Mechanical

Tracheostomy bleeding / possible sentinel bleed

Before / During / After / Pitfalls

Before

• Treat significant trach bleeding as high risk; call ENT/surgery/anesthesia immediately.
• Prepare for airway control, suction, blood products, and OR pathway.
• Differentiate minor bleeding from sentinel bleed but do not be falsely reassured.

During

• Suction, oxygenate, control airway.
• If massive bleeding, emergency maneuvers may include cuff hyperinflation/digital compression per local protocol/expert guidance.
• Move rapidly to definitive surgical management.

After

• ICU/OR pathway; do not discharge/ignore sentinel bleeding.
• Document timing, volume, tube details, and interventions.
• Debrief emergency roles.

Pitfalls

• Labeling sentinel bleed as minor irritation.
• Delay in surgical call.
• Poor suction/airway control during hemorrhage.