Tracheostomy Emergencies

Question 1

What are the primary trach issues for patient in respiratory distress?

Answer 1

obstruction

displaced

Question 2

How do you rapidly r/o the trach as the source of respiratory distress?

Answer 2

oxygen over mouth/nose and trach site
remove any external devices and inner cannula
Inner cannula often gets blocked off
pass soft suction pass
suction catheter passes? not obstructed and in right spot
(consider bronchoscope)

Question 3

Does this patient have a patent upper airway?

Answer 3

Yes - take our tracheostomy tube and manage airway like you always would. Assume difficult airway. Have someone ventilating or blocking air leak.

No - Oxygenate and ventilate through the stoma. Replace trach tube or

Question 4

How do you intubate the stoma?

Question 5

How do you handle bleeding from tracheostomy site?

Answer 5

tiny bleeds - small cautery. Can be a sentinal bleed
‘worse case: Tracheoinnominate fistula

Every patient needs an ENT consult before they go home

direct pressure - hyperinflate the tracheostomy cuff (works 85-90% of the time)
Swap out for cuffed tube

reverse coagulopathy