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Tracheostomies

Jennifer Farah, MD and Mel Herbert, MD MBBS FAAEM
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Crunch Time - Lungs - Written Summary 491 KB - PDF

Tracheostomies

Jennifer Farah MD and Mel Herbert MD

  • Know the complications!!!!
  • Takes 1 week for track to mature
  • If trach ≤ 1 week talk to ENT
  • Accidental decannulation
    • From coughing or neck extension
    • Re-insert with neck hyperextended
  • Obstruction
    • Usually from mucous plug
    • Remove inner cannula
    • Preoxygenate and suction
  • Infection
    • Tracheitis
    • Antibiotics for Staph, Pseudomonas and Candida
  • Tracheal Stenosis
    • Late complication
    • Prevention = change to cuffless tube 1 week post-op
  • Remember these options
    • Can always bag the patient
    • Can use a bougie and re-insert tube
    • Attempt intubation
  • Tracheo-innominate artery fistula
    • Rare but life-threatening bleed
      • Usually 1-3 weeks post-op
        • Can have sentinel bleed
      • Local digital pressure or hyperinflate cuff and provide gentle tube traction
      • Suction
      • May need to re-intubate
      • Call ENT

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Lungs Full episode audio for MD edition 65:03 min - 90 MB - M4ACrunch Time - Lungs - Individual MP3 Files 84 MB - ZIPCrunch Time - Lungs - Written Summary 491 KB - PDF

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