Patient with tracheostomies & ventilators
Tracheostomies & Ventilators
EMT Standing Order:
- The patient should be examined for other possible problems. Do not assume the problem is with the tracheostomy tube and/or the ventilator.
- Examine the patient quickly for possible causes of distress which may be easily correctable, such as a detached oxygen source.
- Patients on mechanical ventilation may exhibit sudden or gradual deterioration, cardiac arrest, increased oxygen demand, increased respiratory rate, retractions, and changes in mental status.
- Try to establish the patient’s baseline respiratory status.
- If on a ventilator, remove the patient from the ventilator and ventilate with BVM and a secure oxygen source; there may be a problem with the ventilator or oxygen source.
- Accumulation of debris may cause an obstruction. Suction the tracheostomy tube with a flexible suction catheter.
- If still no improvements, transport immediately to the closest, most appropriate facility. Initiate resuscitation as needed.
AEMT / Paramedic Standing Order:
- If the tracheostomy tube has an inner cannula, remove it; if the cannula is the cause of obstruction, there should be immediate improvement.
- If there is no improvement and the patient is in severe distress, the tube should be removed and attempt BVM ventilation. If another tube is available, insert into the stoma and resume ventilation. A standard endotracheal tube may be used or the used tracheostomy tube that was removed may be reinserted after being cleaned.
- Refer to Airway Management Protocol (1 Airway Management) as needed.
SPECIAL SITUATIONS
TRACHEOS
- ASSESS AND MANAGE AIRWAY
- CHECK FOR DETACHED OXYGEN SOURCE, IF ON VENTILATOR REMOVE AND MANUALLY VENTILATE PATIENT
- SUCTION PATIENT IF INDICATED
- REMOVE CANNULA IF IT IS CAUSE OF OBSTRUCTION
- MAINTAIN O2 SATS >95%
- EVALUATE PATIENT CONDITION
- MONITOR VITAL SIGNS
- REASSURE PATIENT
- TRANSPORT
- REMOVE TUBE IF PATIENT REMAINS IN DISTRESS AND REPLACE WITH NEW TRACH TUBE OR ET TUBE
- IF NO IMPROVEMENT SEE RESPIRATORY DISTRESS PROTOCOLS
TOMIES AND VENTILATORS
| EMT |
| A EMT/ Paramedic |
| Medical Control |