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Tracheostomy Emergency Algorithm — FRCA Final MCQ

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ModerateAirway ManagementTracheostomy Emergency AlgorithmFRCA Final

A 65-year-old man in the ICU develops sudden respiratory distress through a dual-cannula tracheostomy. Senior help has been summoned, high-flow oxygen is being delivered to both the face and tracheostomy, and the breathing circuit and any external speaking valve or cap have been checked and removed. When assessing tracheostomy patency, which action should be performed next?

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Correct answer: E — Remove the inner cannula

The correct answer is E. Once help, oxygenation and basic equipment checks have been addressed, the NTSP approach assesses tracheostomy patency by removing external attachments and the inner cannula. An inner cannula may be acutely occluded by secretions or blood, and its removal can immediately restore airflow. A suction catheter is then passed to assess and clear the outer tube. If it cannot pass, cuff deflation allows assessment of airflow via the upper airway; persistent obstruction or displacement requires removal of the tracheostomy tube. Immediate tube exchange or oral intubation is therefore premature and may create a false passage or delay simpler oxygenation measures. Specialist assistance should be called early but airway intervention must not be deferred while awaiting it.

Reference: Royal College of Anaesthetists. Guide to the FRCA Examination, SOE 1 answer: Tracheostomies and their complications, pp. 196–197. 2020. https://www.rcoa.ac.uk/media/49226