7/25/2013

7/25/2013

Answers:

The blood supply to the superior half of the trachea is primarily --- where the blood supply to the inferior half is primarily---
A) Sup. Thyroid, Bronchial Arteries
B) Inf. Thyroid, Bronchial Arteries 
C) Sup. Thyroid, Inf. Thyroid 
D) Sup. Thyroid, Esophageal Artery 
E) Inf. Thyroid, Esophageal Artery

The main vascular supply of the trachea comes from the Sup. Thyroid artery for the superior half and from the various bronchial arteries (sup. Middle and Inf.) for the inferior half.

At what external landmark does the innominate artery cross over the trachea?

The innominate artery cross over the trachea a the level of the sternal notch.

MC Question:

After undergoing a tracheotomy, a patient has been intubated in the ICU for the past two weeks. A resident rounding on the patient notices that the trach tube cuff is overinflated and that the trach tube is poorly positioned. Suddenly the patient begins to bleed profusely from their mouth and trach site? What is the most likely diagnosis?
A) Aortic Arch Aneurysm 
B) Coagulopathy
C) Tracheoesophageal Fistula
D) Tracheoinnominate Fistula

Free Response Questions:
What are the three types of postintubation stenosis?

Quick Facts:
Tracheoesophageal Fistula
-Nonmalignant TEF commonly caused by cuff over inflation.
-Can also be caused by trauma, granulomatous mediastinal processes, prior trach surg, stents.
-Most TE fistulas are acquired malignant from esophageal cancer.
-poor prognosis
-treat palliatively
Signs/Symptoms
-Increased tracheal secretions, gastric secretions are often seen in airway.
-Pt may have massive dilation of stomach and recurrent PNA.
Treatment
-For nonmalignant attempt to correct surgically w/ debridement and 2 layer closure, interpose strap muscle btwn layers.
-For malignant fistula treat as least invasively as possible.
-Esophageal stenting is common.
-Survival is rarely past 1 year.