Percutaneous Tracheostomy

Percutaneous Tracheostomy involves Seldinger technique and dilatation of trachea between rings.

 Tracheo-innominate Fistula

Dr. Weingart shares with us what he has learned about how to manage massive hemoptysis in tracheostomy patients, and in particular, a step-wise approach to managing a tracheo-innominate fistula.

 Tracheostomy

This is the LITFL CCC master page for tracheostomy...

 Tracheostomy and Trach Emergencies

Tracheoinnominate Artery Fistula (TIA)-causes severe airway bleeding which can be fatal. Consider hyperinflating the cuff to tamponade bleeding as temporizing measure. In differential of any bleeding >48 hours after placement.

 Tricks of the Trach: Approach to Tracheostomy Patients in the Emergency Department

In this post, we will review the anatomy, essential history, and common presentations of tracheostomy patients in the ED, including obstruction, decannulation, bleeding, tracheal stenosis, and infection.

 Troubleshooting the Crashing Patient with a Tracheostomy

Patients presenting to the ED with respiratory distress and a tracheostomy can unnerve almost any provider, and management is often fraught with preventable errors. This recognition has led to the development of treatment algorithms from groups including the U.K. National Tracheostomy Safety Project to improve the safety and quality of care for patients with tracheostomies.

Approach to tracheostomy emergencies in the ED

Algorithm...

Common Tracheostomy Issues

Complications can be immediate, short term or long term after placement.

Deep Breath: How to Handle Tracheostomy Emergencies

If you find yourself needing to replace the tracheostomy tube, consider using an exchange catheter or bougie even if the trach is well established. This provides extra safety. Consider sizing down, especially if changing brands (e.g. Shiley have larger outer diameters than Portex of same inner diameters). Replace with a cuffed tracheostomy tube to aid you in resuscitation even if the original tracheostomy tube was uncuffed.

Field Notes on Tracheostomy Part 1: The Basics

Hello! This is not a comprehensive textbook on how to manage patients with tracheostomies. This is a humble collection of practical brief notes, as requested by a twitter friend. This is a primer. For more extensive information, feel free to consult the big texts.

Field Notes on Tracheostomy Part 2: The Problems

Our beloved patients need to be empowered through education. The tracheostomy tube is a marker of severe life threatening illness.

How Fast Should an Emergency Tracheostomy Take?

The main question here is how quickly should such a procedure take in order for it to be considered a success? Clearly, it should take less than 4 minutes given that is how long a brain can survive without oxygen before permanent damage sets in.

Management of Acute Respiratory Distress in a Tracheostomy Patient

Dislodgement and Obstruction are the two most common causes of respiratory complications in tracheostomy patients. After removal of the inner cannula, attempt to pass a suction catheter, if unable to pass then the tube is most likely obstructed. If you are able to pass a suction catheter, then dislodgement is more likely.

Managing the Tracheostomy Patient

Real-world strategies for handling this difficult airway.

Mini Tracheostomy

Narrow bore tracheostomy tube inserted through the cricothyroid membrane.

Respiratory distress in the patient with a tracheostomy (update)

In patients with normal upper airway anatomy, you are going attempt to ventilate or intubate orally. In patients with a laryngectomy, or with large tumors that occlude the airway, skip those steps.

The Dreaded False Passage: Management of Tracheostomy Tube Dislodgement

Accidental decannulation before a stable tract has formed can result in loss of airway. Factors that predispose to accidental decannulation include loosened straps or sutures securing the tracheostomy tube, edema of the neck, swelling and friable tissue, excessive coughing, agitation or undersedation, morbid obesity, and a tracheostomy tube that is too short for the tract.

Trach Basics: Pediatric Trach Types

Most trach tubes these days are made of plastic or silicone, though on rare occasions a metal trach tube may be used.

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

The following article aims to provide the emergency medicine physician with quick, effective, practical strategies for managing common trach airway emergencies. Hemorrhagic complications related to trachs, such as the appropriately feared tracheoinnominate fistula, or TIF, will not be discussed.

Tracheostomy Emergencies

Sometimes difficult to replace trach with same sized one, its ok to downsize. You can replace with ETT, would recommend using 6.0 cuffed tube.

Tracheostomy Emergencies and Neck Infections

The two most common complications are obstruction and dislodgement.

Trouble with Trachs - Recannulating the Stenosed Trach Site

You’ll need to get something back in there but because the hole is rapidly closing, you aren’t likely to be able to put in the same size tracheostomy tube. Oftentimes a tracheostomy tube one size smaller will even be too big to put in its place. You could always just put a very small ET tube or tracheostomy tube in place temporarily, but the patient is going to be better off if you can dilate the tract and replace the same size tracheostomy tube.