Editing Tracheostomy (section)

== '''Early complications''' ==

* Blockage/obstruction
** Presents with airway compromise
** Use CCrISP algorithm
** Is tube displaced or blocked?
*** If displaced, pt will be breathing through nose/mouth
**** Generally safer to remove, give oxygen, monitor. Don't reinsert until experienced help arrives.
**** If bag/valve/mask - need to occlude stoma
**** If upper airway patent - oropharyngeal intubation on ward
**** If upper airway not patent - reintubate in theatre - if the tissue is friable you may need to use something softer to guide it in like NGT, if normal tissue use a bougie
*** If partially blocked
**** Cough
**** Suction
**** Oxygen via tracheostomy and facemask
**** Remove/change inner canula
*** Completely blocked
**** CALL FOR HELP
**** Try suctioning - if you can pass the suction, it's not completely blocked
**** Remove inner cannula if present, or if not, saline lavage and suctioning
**** Establish an airway by other means
* Subcutaneous emphysema/PTX
* Bleeding (<48 hours)
** Usually trauma to anterior jugular or inferior thyroid veins
* Early displacement
** Default and safest option - re-intubate the patient orally, then evaluate for replacement. Can safely put a new tube in, preferably via Seldinger.