[mina123]

What do you do in this scenario????????? Trach and vent 5 month old pt: pt has upper airway obstruction pt starts to desats you suction, nothing happens you try to insert another trach it does not go in, you try a smaller size trach it does not go in. This whole scenario is in home care. Can;t bag the pt from upper airway due to obstruction tried but no air going in!!!!!!!! Even tried to bag thru tracheal stoma nothing is going in !!!!!!!!! Ofcourse by this time parmedics are on there way for MAYBE endotracheal intubation but in meantime what can you do when you are all alone or some times maybe parents are there in home care situation. CPR can start only compression but no airway?????????

[SteveRN21]

I would have to say that as a NICU nurse, I have never been in this position. There's always someone around who can intubate.

I probably would have kept up the compressions until paramedics arrived, and if there was another person there, kept fiddling with the smaller size trach tube. I would also start the foreign body aspiration protocols we learned in BLS alternating with compressions. I learned in PALS about inserting a 14-18 ga angiocath in the trachea through the neck, but I would NEVER do this in the field.

Another option is to try and insert different sized ETT's in the stoma. Otherwise, all you can do is wait for the paramedics.

[mina123]

Thanks but i think i'll just stick with the compressions, or we have been taught to thread a cath thru the stoma small sized suction cath and try to guide the smaller trachs. ETT i think is a bad idea for us nurses; when i look at the size of a portex ETT tube i don't think i can do that by myself in field because its so long i might just perforate underlying organs so i guess i have to just pray to god try my best and focus on situation at hand; btw this infant i am taking care of had multiple codes in the hospital;has an artifical/false airway so i just brought up this question if anything would happen at home.