Tutorial presented by John Bayliss, Paramedic and Resuscitation Officer, East of England Ambulance Service

In this tutorial, John explores how to approach acute events in patients with tracheostomies that are not directly related to their tracheostomy. Key considerations include determining whether the tracheostomy is:

1. A Concurrent Issue:
   • Example: A patient with a fractured leg.
   • The tracheostomy plays a minor role in care, assessed during the standard A–E approach but not central to management. Avoid “tracheostomy fog” by focusing on the primary issue.
2. A Contributory Issue:
   • Example: A patient with a serious chest infection.
   • Secretions may block the tracheostomy tube, requiring airway management as a priority.
   • Actions include suctioning, cleaning the tube, or replacing it with an endotracheal tube if necessary.
   • Treatments like nebulizers should be applied directly to the tracheostomy, ensuring mucus clearance to maintain a patent airway.
   • Admission thresholds should be lower due to the risk of airway blockage.
3. An Important Comorbidity:
   • Example: A patient with multisystem issues or trauma.
   • The tracheostomy serves as the primary airway access for oxygen delivery and ventilation.
   • Maintain a patent airway while addressing systemic symptoms, using appropriate oxygen delivery methods via the tracheostomy port or face mask as needed.