Trisha and a clinical team respond to an infant in respiratory distress with a blocked tracheostomy. They perform an emergency trach change, deflate and replace the tube, and immediately see the baby's oxygen levels, heart rate, and color improve.
So we're on scene with a baby who we just popped off the vent. She was throwing high pressure alarms. She's de sadding on us. She doesn't look so great. We've attempted suctioning. I've assessed her trach to make sure it's in place. I've assessed patency and she's becoming a little bit more difficult for me to bag again. I'm worried that she's gonna start braiding on us and I've determined that I think it's time for an emergency trach change. So guys, let's get her supplies ready.
Okay. I'm gonna go find her, get her trach bag. We made sure that we didn' leave it so it's at all of her supplies in here. I'm going to find that trach the same size for you.
I'm going to go ahead and have you start bagging her over the nose and mouth to do that. I'm going to ensure that we have this cuff deflated since we just pulled her off the vent.
Hey, Trisha is also a size smaller in here if you didn't need it.
Okay, thank goodness. I'm going to try to suction one more time. Oh yeah, I'm not getting, I'm not getting really anywhere with that. Let's get her in the proper position.
I'm going to position her with a towel roll underneath. Let's get her hyper extended here so we can really expose that area. Can you go ahead and get her ties undone for me?
Her ties are undone. The cuff is deflated.
Okay, great. On my count. 3, 2, 1. I got this new trach ready to go. I'm passing it. I'm gonna pull out my obturator. Can you get those ties down down for me?
And then I'm gonna. Let's go ahead and bag her again.
Right away from bag to trach.
Okay. And I'm going to go ahead and re inflate this with the water that came out of the old trach. Okay.
How is she bagging?
Much easier.
Oh, good. I'm going to take a listen here. Oh, I've got much better aeration.
Good. How does she look on the monitor, guys?
Yeah, she's actually picking her heart rate back up and her oxygen saturation is coming up.
Oh, her color looks much better too. Good job, everybody.
Melissa Olen MSN, FPN-C, CCRN: Sudden Cardiac Arrest Training in Schools (Project ADAM) 4/25/25
Pediatric Hospital Readiness: How Teamwork & CPR Metrics Drive Better Outcomes
Chelsea Kadish, MD & Kyle Goodknight, EMT-P, RT: Pediatric CPAP in EMS (3/14/25)
