Whilst this is an elective tracheostomy, it demonstrates the surgical anatomy of the neck & trachea, well for this procedure.
- Note the vertical incision once again, from skin, to fascia, right through tracheal rings. CUT TO AIR as Scott Weingart says! A colleague had to perform an emergency tracheostomy in a true Cannot Intubate/Cannot ventilate case where a cricothyrotomy had failed. The vertical incision extended was the only thing that allowed identification of the trachea and saved the patient’s life.
- There will be blood. Anticipate this. IN the video, the surgeons take there time and achieve good haemostasis as they dissect. In a true emergency you will not have time to do this. It is likely you will not have time to carefully dissect and control bleeders. Dont worry. Blood loss is a secondary priority in the true emergency tracheostomy!
- Note the thyroid isthmus and it being retracted out of the way. Dont worry too much if you miss this. It means you will have more bleeding into the surgical field if you cut the isthmus accidentally. Refer to point 2.
- If you are in a hurry, dont worry about the local anaesthetic!
- Have really good lighting overhead. Even better use a focusable bright head torch.
- Watch this video and mentallyrehearse. Spend some time with an ENT surgeon observing and assisting in this technique.