Tracheostomies

Question 1

complications

Answer 1

• obstruction
• misplacement
• bleeding
• tissue emphysema / pneumomediastinum
• pneumothorax

Question 2

rx: minor bleeding in tracheostomy

Answer 2

• apply pressure
• consider adrenaline soaked swab
• do not remove (inflate cuff if present) to tamponade

Question 3

rx: major bleeding with trache

Answer 3

• artery forcep - call surgeons
• do not remove trache
• inflate cuff

Question 4

KEY: laryngectomy patients

Answer 4

NO upper airway
OBLIGATE NECK BREATHERS
cannot be ventialted through mouth or nose

Question 5

what to do in trache emergency?

Answer 5

call for senoir help - anaesthetics and ENT

Question 6

rx: obstructed cuffed tracheostomy

Answer 6

deflate cuff and allow air to flow around trache to buy time until anaesthetics come

Question 7

rx: blocked dual cannula trache

Answer 7

inner tube may be blocked by secretions

Question 8

important to remember in dual cannula trache with BVM

Answer 8

that both cannulae are in to bag valve mask ventilate - ensure inner cannula is in

Question 9

rx: obstructed trache with speaking valve

Answer 9

take out valves and cap

Question 10

rx: tracheostomy emergency

Answer 10

1. apply O2 to face AND tracheostomy tube unless known to be laryngectomy - then only to trache
2. remove stoma cover, cap, speaking valve, inner tube
3. assess patency of tube - attempt to pass suchtion catheter
4. if stoma not patent (catheter cannot pass), deflat ecuff
5. if apnoeic and patent upper airway ventilate upper airway (cover stoma with swabs/hands)
6. if apnoeic and end stoma - ventilate via laryngectomy stoma

Question 11

rx: trache obstruction

Answer 11

• look, listen feel to check for trache patency
  1. ask patient to cough to bypass obstruction
  2. if patent and patient ventilating apply O2 to trache site and wait for anaesthetics
  3. if not patent - remove speaking valves, caps and inner tubes
  4. attempt to pass soft suction catheter to check patency and remove secretions
  5. if trache not patent, deflate cuff and assess mouth and nose airway to see if ventilation is now occuring
  6. if airway not patent after deflating cuff, remove trache and administer O2 anaesthetic bleep
  7. attempt to ventilate via nose and mouth, LMA or cannulate stoma and look listen feel for ventilation (LMA can be placed over stoma)

Question 12

preventing trache obstruction

Answer 12

humidify airway and inspired gas in new tracheostomies to prevent secretion blockage

Question 13

what should not be prescribed in new trache obstruction

Answer 13

saline nebs

Question 14

rx: dislodged trache

Answer 14

• ABCDE approach
• if patient can ventilate wait for anaesthetics to arrive
• if obstruction caused dislodgement - follow obstruction pathway
• best place for reinsertion is operating theatre - do not attempt to reinsert

Question 15

rx: bleeding trache

Answer 15

usually soon after insertion
* minor = direct pressure (do not compromise airway) with adrenaline soaked swabs
* major = surgeon to place artery forceps on vessel
* DO NOT REMOVE TRACHE OR DEFLATE CUFF

Question 16

rx: surgical emphysema

Answer 16

• potentially life threatening
• inform anaesthetics/ICU
• could cause pneumomediastinum if +ve pressure ventilation applied causing difficult intubation

Question 17

rx: pneumothorax trache

Answer 17

• usually at time of insertion
• contact ICU and surgeons