Tracheostomy crisis management

 

Components:

Cuff

·         Seals larynx to a) allow ventilation b) prevent aspiration

Inner cannula

·         Lamb to the slaughter. Removable in case of blockage.

Fenestration

·         Allows speech

Cap

·         Allows speech

 

Complications are common:

Early

·      Dislodgement*

·      Blockage*

·      Bleeding -> airway obstruction*

·      Infection

·      Pneumothorax/mediastinum

Late

·      Tracheoinnominate fistula

·      Tracheoesophageal fistula

·      Tracheocutaneous fistula

·      Stenosis

·      Tracheomalacia

*Lethal

 

Trouble-shooting:

Problem:

Steps:

Unspecified

Diagnose:

·         What happened?

·         Upper airway present?

·         Type of trachie?

·         Age of trachie?

Treat:

·         Suction

·         Oxygenate: a) over trachie b) over mouth

·         ±Ventilate: a) directly to the trachie b) LMA over the hole

Blockage

·         Suction

·         Deflate cuff

·         Remove cannula

·         Remove trachie and splint the hole

·         Intubate from above

Dislodgement

·         Suction

·         Deflate cuff

·         Attempt re-insertion

·         Remove trachie

·         Intubate from above

Bleeding

·         Suction

·         Remove cannula

·         Inflate cuff +++

·         Theatre

 

 

Feedback welcome at ketaminenightmares@gmail.com