Accidental displacement of tracheal tube

FRCEM EXAM QuestionsCategory: December 2016Accidental displacement of tracheal tube
FRCEM Intermediate Staff asked 2 years ago
A 33 year-old-man is intubated for airway protection following a large mixed overdose. He remains ventilated in the ED whilst awaiting an ICU bed. 30 minutes after intubation, the nursenotes the patient has become hypoxic with Sat of 78%. Intubation was uneventful, there was no suspicion of aspiration and he had Sat of 100% both before and after intubation.
A.What is the immediate first step in managing this patient? (1 mark)
B.How will you confirm tube displacement? (1 mark)
B.What is your management if tube displacement confirmed? (1 mark)

1 Answers
FRCEM Intermediate Staff answered 2 years ago
A.
Call for Help
Apply high flow oxygen
Check Capnography (ETCO2) if not, put it on
Call for Difficult airway trolley
Attach water circuits

B.
is ETc02 trace a normal square wave?
is water circuit moving with spontaneous respirations?
is chest moving up and down and easy to ventilate?
Check tracheal tube at teeth has TT been pushed or fallen out?

C.
Remove the tracheal tube and call for a senior anesthetist
ventilate with 100% oxygen using bag and facemask with Guedel airway and two hands on the mask
Consider LMA/i-gel/Pro seal LMA, await senior help
oral intubation if you have the skill