Emergency

tracheostomy management - Patent upper airway

Call for airway expert help
Look, listen & feel at the mouth and tracheostomy
A Mapleson C system (e.g. Waters circuit) may help assessment if available
Use waveform capnography when available: exhaled carbon dioxide indicates a patent or par6ally patent airway

No Is the pa0ent breathing? Yes

Call Resuscita6on Team Apply high ow oxygen to BOTH
CPR if no pulse / signs of life the face and the tracheostomy

Assess tracheostomy patency

Remove speaking valve or cap (if present)

Remove inner tube
Some inner tubes need re-inser6ng to connect to breathing circuits

The tracheostomy tube is patent

Can you pass a suc0on catheter? Yes Perform tracheal suc6on
Consider par6al obstruc6on
No Ven6late (via tracheostomy) if
Deate the cu (if present) not breathing
Look, listen & feel at the mouth and tracheostomy Con6nue ABCDE assessment
Use waveform capnography or Mapleson C if available
Tracheostomy tube par0ally

Is the pa0ent stable or improving?

Yes obstructed or displaced
Con6nue ABCDE assessment

No
REMOVE THE TRACHEOSTOMY TUBE
Look, listen & feel at the mouth and tracheostomy. Ensure oxygen re-applied to face and stoma
Use waveform capnography or Mapleson C if available

Call Resuscita6on team No Is the pa0ent breathing?

Yes Con6nue ABCDE
CPR if no pulse / signs of life assessment

Primary emergency oxygena6on Secondary emergency oxygena6on

Standard ORAL airway manoeuvres AEempt ORAL intuba0on

Cover the stoma (swabs / hand). Use: Prepare for dicult intuba0on
Bag-valve-mask Uncut tube, advanced beyond stoma
Oral or nasal airway adjuncts
SupragloWc airway device e.g. LMA

AEempt intuba0on of STOMA

Tracheostomy STOMA ven6la6on Small tracheostomy tube / 6.0 cued ETT
Paediatric face mask applied to stoma Consider Aintree catheter and breop6c
LMA applied to stoma scope / Bougie / Airway exchange catheter

National Tracheostomy Safety Project. Review date 1/4/16. Feedback & resources at www.tracheostomy.org.uk