Tracheostomy Emergencies
“Tracheostomy-related emergencies are rarely encountered in the emergency department but carry high morbidity and mortality.”
We’re back after our short break, and you may have noticed our articles are looking a bit different….namely shorter. We discuss why here .
In this months episode, we were joined by Dr Brendan Mcgrath, Consultant anaethetist and intensivist and head of the National Tracheostomy Safety Project (NTSP).
We discussed:
What is a Tracheostomy
What is a Laryngectomy
The normal Tracheostomy and its care
Transoesophageal punctures
Suctioning Tracheostomies
Humidification requirements and methods
Tracheostomy Complications
Emergency Assessment of the Tracheostomy
Managing Tracheostomy and Laryngectomy emergencies
As we discussed there are loads of fantastic resources on the NTSP website. We suggest you spend some time there, watching some of the video resources and consolidating what we’ve discussed in the podcast.
Get the NTSP app
Take Away Points
Take Away Points
Tracheostomies and Laryngectomies might seem scary, but by understanding their intricacies, and following a simple stepwise approach to them, they really aren’t that difficult to manage.
Tracheostomies are a hole in the hosepipe, this means they don’t have a disconnected upper airway and so we MAY have two airways through which to oxygenate.
Laryngectomies are a separation of the trachea from the upper airways, as a result the laryngectomy stoma is our only option for oxygenation.
The main emergencies we are likely to encounter in these airways are either a tube blockage or a tube dislodgement, but remember… these patients have other co-morbidities too, so not all difficulties in breathing are going to be stoma related… don’t miss the obvious PE whilst you’re looking for the suction.
These patients can often have problems with secretions so consider ways of humidifying the air they breathe, particularly if they require supplementary oxygen.
In an emergency ask yourself do I have 2 potential airways to work with or only one?
In the case of a tracheostomy, look listen and feel and both airways and consider applying oxygen to both. If you’re ventilating via the mouth, don’t forget to occlude the tracheostomy site.
If you’re suctioning an airway, remember to only use a soft tip catheter, no more than 200mmHg of suction and don’t suction further than about 20cm or less if it’s a child or very small adult.
You may need to remove inner tubes and outer tubes if you’re unable to suction or improve the situation, remember to do this in a step wise format, reassessing after each stage.
Finally, we’ve discussed the various means in which to manage the airway of a tracheostomy or laryngectomy patient, don’t forget to use end-tidal capnography here and as we’ve said, don’t reach straight for the Endotracheal tube as often less invasive interventions will work to oxygenate these patients.