Firs10EM - May 26, 2015
"Even small amounts of bleeding should be treated as emergencies, as they may represent sentinel bleeding from a tracheo-innominate fistula. Most sources say that all late bleeds must be assessed by a surgeon. Others say any bleed greater than 10ml should be presumed to be arterial in nature."
http://first10em.com/2015/05/26/the-bleeding-tracheostomy/
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First10EM - May 26, 2015
"For every patient with a laryngectomy (no remaining connection between the upper airway and the trachea), there are 20-30 patients with tracheostomies (the connection remains).
The initial approach to a deteriorating patient with a tracheostomy is similar to the approach to the intubated patient, so it is reasonable to start with the DOPES mnemonic:
- Displacement of the tube
- Obstruction of the tube
- Pneumothorax
- Equipment problems (ventilator)
- Stacked breaths
In general, do not replace a tracheostomy that is less than 7 days old. Call ENT. (However, if the patient is dying, you aren’t going to wait for the surgeon. In emergency medicine, we often have to break these kinds of rules. I would use a bougie through the stoma first, both because of its smaller size, and the potential to ‘confirm’ that you are in the airway. I would then advance a small sized tube over top.)"
http://first10em.com/2015/05/26/respiratory-distress-in-the-patient-with-a-tracheostomy/