In any airway emergency, oxygenation is the priority. It might be necessary to re-insert a new tracheostomy tube or other tube into the airway, but often, a patient can be (re)oxygenated by less invasive means. A stable, more oxygenated patient is in a much better position to tolerate airway procedures.

Face-masks, airway adjuncts (oral or nasal airways) and supraglottic airways (such as Laryngeal Mask Airways or LMAs) are familiar to most acute healthcare staff. 

If a patient is not breathing, then start by treating them as you would any other collapsed patient who isn’t breathing. An ‘Ambu bag’ (Bag-Valve-Mask) system can deliver effective ventilation breaths, as can anaesthetic breathing systems, such as Waters’ circuits. A tight-fitting face-mask or supraglottic airway is required.

Gas may escape via the stoma, and this may need to be covered by a second responder. We will show you how in these videos.

Of course, if the patient has had a laryngectomy, delivery of oxygen via the face will not work.