A 2-year-old girl with a tracheostomy was brought to the emergency department due to acute respiratory difficulty that started suddenly. On examination, the child was cyanotic with extremely severe respiratory effort. What is the first immediate procedure the emergency physician should perform?
Text emphasizes that any respiratory deterioration in a child with a stoma is a supreme emergency. The most common cause is tube obstruction. First step is to attempt suction to confirm patency. If this fails (catheter does not pass), complete obstruction must be assumed, and tube must be removed immediately and ventilation attempted with face mask (until alternative airway is secured) | Why other options are incorrect: A- Giving oxygen alone without addressing obstruction is insufficient | C- Requesting chest X-ray wastes precious time | D- Adrenaline is not required in this context | E- Waiting is unacceptable in a supreme emergency | ENT and pediatric anesthesia consultation urgently required, but do not wait for their arrival to begin resuscitation | The variable that changes the answer: If child is breathing well after tube removal, may not need immediate intervention | Consultant Pearl: In pediatric trach emergency with severe distress, assume obstruction first; remove inner cannula if present, attempt suction, and if fails, remove entire tube and ventilate from above immediately | Sources: Scott Browns Otorhinolaryngology 8th edition volume 2 — p. 69 | CUMMINGS OTOLARYNGOLOGY–HEAD AND NECK 7th Ed p1 — pp. 48-50