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Tracheostomy Complications. Blood on the Hands?

May 23, 2017

 

Tracheostomy exchanges.

3 possible ways of doing so.

A. Just take out the defective or faulty tracheostomy tube and replace with another one. The patient is vomiting and possibly aspirating. To take out an uncuffed tube for replace with a cuffed tube to prevent aspiration.

B. Use one of 2 conduits to exchange out the current tracheostomy.

--Bougie

--16 french tracheostomy suction tubing

C. The last one is the most I deal but requires the most technology to use the Ascope or true Fiberoptic scope to confirm tracheostomy in the correct tract in the trachea then replace the tracheostomy with a new shiley/tracheostomy tube already loaded on the SCOPE to ensure successful replacement.  2 other causes are to be mentioned in the Video Below.

 

.......

 

This past week. I did Option B. Used the more rigid Bougie for the exchange.

This was an ill man will diseased lung from prior Tuberculosis and Severe COPD.

The patient came in as upper gib, with coffee grounds found on the patient's gown and in his mouth.

Tachypneic and assumed to have aspirated this emesis.

 

Check out the Video soon to follow.

Key words to remember.

FROG-FACE means Subcutaneous Emphysema

 

 

 

SUBQ Air Means a leak from the Tracheostomy site, further down along Trachea, Rupture at the alveoli after overbagging with Bag Mask Ventilation, or from Extensive Pleural rupture to cause Massive Pneumothorax.

Unilateral Subcutaenous Emphysema on One side of the Chest, i.e., Right sided findings usaully means needs chest tube there on that right side. 

My patient was treated for sepsis from recurrent pna, health care associated. Right percutaneous chest tube was placed.

 

 CT surgery called. and wanted an Esophagram done. Gastroenterology consult called for upper gib but given the respiratory distress and pneumothorax and subcutaneous emphysema, deferred on scoping pt until was stabilized. In the meantime, serial hematocrits and iv protonix drip. Stop Nsaids.

MICU attempted to decompress the Subcutaneous Air with needle catheter to SubQ air only.

Patient later made dnr/dni and the Subcutaneous air resolved slowly. No upper endoscopy done.

Patient survived micu. Palliative care agreed upon by patient's family.

 

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