Tracheostomy and laryngectomy emergencies are classic high-acuity, low-frequency situations. They do not happen every day, but when they do, airway problems can develop quickly, and the wrong intervention can make things significantly worse.
In this episode, we work through the practical approach to these patients, starting with the most important distinction: a patient with a tracheostomy may still have a patent upper airway, whereas someone who has undergone a total laryngectomy is an obligate neck breather. That single anatomical difference determines where oxygen and ventilation need to be delivered.
We'll look at the different tubes, cuffs, inner cannulas, speaking valves and humidification devices you may encounter, before moving through the common causes of deterioration, particularly obstruction, displacement and bleeding.
Using the National Tracheostomy Safety Project's green and red emergency algorithms, we break management down into simple, sequential steps: apply oxygen, remove attachments, remove the inner cannula, pass a suction catheter, deflate the cuff when appropriate and remove a non-functioning tube when necessary.
These cases can initially feel intimidating, but a calm, structured approach can make them far more manageable.
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Simon. Rob & James