Tracheostomy emergencies

See GREEN algorithm

possible problems

  • tube displacement
    • migration
    • erosion into tissues
    • dislodgement
    • false passage
  • tube obstruction
    • secretions
    • bleeding (yeah see below)
    • foreign body
  • bleeding
    • granuloma formation
    • erosion into vessel - tracheo-innominate fistula, etc.

immediate management → 'green' vs 'red'

green = upper airway i.e. potentially amenable to oral intubation
red = no upper airway

  • FiO2 100% to tube and face
  • Manually ventilate
  • Remove inner tube → Pass suction catheter
    • partial obstruction?
    • ventilate via trache?
  • If unable:
    • cuff down
    • look/listen/feel at mouth and trache
    • if improves = tube partially displaced
  • If still deteriorating:
    • remove trache tube
    • standard oral airway manoeuvres
    • prepare for difficult intubation
    • use uncut tube BEYOND stoma
    • or intubate stoma 6.0 cuffed ETT

recent tract → patient improves with manual ventilation

  • perforation - posterior trachea or oesophagus
  • wound too large
  • then progress to imaging of some sort
  • if you think there's a perf don't put a bronchoscope in there!!

patient does not improve

#airway #ent #icu

https://derangedphysiology.com/main/required-reading/airway-management/Chapter-313/dislodged-tracheostomy
https://derangedphysiology.com/main/required-reading/airway-management/Chapter-212/complications-percutaneous-and-surgical-tracheostomy
https://tracheostomy.org.uk/healthcare-staff/emergency-care/emergency-algorithm-tracheostomy
https://onepagericu.com/trach-emergencies

Resus OSCE