MattiesMama, I know that from a student's point of view, everything is possible, but from my experience, it's being able to discern the matter of degrees that leans possibilities towards one clinical event versus another. Your question regarding this as a possible indication of bleeding esophageal varices shows that you're thinking about all the possible reasons, but have probably never seen an actual esophageal variceal bleeding event.
Just imagine this; take a gallon bucket of blood, and pour it onto the patient's mouth and chest. That
is what rupturing esophageal varices looks like. Add on top of that the patient is white as a sheet, with a rapid heart rate, and a look of impending doom on his face if he's still conscious. Or put it this way, if you've ever seen one, you'll never, ever forget it.
Tracheostomies, especially long term ones, can
form fistulas and have open communication with the esophagus, and other structures within that area of the neck and chest. Generally, these require a dye swallow test, where the patient is given a pureed food (like mash potatoes) that is mixed with methylene blue. If the area around the trach leaks dye, then a tracheal esophageal fistula is confirmed.
Further, erosion of the surrounding tissue can also occur. If the erosion extends into a blood supply, such as with an innominate artery fistula, then it can indeed be deadly. But generally bright red blood would be rapidly accumulated around the site. Other potential complications include tracheomalacia, laryngeal damage, subcutaneous emphysema, pnuemothorax, and of course, infection.
With this patient, despite the cuffless trach, some degree of tissue erosion may be a possibility. It may be advisable to get an ENT consult to do a full assessment of her neck (structure) and numbers (labs) to get to the bottom of the blood source.
Good luck, it's nice to see nursing students so clinically aggressive.