Sat27November0556PM 30

An intensive care patient who is being ventilated via a tracheostomy tube airway suddenly desaturates to 85%.

The most important immediate action is:

(Please select 1 option)

Call for help Incorrect answer selected

Attempt to pass a suction catheter down the tracheostomy tube

Remove the tracheostomy tube

Administer 100% oxygen This is the correct answer

Connect the tracheostomy tube to an anaesthetic breathing bag and attempt to manually support ventilation

Explanation

The most immediate action is to administer 100% oxygen and then connect the tracheostomy to an anaesthetic breathing bag and attempt to manually support ventilation. These two manoeuvres will guarantee the delivery of 100% oxygen and enable the assessment of the patency of the airway and efficiency of breathing. Assessment of lung compliance, lung expansion and any abnormal auscultatory findings can quickly be established. An end-tidal CO2 monitor would be useful to determine whether the tracheostomy tube has been dislodged. The cardiovascular status (blood pressure/cardiac output) of the patient will be important at this stage, as a dramatic fall in pulmonary perfusion may be the primary cause.

If the patient fails to respond to these early simple measures then help should be called for, as the airway may need to be replaced if necessary, under general anaesthetic. In the interim it would be worth attempting to pass a suction tube down the tracheostomy tube to see whether a sputum plug or clot in the tube or lungs is the cause. Tracheostomy cuff herniation, kink or malalignment will need to be excluded. If it is established that the tracheostomy tube is the cause, then it should be replaced either via the stoma or via the oral route.

Answer Statistics

1

16%

2

15%

3

1%

4

63%

5

6%

Times answered: 266