The Artificial Larynx

Image from Protip Medical We have had artificial lungs, artificial hearts, artificial kidneys... but now we also have an artificial larynx. Published in the New England Journal of Medicine in Jan 2017, French researchers described a patient who required the entire voicebox removed (laryngectomy) due to cancer and than implanted with a totally artificial larynx in 2015. This patient is actually the second patient who has undergone artificial laryngeal implantation. The first occurred in 2…

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How Fast Should an Emergency Tracheostomy Take?

Image courtesy of digitalart at FreeDigitalPhotos.net When faced with an emergency airway situation, a surgical airway may be required in order to save a person's life. Such surgical airways include emergency tracheostomy or cricothyroidotomy. The main question here is how quickly should such a procedure take in order for it to be considered a success? Clearly, it should take less than 4 minutes given that is how long a brain can survive without oxygen before permanent damage sets in…

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Deputy Performs Life-Saving Tracheostomy on 12 year old in Car Accident

Image from WYFF4 On Nov 8, 2014, there was a terrible car accident that claimed the lives of 3 young adults and another barely hanging on. EMS workers who arrived on the scene found 12-year-old Cheyenne Queen trapped in the car and barely breathing. A deputy coroner on the scene was called to assess Cheyenne and determined that a trach was the only way to give her a fighting chance at survival. An emergency on-the-field tracheostomy was performed and was felt to have saved her life. On D…

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How a Tracheostomy Hole Heals Closed (Time Lapse)

When a patient undergoes a tracheostomy , it is not a permanent thing. Once a patient is healthy enough, the tracheostomy tube can be removed and the existing hole in the throat will spontaneously start to heal closed. In a process called healing by secondary intention, the body creates granulation tissue along with scarring that slowly but surely closes the trach opening shut. In the rare situation it does not completely close, a surgical procedure can be performed. Here are some pictures…

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JCAHO Mandates Time-Out for Emergency Tracheostomy

Due to confusion from readers, please note that this is a work of satirical fiction . Washington DC August 31, 2014 - Effective September 1, 2014, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has mandated that time-outs must be performed prior to emergency tracheostomy due to any reason, no exceptions. Due to numerous incidences of "never" events and lack of consistent acquisition of consent prior to emergency tracheostomy to treat catastrophic airway…

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Man Sues ENT for Wrongful Tracheostomy

Image from ParaMedicine101 In December 2012, a West Virginia man suffered angioedema causing tongue swelling due to a not uncommon reaction from lisinopril . Presumably due to airway concern from the tongue swelling, an urgent tracheostomy (cutting a hole in the throat) was performed. The patient later filed suit against the ENT who performed the tracheostomy stating that it was unnecessary as the tongue swelling was getting better. [ link ] Although a tracheostomy is not always perf…

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Tracheostomy Fire During Surgery Burning Patient

Image from Wikipedia In early 2012, a surgeon was performing a trach (breathing hole in the neck) when the oxygen used during the procedure caught fire severely burning the patient. Apparently, the surgeon used an electrocautery device which most likely emitted a spark igniting the oxygen being given to the patient leading to the fire. [ link ] What happened? Tracheostomy procedures are performed typically in very sick patients who have been intubated for a prolonged period of time. …

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Scam Tracheostomy in Hospital Leading to Arrests

Image from Wikipedia A Chicago hospital owner and a few doctors were arrested in a horrific scandal involving deliberately  over-sedating patients thereby ensuring a patient will not be able to come off the breathing machine leading to the excuse needed to perform a tracheostomy [ link ]. All done in the name for greater profits. This scandal is particularly notable given it has come right at the heels of a New York Times story  which reported that hospitals often profit from surgical err…

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Celebrity Actors Who Have Received a Trach (Catherine Zeta Jones Included)

Image Taken From www.TopScarCream.com Tracheostomy (also known as trach) is when a hole is made in the midline neck directly into a person's windpipe ( watch video ). Although many people may shy away from this deforming procedure, it can be life-saving. On that note, here is a short list of famous celebrity actors who have undergone an emergency trach for one reason or another: Catherine Zeta-Jones Apparently, when she was a child, she had an emergency trach done. She still has a…

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Is Patient Abandonment in the Operating Room Ever Justified?

I ask this question mainly because there WAS an ENT who WAS sued for NOT abandoning his patient in the operating room [ link ]. No way to verify, but additional details can be found in this facebook post . Imagine this hypothetical scenario (as details from original case are not available)... You are an ENT surgeon in a rural community hospital performing a fairly difficult but elective sinus surgery on a 12 years old child with cystic fibrosis with extensive pan-sinus nasal polypoid d…

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Creative Ways to Wear a Scarf for Patients with a Trach or Ugly Neck Scar

[Watch the video below!!!] Given I operate on the neck not uncommonly... a common fear for a patient is how the incision will look afterwards. For a simple neck mass excision, the incision almost always heals just fine to the point nobody will notice the scar. However, this concern is multiplied a hundred-fold when a patient undergoes a tracheostomy (hole in neck) for severe obstructive sleep apnea or for some other airway reason. It could even be a laryngectomy where the entire voi…

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Singer George Michael With Tracheostomy

Reuters reported today that singer George Michael suffered from severe pneumonia and underwent a tracheostomy during his hospitalization. A tracheostomy is when a hole is made in the throat for a patient to breath through. Here is a video of what his trach surgery may have looked like. Michael apparently was in the middle of a tour when he became ill requiring him to cancel upcoming shows. A tracheostomy is often performed whenever a patient has been intubated (tube down the throa…

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Nasal Congestion Affected By How Well the Nose is Able to Cool Itself

Researchers at Monell Chemical Senses Center have figured out that nasal congestion is influenced by more than just nasal airflow. Apparently temperature and humidity influence the perception of nasal congestion just as much as how physically obstructed the nose is. By having volunteers breath air with variations in temperature and humidity, they have determined that cool and dry air minimizes nasal congestion without any change in how open the nasal cavity is. By taking into account …

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Keychain Emergency Airway Device (Video)

Health professionals who know how to perform cricothyroidotomy to obtain an emergency airway in someone who is obstructing can appreciate a nifty keychain device called LifeStat . LifeStat can be carried around and immediately utilized to perform emergency cricothyroidotomy in any setting. Watch a video here to see how it works. It can be purchase from Shippert Medical for $145 here . Reference: Utilization of the LifeStat emergency airway device . Ann Otol Rhinol Laryngol. 2008 Ja…

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Best Ballpoint Pen for Emergency Cricothyroidotomy?

I recently blogged about a man who choked to death on an airplane and the impossibility of saving this man's life with a surgical airway like a cricothyroidotomy without a sharp object around inside the plane (ie, knife or scalpel). I also stated that "Some surgeons would argue a strong, stiff ball-point pen could have been used to perform the cricothyroidotomy, but as someone who has performed a dozen emergency cricothyroidotomies and tracheotomies in the past, even under the b…

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U.S. Rep. Gabrielle Gifford Gets a Tracheostomy After 7 Days of Intubation

U.S. Rep. Gabrielle Gifford who is recovering from a gunshot wound to the head 7 days earlier had her breathing tube removed and a tracheostomy tube placed on January 15, 2011. Many people will wonder why a tracheostomy tube was placed when she's been intubated for only 7 days and even though she has been able to breath on her own since Tuesday. Along with the trach tube, a stomach feeding tube was also placed. A tracheostomy tube is a small tube placed through an opening in the nec…

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New Video On Performing a Tracheostomy

A new video on performing a surgical tracheostomy has been created by our office and uploaded onto our YouTube channel . Watch the video here or below!

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How a Tracheostomy is Performed Step-by-Step with Pictures

Below is a step-by-step description with pictures of how a tracheostomy is performed. To read more about this procedure as what to expect with swallowing, eating, talking, etc, click here . Step 1:  Neck is sterilized with beta dine to clean the skin and draped to prevent any contamination from the environment. Step 2 : After the incision, underlying fat is removed. Step 3:  Dissection is carried down to the windpipe which is completely exposed in this picture. One can see the faint out…

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Journal Article By Dr. Chang Published in ENT Journal

A new peer-reviewed article by Dr. Chang has been published in the June 2008 edition of ENT Journal . The article titled "Adult-Onset Iatrogenic Tracheomalacia" describes a very unusual case of tracheomalacia that was also stenotic in an adult patient after recovering from a tracheostomy. Click here to read more about it.

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Journal Article by Dr. Chang Published in Journal of Trauma

An article entitled "Neo-Ossification of the Cricothyroid Joint After Elective Cricothyroidotomy: A Case Report and Discussion on the Merits of This Procedure" authored by Dr. Chang has been published in pre-print form online in the Journal of Trauma, a peer-reviewed publication. This article will be published in print in the near future. Click here to view the pubmed stub.

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