Percutaneous tracheotomy

A more rapid procedure with less tissue trauma and scarring than the standard open surgical technique. It can be performed in the ICU, avoiding the need to transfer patients to theatre. Coagulopathy should be excluded or treated first. Subcutaneous tissues are infiltrated with 1% lidocaine and epinephrine (adrenaline). After a 1-1.5cm midline skin crease incision, the subcutaneous tissue is blunt dissected to the anterior tracheal wall. The endotracheal tube tip is withdrawn to the level of the vocal cords. The trachea is then punctured in the midline with a 14G needle between the 1st and 2nd tracheal cartilages (or lower), allowing guide wire insertion. The stoma is created by dilatation to 32-36Fr (Ciaglia technique) or by a guided forceps dilating tool (Schachner-Ovill technique). In the former case, the tracheostomy tube is introduced over an appropriate sized dilator and in the latter through the open dilating tool. End-tidal CO2 monitoring confirms adequate ventilation during the procedure. Fibreoptic bronchoscopy may be used to confirm correct tracheal placement and no trauma to the posterior tracheal wall, though this may compromise ventilation.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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