A Tricky Trache

Author: Dan Bewick / Editor: Nick Tilbury / Codes: / Published: 29/11/2021

A 60-year-old man is brought into the emergency department (ED) with acute shortness of breath. He has a tracheostomy, having previously had a cerebrovascular accident (CVA).

In addition to the previous CVA, he has a past medical history of hypertension and takes ramipril, aspirin and simvastatin.

On examination he is in clear respiratory distress and is using his accessory muscles to aid his ventilation. He is cyanosed, pale and clammy.

His observations are:

  • Respiratory rate – 40
  • SpO2 – 82% with 15L/min of oxygen to both the patients tracheostomy and face
  • Heart rate – 112
  • Blood pressure – 140/78
  • Temperature – 35.7

He is frantically pointing at his tracheostomy. You suspect it is acutely obstructed.

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