1 Amy Godiksen, BSN, RN, CPN CCMC OtolaryngologyEar, Nose and Throat Amy Godiksen, BSN, RN, CPN CCMC Otolaryngology
2 Emergency Bag Portable suction with suction cathetersSame size tracheostomy tube with ties in place ½ size smaller trach tube Resuscitation bag Normal saline Water soluble lubricant Scissors Extra trach ties Syringe if child has cuffed tube Tap water to flush suction catheter Hand sanitizer Emergency phone list
3 Accidental DecannulationStay calm, act quickly Priority- keep the airway open Reinsert tube immediately. Use spare trach when able, if not able- replace with tube that came out and replace with clean tube later If unable to reinsert same size, try ½ size smaller If unable to reinsert, call 911, start CPR as needed
5 Mucus plugging Prevention Treatment Humidification/HMEVideo: Children’s Hospital Colorado Prevention Treatment Humidification/HME Ensure adequate hydration Encourage child to cough out secretions Suction Perform routine trach changes Try suctioning Place 1-2 saline drops into trach tube to loosen secretions, then suction again For signs of respiratory distress- change the trach tube https://www.smiths-medical.com/products/respiratory/humidification-systems/passive-humidification-systems/thermovent-heat-and-moisture-exchanger-filters
6 Respiratory distress Early signs: Tachypnea, tachycardia, pallor, restlessness/anxiety/agitation, noisy breathing Late signs: Retractions, nasal flaring, bradypnea, apnea, bradycardia, cyanosis, poor cap refill, low O2 sat
7 Bleeding: Causes and PreventionDryness Frequent, deep suctioning Infection Irritation/granuloma Excessive coughing Trauma Foreign object Use humidification Use appropriate suctioning technique Use water base lubricant when changing trach to prevent trauma
8 Bleeding: How To Treat Gently suction to appropriate depthIncrease use of humidity/use HME Provide saline as directed by MD
9 Bleeding Call the doctor if: Persistent blood-tinged or pink colored secretions or concern for illness When to seek emergency care: Copious amounts of bright red blood
11 School Tracheostomy Orders
14 Treatment Humidification i.e. nasal saline spray, Ayr gelBacitracin or Neosporin Afrin Nasal cautery with silver nitrate (in office) or bigger vessels with electrocautery in OR
15 Otitis Externa vs. Acute Otitis MediaSymptoms of otitis externa: Ear pain (can be severe and is exacerbated by touching or pulling on earlobe and tragus) Pain with chewing/moving jaw Swelling and redness of the outer ear and ear canal Enlarged and tender lymph nodes around ear Usually afebrile Symptoms of acute otitis media: Ear pain (worse when lying down, chewing or sucking = caused by pressure changes) Fever Drainage TM erythematous Difficulty hearing Nausea/vomiting Dizziness Irritability
16 Urgent vs. Non Urgent Ear PainNon urgent: Refer to PCP or non-urgent visit/call to ENT Urgent: refer to ENT or ED Wax accumulation or waxy drainage Tube extrusion Tube otorrhea Otitis media with or without tubes Otitis externa Middle ear effusion causing popping or fullness Mastoiditis Post auricular erythema and edema Proptosis/lateral and forward displacement of the ear Foreign object Change in mental status Facial nerve dysfunction Sudden hearing loss Severe pain or severe headache Vertigo Trauma
18 Criteria for Surgery Tympanostomy tubes T&A Acute Otitis Media (AOM)>4 infections in 6 months >6 infections in 1 year Persistent OME with hearing loss and associated language, speech/learning issues Bilateral: >3 months Unilateral: >6 months >3 infections/year for 3 consecutive years >5 infections/year for 2 consecutive years >7 infections/year for 1 year
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