There are several scenarios that can lead to a tracheostomy emergency.

The most common are a dislodged or displaced tracheostomy, a blocked tracheostomy tube, and a bleeding tracheostomy site.

During a tracheostomy emergency, the Tracheostomy emergency algorithm should be followed (linked below). Each step of the emergency tracheostomy algorithm is to assess and achieve patient stability until expert airway help arrives.

The following steps provide a brief summary, but should not replace the application of the emergency algorithm:

1. Assess the patient’s tracheostomy airway.
2. Remove the speaking valve or cap (if present).
3. Apply oxygen using a tracheostomy mask.
4. Remove the patient’s inner tube and replace with a new tube.
5. Attempt to pass a suction catheter.
6. Deflate the cuff (if present).
7. Call for expert airway help.
8. Apply oxygen to the patient’s face.
9. Attach the pulse oximeter for observations.
10. Prepare the tracheostomy ambu bag.
11. Prepare to remove the tracheostomy tube, checking the cuff is deflated before removing the tube.
12. Remove the tracheostomy tube and apply oxygen to face and the stoma. If the patient is not breathing, occlude the stoma site to begin oral emergency oxygenation using an Ambu bag or similar.
13. Continue attempting to deliver oxygen to the patient’s airways until help arrives.