Heavy Lies the Helmet Episode 133 - Tracheostomy: The Neck's Best Thing
Oct 3, 2025
A fast-paced dive into managing tracheostomies in high-stakes transport and critical care. Topics include troubleshooting occlusions, dislodgements, and bleeding. Practical tips on tube exchanges, cuff strategies, using ET tubes and bougies, and when to perform blunt dissection or tamponade. Special situations like laryngectomy airways and caregiver rescue kits are also covered.
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Old Trach With Post-Discharge Bleed
- Amanda describes receiving a flight patient with an old trach who presented bleeding and was alert.
- The trach was years old and the patient was on Eliquis, which complicated bleeding risk.
Pause First When Patient Is Stable
- If a trach patient arrives oxygenating and alert, pause and take your own pulse before acting.
- Use that minute to assess device age, ventilation status, and prepare equipment calmly.
Switch To A Cuffed Tube Quickly
- Always know whether the trach is cuffed or uncuffed before intervening.
- If uncuffed and patient is decompensating, replace with a cuffed device (6.0 ET if needed) and inflate cuff.