Like us on Facebook!
 

LOGIN

REGISTER

English English

By accepting you will be accessing a service provided by a third-party external to https://foamfrat.com/

Podcast 92 - A Bleeding Hole In The Neck w/ Brian King

 

My friend and kick@$$ flight clinician, Brian King (@BKing1453), recently finished the Speaker's Atlas Course. For his Capstone project, he recorded an amazing video and blog on managing the tracheoinomiate fistula. Watch his use of animations, engaging graphics, and vocal modulation!

Ladies & Gentlemen, I present ... Brian King.

A Bleeding Hole In The Neck w/ Brian King

If you are like me, you are thankful that a bleeding trach is a rare encounter. After all you are staring into a black hole with blood coming from a unknown source. But there is one cause of tracheostomy bleeding that should give you nightmares and that’s bleeding from a tracheoinnominate artery fistula. 

The innominate artery arises off of the aortic arch and crosses the trachea at approximately the 9th trachea ring and goes on to bifurcate into the right subclavian artery and the right common carotid artery.

Tracheoinomiate Artery Fistula

Tracheoinomiate Artery Fistula is a thankfully a exceedingly rare complication of tracheostomy placement occurring in 0.7% of patients. Even with it being a rare complication it carries a 100% mortality rate without operative intervention. It occurs from erosion of the innominate artery by either the tracheostomy tube or the balloon itself. Bleeding develops between weeks 3 and 4 post tracheostomy. Over 50% of bleeding from a tracheoinomiate artery fistula will present with a “sentinel bleed”. So even in the setting of minor tracheostomy bleeding, tracheoinomiate artery fistula should remain on your differential until excluded. A pulsating tracheostomy tube is also a sign of a possible tracheoinomiate artery fistula. 

Patient Assessment & Management: 

Any patient with a tracheostomy, bleeding or not there are a number of questions that need to be answered. 

  • What was placed? 
    • Cuffed or Uncuffed Tracheostomy Tube 
    • What Size Tracheostomy Tube
    • Simple Tracheostomy or Laryngectomy 
  • When was it placed? 
    • This question is most important for patients who have decannulated their trach as stomas take 7-10 days to mature. 
  • Why was it placed? 
    • This question is important, as it will give you a better idea of the patient’s history. 

In the setting a of SEVERE bleeding with a cuffed tracheostomy tube. You will want to hyperinflate the balloon with 50cc of air. By overinflating of the cuff, the hope is that the balloon will tamponade the innominate artery until definitive operative management can be undertaken. This technique is successful in 85% of cases. 

If this technique is unsuccessful, there is one remaining option. You will deflate the cuff, orally intubate the patient and then remove the tracheotomy tube. After the tube has been removed compression of the innominate artery by finger compression through the stoma site, which is referred to as the Utley maneuver and is successful in 90% of cases. 

Refrences: 

Grillo, H. C. (2004). Surgery of the trachea and bronchi. Hamilton: BC Decker.

Jafri, S., Dinh, K., & Akkanti, B. (2019). A Rare Case Of Tracheoinominate Fistula. Chest156(4). doi: 10.1016/j.chest.2019.08.1576

Lee, E. (2018, June 7). Tricks of the Trach: Approach to Tracheostomy Patients in the Emergency Department. Retrieved from https://emottawablog.com/2018/06/tricks-of-the-trach-approach-to-tracheostomy-patients-in-the-emergency-department/

Leyn, P. D., Bedert, L., Delcroix, M., Depuydt, P., Lauwers, G., Sokolov, Y., … Schil, P. V. (2007). Tracheotomy: clinical review and guidelines. European Journal of Cardio-Thoracic Surgery32(3), 412–421. doi: 10.1016/j.ejcts.2007.05.018

Nickson, C. (2019, February 10). Bleeding Tracheostomy • LITFL • CCC Airway, ENT. Retrieved from https://litfl.com/bleeding-tracheostomy/

 

0
Episode 27: DOSE VF Pilot – DSD revisited
Episode 26: REVERT: A New Approach to An Old Techn...
20 June 2020
FOAMfrat Podcast
 I remember when we first started to entertain the idea of starting a podcast, Eric Bauer @FlightBridgeED had told us the key to a successful podcast was consistency. The internet is flooded with podcasts that start off with a ton of steam and s...
22 May 2020
FOAMfrat Podcast
“Tube’s in.”“Let’s double check that depth.”“I’ve got a good end tidal CO2 waveform.”“Saturations maintaining?”“Tube still looks good in the glottis.”"Let’s secure this thing." “How long ago did we give that ketamine?”….For some, the next words ...
19 May 2020
FOAMfrat Podcast
 When I first started learning ultrasound a few years ago I was taught that vertical lines moving back and forth with ventilation indicated fluid in the lungs. It looked like a car's head light in the fog and was called a "B-Line".  Th...
29 April 2020
FOAMfrat Podcast
In this episode we talk with Michael Perlmutter (@DitchDoc14) who recently released a poster board for an upcoming paper evaluating the safety and efficacy of push-dose nitroglycerin in EMS for patients experiencing sympathetic induced pulmonary edem...
26 April 2020
FOAMfrat Podcast
A few months ago Sam and I started putting together a ventilator module within the FOAMfrat refresher course. Our hopes were to create a "beginners guide" into the world of mechanical ventilation. As we created each lesson, we would discuss further p...

 © 2012-2020 FlightBridgeED, LLC. - All rights reserved.

~ Established 2012. FlightBridgeED, LLC. is headquartered in Scottsville, Kentucky.~
The name FlightBridgeED is a registered trademark of FlightBridgeED, LLC. The FlightBridgeED helicopter logo is a trademark of FlightBridgeED, LLC.
F.A.S.T. is a sales mark of FlightBridgeED, LLC. related to printed books and other related materials, as well as the F.A.S.T. symposium.

Privacy Policy - Refund Policy - Exam Pass Commitment

SiteLock