Tracheostomy displacement (fresh total laryngectomy)

65 year old man with a 120 pack year smoking history who has been in the surgical intensive care unit (SICU) for 24 hours. He had a total laryngectomy performed 1 day prior for laryngeal carcinoma. He required mechanical ventilatory support immediately postoperatively via a #8 cuffed tracheostomy tube with an inner cannula. You are called to the bedside by the intensive care unit nurse because immediately after completion of a portable chest x-ray the ventilator low pressure alarm is going off and the nurse notes that the new tracheostomy has been totally displaced from the stoma and is sitting on the chest wall, and the patient is hypoxic, tachypneic and in respiratory distress.


Learning Objectives:

1. Recognize the importance of determining: 1) why a tracheostomy was performed, 2) when it was performed, and 3) the type of tracheostomy tube in place.
2. Recognize that the patient has had a total laryngectomy and therefore is able to ventilate only through the laryngectomy stoma.
3. Demonstrate appropriate management of tracheostomy displacement from a laryngectomy stoma.
4. Recognize that this patient will not be able to be intubated via the mouth or nose.

Additional information

Learner

Physician

Contributor

NYU

Case Setting

ICU

Specialty

Emergency medicine, ENT, Internal medicine, Pulmonology, Surgery

Room Size

12×12

Language

English

Status

Not For Purchase