tracheostomy scenario
Patient with patent upper airway - trache inserted for slow wean + long term ventilation in context of neuromuscular disease
recently discharge on home ventilation, usually has speaking valve
Today called 999 as was getting more breathless and now in extremis
Patient's spouse is available to clarify details - very anxious - trained to do basic care including suction
- Washes hands introduces self
- confirms patient identity
- clarifies reason for tracheostomy
- Calls for help - anaesthetics/ICU, ENT immediately
- Recognises red vs green algorithm
- Asks for printed flow sheet which patient should have at bedside
- Asks for difficult airway trolley
- Applies high flow oxygen to both face and stoma
- Removes inner tube
- Attempts suction
- Deflates cuff
- Inspects/listens at mouth and trache - patient still gasping and looks cyanosed
- Removes trache tube
- Re-assesses A-E