tracheal stenosis

Due to the lack of breath sounds, you suspect an airway obstruction.

Common sources of obstruction are mucus plugs, clots, tracheal stenosis, or equipment failure.

In this case, from the patient history, a mucus plug is the most likely source of obstruction.

Your initial step is to inspect and remove anything potentially obstructing the external end of the tracheostomy lumen, such as speaking valves, obturators, decannulation cap, also known as a cork, etc.

About one hour ago, she underwent a tube change to a smaller tracheostomy tube.

You were called by her nurse for new episodes of desaturations, increased ventilator pressures, and significant stridor.

On fiber optic assessment, you see tracheal stenosis.

Like the last case, the presentation points to an obstruction, so we would use the same troubleshooting steps listed in the last few cases.