Tracheostomy care and emergencies: Viva

Branch 1: The emergency approach to the distressed child

The candidate should recognise this as a tracheostomy emergency and state that a child with a tracheostomy who is acutely distressed has a blocked or displaced tube until proven otherwise. They should describe the algorithm: call for help, give high-flow oxygen to both the face and the stoma, remove any speaking valve or cap and the inner cannula if present, then pass a suction catheter to test patency. A catheter that passes indicates a patent tube to suction and reassess, while a catheter that will not pass indicates a blocked or displaced tube. ^[1]

The candidate should then explain that if the tube cannot be cleared, the correct step is to deflate the cuff if present and remove the tracheostomy tube, because a tube that cannot be cleared only occupies the airway. After removal they should oxygenate via the intact upper airway with the stoma covered, or via the stoma, and only then attempt controlled re-cannulation with the same size and then a smaller tube. A strong candidate emphasises that a visible tube is never proof of a patent airway and that patency must be confirmed by air movement and capnography. ^[1]