In this scenario, the patient is a 65-year-old man with prolonged recovery from ARDS due to pneumonia. He underwent percutaneous tracheostomy insertion 2 days ago and requires continued mechanical ventilatory support. The learner is called to the bedside by the MICU nurse due to bright red blood oozing from the tracheostomy and from the stoma. The learner should suspect a tracheoinnominate fistula (TIF), call for an airway team and stat ENT consult and perform the appropriate bedside management for TIF.

Learning Objectives

‘- Recognize the importance of determining why a tracheostomy was performed when it was performed, and the type of tracheostomy tube in place.

– Demonstrate appropriate management of suspected tracheoinnominate fistula, including obtaining an emergent ENT consultation.