Displacement (fresh) - tracheostomy complications

The patient is a 65 year old man who has been in the MICU for 14 days with acute respiratory distress syndrome (ARDS). He had a percutaneous tracheostomy performed two days ago and he continues to require mechanical ventilatory support. You are called to the bedside by the ICU nurse because the ventilator’s high pressure alarm is going off and the patient is becoming hypoxic. The nurse states that this happened immediately after completion of a portable chest x-ray. The patient will initially be in respiratory distress and then will develop progressive hemodynamic instability and worsening hypoxemia. The learner should assess the patient, diagnose and manage tracheostomy displacement and tension pneumothorax.