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.
Recorded May 2015; Published June 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