The Best Paper and the most amazing site
Guidelines for Tracheostomy and Laryngectomy Emergencies (Anaesthesia 2012;67:1025)
from the National Tracheostomy Safety Project (NTSP), the ultimate site for trach emergency management
Bedside Signs
Get the Tracheostomy Sign as double-sided sign for the bedside
Get the Laryngectomy Sign as double-sided sign for the bedside
Here is the version to edit your own signs
Laryngectomy Emergency Management
Additional New Information
More on EMCrit
Additional Resources
You Need an EMCrit Membership to see this content. Login here if you already have one.
Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Latest posts by Scott Weingart, MD FCCM (see all)
- EMCrit 383 – The Ultrasound Hierarchy of Needs in Cardiac Arrest with Mike Prats - September 6, 2024
- EMCrit RACC Lit Review – September 2024 - September 3, 2024
- EMCrit 382 – A Deep Dive on Vasopressin: Timing, Push Dose Vaso and the Vasopressin Load Test - August 23, 2024
Scott, On behalf of all my fellow colleagues, thank you so much for doing this podcast. As a critical care medic, I do countless interfacility transports of tracheostomy patients, most of whom are vent dependent. The two-sided handout is just what we need in the field (for both 911 and interfacility), and I am sharing this with all my fellow medic colleagues. I have referred many of them to your website and we all love your podcasts, and that you take the time to include EMS in a lot of your discussions. Thanks for all you do and thank your… Read more »
Regarding your comment about a double set up to oxygenate from the top and the tracheostomy when the patient is in extremis (not including the laryngectomy patients in this), I’d be very wary attempting to BVM through a potentially misplaced tracheostomy – if it is in a false passage etc then insufflating air into the mediastinum will make any subsequent airway attempts incredibly difficult/impossible.
totally agree–the double bagging is face and stoma. Did I say otherwise, I thought I specifically mentioned using a peds facemask or lma which hopefully nudges people to have the stoma empty. Did I say this in a confusing manner? If you remember at what part, I’ll fix it up.
You’re quite right, it’s at around 15:30 of the podcast and it is bagging the stoma you’re talking about not the trach. My bad, I listen to these while running so get distracted occasionally. Cheers.
We literally just ran cases on this during my PICU roounds this morning. Great timing! Thank you!
Scott, which type nasal endoscope do you have/use/recommend?
hi. im a surgical resident and we have a brisk TBI service with a lot of trachs and exchanges. i listened with interest to your podcast and had a thought. personally i think the standard disposable bougie is too stiff, althouhg a good thing to have on hand for troubleshooting or a really difficult exchange (upsizing significantly, significant difficulties with prior exchanges). the red rubber catheter is too floppy, as are standard trach/ET suction caths. there is the possibility that you will kink the exchanger/catheter in the subq and generate a false passage. (ie, you are passing the trach in… Read more »
this paper, Scott, (Guidelines for Tracheostomy and Laryngectomy Emergencies (Anaesthesia 2012;67:1025), at the very top, is indeed, superlative. It is so odd that of all the things i have done in EM, one of the emergencies that perturb me, bother me the most,(until now) was the respiratory distress patient with a tracheostomy tube or laryngectomy, and now “can’t breathe”, or is bleeding at the site. while the Brits might not make the best lasagna (debatable), this article is as clear, strait forward, and has dispelled most of the the ignorance and fear with which i approached these cases before, in… Read more »
ok…. and the rest of the “podcast” beyond that first British Anaesthesiology report, specifically your auditory section was excellent as well, the Brit article providing a good intro for your talk, Scott. I remember once reading (emedhome.com i believe) the emergency of the innominate arterial bleed. they stressed just putting your finger in the hole and direct super-firm pressure , compressing anteriorly from within up and out against the sternal manubrium like you might with any other severe arterial bleeder, and holding on for dear life until the CV surgeon said go home. i guess if hyperinflation of the balloon… Read more »
the first part of my comment got lost… i simply stated that the beginning article (Guidelines for Tracheostomy and Laryngectomy Emergencies (Anaesthesia 2012;67:1025) was wonderfully helpful.
patients with trachs/laryngectomies coming in with respiratory distress has always caused me exceeding angst,… but much less now after this clear systematic review article by our British colleagues.
thank you and them.
tom
Glad to see the National Trach Safety Project getting some recognition state side…most docs in the US aren’t aware of this tremendous resource. Many residents don’t understand the difference between a trach and a lary.
– Jeremy Rohrlich MD
[…] Tracheostomy emergencies on EMCrit […]