You have taken handover for a 63-year-old male in your resuscitation department. He has a tracheostomy tube and been admitted with cough, increased secretions and confusion. Your colleague has seen the patient and commenced treatment for a chest infection.
The nurse caring for the patient runs to you to tell you that the patient has suddenly become very agitated and is trying to climb out of bed.
On arrival at the bedside the patient appears panicked, is making inspiratory noises, and has pulled off his monitoring equipment. You see a green sheet by the bedside indicating the patient has a surgical tracheostomy that is around 6 weeks old, with a cuff and inner tube.
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What are the two most likely causes of the patient’s sudden change in presentation?
Regarding the same patient, which of the following actions would you perform as part of your initial management? (Select all that apply)
You oxygenate the patient via the face and stoma, attach waveform capnography and oximetry, and remove the inner tube, but there is no improvement. Following the tracheostomy emergency algorithm, you pass a suction catheter into the tube. It descends 2-3 centimetres then meets resistance.
What is your next step?
You deflate the cuff and reassess. After several seconds the patient’s agitation eases and the inspiratory noises change but do not completely resolve. Capnography begins to show a trace. SpO2 is 91%.
What do you do following this? (Select all that apply)