Tracheostomy bleeding - Revision history

Elcatracho: /* Management */

2021-02-05T02:32:17Z

Management

← Older revision		Revision as of 02:32, 5 February 2021
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	**Tracheoinnominate artery fistula (TIF) until proven otherwise		**Tracheoinnominate artery fistula (TIF) until proven otherwise
	***Most patients present within first 3wk after tracheostomy		***Most patients present within first 3wk after tracheostomy
			***May be preceded by hours to days with small-volume "sentinel bleed"
	***Very high mortality rate		***Very high mortality rate
	***Delegate team member to obtain surgical assistance, especially with massive bleed		***Delegate team member to obtain surgical assistance, especially with massive bleed

2019-09-30T22:53:55Z

← Older revision		Revision as of 22:53, 30 September 2019
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	==Risk Factors==		==Risk Factors==
	*Infection		*[[tracheostomy infection\|Infection]]
	*Corticosteroids		*[[Corticosteroids]]
	*Diabetes		*[[Diabetes]]

	==Differential Diagnosis==		==Differential Diagnosis==

2016-07-26T01:40:59Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 01:40, 26 July 2016
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	{{Tracheostomy DDX}}		{{Tracheostomy DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Large bleed is tracheoinnominate fistula until proven otherwise		*Large bleed is tracheoinnominate fistula until proven otherwise

2016-07-10T16:22:52Z

Text replacement - "C/s" to "Consult"

← Older revision		Revision as of 16:22, 10 July 2016
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	*Emergent OR for TIF		*Emergent OR for TIF
	*Most minor bleeds do not require admission and observation if controlled in ED		*Most minor bleeds do not require admission and observation if controlled in ED
	*~~C/s~~ with primary surgeon for new tracheostomies		*Consult with primary surgeon for new tracheostomies

	==See Also==		==See Also==

2016-06-21T16:49:42Z

Text replacement - " pts" to " patients"

← Older revision		Revision as of 16:49, 21 June 2016
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	*Brisk Bleeding		*Brisk Bleeding
	**Tracheoinnominate artery fistula (TIF) until proven otherwise		**Tracheoinnominate artery fistula (TIF) until proven otherwise
	***Most ~~pts~~ present within first 3wk after tracheostomy		***Most patients present within first 3wk after tracheostomy
	***Very high mortality rate		***Very high mortality rate
	***Delegate team member to obtain surgical assistance, especially with massive bleed		***Delegate team member to obtain surgical assistance, especially with massive bleed

2016-06-01T02:35:43Z

← Older revision		Revision as of 02:35, 1 June 2016
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	***Delegate team member to obtain surgical assistance, especially with massive bleed		***Delegate team member to obtain surgical assistance, especially with massive bleed
	***Treatment:		***Treatment:
	***#Hyperinflate the cuff (85% successful), up to 50 cc		***#Hyperinflate the cuff (85% successful), up to 50 cc to tamponade bleeding
	***#If above fails, withdraw tube while placing pressure against anterior trachea		***#If above fails, withdraw tube while placing pressure against anterior trachea
	**#ETT from above (as long as there is no laryngectomy)		**#ETT from above (as long as there is no laryngectomy)

2016-05-05T00:44:34Z

Tracheostomy bleeding risk factors

← Older revision		Revision as of 00:44, 5 May 2016
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	**Tube suction and manipulation		**Tube suction and manipulation
	**Tracking of blood from nearby surgical site		**Tracking of blood from nearby surgical site

			==Risk Factors==
			*Infection
			*Corticosteroids
			*Diabetes

	==Differential Diagnosis==		==Differential Diagnosis==

2016-02-17T02:31:39Z

← Older revision		Revision as of 02:31, 17 February 2016
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	***Treatment:		***Treatment:
	***#Hyperinflate the cuff (85% successful), up to 50 cc		***#Hyperinflate the cuff (85% successful), up to 50 cc
	~~[[File:hyperinflation-leveraging against innominate.jpg\|thumbnail]]~~
	***#If above fails, withdraw tube while placing pressure against anterior trachea		***#If above fails, withdraw tube while placing pressure against anterior trachea
	**#ETT from above (as long as there is no laryngectomy)		**#ETT from above (as long as there is no laryngectomy)
	**#Apply digital pressure of innominate artery against the manubrium from inside tracheostomy tract		**#Apply digital pressure of innominate artery against the manubrium from inside tracheostomy tract
	**#Go to the OR with finger tamponade innominate artery		**#Go to the OR with finger tamponade innominate artery
	~~[[File:finger tamponade.JPG\|thumbnail]]~~
	***#If above fails, place a cuffed ET tube to prevent pulmonary aspiration of blood		***#If above fails, place a cuffed ET tube to prevent pulmonary aspiration of blood
	***#Correct coagulopathies and administer blood products as needed		***#Correct coagulopathies and administer blood products as needed
	***Requires emergent OR exploration and definitive management		***Requires emergent OR exploration and definitive management
			[[File:hyperinflation-leveraging against innominate.jpg\|thumbnail]]
			[[File:finger tamponade.JPG\|thumbnail]]

	==Disposition==		==Disposition==

2016-02-17T02:31:02Z

Management

← Older revision		Revision as of 02:31, 17 February 2016
Line 24:		Line 24:
	***Treatment:		***Treatment:
	***#Hyperinflate the cuff (85% successful), up to 50 cc		***#Hyperinflate the cuff (85% successful), up to 50 cc
			[[File:hyperinflation-leveraging against innominate.jpg\|thumbnail]]
	***#If above fails, withdraw tube while placing pressure against anterior trachea		***#If above fails, withdraw tube while placing pressure against anterior trachea
	**#ETT from above (as long as there is no laryngectomy)		**#ETT from above (as long as there is no laryngectomy)
	**#Apply digital pressure of innominate artery against the manubrium from inside tracheostomy tract		**#Apply digital pressure of innominate artery against the manubrium from inside tracheostomy tract
	**#Go to the OR with finger tamponade innominate artery		**#Go to the OR with finger tamponade innominate artery
			[[File:finger tamponade.JPG\|thumbnail]]
	***#If above fails, place a cuffed ET tube to prevent pulmonary aspiration of blood		***#If above fails, place a cuffed ET tube to prevent pulmonary aspiration of blood
	***#Correct coagulopathies and administer blood products as needed		***#Correct coagulopathies and administer blood products as needed
	***Requires emergent OR exploration and definitive management		***Requires emergent OR exploration and definitive management
	~~[[File:finger tamponade.JPG\|thumbnail]][[File:hyperinflation-leveraging against innominate.jpg\|thumbnail]]~~

	==Disposition==		==Disposition==

2016-02-17T02:30:21Z

← Older revision		Revision as of 02:30, 17 February 2016
Line 25:		Line 25:
	***#Hyperinflate the cuff (85% successful), up to 50 cc		***#Hyperinflate the cuff (85% successful), up to 50 cc
	***#If above fails, withdraw tube while placing pressure against anterior trachea		***#If above fails, withdraw tube while placing pressure against anterior trachea
			**#ETT from above (as long as there is no laryngectomy)
	**#Apply digital pressure of innominate artery against the manubrium from inside tracheostomy tract		**#Apply digital pressure of innominate artery against the manubrium from inside tracheostomy tract
			**#Go to the OR with finger tamponade innominate artery
	***#If above fails, place a cuffed ET tube to prevent pulmonary aspiration of blood		***#If above fails, place a cuffed ET tube to prevent pulmonary aspiration of blood
	***#Correct coagulopathies and administer blood products as needed		***#Correct coagulopathies and administer blood products as needed