Prompt

You have 9 minutes with a 4-year-old child with cerebral palsy, a gastrostomy and a tracheostomy, who has desaturated to 80 per cent on the ward and whose suction catheter will not pass. Run the tracheostomy emergency algorithm, manage the decannulated tube using tract maturity, and recognise a late tracheostomy bleed.

Station brief (candidate)

Assess the child before the device, and recite the National Tracheostomy Safety Project paediatric emergency algorithm in order to resolve the obstruction.
Manage the tube that has fallen out entirely, using the tract-maturity rule to decide between bedside replacement and ventilation-with-surgical-call.
Recognise a late tracheostomy bleed as a tracheoinnominate artery fistula and give the immediate cuff, pressure and referral actions.
State the disposition after a device emergency and the equipment that must be at the bedside. [4] [8]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[3]Wynings EM Accidental Tracheostomy Decannulations in Children: A Prospective Cohort Study of Inpatients. Laryngoscope, 2023.PMID 35712851
[4]Willis LD Pediatric Tracheostomy Year in Review. Respir Care, 2024.PMID 38626953
[5]Chauhan JC Tracheoinnominate Artery Fistula Formation in a Child with Long-Term Tracheostomy Dependence. J Pediatr Intensive Care, 2019.PMID 31093462
[6]Chiaravalli J Management of an Obstructed Tracheostomy in a Limited-Resource Setting. Cureus, 2017.PMID 28616369
[7]Espinel AG Tracheostomy manipulations: Impact on tracheostomy safety. Pediatr Investig, 2019.PMID 32851308
[8]Giordano P Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. Ann Hematol, 2015.PMID 26300457

Station brief (candidate)

Assess the child before the device, and recite the National Tracheostomy Safety Project paediatric emergency algorithm in order to resolve the obstruction.

Manage the tube that has fallen out entirely, using the tract-maturity rule to decide between bedside replacement and ventilation-with-surgical-call.

Recognise a late tracheostomy bleed as a tracheoinnominate artery fistula and give the immediate cuff, pressure and referral actions.

State the disposition after a device emergency and the equipment that must be at the bedside. [4] [8]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[3]Wynings EM Accidental Tracheostomy Decannulations in Children: A Prospective Cohort Study of Inpatients. Laryngoscope, 2023.PMID 35712851
[4]Willis LD Pediatric Tracheostomy Year in Review. Respir Care, 2024.PMID 38626953
[5]Chauhan JC Tracheoinnominate Artery Fistula Formation in a Child with Long-Term Tracheostomy Dependence. J Pediatr Intensive Care, 2019.PMID 31093462
[6]Chiaravalli J Management of an Obstructed Tracheostomy in a Limited-Resource Setting. Cureus, 2017.PMID 28616369
[7]Espinel AG Tracheostomy manipulations: Impact on tracheostomy safety. Pediatr Investig, 2019.PMID 32851308
[8]Giordano P Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. Ann Hematol, 2015.PMID 26300457

Gastrostomy, tracheostomy and central-line troubleshooting — OSCE

Station brief (candidate)

Gastrostomy, tracheostomy and central-line troubleshooting — OSCE

Station brief (candidate)