Tracheostomy Emergencies by Dr. Emily Damuth

Dr. Damuth is an Intensivist as well as and Emergency physician. In this video from ResusX:2019 she goes over all the things that you should know when approaching a patient with a tracheostomy who presents with an airway emergency. Here's a summary:

Here's a summarized version of the transcript "Tracheostomy Emergencies" in 5 bullet points:

1. Tracheostomy patients, especially those facing emergencies, can be among the most challenging to treat in the emergency department.

2. An algorithm has been developed to systematically approach any tracheostomy patient with respiratory distress. This includes procedures like applying oxygen, clearing obstructions, and potentially replacing the trach tube.

3. In the U.S., there are approximately 110,000 tracheostomies performed annually, with 40-50% of tracheostomy patients experiencing complications. Catastrophic airway complications occur in 1% of tracheostomy patients.

4. It's essential to understand the components of a tracheostomy tube, including the outer cannula, inner cannula, and obturator, to effectively manage any complications.

5. When facing a tracheostomy emergency, using the algorithm, which includes steps like applying oxygen to both the face and neck, can help healthcare professionals navigate the situation and provide appropriate care.

Watch the video and be ready for your next patient with a trach!

Chris Reilly is a guitar-swinging, song-singing, education-bringing physician from NYC. Follow at @docreilles on Instagram and TikTok. Let's see what Chris has for us this week.

Hemorrhage Control 101

Addressing hemorrhage control in trauma is key! Massive hemorrhage is the leading preventable cause of all trauma-related deaths so today we’re going to hammer home some concepts. First off, let’s switch from the conventional ABCs (Airway, Breathing, Circulation) approach to CCAB (Circulation, Control of Hemorrhage, Airway, Breathing). This can lead to a substantial reduction in hemorrhage-related deaths. 

All shock in trauma should be assumed to be hypovolemic shock due to massive hemorrhage until proven otherwise. Start your Massive Transfusion Protocol (MTP) early in your tachycardic and/or hypotensive trauma patients. Remember, when initiating MTP to keep an eye on the calcium levels as Citrate in the transfused blood can severely decrease your patient’s Calcium. You can also look for evidence of QT prolongation to monitor hypocalcemia from MTP. You can also classify your patient’s blood loss with an easy-to-remember mnemonic relating percent blood loss/Class of hemorrhagic shock to a tennis match! 0-15 (Class 1), 15-30 (Class 2), 30-40 (Class 3), 40-match (Class 4)! Subsequent changes per class: Class 1 (no vital sign changes), Class 2 (elevated HR), Class 3 (decreased BP and tachypnea), and Class 4 (altered mentation). BOOM!

Keep in mind some basic techniques for hemorrhage control including direct pressure, wound packing, pelvic binders, and management of long bone fractures. When aiming for adequate blood pressure, most trauma intensivists prefer permissive hypotension in bleeding patients.  So, avoid aggressive crystalloid resuscitation, make sure you have early use of blood products, and consider using tranexamic acid within three hours of reporting trauma (CRASH2 &3 trials). TXA does NOT increase clotting. It’s an antifibrinolytic, preventing the breakdown of clots, not a clot former…

That was a lot to unpack… Check out the full article for a deeper dive into Critical Care Now by Dr. Shyam Murali and Dr. Mohamed Hagahmed.