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:

(these are my own formulations, not blue book material)

Problem:

Steps:

Unspecified

Temporise:

·           Suction

·           Oxygenate: a) over trachie b) over mouth

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

Diagnose:

·           Arrested? (usual way)

·           Patent? (suction catheter)

·           Upper airway normal? (appearance, history)

·           Type of trachie?

·           Age of trachie?

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

 

 

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