In this Best Case Ever with Dr. Scott Weingart, the brains behind EMcrit.org, we hear the devastating story of a tracheostomy gone bad. Dr. Weingart shares with us what he has learned about how to manage massive hemoptysis in tracheostomy patients, and in particular, a step-wise approach to managing a tracheo-innominate fistula.
We discuss the balance between providing maximal aggressive critical care while maintaining a deep respect for the risks associated with the procedures we perform. Recorded at North York General’s EM Update Conference, 2015.
To review the initial management of massive hemoptysis in the tracheostomy patient and how to deal with the dreaded tracheo-innominate fistula see Justin Morgenstern’s First10EM post – The Bleeding Tracheostomy
Repair of a Tracheo-innominate Fistula
McGrath BA et al. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia. 2012;67:1025-41.
Dr. Helman & Dr. Weingart have no conflicts of interest to declare
Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.