Tracheostomy Emergencies

A tracheostomy provides a direct route through the neck into the trachea. The tube may be the patient’s only effective airway, but in most patients a connection between the mouth, nose, pharynx, and trachea remains. That distinction determines where rescue oxygen can work. A laryngectomy is different. The larynx has been removed and the trachea is permanently separated from the upper airway. A laryngectomy patient is therefore a neck-only breather: oxygen applied to the face, bag-mask ventilation over the mouth, and oral or nasal intubation cannot oxygenate the lungs. If the type of neck opening is uncertain during an emergency, apply high-flow oxygen to both the face and the stoma until the anatomy is confirmed. The tracheostomy tube also bypasses the nose and upper airway’s warming, filtering, and humidifying functions. Dry gas thickens secretions, impairs mucociliary clearance, and allows crusting or mucus to obstruct the lumen. A blockage can therefore develop from a removable device, a dried secretion, blood clot, displaced inner cannula, granulation tissue, cuff herniation over the tube tip, or the tip pressing against the tracheal wall. Displacement...