A 75-year-old thin cachectic woman undergoes a tracheostomy for failure to wean from the ventilator. One week later, she develops significant bleeding from the tracheostomy. Which of the following would be an appropriate initial step in the management of this problem?
The patient had a sentinel bleed from a tracheoinnominate aery fistula, which carries a greater than 50% moality rate. If the bleeding has ceased, then immediate fiberoptic exploration in the operating room is indicated. If the bleeding is ongoing, several stopgap measures can be attempted while preparing for median sternotomy in the operating room, including inflation of the tracheostomy balloon to attempt compression of the innominate aery, reintubation of the patient with an endotracheal tube, and removal of the tracheostomy and placement of the finger through the site with anterior compression of the innominate aery
Remove the tracheostomy and place pressure over the wound.
Deflate the balloon cuff on the tracheostomy.
Attempt to reintubate the patient with an endotracheal tube
Upsize the tracheostomy
Miscellaneous