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Chapter 15. Tracheotomy

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All of the following are reported complications of a surgical airway EXCEPT:

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A. hemorrhage

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B. fracture of the cricoid cartilage

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C. subglottic stenosis

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D. direct injury to the vocal cords

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E. pneumomediastinum

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(D) It would be extremely rare to damage the vocal cords directly while performing a surgical airway (either a cricothyrotomy or tracheotomy) because the site of entry should be below the thyroid cartilage lamina. Only in cases where the landmarks have been severely misjudged and the airway opened in the thyrohyoid space, would damage to the true vocal cords be possible.

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All of the following are potentially likely causes of a patient having decreased oxygen saturation levels in the recovery room following an awake tracheotomy EXCEPT:

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A. pneumothorax

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B. accidental decannulation

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C. tracheotomy tube blocked by blood or secretions

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D. post-obstructive pulmonary edema

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E. pulmonary embolus

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(E) While pulmonary embolism is always a possibility during the postoperative period, given that a surgical tracheotomy procedure tends to be relatively brief and the patient was awake and not paralyzed, it would be a less likely cause of this patient's decreased oxygen saturation.

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Which of the anatomic structures below is the least important to identify prior to making your incision during a tracheotomy?

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A. hyoid bone

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B. tracheal rings

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C. suprasternal notch

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D. cricoid cartilage

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E. thyroid notch

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(B) While palpation of the anterior trachea and its rings is essential once the dissection has reached the airway, palpation of the tracheal rings through the skin is likely the least important of the listed structures to identify and mark prior to tracheotomy.

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