Preparing for the Most Common Pitfalls
When I first started teaching airway management, tracheostomy care wasn’t high on my priority list. Honestly, the device seemed simple enough (a plastic tube in the neck), and it felt like a niche skill, something I might encounter occasionally but not often enough to worry about.
Then COVID happened.
Suddenly, tracheostomies were everywhere. And, like many clinicians, I realized pretty quickly that I wasn’t as comfortable managing them as I wanted to be. Tracheostomy emergencies make people nervous — for good reason. The anatomy is different. The gear is different. The stakes are high, and when things go wrong, they can quickly spiral out of control.
When I finally began building a dedicated tracheostomy curriculum, I was surprised by how many others shared the same sentiment. I wasn’t the only one who had that low-key anxiety when faced with a trach emergency. That’s exactly why this training exists.
High-risk. High-consequence. Zero room for guessing.
In this new video, we break down a simple, actionable approach to managing tracheostomy emergencies. Whether you’re in the ED, ICU, OR, or managing patients on the floor, these situations demand a clear mental model, rapid assessment, and decisive action. And when you’re ready to go deeper, check out our dedicated Tracheostomy Learning Space — packed with additional content and designed to help you create your own pop-up, hands-on training sessions. It’s an incredibly flexible tool for residency education, faculty development, or team-based airway training, whether you’re running sessions inside your hospital or out in the field.
Key Takeaways
The Core Rule: Oxygenation Wins. Always.
✅ Can they breathe?
✅ Are they oxygenating?
✅ Can you oxygenate from above or below?
Forget the gear for a second. Manage the patient. Oxygenation is your first priority. Everything else is details. The trach tube may look like the problem, but your focus may have to be bigger. First you have to either fix the problem with the trach tube or take it out of the equation.
Two Big Buckets of Trouble
👉 Blocked or Dislodged
Mucus plug, clot, kinked tubing, partial displacement — it doesn’t matter why the trach isn’t working. If it’s not functional, you may need to pull it and oxygenate from above. If it’s a fresh trach (<7 days), blind reinsertion can make things worse. Think first. Act smart.
👉 Bleeding
Small amounts? Common. But significant or delayed bleeding? Assume tracheoinnominate fistula (TIF) until proven otherwise. This is the time to apply pressure, call for help, and prepare for major escalation.
Your Mental Algorithm
- Check the patient. Don’t fix the tube before you assess the person.
- Oxygenate first — mouth, nose, stoma, whatever works.
- If the trach isn’t functional, pull it. Oxygenate from above.
- Only reinsert if you’re certain the tract is mature.
- Call for help early. You want backup before you need it.
Bottom Line
Tracheostomy emergencies aren’t rare anymore. These patients are everywhere — and they won’t wait for you to figure it out. Build your framework now. Know the anatomy. Understand the gear. Lock in your plan.
Because when the call comes, you don’t want to start thinking — you want to start acting.
A Better Way to Train for Trach Emergencies
Print Them, Set Them Up, Grab Some Equipment, Start Training
Our unique educational design bridges the gap between online content and hands-on practice. Print the posters, set them up in any available space, gather your equipment, and let your team get started. It’s flexible, scalable, and ready to go — perfect for residency training, faculty development, or team-based airway drills, whether you’re running sessions inside the hospital or building skills out in the field. 👉 Visit the Learning Space.
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