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Medical Emergencies

Place the nurse's actions in priority order after accidental decannulation of a mature tracheostomy.

Ordered Response

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Apply oxygen to the face and stoma while assessing breathing, oxygen saturation, airflow, and the stoma.
If trained and oxygenation permits, gently insert the same-size spare tracheostomy tube with its obturator through the mature stoma, then remove the obturator.
If the same-size tube meets resistance, stop rather than force it and attempt the one-size-smaller spare tube while expert help continues airway support.
Confirm ventilation with airflow or capnography, breath sounds, chest movement, and improving oxygen saturation, then secure the tube.
Stay with the client, call expert airway or emergency help, and bring the bedside tracheostomy emergency equipment.
Explanation
Accidental decannulation is an airway emergency. Call for expert help and oxygenate through both potential airways while rapidly assessing the client. In a confirmed mature stoma, a trained clinician may gently replace the same-size tube and then try one size smaller if needed; forcing the tube risks a false passage. Confirm ventilation before securing the replacement.
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For study reference only. Always follow current clinical guidelines and your institution’s protocols.