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

Emergency Pediatric Tracheostomy Lecture with Instructor Notes TtT

Pdf Summary

This document is an EMS-focused training module (Revised 04/2026) on managing pediatric tracheostomy emergencies, emphasizing that trach-dependent children have significant morbidity and mortality risk and that all responders must be able to troubleshoot rapidly. It frames a tracheostomy tube as functionally similar to an endotracheal tube and stresses use of standard airway troubleshooting (DOPE), capnography, and documenting patency.<br /><br />The training reviews why children receive tracheostomies: prolonged ventilator dependence and/or airway malformations that prevent maintaining a patent upper airway (e.g., subglottic stenosis, laryngomalacia, tracheomalacia). Key pediatric differences are highlighted: most pediatric trachs are soft, single-lumen tubes (inner cannulas are rare), secured with Velcro ties, inserted with an obturator, and may be cuffed or uncuffed. Cuffed tubes are identified by a pilot balloon and must be deflated before tube changes; cuff inflation volumes are child-specific and should be available on a trach card/STARS form.<br /><br />The module identifies two main “killers” in trach patients: (1) decannulation/dislodgement and (2) obstruction (mucus plug, blood, kinking). For dislodgement, responders should confirm the tube is in the stoma, attempt recannulation (same size, then one size smaller), consider an ETT if needed, and ventilate via mouth/nose while covering the stoma (or ventilate directly over the stoma) if recannulation fails. For obstruction, remove accessories (HME, caps, speaking valves), consider cuff deflation to allow airflow, suction properly (appropriate pressure and time limits), provide oxygen, assist with BVM, and proceed to an emergency trach change when indicated. A cuffed, inflated tube that becomes plugged is noted as especially dangerous because it can fully eliminate the airway.<br /><br />It also covers equipment and accessories (HME, Passy Muir valve and associated hazards), BVM-to-trach ventilation technique, oxygen delivery options, complications such as false tract (with signs like subcutaneous emphysema and difficult ventilation/suctioning), and the importance of caregiver input. EMS should transport the patient’s “Go Bag” with backup trachs and supplies and take the patient to an appropriate pediatric facility. The module’s core message: “When in doubt, change it out.”

Keywords

pediatric tracheostomy emergencies

EMS airway management training

tracheostomy tube dislodgement decannulation

tracheostomy tube obstruction mucus plug

DOPE airway troubleshooting

capnography in trach patients

emergency tracheostomy tube change

BVM ventilation via tracheostomy stoma

Passy Muir speaking valve hazards

false tract subcutaneous emphysema