SOE1 RCOA

Question 1

Failed ventilation on a trache

Answer 1

NTSP guideline

1. Call for senior help
2. Look listen + feel mouth + trache

Waters / mapleson C to aid
Capnography

3. If breathing apply O2 both mouth + trach
   (2 supplies)
4. Not breathing but signs of life
   Assess trach ptancy, removes valve / cap / tubes
5. Attempt to insert suction catheter
   If successful - patent / partial obstruction

Suction

6. Ventilate via trach = not overly aggressive - surgical emphysema
7. If fails - remove trach + ensure O2 to mouth + stoma

Improves continue ABCDE

8. If fails maintain oxygenation through oro nasal after cover stoma
   or Paeds facemask to trach
9. If these fail - 2nd emergency oxygenation maneouvre

Oral intubation or intubate through stoma

Question 2

Airway info before secondary maneouvre

Answer 2

1. Intubation difficulty?
2. Reason for Trach
3. Duration of problem?
4. Surgical or Perc trach
   surgical easier to replace as dilated stoma

Question 3

What equipment would you need during secondary emergency O2 manoeuvre

Answer 3

Humidification equipment

Basic airway equipment
O2 masks
Suction
Self inflating bags
OPA + NPA

Catheters

Advance airway management

Spare tracheostomy tubes
airways and laryngoscopes
one tube size smaller

Capnography

Spare inner cannula

Fibreoptic scope

Sterile water - cleaning suction tube

tracheal dilo

Scissors

Lube

Sterile pack

Trach dressings + Tapes

PPE

Sterile gloves

Question 4

Indications for trach in ICU

Answer 4

1. Assist weaning from artificial ventilation
2. Facilitate withdrawal of sedation
3. Ongoing airway toilet / reduce secretion retention

reduce OPA / tracheal complication long term tube

Protect airway neurological dysfunction

Long term
facilitate discharge icu / domiciliary

Ventilation in those with chronic conditions