Percutaneous tracheostomies (PCT) performed in the intensive care unit (ICU) are becoming a routine procedure in the care of the patient who is likely to require ventilatory support for seven days or more. As the frequency of this procedure increases so will the numbers of complications, such as tracheal stenosis. We discuss the diagnosis of tracheal stenosis in the emergency setting and the use of the Empey index.

CASE HISTORY

A 26 year old woman presented to the emergency department (ED) complaining of shortness of breath and difficulty clearing secretions. She had been discharged from hospital two weeks previously after a four week stay, including 20 days in the ICU. On that occasion she presented with increasing shortness of breath and stridor attributable to bacterial tracheitis. While in the ICU she developed pneumonia and severe sepsis. On day four of her ICU stay she underwent PCT in the ICU with a Blue Rhino tracheostomy set, which remained in situ for 16 days. Before her ICU stay she had been fit and well.

On presentation to the ED she was anxious but looked well with Sao₂ 100% on oxygen, respiratory rate 20, blood pressure 110/70, pulse 98. Examination of her chest showed a prolonged inspiratory phase and transmitted upper airways noises, presumed to be from secretions but no stridor. Besides a well healed tracheostomy scar and appearing to be undernourished the rest of the examination was normal.

A chest radiograph and …