Ver el código de «Tracheostomy bleeding»

==Background==
{{Tracheostomy background}}

==Clinical Features==
*Minor bleeds within first few days usually due to:
**Lack of hemostasis
**Tube suction and manipulation
**Tracking of blood from nearby surgical site

==Risk Factors==
*Infection
*Corticosteroids
*Diabetes

==Differential Diagnosis==
{{Tracheostomy DDX}}

==Diagnosis==
*Large bleed is tracheoinnominate fistula until proven otherwise

==Management==
*Local Bleeding
**Use silver nitrate if bleeding source is identified
*Brisk Bleeding
**Tracheoinnominate artery fistula (TIF) until proven otherwise
***Most pts present within first 3wk after tracheostomy
***Very high mortality rate
***Delegate team member to obtain surgical assistance, especially with massive bleed
***Treatment:
***#Hyperinflate the cuff (85% successful), up to 50 cc to tamponade bleeding
***#If above fails, withdraw tube while placing pressure against anterior trachea
***#*ETT from above (as long as there is no laryngectomy)
***#*Apply digital pressure of innominate artery against the manubrium from inside tracheostomy tract
***#*Go to the OR with finger tamponade innominate artery
***#If above fails, place a cuffed ET tube to prevent pulmonary aspiration of blood
***#Correct coagulopathies and administer blood products as needed
***Requires emergent OR exploration and definitive management
[[File:hyperinflation-leveraging against innominate.jpg|thumbnail]]
[[File:finger tamponade.JPG|thumbnail]]

==Disposition==
*Emergent OR for TIF
*Most minor bleeds do not require admission and observation if controlled in ED
*C/s with primary surgeon for new tracheostomies

==See Also==

==External Links==

==References==
<references/>
*Allan JS, Wright CD. Tracheo-innominate fistula: diagnosis and management. Chest Surg Clin NA. 2003;13(2):331-41.


[[Category:ENT]]