Emergency Tracheostomy M anagement – Critical Care

1. Emergency TracheostomyManagement – Critical Care Call for Airway Expert help: On-call Critical Care Doctor (bp:7403)/ENT surgeon (switchboard) Look, listen & feel at the mouth and tracheostomyA Waters circuit may help assessment if availableUse Capnography whenever available: exhaled carbon dioxide indicates a patent airway No Yes Is the patient breathing? Call Resuscitation teamCPR if no pulse Apply high flow oxygen to BOTH the face and the tracheostomy Assess tracheostomy patency Remove speaking valve or cap (if present) Remove inner tube (but do not discard)Some inner tubes need re-inserting to connect to breathing circuits The tracheostomy is patentPerform tracheal suction Consider partial obstructionVentilate if not breathing Continue ABCDE assessment Yes Can you pass a suction catheter? No Deflate the cuff (if present) Look, listen & feel at the mouth and tracheostomyUse Waters circuit or capnography if available Partially obstructed or displacedContinue ABCDE assessment Yes Is the patient stable or improving? No REMOVE THE TRACHEOSTOMY TUBE Look, listen & feel at the mouth and tracheostomy. Re-apply oxygen to face and stomaUse Waters circuit or capnography if available No Yes Call Resuscitation teamCPR if no pulse Continue ABCDE assessment Is the patient breathing? Primary emergency oxygenation Secondary emergency oxygenation Standard ORALairway manoeuvresCover the stoma (swabs / hand) Bag-Valve-Mask Oral or nasal airway adjunctsLMA (Laryngeal Mask Airway) Attempt ORAL intubation (unless previous laryngectomy)Prepare for difficult intubationUncut tube. Advance beyond stoma Attempt intubation of stoma Small tracheostomy tube / 6.0 cuffed ETTConsider Bougie / Fibreoptic‘scope Tracheostomy STOMA ventilation Paediatric face mask applied to neck LMA applied to neck Adapted from National Tracheostomy Safety Project, 2012 www.tracheostomy.org.uk