A bleeding tracheostomy is another airway challenge. Make sure that the trach balloon is fully inflated. Compress the innominate artery by pressing against the sternal notch. If this does not work, replace the trach with a cuffed endotracheal tube. The endotracheal cuff may need to be slowly inflated much more than normal, upwards of 30 to 50 cc of air. If the innominate fistula breaks loose, remove the trach, insert a finger into the opening, and compress the artery between the finger and the externally placed thumb. Take a ride with the patient on the gurney to the operating room.
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