Tracheostomy care and emergencies: Case

This is a technology-dependent child with an established, mature tracheostomy who has presented with a blocked tube, the everyday tracheostomy emergency. Two features are reassuring and instructive. His mother is trained, has already worked through part of the algorithm by suctioning and oxygenating the stoma, and has brought his emergency bag, and his tracheostomy is well established, so the stoma tract is mature and reinsertion is far safer than in a fresh stoma. The case tests emergency management, home care, and the eventual path to decannulation. ^[1]

Clinical findings

The key findings are the acute distress and duskiness of a child with a tracheostomy, which define a tube emergency, and the partial response to suction and stoma oxygen, which points to a blocking secretion problem rather than complete displacement. The candidate should describe completing the algorithm in the emergency department: giving oxygen to both the face and the stoma, removing any speaking valve or inner cannula, passing a suction catheter to confirm patency and clear the plug, and being ready to remove and replace the tube from the go-bag if it cannot be cleared. ^[1]

The candidate should recognise the value of the trained parent and the emergency bag, and use them. The go-bag should contain a same-size and a smaller tracheostomy tube, suction equipment and catheters, lubricant, and the child's written emergency plan naming his tube. Confirming that his emergency equipment is present and correct, and listening to a mother who knows the tube intimately, is often the fastest route to safety, particularly in a regional department where staff may be less familiar with paediatric tracheostomies. ^[2]