Dealing with Emergencies

Subject: Medical and Surgical Nursing II (Theory)

Overview

Dealing with Emergencies includes reassuring the patient, call for medical help, ask the patient to breathe normally via their stoma while waiting for the doctor, prepare for insertion of the new tracheostomy tube, once replaced, tie the tube securely, leaving one finger space between ties and the patient’s neck.Acute dyspnea for a patient with a tracheostomy is most commonly caused by partial or complete blockage of the tracheostomy tube retained secretions. It is possible that the tracheostomy may have become displaced. Stay with the patient until assistance arrives. Prepare for a change of tracheostomy tube.

If the tracheostomy tube falls out:

  • DON’T PANIC!
  • Once the tracheostomy tube has been in place for about 5 days the tract is well formed and will not suddenly close.
  • Reassure the patient
  • Call for medical help.
  • Ask the patient to breathe normally via their stoma while waiting for the doctor.
  • The stay suture (if present) or tracheal dilator may be used to help keep the stoma open if necessary.
  • Stay with a patient.
  • Prepare for insertion of the new tracheostomy tube
  • Once replaced, tie the tube securely, leaving one finger space between ties and the patient’s neck.
  • Check tube position by (a) asking the patient to inhale deeply – they should be able to do so easily and comfortably, and (b) hold a piece of tissue in front of the opening – it should be “blown” during patient’s exhalation

Patient is having Acute Dyspnea

Acute dyspnea for a patient with a tracheostomy is most commonly caused by partial or complete blockage of the tracheostomy tube retained secretions. To unblock the tracheostomy tube:

  1. Ask the patient to a cough: A strong cough may be all that is needed to expectorate secretions.
  2. Remove the Inner Cannula: If there are secretions stuck in the tube, they will automatically be removed when you take out the inner cannula. The outer tube – which does not have secretions in it – will allow the patient to breathe freely. Clean and replace the inner cannula.
  3. Suction: If coughing or removing the inner cannula do not work, it may be that secretions are lower down the patient's airway. Use the suction machine to remove secretions.
  4. If these measures fail – commence low concentration oxygen therapy via a tracheostomy mask, and call for medical assistance.

It is possible that the tracheostomy may have become displaced. Stay with the patient until assistance arrives. Prepare for a change of tracheostomy tube.

Patient needing Cardiopulmonary Resuscitation

In the event of cardiopulmonary arrest, treat tracheostomy patients as other patients:

  • Step 1: Expose the patient’s neck.Remove any clothing covering the tracheostomy tube and the neck area. Do not remove tracheostomy.
  • Step 2: Check the patency of the inner cannula.To check inner cannula: Wearing a non-sterile glove, remove inner cannula. If clean, reinsert and lock into place. If soiled– replace. Continue resuscitation.
  • Step 3: Ventilate.Use the Ambu-bag directly to the t-tube.
  • If unable to ventilate:
    • Try to suction.To remove or clear the secretions blocking the tube.
    • If still unable to ventilate. The tube may be displaced and the doctor may:
      • Change the tube
      • Intubate orally

REFERENCE

HealthLine. 2005. 2017 http://www.healthline.com/health/tracheostomy

KidsHealth. 1995. 2017 http://www.rch.org.au/kidsinfo/fact_sheets/Tracheostomy_information_for_parents/

Mandal, G.N. Textbook of Adult Nursing. Kathmandu: Makalu Publication House, 2013.

Mayo Clinic. 1998. 17 August  2016 http://www.mayoclinic.org/tests-procedures/tracheostomy/home/ovc-20233993

MedicineNet. 1996. 2017 http://www.medicinenet.com/tracheostomy/article.htm

Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/002955.htm

Medscape. 1994. 2017 http://emedicine.medscape.com/article/865068-overview

NHS Choice. http://www.nhs.uk/conditions/Tracheostomy/Pages/Introduction.aspx

Web MD. 2005. 2017 http://www.webmd.boots.com/a-to-z-guides/tracheostomy

 

 
Things to remember
  • Dealing with Emergencies includes reassuring the patient, call for medical help, ask the patient tracheostomy o breathe normally via their stoma while waiting for the doctor, prepare for insertion of the new tracheostomy tube, once replaced, tie the tube securely, leaving one finger space between ties and the patient’s neck.
  • Acute dyspnea for a patient with a tracheostomy is most commonly caused by partial or complete blockage of the tracheostomy tube retained secretions.
  • It is possible that the may have become displaced. Stay with the patient until assistance arrives. Prepare for a change of tracheostomy tube.
Questions and Answers

If the tracheostomy tube falls out

  1. DON’T PANIC!
  2. Once the tracheostomy tube has been in place for about 5 days the tract is well formed and will not suddenly close.
  3. Reassure the patient
  4. Call for medical help.
  5. Ask the patient to breathe normally via their stoma while waiting for the doctor.
  6. The stay suture (if present) or tracheal dilator may be used to help keep the stoma open if necessary.
  7. Stay with a patient.
  8. Prepare for insertion of the new tracheostomy tube
  9. Once replaced, tie the tube securely, leaving one finger-space between ties and the patient’s neck.
  10. Check tube position by (a) asking the patient to inhale deeply – they should be able to do so easily and comfortably, and (b) hold a piece of tissue in front of the opening – it should be “blown” during patient’s exhalation

Patient is having Acute Dyspnea

Acute dyspnea for a patient with a tracheostomy is most commonly caused by partial or complete blockage of the tracheostomy tube retained secretions. To unblock the tracheostomy tube:

  1. ASK THE PATIENT TO COUGH:A strong cough may be all that is needed to expectorate secretions.
  2. REMOVE THE INNER CANNULA:If there are secretions stuck in the tube, they will automatically be removed when you take out the inner cannula. The outer tube – which does not have secretions in it – will allow the patient to breath freely. Clean and replace the inner cannula.
  3. SUCTION:If coughing or removing the inner cannula do not work, it may be that secretions are lower down the patients airway. Use the suction machine to remove secretions.
  4. If these measures fail – commence low concentration oxygen therapy via a tracheostomy mask, and call for medical assistance.

It is possible that the tracheostomy may have become displaced. Stay with the patient until assistance arrives. Prepare for a change of tracheostomy tube.

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