuffed tube.

Key Pimp Questions

• Q: Early vs late complication? Bleeding vs tracheal stenosis (PMID 31376008).

Critical Anatomy

• Landmarks: Thyroid isthmus, tracheal rings.
• Danger zones: Innominate artery (low trachs).

Informed Consent Highlights

• Bleeding __ Pneumomediastinum __ Tracheal stenosis ___

Post-op Considerations

• Humidified air; first tube change > 5 days.

References

• Chassin’s, Neck surgery. Clinical Scenarios, Airway.
• Dulguerov 2019 (PMID 31376008).