c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Tracheostomy: 1

A D V E R T I S E M E N T

   
 

The trachea descends into the chest through the superior thoracic aperture at an anterior to posterior angle (refer to other neck folios). It passes behind the aortic arch and the arch vessels straddle the trachea as they ascend. The brachiocephalic artery overlies the trachea just within the superior aperture (arrow) and is at risk if the tracheostomy is placed too low.      

Notes:

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Tracheostomy: 2

A D V E R T I S E M E N T

   
 

The relationship of the brachiocephalic artery to the trachea is seen clearly in the lateral view. For exposure during tracheostomy, the patient is positioned with a roll under the shoulders and the head extended. This elevates more of the trachea out of the chest and exposes more tracheal rings than would be seen in the natural anatomic position. Because the thyroid isthmus normally overlies the second tracheal ring, it is tempting to go below it.      

Notes:

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Tracheostomy: 3

A D V E R T I S E M E N T

   
 

It is safest to divide the isthmus if necessary and use the second tracheal ring. In this position, the curve of the tube assumes a proper position in the center of the tracheal lumen when the neck is flexed after the procedure and the trachea slides down into the chest.      

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This page was last modified on 2/7/1999.