UMEM Educational Pearls

Title: Tracheostomy Emergencies

Posted: 3/5/2019 by Mike Winters, MBA, MD
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A True Tracheostomy Emergency

Patients with a tracheostomy often present to the ED for evaluation of a potential complication.
Consider a tracheoarterial fistula in any patient with a tracheostomy who presents with brisk bleeding.
Most occur within 3 to 4 weeks following tracheostomy placement, and the most common location is the innominate artery.
Up to 50% of patients will present with a sentinel bleed - an episode of brisk bleeding that has usually stopped at the time of presentation.
For patients who present with active hemorrhage, overinflate the tracheostomy cuff in an attempt to tamponade the bleeding.
If that does not stop the bleeding, remove the tracheostomy and compress the artery against the poterior sternum with your finger.

Przbylo JA, Wittels K, Wilcox SR. Respiratory distress in a patient with a tracheostomy. J Emerg Med. 2019; 56:97-101.