Clinical meaning
A tracheostomy is a surgical opening in the anterior trachea (usually between the 2nd and 4th tracheal rings) with insertion of a tracheostomy tube to establish an airway. It bypasses the upper airway, eliminating the nose and mouth's ability to warm, humidify, and filter inspired air. The cuff (when inflated) seals the airway for mechanical ventilation and prevents aspiration. Loss of airflow through the vocal cords eliminates the patient's ability to speak unless a speaking valve is used.
Exam relevance
Risk factors: - Prolonged mechanical ventilation (> 10-14 days) - Upper airway obstruction - Failed extubation attempts - Neuromuscular disease requiring long-term ventilation - Head and neck cancer - Severe facial or neck trauma
Diagnostics: - Assess tracheostomy site for redness, swelling, drainage, or skin breakdown - Monitor respiratory rate, effort, and oxygen saturation - Assess stoma and surrounding skin integrity - Monitor for tube displacement or obstruction - Observe inner cannula for secretion buildup