The Intern At Work: Internal Medicine Trach 102 - An Approach to Tracheostomy Associated Emergencies (Repeat)
Oct 11, 2026
A case-based guide to tracheostomy emergencies, from early accidental decannulation and mucus plugging to false passages, stenosis, and laryngectomy airway challenges. The discussion also covers catastrophic bleeding, infection, tension pneumothorax, and meal-related desaturation suggesting a tracheoesophageal fistula, concluding with a practical ABC-based rescue algorithm.
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Start Every Trach Emergency With A Structured Airway Assessment
- Assess ABCs, identify tracheostomy versus laryngectomy, and establish tube age, type, size, cuff status, and insertion method.<br>- A tract usually matures after seven days, while a difficult upper airway changes the equipment and rescue plan.
Fresh Decannulation Requires Immediate Visualization
- Three days after insertion, Mrs. Stomatis’s tube fell out during hygiene care, creating a high-risk early decannulation emergency.<br>- Replace tubes within the first week under fiber-optic visualization; if resistance occurs, stop and use a smaller tube rather than creating a false passage.
A Mucus Plug Can Turn Into Rapid Airway Loss
- Mr. Mux developed severe hypoxemia from likely mucus plugging four days after percutaneous tracheostomy.<br>- Remove external attachments and the inner cannula, then pass suction through the entire tube; inability to pass suggests complete obstruction or false passage.