Wednesday, 10 December 2008

Tracheostomy in Hokkaido

Dear Bloggers

Today I want to show you some of my recent experiences in Hokkaido. I was invited by Dr K to his hospital to teach the residents.

During my visit, I rounded with the team and also lectured on a very rare complication of atrial fibrillation and on the basics of heart murmurs, added sounds and splitting of the heart sounds.

However, I was very lucky to be able to catch on camera the placement of a tracheostomy tube in a patient with COPD. The photos are obscured in such a way as to maintain the anonymity of the patient. The placement is done by the Seldinger technique (the technique is also used for CVP line and mini chest drain placement etc) which makes a hole in the trachea which is subsequently dilated up and further widened with forceps until the tracheostomy tube can be placed into the trachea proper.

The procedure went without too much problem although the patient repeatedly desaturated during inspection with the bronchoscope as a result of the severe underlying lung disease. Hence, as can be seen below, it required the presence of someone managing the airway / endotracheal tube (Dr T - 2nd year doctor in training), someone to perform the bronchoscopy to check for correct positioning of the needle and trach-tube (Professor M), and two doctors (Dr K and Dr K2 - 4th year doctor in training) to perform the actual trach placement.

The procedure was successfully completed to delight of the doctors and nurses -- and me too! :-)

I was also lucky to be able to see Dr K (above) perform mutilpe variceal ligation (banding) in a patient with previously undiagnosed portal hypertension who presented to the hospital with mild fresh upper GI bleeding but no variceal rupture.

All in all, although I went to teach on various aspects of medicine, I definitely benefited from the experience myself.

Remember, if you think you have ever stopped learning, it is time to hang up your stethoscope.

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