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  • Laryngectomy Airway: Emergency Tracheostomy Airway Management

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    Dana Ilie
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    1) Emergency tracheostomy airway management involves applying maximum oxygen to the stoma and face to prevent confusion in emergencies, despite there being no patent upper airway. 2) Key steps include assessing for danger, the patient's response, and calling for medical help. The stoma or trachea is then assessed for patency. 3) For patients with a tracheostomy tube in place, the inner cannula should be changed if needed, the cuff inflated, and the device's position and integrity ensured. For those without a tube, the stoma cover is removed if present and BLS commenced if not breathing.

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    Emergency-tracheostomy-laryengectomy

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    1) Emergency tracheostomy airway management involves applying maximum oxygen to the stoma and face to prevent confusion in emergencies, despite there being no patent upper airway. 2) Key steps include assessing for danger, the patient's response, and calling for medical help. The stoma or trachea is then assessed for patency. 3) For patients with a tracheostomy tube in place, the inner cannula should be changed if needed, the cuff inflated, and the device's position and integrity ensured. For those without a tube, the stoma cover is removed if present and BLS commenced if not breathing.

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    27 views1 page

    Laryngectomy Airway: Emergency Tracheostomy Airway Management

    Uploaded by

    Dana Ilie
    1) Emergency tracheostomy airway management involves applying maximum oxygen to the stoma and face to prevent confusion in emergencies, despite there being no patent upper airway. 2) Key steps include assessing for danger, the patient's response, and calling for medical help. The stoma or trachea is then assessed for patency. 3) For patients with a tracheostomy tube in place, the inner cannula should be changed if needed, the cuff inflated, and the device's position and integrity ensured. For those without a tube, the stoma cover is removed if present and BLS commenced if not breathing.

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    Emergency tracheostomy airway management: Laryngectomy

    Respiratory Distress AIRWAY


    Apply maximum Oxygen to stoma & face*

    Assess for Danger


    * Despite no patent upper
    Assess patient Response airway, this is a standard
    practice for all patients with
    trache devices- prevents
    Call 222/alert for medical emergency confusion in emergency
    Reference: McGrath BA, Bates L, Atkinson D, Moore JA. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia. 2012 Jun 26. doi: 10.1111/j.1365-2044.2012.07217

    Assess laryngectomy stoma patency Most laryngectomies


    will not have a trache
    If TRACHE insitu: NO TRACHE insitu
    • Change inner cannula • Remove stoma cover if insitu
    • Ensure cuff inflated if present • Do not remove tacheosophageal
    • Head tilt –ensure device not
    puncture TPE device
    kinked
    • Ensure Device position insitu

    Patient
    Breathing?
    YES NO Commence
    Can you pass a suction BLS
    catheter?

    YES NO

    Laryngectomy stoma/trache patent Trache insitu:


    • Deflate cuff
    Consider partial obstruction • Assess breathing- Can you hear air leak?
    • Suction airway • Attach Mapleson circuit/BMV assess
    • Continue ABCDEF assessment breathing or utilise capnography if available
    • Re-establish oxygenation & ventilation
    Stoma/tracheostomy is blocked or trache
    malpositioned

    Is oxygenation & ventilation


    YES NO
    adequate & improving?
    Call Anesthetic Consultant or ENT for support

    Trache:
    • Continue ABCDEF assessment Do you have a patent airway?
    • Consider tracheostomy tube change
    • Continue assessment of airway
    adequacy • Consider removal of tracheostomy
    • Re-establish oxygenation & • Prepare for potential endotracheal
    ventilation intubation /laryngeal mask insertion
    • Prepare for tracheostomy
    change if insitu No trache:
    Continued deterioration • Prepare for potential endotracheal
    intubation /laryngeal mask insertion

    EMERGENCY STOMA OXYGENATION: EMERGENCY STOMA INTUBATION:

    • Ventilate stoma using a paediatric facemask • Insert smaller sized tracheostomy tube / 6.0 cuffed ETT
    applied over stoma or LMA applied over stoma • Consider Aintree catheter and fibreoptic scope/
    Bougie/ Airway Exchange catheter

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