The provided UK guidelines do not specifically detail the emergency management of a patient with an existing tracheostomy who presents with respiratory distress.
However, general principles for emergency airway and breathing management from major trauma guidelines may be broadly applicable in a respiratory distress scenario, though they are not specific to tracheostomy complications NICE NG39. For patients with major trauma who cannot maintain their airway and/or ventilation, drug-assisted rapid sequence induction (RSI) of anaesthesia and intubation is the definitive method for securing the airway NICE NG39. If RSI fails, basic airway manoeuvres and adjuncts, or a supraglottic device, should be used until a surgical airway or assisted tracheal placement is performed NICE NG39.
In cases where respiratory distress is due to chest trauma, such as a suspected tension pneumothorax, chest decompression should be performed if there is haemodynamic instability or severe respiratory compromise NICE NG39. This involves using open thoracostomy followed by a chest drain NICE NG39. Immediate chest X-ray and/or eFAST (extended focused assessment with sonography for trauma) may be considered for adults with severe respiratory compromise to assess chest trauma NICE NG39.