STARS Train the Trainer Class (TtT) - Beta-Emergency Pediatric Tracheostomy Lecture

Emergency Pediatric Tracheostomy Lecture

Pdf Summary

This EMS training document outlines recognition and emergency management of pediatric tracheostomy complications. It reviews what a tracheostomy is (a thin, flexible tube placed through a surgically created, healed stoma) and notes that pediatric trachs are typically changed at home weekly or biweekly. It explains why children may have tracheostomies, most commonly due to ventilator dependence, but also because of airway abnormalities such as subglottic stenosis, laryngomalacia, and tracheomalacia.<br /><br />Key differences between pediatric and adult trach tubes are emphasized. Pediatric tubes are usually soft, single-lumen, rarely have an inner cannula, are secured with Velcro ties, and use an obturator for insertion. They may be cuffed or uncuffed. Cuffed tubes have a pilot balloon (inflated with sterile water), must be deflated before a change, offer some aspiration protection, and are used for high ventilator pressures or poor secretion control. Uncuffed tubes allow air to pass around the tube and offer little aspiration protection. Adult tubes more often have removable inner cannulas and may be fenestrated.<br /><br />The central teaching is: “The trach is the problem, until proven otherwise.” The two primary life-threatening issues are (1) decannulation/dislodgement and (2) obstruction (e.g., mucus plug). For dislodgement, EMS should verify the trach is in the stoma, attempt cleaning/replacement, use a size-smaller tube if needed, or an endotracheal tube if necessary. If recannulation fails, ventilate by covering the stoma and bagging via mouth/nose, or ventilate directly over the stoma.<br /><br />For obstruction, interventions include suctioning (limit to 5 seconds, twirl on withdrawal, oxygenate between attempts, consider saline and humidified oxygen), supplemental oxygen, BVM ventilation, and considering an emergency trach change. Waveform EtCO₂ is recommended for assessing ventilation. A cuffed, inflated tube with a plug is highlighted as especially dangerous.<br /><br />The DOPE approach is taught for troubleshooting: Dislodgement/Decannulation, Obstruction, Pneumothorax/Pulmonary problem, and Equipment failure. EMS should use the patient’s trach “Go Bag,” which includes spare trachs (current size and one smaller), suction supplies, ties, saline, lubrication, HME caps, and BVM (often with PEEP). The guide also covers trach-change complications (false tract, difficult stoma, complex anatomy) and stresses consulting caregivers and prioritizing airway management and transport.

Keywords

pediatric tracheostomy complications

EMS airway management

tracheostomy dislodgement decannulation

tracheostomy obstruction mucus plug

pediatric trach tube differences

cuffed vs uncuffed tracheostomy tubes

tracheostomy suctioning technique

DOPE troubleshooting algorithm

waveform end-tidal CO2 monitoring

trach go bag emergency supplies