Trach Emergencies

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Tracheostomy and laryngectomy emergencies demand specific knowledge and immediate action to prevent devastating complications. Jess Mason delivers critical pearls on managing occluded, dislodged, and bleeding tracheostomies that are essential for both board exams and clinical practice.

• Cuffed tracheostomies have a pilot balloon and are required for positive pressure ventilation
• Uncuffed tracheostomies are more common in established patients but cannot be used with ventilators
• Occluded tracheostomies should be managed with oxygen first, followed by suctioning and inner cannula cleaning
• Dislodged tracheostomies require immediate replacement to prevent stomal narrowing
• Bleeding tracheostomies may signal a tracheo-innominate artery fistula, especially with "sentinel bleeds"
• Laryngectomies fundamentally differ from tracheostomies in that they have no communication between mouth/nose and lungs
• You can ONLY manage a laryngectomy patient's airway through their stoma

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