Airway management: tracheo-innominate fistula: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Anaesthesia · Airway management: tracheo-innominate fistula

Sample item

Ten days after a tracheostomy a patient has a small bleed from the stoma, and soon after a sudden torrential bright red haemorrhage that pulsates with the tube. What is the first action?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Over-inflate the cuff and press forward through the stoma against the sternum

A tracheo-innominate fistula is a life-threatening haemorrhage from erosion of the innominate artery by the tube tip or cuff. Immediate control comes from over-inflating the cuff and applying finger pressure forward through the stoma to compress the artery against the sternum, followed by urgent surgery. The sentinel bleed warns of the event.

Option by option

  • A. Over-inflate the cuff and press forward through the stoma against the sternum (correct)

    Correct. Cuff tamponade with anterior finger pressure compresses the artery until surgery.

  • B. Transfuse and observe

    Transfusion alone does not stop arterial bleeding.

  • C. Perform bedside bronchoscopy

    Bronchoscopy delays control of an exsanguinating bleed.

  • D. Remove the tube and pack the stoma tightly

    Removing the tube loses the airway and the tamponade, and packing cannot control an arterial bleed.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Anaesthesia questions

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Over-inflate the cuff and press forward through the stoma against the sternum. A tracheo-innominate fistula is a life-threatening haemorrhage from erosion of the innominate artery by the tube tip or cuff.

Why is "Transfuse and observe" not the answer?

Transfusion alone does not stop arterial bleeding.

Why is "Perform bedside bronchoscopy" not the answer?

Bronchoscopy delays control of an exsanguinating bleed.

Why is "Remove the tube and pack the stoma tightly" not the answer?

Removing the tube loses the airway and the tamponade, and packing cannot control an arterial bleed.

What concept does this question test?

It tests Airway management: tracheo-innominate fistula in Anaesthesia. Immediate control comes from over-inflating the cuff and applying finger pressure forward through the stoma to compress the artery against the sternum, followed by urgent surgery. The sentinel bleed warns of the event.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Airway management: tracheo-innominate fistula?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.