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No Yes - Lippincott Williams & Wilkinsdownload.lww.com/wolterskluwer_vitalstream_com/...No No Yes...

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Emergency tracheostomy management - Patent upper airway Tracheostomy tube partially obstructed or displaced Continue ABCDE assessment The tracheostomy tube is patent Perform tracheal suction Consider partial obstruction Ventilate (via tracheostomy) if not breathing Continue ABCDE assessment Tracheostomy STOMA ventilation Paediatric face mask applied to stoma LMA applied to stoma Attempt intubation of STOMA Small tracheostomy tube / 6.0 cuffed ETT Consider Aintree catheter and fibreoptic ‘scope / Bougie / Airway exchange catheter Can you pass a suction catheter? Remove speaking valve or cap (if present) Remove inner tube Some inner tubes need re-inserting to connect to breathing circuits 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 No No Yes Yes National Tracheostomy Safety Project. Further information at www.tracheostomy.org.uk Yes No Standard ORAL airway manoeuvres Cover the stoma (swabs / hand). Use: Bag-valve-mask Oral or nasal airway adjuncts Supraglottic airway device e.g. LMA Attempt ORAL intubation Prepare for difficult intubation Uncut tube, advanced beyond stoma Yes Deflate the cuff (if present) Look, listen & feel at the mouth and tracheostomy Use waveform capnography or Mapleson C if available No Secondary emergency oxygenation Primary emergency oxygenation Assess tracheostomy patency Is the patient breathing? 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 partially patent airway Call Resuscitation Team CPR if no pulse / signs of life Apply high flow oxygen to BOTH the face and the tracheostomy Call Resuscitation team CPR if no pulse / signs of life Continue ABCDE assessment Is the patient breathing? Is the patient stable or improving?
Transcript
Page 1: No Yes - Lippincott Williams & Wilkinsdownload.lww.com/wolterskluwer_vitalstream_com/...No No Yes Yes National Tracheostomy Safety Project. Further information at Yes No Yes Deflate

Emergency tracheostomy management - Patent upper airway

Tracheostomy tube partially obstructed or displacedContinue ABCDE assessment

The tracheostomy tube is patentPerform tracheal suction Consider partial obstructionVentilate (via tracheostomy) if not breathing Continue ABCDE assessment

Tracheostomy STOMA ventilationPaediatric face mask applied to stomaLMA applied to stoma

Attempt intubation of STOMA Small tracheostomy tube / 6.0 cuffed ETTConsider Aintree catheter and fibreoptic‘scope / Bougie / Airway exchange catheter

Can you pass a suction catheter?

Remove speaking valve or cap (if present)Remove inner tube

Some inner tubes need re-inserting to connect to breathing circuits

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

No

No

Yes

Yes

National Tracheostomy Safety Project. Further information at www.tracheostomy.org.uk

Yes

No

Standard ORAL airway manoeuvresCover the stoma (swabs / hand). Use:

Bag-valve-maskOral or nasal airway adjunctsSupraglottic airway device e.g. LMA

Attempt ORAL intubationPrepare for difficult intubationUncut tube, advanced beyond stoma

Yes

Deflate the cuff (if present)Look, listen & feel at the mouth and tracheostomy

Use waveform capnography or Mapleson C if available

No

Secondary emergency oxygenationPrimary emergency oxygenation

Assess tracheostomy patency

Is the patient breathing?

Call for airway expert helpLook, listen & feel at the mouth and tracheostomy

A Mapleson C system (e.g. ‘Waters circuit’) may help assessment if availableUse waveform capnography when available: exhaled carbon dioxide indicates a patent or partially patent airway

Call Resuscitation TeamCPR if no pulse / signs of life

Apply high flow oxygen to BOTHthe face and the tracheostomy

Call Resuscitation teamCPR if no pulse / signs of life

Continue ABCDE assessment

Is the patient breathing?

Is the patient stable or improving?

Page 2: No Yes - Lippincott Williams & Wilkinsdownload.lww.com/wolterskluwer_vitalstream_com/...No No Yes Yes National Tracheostomy Safety Project. Further information at Yes No Yes Deflate

This patient has a

TRACHEOSTOMYThere is a potentially patent upper airway (Intubation may be difficult)

www.tracheostomy.org.uk

Surgical / Percutaneous

Performed on (date) ..............................

Tracheostomy tube size (if present) ...............

Hospital / NHS number ..............................

Notes: Indicate tracheostomy type by circling the relevant figure.Indicate location and function of any sutures.Laryngoscopy grade and notes on upper airway management.Any problems with this tracheostomy.

Emergency Call: Anaesthesia ICU ENT MaxFax Emergency Team

Page 3: No Yes - Lippincott Williams & Wilkinsdownload.lww.com/wolterskluwer_vitalstream_com/...No No Yes Yes National Tracheostomy Safety Project. Further information at Yes No Yes Deflate

Emergency laryngectomy management

Continue ABCDE assessment

The laryngectomy stoma is patentPerform tracheal suction Consider partial obstructionVentilate via stoma if not breathing Continue ABCDE assessment

Laryngectomy stoma ventilation via eitherPaediatric face mask applied to stomaLMA applied to stoma

Attempt intubation of laryngectomy stoma Small tracheostomy tube / 6.0 cuffed ETTConsider Aintree catheter and fibreoptic ‘scope / Bougie / Airway exchange catheter

Can you pass a suction catheter?

Remove stoma cover (if present)Remove inner tube (if present )

Some inner tubes need re-inserting to connect to breathing circuitsDo not remove a tracheoesophageal puncture (TEP) prosthesis

REMOVE THE TUBE FROM THE LARYNGECTOMY STOMA if presentLook, listen & feel at the laryngectomy stoma. Ensure oxygen is re-applied to stoma

Use waveform capnography or Mapleson C if available

No

No

Yes

Yes

National Tracheostomy Safety Project. Further information at www.tracheostomy.org.uk

Yes

No

Yes

Deflate the cuff (if present)Look, listen & feel at the laryngectomy stoma or tubeUse waveform capnography or Mapleson C if available

No

Secondary emergency oxygenationPrimary emergency oxygenation

Call Resuscitation TeamCPR if no pulse / signs of life

Continue ABCDE assessment

Is the patient breathing?

Laryngectomy patients have an end stoma and cannot be oxygenated via the mouth or nose*Applying oxygen to the face and stoma is the default emergency action for all patients with a tracheostomy

Most laryngectomy stomas will NOT have a tube in situ

Apply high flow oxygen to laryngectomy stomaIf any doubt whether patient has a

laryngectomy, apply oxygen to face also*

Call Resuscitation TeamCPR if no pulse / signs of life

Is the patient breathing?

Call for airway expert helpLook, listen & feel at the mouth and laryngectomy stoma

A Mapleson C system (e.g. ‘Waters circuit’) may help assessment if availableUse waveform capnography whenever available: exhaled carbon dioxide indicates a patent or partially patent airway

Is the patient stable or improving?

Assess laryngectomy stoma patency

Page 4: No Yes - Lippincott Williams & Wilkinsdownload.lww.com/wolterskluwer_vitalstream_com/...No No Yes Yes National Tracheostomy Safety Project. Further information at Yes No Yes Deflate

This patient has a

LARYNGECTOMYand CANNOT be intubated or oxygenated via the mouth

www.tracheostomy.org.uk

Follow the LARYNGECTOMY algorithm of breathing difficulties

Performed on (date) ..............................

Tracheostomy tube size (if present) ...............

Hospital / NHS number ..............................

Notes:

There may not be a tube in the stoma.The trachea (wind pipe) ends at the neck stoma

Emergency Call: Anaesthesia ICU ENT MaxFax Emergency Team


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