What is the stepwise approach to a tracheostomy emergency?
- Call for airway expert help
- Assess the tracheostomy quickly:
- Look, listen & feel at the mouth and tracheostomy
- Use a ‘Waters circuit’ and capnography if available
- If not breathing call for the emergency team and commence CPR if no signs of life
- If breathing apply oxygen to both the mouth and tracheostomy
- Assess the tracheostomy patency:
- Remove inner tube and any valves / caps
- Try to pass a suction catheter
- If unable to pass a catheter deflate cuff
- If not improving remove the tracheostomy tube
- If breathing and stable continue assessment
- If not breathing call arrest team and attempt primary means of oxygenation
- Primary attempts at oxygenation:
- Standard oral airway manoeuvres / LMA with stoma covered
- LMA or paediatric facemask applied to stoma
- Secondary attempts at oxygenation if still unsuccessful
- Oral intubation with uncut tube past stoma
- Stoma intubation:
- Size 6.0 ETT over bougie
- Consider fibreoptic scope and Aintree catheter as first line
