Tracheostomy Emergencies

Trach Travails: Need-to-Know ED Tricks for Airway Emergencies 

in Tracheostomy Patients

emDocs - July 16, 2018 - Authors: Schwartz J., Lentz S., Roginski M. 

Edited by: Koyfman A and Long B

"Take Away Points

• Differentiate simple tracheostomy versus total laryngectomy patients by ETCO2at the nose. 
• Simple tracheostomy patients are (potentially) intubatable from the oropharynx. Total laryngectomy patients are not. 
• Mucus plugging is common. Attempt suction and replace the tracheostomy tube’s inner cannula. 
• Let down the cuff, if present, to reposition a tracheostomy tube. 
• Use caution when replacing dislodged trach tubes in fresh tracheostomies. Consider orotracheal intubation instead. 
• Bougie, Cook, and Aintree catheters can assist with tracheostomy tube exchange. 
• Always confirm position of the exchanged tracheostomy tube by direct fiberoptic visualization or ETCO."