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A patient with amyotrophic lateral sclerosis presents with sats of 75%, central cyanosis and poor respiratory effort. He has a tracheostomy in situ with bloody sputum visible at the site.

1. List five initial steps in your approach to this situation. 5 marks

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Patency of the patient’s tracheostomy is achieved, however, the bleeding from the site has become significantly worse.

2. List two possible causes of bleeding from the tracheostomy site. 2 marks

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3. Outline five priorities of your ongoing management. 5 marks

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