1 rich Libsyn https://www.libsyn.com 90 600 Contributor: Aaron Lessen, MD Educational Pearls: Tracheostomy bleeding is a rare but potentially life-threatening complication that usually occurs within the first month of tracheostomy tube placement No matter how severe the bleeding, every patient should be evaluated to rule out a tracheo-innominate fistula between the tracheostomy and the innominate artery If the patient is currently bleeding and has a cuffed tracheostomy tube, over-inflate the balloon to compress the bleeding vessel Consider replacing an uncuffed tracheostomy tube with a cuffed tube or an ET tube If the tracheostomy was performed in the last seven days, use a bougie or bronchoscope to replace the uncuffed tube due to increased risk of opening a false track into the subcutaneous tissue If bleeding cannot be controlled, follow mass-transfusion protocols, and as a last resort, remove the tube and insert a finger into the stoma to manually compress the artery References Bontempo LJ, Manning SL. Tracheostomy Emergencies. Emerg Med Clin North Am. 2019;37(1):109-119. Khanafer A, Hellstern V, Meißner H, et al. Tracheoinnominate fistula: acute bleeding and hypovolemic shock due to a trachea-innominate artery fistula after long-term tracheostomy, treated with a stent-graft. CVIR Endovasc. 2021;4(1):30. Manning Sara, Bontempo Laura. Complications of Tracheostomies. In: Mattu A and Swadron S, ed. ComPendium. Burbank, CA: CorePendium, LLC. https://www.emrap.org/corependium/chapter/reckOdDn9Ljn7sBLy/Complications-of-Tracheostomies. Updated August 17, 2021. Accessed June 5, 2022. &amp;nbsp; Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MD, MPH &amp; Erik Verzemnieks, MD &amp;nbsp; The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.&amp;nbsp; Donate to EMM today! Emergency Medical Minute https://www.emergencymedicalminute.com <iframe title="Libsyn Player" style="border: none" src="//html5-player.libsyn.com/embed/episode/id/23348906/height/90/theme/custom/thumbnail/yes/direction/forward/render-playlist/no/custom-color/fa102a/" height="90" width="600" scrolling="no" allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen></iframe> https://assets.libsyn.com/secure/content/129375608