Respiratory distress in the patient with a tracheostomy (update)

A summary of the emergency medicine approach to respiratory distress in the patient with a tracheostomy

This is an update of a previous version of this post. I am reposting to coincide with the release of a new textbook that I am pretty excited about. The textbook is the Resuscitation Crisis Manual. It provides very succinct action scripts for the major emergencies that we see. It is exactly the textbook that I always wanted in residency, but didn’t exist. The absence of this kind of resource was exactly the reason that I started First10EM. (Perhaps, in the future, Scott can just keep me up to date on his projects. If I had just waited a couple years, I could have had the textbook without feeling like I had to write it by myself.) I wrote the “Tracheostomy Emergencies” chapter of the book – hence the decision to repost this topic. (I guess I should note that I don’t get anything for writing that chapter, so I don’t have any financial conflicts of interest – just intellectual biases.)

If you want to hear more about the book, check out this EMCrit podcast.

Case

A 45 year old man, well known to your department because of a prior anoxic brain injury and multiple complications including a permanent tracheostomy, is brought in by ambulance from home in respiratory distress. You know from prior conversations with the family that the patient is to receive full, aggressive medical management. He is using every accessory muscle that you can see, his respiratory rate is 55, and his oxygen saturation is 87% on room air…

Continue reading “Respiratory distress in the patient with a tracheostomy (update)”

Articles of the month (May 2018)

A monthly (ish) summary of the emergency medicine literature

Welcome to another edition of the (bi)monthly medical articles that caught my attention. As always, you can hear Casey and I ramble on about these articles and other quasi-related medical issues on the BroomDocs podcast. Continue reading “Articles of the month (May 2018)”

Articles of the month (March 2018)

A monthly (ish) summary of the emergency medicine literature

Every two months or so I write a monthly summary of the most interesting medical literature that I have encountered. This is one of those summaries. Continue reading “Articles of the month (March 2018)”

Post-intubation deterioration in asthma

When the intubated asthma patient crashes: A Brief guide to the first 10 minutes of resuscitation

Case

The 16 year old female with severe asthma you resuscitated last week ended up getting intubated. After calling the pediatric ICU you headed back into an overcrowded sea of belly pains and sprained ankles. 30 minutes later you are called overhead because the patient is now severely hypotensive and hypoxic…

Continue reading “Post-intubation deterioration in asthma”

Management of severe anaphylaxis in the emergency department

A brief review of the management of the critically ill patient with anaphylaxis in the emergency department

Case

A 31 year old female is brought into the emergency department by ambulance after she collapsed at a family birthday party. She has a diffuse red rash, a blood pressure of 80/40, and an oxygen saturation of 88% on room air. She is wearing a medicalert bracelet. Her uncle guiltily admitted to EMS that he hadn’t told people that the vegan “cheese ball” he brought was actually just pureed nuts…

Continue reading “Management of severe anaphylaxis in the emergency department”

The bleeding tracheostomy

Managing acute hemorrhage from a tracheostomy

Case

On another shift, the 45 year old man with a tracheostomy from the prior case is brought back into the emergency room. This time, he is actively bleeding from his tracheostomy site…

Continue reading “The bleeding tracheostomy”

Respiratory distress in the patient with a tracheostomy

Managing acute respiratory distress in a patient with a tracheostomy

Case

A 45 year old man, well known to your department because of a prior anoxic brain injury and multiple complications including a permanent tracheostomy, is brought in by ambulance from home in respiratory distress. You know from prior conversations with the family that the patient is to receive full, aggressive medical management. He is using every accessory muscle that you can see, his respiratory rate is 55, and his oxygen saturation is 87% on room air…

Continue reading “Respiratory distress in the patient with a tracheostomy”